By John J. Seidenfeld, MD

The State of Texas and Cannabis

By John J. Seidenfeld, MD

Texas once again finds itself as the Lone Star “island.” Surrounded by the states of Oklahoma, New Mexico, Arkansas, Louisiana and the countries of Canada and Mexico that have all agreed on medicinal use of cannabis products (and adult use for some), we alone limit compassionate medical use to a very few patients in very few circumstances with cannabidiol (CBD) and very small amounts (</=1%) of tetrahydrocannabinol (THC). We have misdemeanor penalties for possession of amounts starting at less than 2 oz. with felony charges starting for possession of over 4 oz. This legislative session, we made minor adjustments to our compassionate use laws but continue to severely restrict medicinal prescribing and harshly penalize adult use.1

Who uses cannabis? Why should we be concerned? People with conditions such as emesis, epilepsy, Post Traumatic Stress (PTS), anorexia, glaucoma, pain with the goal of reducing opioid use, multiple sclerosis, Parkinson’s and Huntington’s disease and cancer pain relief have been treated and studied with promising results.2 Journals such as the Journal of Cannabis Research are now devoted to the study of cannabinoids, cannabinoid agonists and antagonists and metabolic pathways. Despite Federal controlled substance classification, research has never been more active in this field. Likely, the field of therapeutics will be enriched in years to come by this work.

According to the CDC (Center for Disease Control), 38% of youths have used cannabis.3 Studies in The Texas Tribune note that 76% of Texans favor medicinal use of marijuana, and support has increased from 2015 to 2017.4 Studies of veterans have shown 11% use and veterans with PTS, up to 28%. 5

While some see no likelihood of improvement in expanding the therapeutic armamentarium, others argue that we could see expansion. Just a few years ago, tobacco was consumed in Texas hospitals, public buildings and other gathering places. Many of us worked hard to show the advantages of a smoke-free environment, and today we all appreciate the smoke-free air in our workplaces. Someday soon, patients could be able to access pills or edible cannabis products with assurance of dosage and clearly labeled ingredients, as with most regulated therapeutic agents.

References 1. https://guides.sll.texas.gov/cannabis 2. http://bcms.org/SAM/2019/SAM

Dec2019/mobile/index.html#p=26 3. https://www.cdc.gov/marijuana/factsheets/teens.htm 4. UT/TT Poll: Support for marijuana growing like a weed in Texas. Texans are more open to legalizing marijuana — and not just for medical use.2/21/2017.

R. Ramsey, University of Texas/Texas

Tribune Poll. 5. https://www.ptsd.va.gov/professional /treat/cooccurring/marijuana_ptsd_vets.asp

John J. Seidenfeld, MD is the Chair of the BCMS Publications Committee.