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The Texas Compassionate-Use Program: who can get low-THC cannabis, and what House Bill 46 changed

Checked 5 October 2026 against the Department of Public Safety's own Compassionate Use Program pages and its published count reports, and against the enrolled texts of the four Acts that built the programme — plus the engrossed text of a fifth bill that never passed — as the Legislature publishes them at capitol.texas.gov/tlodocs.

The short version

Texas has no legal adult-use cannabis market. It does have one narrow lawful route to cannabis: the Compassionate-Use Program, often written TCUP, which the Legislature created in 2015 and has widened in three sessions since: 2019 (House Bill 3703), 2021 (House Bill 1535) and 2025 (House Bill 46). A fourth attempt, House Bill 1805 of 2023, passed the House and died in the Senate. A patient needs a prescription from a registered specialist physician for one of thirteen listed conditions. The Department of Public Safety runs the registry and licenses the companies that dispense.

This is a separate fight from the 2025 hemp-THC ban that dominates Texas cannabis news. The same legislators frequently did both: voted to expand the medical programme and voted to shut down the hemp market. This site records those as two things, because they are two things.

Who administers it

The Department of Public Safety, under Chapter 487 of the Health and Safety Code. DPS's own description: it "operates a secure online registry of qualified physicians who can prescribe low tetrahydrocannabinol (THC) to patients with specific medical conditions. The registry, called the Compassionate Use Registry of Texas (CURT), is designed to prevent more than one qualified physician from registering as the prescriber for a single patient, is accessible to law enforcement agencies and dispensing organizations to verify patients of low-THC cannabis, and allows a physician to input safety and efficacy data derived from the treatment of patients for whom low-THC cannabis is prescribed." DPS also licenses the dispensing organisations.

There is no paper prescription and no patient card. A prescription under this chapter is an entry in CURT. The prescribing rules live in Chapter 169 of the Occupations Code.

Who may prescribe

Not any doctor. Under Occupations Code section 169.002, as it has read since 2019, "Only a physician qualified with respect to a patient's particular medical condition as provided by this section may prescribe low-THC cannabis." A physician is qualified if they are licensed in Texas, are "board certified in a medical specialty relevant to the treatment of the patient's particular medical condition by a specialty board approved by the American Board of Medical Specialties or the Bureau of Osteopathic Specialists," and "dedicates a significant portion of clinical practice to the evaluation and treatment of the patient's particular medical condition." They must also register with DPS.

Two earlier barriers are gone. The 2015 Act let only epilepsy and neurology specialists prescribe, and required a second qualified physician to concur in the prescription, with the concurrence recorded in the patient's medical record. House Bill 3703 of 2019 struck the second-physician requirement and replaced the narrow specialty list with the relevant-specialty test above. HB 46 of 2025 did not change who may prescribe.

DPS's Physician Count Report for August 2026 puts the number of physicians approved to prescribe at 978, having moved between 927 and 979 over the year.

What conditions qualify

Thirteen, after HB 46, plus conditions under the state's research programme. The statutory list as HB 46 left it: epilepsy; a seizure disorder; multiple sclerosis; spasticity; amyotrophic lateral sclerosis; autism; cancer; an incurable neurodegenerative disease; post-traumatic stress disorder; a condition that causes chronic pain; traumatic brain injury; Crohn's disease or other inflammatory bowel disease; a terminal illness or a condition for which a patient is receiving hospice or palliative care; and a condition approved for a research programme under Chapter 487. The four in bold are new in 2025.

HB 46 did not add post-traumatic stress disorder. That is a common misstatement and it is wrong by four years. PTSD is clause (ix) of the diagnosis list in Occupations Code section 169.003(a)(3)(A), and it was added in 2021 by HB 1535, whose enrolled text reads "(ix) post-traumatic stress disorder; or" as new text with no bracketed deletion. What HB 46 added, as new clauses, is "(x) a condition that causes chronic pain", "(xi) traumatic brain injury", "(xii) Crohn's disease or other inflammatory bowel disease" and "(xiii) a terminal illness or a condition for which a patient is receiving hospice or palliative care" — HB 46 renumbered the research-programme clause from (x) to (xiv), which its enrolled text shows as "(xiv) [(x)]".

HB 46 also defines chronic pain narrowly: "pain that is not relieved with acute, post-surgical, post-procedure, or persistent non-chronic pain treatment and is associated with a chronic pathological process that causes continuous or intermittent severe pain for more than 90 days and for which tetrahydrocannabinol is a viable method of treatment."

A physician may now petition the Department of State Health Services, with peer-reviewed evidence, to have it report to the Legislature that low-THC cannabis may help a condition not on the list. Only the Legislature can add one.

The THC limit, and how it has moved

The limit is in the definition of "low-THC cannabis." Two of the three widening Acts moved it, and one did not — HB 3703 of 2019 left the 0.5 percent ceiling exactly where the 2015 Act set it and struck the cannabidiol floor instead:

ActLimit it set
SB 339, 2015not more than 0.5 percent by weight of THC, and not less than 10 percent by weight of cannabidiol
HB 3703, 2019kept 0.5 percent; dropped the cannabidiol floor
HB 1535, 2021"not more than one [0.5] percent by weight"
HB 1805, 2023would have set "not more than 10 milligrams [one percent by weight] … in each dosage unit" — this bill died in the Senate
HB 46, 2025enacted exactly that: "not more than 10 milligrams [one percent by weight] of tetrahydrocannabinols in each dosage unit"

The switch from a percentage of weight to milligrams per dose is the single most consequential change HB 46 made, because a percentage cap limits concentration while a milligram cap limits dose. HB 46 added a second ceiling on top: a dispensing organisation may not dispense low-THC cannabis in a "package or container that contains more than a total of one gram of tetrahydrocannabinols," nor in an inhalation device containing more than one gram.

Smoking, and the new exception

"Medical use" has always excluded smoking. HB 46 kept that and carved out vaporisation: it defines "smoking" as "burning or igniting a substance and inhaling the smoke" and adds that the "term does not include inhaling a medication or other substance that is otherwise aerosolized or vaporized for administration by pulmonary inhalation." A new section lets a physician "prescribe pulmonary inhalation of an aerosol or vapor as a means of administration of low-THC cannabis if the physician determines that based on the patient's condition there is a medical necessity for that means of administration."

How many dispensing organisations

The 2015 Act required DPS to license "at least three." HB 46 raised that to a hard number: "The department shall issue 15 licenses under this section to dispensing organizations in this state provided that the department receives applications from a sufficient number of applicants." HB 46 also set deadlines — at least nine new licences by 1 December 2025, and at least three more by 1 April 2026 — and told DPS to issue and renew licences "in a manner that ensures adequate access to low-THC cannabis for patients registered in the compassionate-use registry in each public health region."

What the state publishes today does not yet show fifteen. DPS's Licensed Dispensaries page, last updated 5 December 2025 and checked on 5 October 2026, lists three active licence holders — Fluent (licence 0004), Texas Original (0005) and goodblend (0006) — and says that "With 3 current active licenses, DPS will issue an additional 12 new licenses." DPS's own Compassionate Use news page has published nothing since 8 August 2025, when it opened the application window and said it would "issue nine licenses by December 1, 2025, and three licenses by April 1, 2026." We checked both pages and found no later DPS notice naming new licensees; we are not saying the licences were not issued, only that the state has not published them where it publishes the others.

How HB 46 widened where the cannabis can physically be

Before 2025 a licensee operated from locations the department approved, and whether it could move inventory between them before a prescription existed was unsettled enough to need an Attorney General opinion. Opinion KP-0469, issued 3 July 2024, concluded that "Neither the Compassionate-Use Act nor its associated regulations prohibit a licensed dispensing organization from transporting its low-THC cannabis inventory between Department-approved locations prior to a prescription being issued and filled."

HB 46 put the answer in statute. A new section 487.1035 lets a dispensing organisation operate satellite locations in addition to its primary facility, each approved by DPS, and ties them to the state's public health regions. HB 46 also made the licensee's own inventory transport between approved locations part of the licensed activity rather than a question for an opinion.

Two other HB 46 changes worth knowing

Patient privacy. HB 46 made registry information identifying a patient — "including the fact that a person is listed as a patient in the registry" — confidential, accessible only to DPS, registered physicians and dispensing organisations, and exempt from the Public Information Act. A patient may ask DPS to release their own information to themselves or to someone they name.

Only plant-derived cannabinoids. A new section 487.1071 bars dispensing a low-THC cannabis product containing a cannabinoid that is not a "phytocannabinoid," which the section defines by natural creation in Cannabis sativa L. and decarboxylation without a chemical catalyst.

Prescriptions may cover a 90-day supply with up to four refills, and a physician may prescribe more than one package in a 90-day period. Counties and municipalities may not prohibit the cultivation, production, storage, dispensing or possession of low-THC cannabis authorised by Chapter 487.

How many patients

DPS's Patient Count Report for August 2026 charts a figure it labels "CUP Active Patient Count" rising from 138,567 in January 2026 to 169,058 in August 2026.

Read that number carefully, because DPS footnotes it: "*Lifetime counts since the inception of the Texas Compassionate Use Program in 2017." The chart's title says active and its footnote says lifetime, and the state does not reconcile the two. We report both words because DPS prints both. These are aggregate figures published by the state; nothing here, and nothing anywhere on this site, identifies a patient.

Why this site scores a Compassionate-Use vote at +1, not +2

Supporting a prescription-only programme for thirteen listed conditions is not supporting a legal adult market, and this site will not let one stand in for the other. A Compassionate-Use measure does widen who may lawfully possess cannabis in Texas, so it scores on the expansive side — but only for patients with a prescription, so it scores +1 where adult-use legalisation scores +2. That is the same distinction the project already draws federally, where the MORE Act scores +2 and SAFE Banking scores +1 because it "eases operation of an existing legal market rather than widening who may lawfully possess."

The practical consequence is that a large number of Texas legislators, most of them Republicans, have a genuine medical-access record and a restrictive hemp record at the same time, and both appear on their page.

A senator put the combination on the record himself. Explaining his Yea on Senate Bill 3 — the intoxicating-hemp-THC ban — in a reason for vote the Senate Journal printed on 19 March 2025, Senator César Blanco wrote: "Just as important, this bill does not impact the Compassionate Use Program." The same statement describes knowing people who live with post-traumatic stress disorder and chronic pain, says he has supported the Compassionate-Use Program from the start and will continue to support efforts to expand it, and thanks the ban bill's author for preserving patient access. One person, one page of the journal, both positions. Senator Blanco's district is not on the 2026 ballot, so he has no page here; the pattern he described runs through the records of candidates who do.

Neither half cancels the other, and this site does not average them into a single impression.

Sources

A note on how KP-0469 was checked. The Attorney General's site asks automated tools not to read it, so nothing was fetched from it for this page. The sentence quoted above was verified as an exact substring of this project's own locally held copy of the opinion text (.cache/kp0469.txt), which also shows the opinion was issued in answer to a 15 December 2023 request letter from the Chair of the Senate Committee on Business & Commerce, and states that it was asked whether low-THC cannabis inventory may be transported between department-approved locations "by a licensed dispensing organization before a prescription is issued and filled under the Compassionate-Use Act." A human should still open the published PDF once before this page ships.

Elsewhere on this site

This page describes the law and the record. Nothing here tells anyone how to vote. Every claim above carries the document it came from; if one is wrong, the correction is published.