Over the last decade, Texas’s medical-cannabis program – known as the Compassionate Use Program (TCUP) – has remained among the strictest in the nation, but an expansion could be forthcoming.
In 2015, Governor Greg Abbott signed into law the Texas Compassionate Use Act, which allowed only a very limited, low-THC marijuana oil for epilepsy patients. That law required the Texas Department of Public Safety (DPS) to license at least three vertically-integrated dispensing organizations (medical cannabis pharmacies) by 2017. Even then, advocates complained that the new program excluded almost all patients except those with “intractable epilepsy.” “This program leaves most patients behind,” said Heather Fazio of the Marijuana Policy Project at the time, even as she called the law “one for the history books.”
Over the past decade, Texas has modestly expanded the program several times. In 2019, the Legislature broadened the list of qualifying conditions to include multiple sclerosis, ALS, autism, cancer (all stages), seizure disorders, and certain degenerative diseases. In 2021, lawmakers raised the THC cap from 0.5% to 1% and added PTSD and all forms of cancer as qualifying conditions. Still, the program has remained narrow: only low-THC, non-smokable products are allowed. Until now, Texas patients could only get cannabis in forms like gummies, lozenges, tinctures, topicals and beverages – all swallowed, never smoked or vaped. Patients must be Texas residents with a qualifying condition, and a registered physician must enter a prescription in the state’s Compassionate Use Registry of Texas (CURT). In practice, this has limited patient access: currently only three licensed dispensaries serve the entire state, and all cultivation, processing and dispensing must occur on-site (no satellite storage or delivery allowed under current law).
How the Current Program Works
Under current law, only patients with very specific conditions can receive low-THC medical cannabis. By statute, qualifying conditions include epilepsy and other seizure disorders, multiple sclerosis (MS) and muscle spasticity, amyotrophic lateral sclerosis (ALS), autism, cancer (typically terminal cancer), and a catch-all category for “incurable neurodegenerative diseases.” For example, a patient with epilepsy that is not controlled by standard medications can see a qualified neurologist or specialist, join the program’s doctor registry, and receive a prescription for THC oil. Patients must be permanent Texas residents and must have tried conventional treatments before doctors will consider prescribing cannabis oil.
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Eligible conditions: Under the Compassionate Use Program, only Texans diagnosed with one of the above medical conditions may obtain prescriptions.
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Patient requirements: Patients must be Texas residents. A CUP-registered physician must be convinced that the patient’s potential benefit outweighs any risk. There is no minimum age, but minors need a legal guardian’s consent.
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Prescription process: Once a physician issues a prescription in the state registry (CURT), the patient (or guardian) brings a valid ID to a licensed dispensary to pick up the medicine.
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Distribution: Texas law currently requires each licensed dispensing organization to cultivate, process, test and dispense their products at one central location. Inventory cannot be stored or sold at satellite sites, so dispensaries must ship any prescriptions across the state – often at great expense.
Patients also face strict product rules. Texas law limits medical cannabis to low-THC formulations (no more than 1% THC by weight under the 2021 law) and bans smokable or vaping products. Currently approved forms are mostly ingestible or topical: gummies, lozenges, tinctures, capsules, lotions, and drinks. For example, a 2021 DSHS guidance emphasizes that medical use is limited to “swallowing, not smoking,” any prescribed low-THC dose. In short, Texas patients have had far fewer options than those in states with broader medical marijuana laws.
Recent Expansion Passed by Legislature
In May 2025, the Texas Legislature gave final approval to House Bill 46, a sweeping expansion of the Compassionate Use Program. The bill drew broad bipartisan support in both chambers, and it is now headed to Governor Abbott, who has indicated he will sign it into law. If Abbott does sign (or allows it to become law without signature, as he is inclined to do), HB 46 will make the most substantial changes to TCUP since 2015. Key provisions include:
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Expanded conditions: HB 46 would add several new qualifying conditions. Most notably, chronic pain (of all types) and traumatic brain injury (TBI) would be added to the program. The bill would also cover terminal illnesses for patients in hospice or palliative care. (Earlier versions of the bill had also included Crohn’s disease and degenerative disc disease, but those were dropped in final negotiations.)
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More dispensaries: The bill dramatically increases the number of companies allowed to participate. Currently only three vertically-integrated “dispensing organizations” operate in Texas. HB 46 would raise that cap to 15. The first three licenses will be awarded from applicants on file, and the remaining licenses would be opened to new qualified applicants. To improve access in rural areas, the bill requires DPS to distribute the new licenses across the state’s different regions, rather than concentrating them in one area. It also creates a 90-day fast-track process for approving these additional licenses, so that many more dispensaries can be online quickly.
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Satellite sites allowed: HB 46 would let each licensed dispensary establish “satellite” storage locations. These are off-site warehouses where cannabis products can be kept overnight or for distribution, rather than forcing a dispensary to ship pills or oils across long distances every day. Supporters note this will greatly ease the high cost and logistical burden on patients in far-flung parts of Texas. For example, if approved, a large dispensary in San Antonio could store medicine at a smaller Texas City location to serve South Texas patients without a 600-mile round trip each time.
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New product forms: In addition to the existing tinctures and edibles, the expansion adds new delivery methods to the menu. HB 46 explicitly allows metered-dose inhalers, nasal sprays, vaporizing devices and transdermal patches – but still only for low-THC cannabis oil. In effect, patients would gain access to the same kinds of vape and inhalation products now common in the hemp CBD market. Importantly, though, the bill continues to ban any smokable flower or buds. “Vaporizers” would be legal under the program, but smoking a joint or pipe would remain prohibited. (Indeed, one health official notes that even after HB 46, the program will still be limited to “swallowing, not smoking” any prescribed dose.)
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Prescriber and patient rules: The expansion does not loosen the rules on who can prescribe or who can qualify beyond adding the above conditions. Doctors still must register with the state registry and follow all DPS requirements when prescribing. Patients still must be Texas residents with one of the allowed conditions. However, supporters emphasize that removing the old requirement for two physician approvals (now only one doctor is needed) and eliminating an earlier mandate that chronic pain sufferers “fail” 90 days of opioid therapy should speed up access for many patients.
In sum, the Legislature’s latest action would broaden access on multiple fronts. As the Marijuana Herald reports, HB 46 “would broaden the state’s limited Compassionate Use Program by adding several new qualifying conditions” and vastly increase the number of dispensaries and drug-delivery options. On the Senate floor, supporters noted that this bill comes after years of Texas having some of the nation’s tightest medical-marijuana rules. One state senator explained simply, “This bill is about compassion,” stressing that Texans in the program have experienced “life-altering” benefits from cannabis.
What’s Next for the Program
With both chambers of the Texas Legislature on record (the House voted 134-1 for HB 46 on May 24, and the Senate passed the amended version on May 25), the bill now moves to Governor Abbott. Abbott is highly unlikely to veto the measure, even though he did not actively campaign for it. Instead, he is expected to either sign the bill or let it become law without his signature. Once he does, Texas’s medical-cannabis laws will change substantially on September 1, 2025, the statute’s official effective date, although it will remain one of the nation’s strictest medical cannabis laws.
What will this mean in practice? Starting next fall, thousands more Texans could become eligible for medical marijuana. Conditions like chronic pain and terminal illnesses affect far more people than just epilepsy or ALS, so patient enrollment is likely to grow substantially. Patients will have more dispensaries to choose from (up to 15 across Texas) and more convenient ways to medicate (inhalers, patches and vapes). Rural and underserved areas should see better access, thanks to the new satellite-store provision and required regional license distribution. Overall, advocates call it “a major step forward for medical marijuana access in Texas.”
Still, even after HB 46 becomes law, Texas’s program will remain comparatively narrow. The state’s cap on THC in medical products is still just 1% by weight – lower than in almost any other medical marijuana state. Smoking will remain banned, so the drug must be ingested or inhaled only through controlled devices. And despite adding new conditions, Texas will continue to exclude common diagnoses like arthritis or fibromyalgia. In short, the Compassionate Use Program will have expanded somewhat, but it still stops well short of full medical legalization.
The bill’s passage comes alongside another major THC policy change: the Legislature also approved a near-total ban on hemp-derived THC products. That separate measure would outlaw most consumable delta-8, -9 and -10 products
While the hemp-THC debate unfolds, patients under the Compassionate Use Program are focused on the expansion.
