The State of Medical Marijuana in Texas

2020 Grade: F

2015 2016 2017 2018-2019 2020

2019-2020 Improvements and Recommendations

In May of 2019, Governor Abbott signed legislation adding several new conditions to the list of eligible health conditions required for patients to secure low-THC medical cannabis products. These conditions include epilepsy, multiple sclerosis, terminal cancer, autism and spasticity. Previously, only patients experiencing intractable epilepsy were permitted access. Following the 2018 passage of the federal Farm Bill authorizing a nationwide hemp production program under USDA, Governor Abbott signed legislation in 2019 allowing in-state production of hemp for industrial and medical purposes. This will allow Texas to license a greater volume of CBD producers and deliver greater product quantity and diversity for qualifying Texas patients.

Like many states in 2020, Texas was forced to turn away from legislative cannabis policy reform improving patient access to turn to emergency measures related to the global pandemic. Unlike many other states, Texas did not deem its limited, low-THC medical program, and associated commercial businesses, essential. However, patients were still able to maintain access via delivery, as Texas maintains the same standards as USDA for hemp-derived CBD products.

Texas still has significant work to do to organize functional patient access to cannabis products containing THC and other plant compounds. ASA encourages lawmakers to approve comprehensive medical cannabis policy legislation in 2021, that includes authorization of commercial cannabis businesses cultivating, manufacturing, testing, distributing and retailing medical cannabis. Other key components should provide patient legal protections for possession and use as well as for employment, remove arbitrary limits on THC and either expand the list of qualifying conditions to include chronic pain, or remove the list in favor of a system that permits patients to secure access based on a physician’s evaluation.


In June of 2015, Governor Abbott signed SB 399, the Texas Compassionate Use Act. This law provided access to patients with severe epilepsy to cannabis with no more than 0.5 percent THC, and authorized dispensing organizations to cultivate, process, and distribute this medical cannabis. SB 399 also established a registered physician recommendation system, through which physicians not only assess a patient’s need for access but also provide recommended dosages that patients take to a dispensing organization to be filled. Oddly the language used in the law refers to these recommendations as prescriptions, which is a significant deviation from other state medical cannabis programs. Doctors may recommend that a patient use cannabis for treatment, but prescribing cannabis is averse to federal law which holds cannabis on Schedule I of the Controlled Substances Act.

Texas did not license its first cultivation facility until the fall of 2017, nearly two full years since the Governor signed SB 399 into law, and low THC product sales for patients did not begin until the spring of 2018 when the state licensed its first medical retail sales facility.

Patient Feedback

Surveyed patients remain disappointed that access to medical cannabis is very limited to specific medical conditions, and that the only product they have access to has a capped TCH level that does not meet the needs of all qualified patients.