House Bill 46: Improves and Expands the Texas Compassionate

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House Bill 46 aims to improve and expand the Texas Compassionate Use Program (TCUP). The bill allows patients to use cannabis patches, lotions, and suppositories as well as approved inhalers, nebulizers, and vaping devices. 

If passed, the list of qualifying conditions would expand significantly, to include those with chronic pain, glaucoma, traumatic brain injury, spinal neuropathy, Crohn's disease or other inflammatory bowel disease, degenerative disc disease, a terminal illness or condition for which a patient is receiving hospice or palliative care, or any medical condition designated by DSHS. Honorably discharged veterans may use cannabis for any medical conditions.

To ensure adequate patient access, HB 46 instructs the Department of Public Safety (DPS) to issue 15 dispensing licenses, which must be located strategically within Texas' public health regions. The bill also allows dispensing organizations to open approved satellite locations. 

Status: 05/13/2025 H Passed Third Reading in House (122-21)

With a bipartisan super-majority vote of 122-21, the Texas House of Representatives has passed Chairman King's HB 46 to expand and improve patient access to medical cannabis. 

Next Step: HB 46 was quickly referred to the Senate State Affairs Committee, which will host a public hearing. Date: TBD.

There were a few changes made through floor amendments, including Rep. Oliverson's prescription monitoring and Chairman King's own amendment improving patient access. 

Chairman King's amendment removed the 1 gram THC limit per package, changed the requirement from 11 to 15 business licenses total, removed the 1% cap on inhalation products, and removed the restriction on "naturally occurring chemical substance from the cannabis plant that is not a phytocannabinoid."

On Monday, April 14, the House Public Health Committee hosted a hearing on Chairman Ken King's HB 46. Witnesses waited more than 13 hours to testify in support of this bill, which would improve and expand the Texas Compassionate Use Program. Testifying witnesses included patients, caregivers, business operators, and medical professionals. 

Chairman King's committee substitute for HB 46 adds chronic pain as a qualifying condition. This is great news! This important change allows Texas patients to use cannabis as an alternative to opioids.

Chairman King closed out the hearing with the following:   

"One thing that's not talked about in here is hospice care. I'm gonna tell you right now, y'all have heard me a lot over the years talk about my mother. I watched her die over 10 1/2 weeks in hospice. And if I had it to do over again, instead of giving her the poison they were shoving down her, I would have gone to Colorado and bought a joint. That's just me. I don't use it myself, but I hope for your favorable consideration on this bill. And if you have suggestions, I'm open to them." (Watch this moment.)

There may be further amendments to the bill before it's passed out of committee. Stay tuned for updates!

Patient Impact

• Prescriptions: Patients would be certified for 1 year, with (4) 90-day supply refills of medication. Prescriptions would be monitored by the Texas State Board of Pharmacy.
• Product Availability: Allows the use of cannabis patches, lotions, and suppositories as well as approved inhalers, nebulizers, and vaping devices. Dosing remains at 1% THC, but makes an exception for vape and inhaler products, which require a higher percentage of THC to be effective.
• Qualifying Conditions: Adds chronic pain, glaucoma, traumatic brain injury, spinal neuropathy, Crohn's disease or other inflammatory bowel disease, degenerative disc disease, a terminal illness or condition for which a patient is receiving hospice or palliative care, or any medical condition designated by DSHS. Honorably discharged veterans may use cannabis for any medical conditions.

Business Impact

• Satellite Locations: With approval from DPS, licensed dispensing organizations could open one or more satellite locations in addition to their primary location.  Currently authorized patient pickup locations will be considered approved as satellite locations.
• Limited Licenses: DPS would be required to issue 15 licenses. 
• Regional Access: New or renewed licenses would be issued strategically to ensure adequate patient access in each of Texas’  public health regions.
• Active Licenses: Dispensing organizations would be required to begin operations within 24 months of receiving their license and must maintain production in order to retain their license. 
• Licensing Process: Instructs DPS to issue initial licenses to dispensing organizations based on competitive evaluation of applicant qualifications relative to other applicants. DPS Must issue at least 9 licenses by Dec. 1, 2025. Applications due by July 1, 2025. Final three licenses to be issued by April 1, 2026.

If passed, HB 46 would go into effect on September 1, 2025 and all necessary rules must be adopted by October 1, 2025. 

Policy Recommendations:  In the spirit of free enterprise and innovation, we recommend removing the statutory cap on the number of licenses. Let the Department of Public Safety determine the appropriate number of licenses based on patient need, population, and infrastructure.

Additionally, licensing fees should be reconsidered. The current $488,000 initial fee and $315,000 renewal fee every two years create a barrier to entry and limit competition—especially for small businesses.