Texas Set to Dramatically Expand Medical Marijuana Program with House Bill 46

29 May 2025

Cannabis plant (Photo by Next Green Wave/Unsplash)

Texas is on the verge of a historic expansion of its medical marijuana program following the state legislature’s passage of House Bill 46 (HB 46). The bill, now awaiting Governor Greg Abbott’s signature, seeks to make medical cannabis more accessible to patients while simultaneously addressing a growing public health and policy concern over hemp-derived THC products. If approved, the bill would bring the most significant changes to the Texas Compassionate Use Program (TCUP) since its inception in 2015.

One of the most important aspects of HB 46 is its expansion of qualifying conditions. Under current law, only patients with a limited list of conditions such as epilepsy, terminal cancer, PTSD, and multiple sclerosis can legally obtain medical cannabis. HB 46 adds chronic pain, terminal illness, and patients in hospice care to this list. These additions are seen as crucial by advocates, especially as opioid use and dependency remain pressing issues in the state.

However, not all proposed additions survived the legislative process. Originally, the bill also included Crohn’s disease, glaucoma, traumatic brain injury, and spinal cord disease. These were ultimately removed during Senate negotiations. Still, the expansion represents a significant step forward in making medical cannabis more inclusive and adaptable to a broader spectrum of patient needs.

Currently, Texas has only three licensed medical cannabis dispensaries operating statewide, an arrangement that has drawn criticism for being too limited, especially for rural residents. HB 46 would increase that number to 12, with the added provision for satellite distribution sites, allowing better access in remote or underserved areas. This marks a pivotal shift in how Texas delivers medical cannabis and is expected to stimulate economic activity and job creation within the state’s cannabis sector.

Another notable reform in the bill involves the range of products available to patients. Previously restricted to low-THC oils, the program will now allow a wider array of delivery methods, including patches, topicals, suppositories, inhalers, and vaporized products. These expanded options aim to improve the quality of life for patients who may not respond well to oral forms of cannabis.

Additionally, the bill changes how THC dosage is regulated. Rather than capping THC content at 1% per product, HB 46 sets a per-dose limit of 10 milligrams of THC, giving physicians more flexibility in prescribing the appropriate dosage based on a patient's needs. This is seen as a medically responsible shift that brings Texas more in line with other states’ guidelines.

HB 46 arrives in tandem with Senate Bill 3, which bans hemp-derived psychoactive products like Delta-8 and Delta-10 THC starting September 1, 2025. These products had filled a gap for patients unable to access medical marijuana legally, but they also raised safety concerns due to inconsistent regulation and potency. With the hemp ban looming, lawmakers saw HB 46 as a necessary counterbalance to ensure that patients still had legitimate access to symptom relief.

The bill’s passage reflects a noticeable shift in Texas politics around cannabis. Lieutenant Governor Dan Patrick, long opposed to expanding marijuana laws, reversed his stance after consulting with Rep. Tom Oliverson, a physician and the bill’s sponsor. Patrick cited a need for regulation that doesn't repeat the mistakes of past prescription drug abuse while addressing legitimate medical needs.

The bill has also gained bipartisan support, in part due to advocacy from veteran groups and caregivers who’ve long called for safer, legal alternatives to addictive painkillers. While not a full legalization of medical marijuana, the bill signals that Texas lawmakers are beginning to see the issue through a public health lens rather than a purely legal one.

Governor Abbott has until mid-June to sign or veto the bill. If he takes no action, the bill will become law automatically. Early indications suggest he may support the bill or at least allow it to pass without intervention. Once enacted, the law could take effect later this year, ushering in a new era for cannabis accessibility in the Lone Star State.

If implemented successfully, Texas’s expansion of medical marijuana access could serve as a blueprint for other conservative states wrestling with similar issues. More importantly, it represents a critical moment for thousands of Texans who have long waited for safe, legal, and effective relief.