In my years of clinical practice, some of the most challenging consultations often center on the limitations of traditional medicine. For too many patients, exhausting every conventional treatment option without finding relief has become a heartbreaking routine.
Texans suffering from debilitating chronic pain or life-altering neurological conditions have long been caught between a rock and a hard place. They are frequently left to choose between highly addictive opioids or "off-the-shelf," unregulated products that offer no guarantees of safety. And for too long, the honest answer from physicians has been that we have simply run out of tools.
Fortunately, the medical landscape in Texas has changed. The 2025 expansion of the Texas Compassionate Use Program (TCUP) through House Bill 46 provides a regulated, medical-grade framework that allows physicians to offer a safer alternative to patients who have exhausted all options. Expansion means Texans living with chronic pain, traumatic brain injuries, PTSD, seizures, and many other conditions now have a legal path to relief with medical cannabis. For those in palliative or hospice care, it provides a vital tool for managing symptoms with dignity.
The true challenge now is educational. While medical cannabis has broad bipartisan support across the state, there is a profound gap between public approval and public knowledge. Recent data suggests a staggering disconnect: a mere 11% of Texans are actually familiar with the TCUP framework.
That means an overhwleming majority, including patients who qualify and physicians who could be prescribing, are unaware that this program even exists, let alone that it was significantly expanded. An expanded program does patients no good if their doctors have never heard of it.
For the medical community, this 89% awareness gap is a call to action. In this information void, patients often inadvertently navigate an unregulated marketplace of untested alternatives. Products like Delta-8 or Delta-10 lack the rigorous batch testing and quality controls I demand for my patients.
In contrast, TCUP is regulated by the Texas Department of Public Safety and maintains the highest level of stringent requirements to assure safety and quality. Every product requires a Certificate of Analysis to verify potency and ensure it is free of heavy metals and pesticides. Properly regulated cannabis is safer than most pharmaceutical drugs, and it can provide an excellent alternative or adjunct to complement one’s regimen. We must do a better job of ensuring patients and doctors alike understand that safety is just a conversation away.
Critically, the program also provides much-needed legal clarity for providers. Previously, many were hesitant to even discuss medical cannabis, unsure of where the regulatory lines were drawn. The Compassionate Use Registry of Texas (CURT) now gives physicians clear authority to recommend tested products with confidence. That certainty matters because patients cannot benefit from a treatment their doctors are afraid to bring up.
Equally important is the state’s move to increase the number of licensed operators from three to fifteen. This expansion introduces a competitive environment that lowers patient costs and accelerates innovation. Furthermore, the inclusion of telemedicine removes geographical barriers, allowing Texans in even the most remote rural areas to consult with specialists without traveling for hours. Together, these advancements secure a future where safe, legal access reaches every corner of our state.
We owe a debt of gratitude to Governor Greg Abbott, Lieutenant Governor Dan Patrick, House Speaker Dustin Burrows, along with Representative Ken King and Senator Charles Perry, for their leadership in championing House Bill 46. These leaders recognized that medical cannabis belongs in a clinical setting, overseen by doctors rather than the ‘Wild West’ of the unregulated market.
But none of this matters if physicians and patients do not know the program exists. It is time for the medical community and the public to bridge the information gap. If you or a loved has a qualifying diagnosis, I encourage you to speak with a registered physician through the Department of Public Safety’s TCUP website. If your provider is not listed, ask them to register for the program. Texas has built a program rooted in clinical integrity; we must ensure that every patient in need knows they have a seat at the table.
Editor’s Note: The above guest column was penned by Dr. Robert S. Marks, MD, a dual board-certified interventional pain management physician and the founder and CEO of Diagnostic Pain Center and Texas Herb Clinic in Austin, Texas. Marks has spent his career at the intersection of advanced pain medicine and emerging therapeutics. A nationally recognized authority on medical cannabis, Marks co-authored the Texas legislation adding chronic pain as a qualifying condition under the Compassionate Use Program and has testified before the Texas Legislature on cannabis policy in every session since the program's inception. He serves as Medical Director of Goodblend, advises the Texas Department of Public Safety on the TCUP program, and represents the United States on the National Compassionate Care Council, where he helps shape federal cannabis policy.
