Despite major expansions to Texas’ medical cannabis law, many chronic pain patients say they were never told the program existed — even after years of treatment with prescription medications.
Interviews and publicly available records reviewed by The Dallas Express show that awareness of the Texas Compassionate Use Program (TCUP) remains limited among both patients and physicians, leaving some Texans unaware of a legal option intended to treat serious and chronic conditions.
In an exclusive interview with a patient who has gone through the legal and medical process of navigating through the marijuana maze for medicinal purposes, The Dallas Express uncovered multiple barriers — including limited physician participation, regulatory complexity, medication shortages, and low public awareness — that continue to restrict access to TCUP.
A Patient’s Search for Relief
The individual was diagnosed with trigeminal neuralgia (TN) in 2011, a chronic pain disorder affecting the trigeminal nerve, often resulting in episodes resembling electric shocks. The American Association of Neurological Surgeons (AANS) notes that TN is “sometimes described as the most excruciating pain known to humanity.”
Not surprisingly, TN has historically been nicknamed the “suicide disease“ (or “suicide condition”) due to the overwhelming intensity of the pain, per the University of Rochester Medical Center.
“I tried all the first-line and second-line medications, including being prescribed numerous opioids,” said the patient to The Dallas Express. “The pharmaceutical industry’s gold standards resembled fool’s gold to me, ultimately failing to maintain its perceived value.”
When Standard Treatments Failed
As a result of going through a laundry list of medications with minimal success, the patient was scheduled for suboccipital craniectomy with microvascular decompression in 2013.
Before proceeding with surgery, the neurosurgeon and treating neurologist jointly decided to pursue one additional course of pharmacotherapy, which included the use of Marinol (dronabinol), a prescription form of synthetic medical marijuana (pharmaceutical-grade delta-9-tetrahydrocannabinol, or THC) approved by the FDA, which her doctors used off-label to help manage her severe pain.
“It felt like I released a breath I hadn’t realized I had been holding in for years,” the patient told DX. “I could function without high anxiety associated with chronic pain. I cancelled the scheduled surgery.”
A 2019 study found 81% of TN patients reported improvement with medical cannabis, with half reducing opioid use.
A Medication Shortage and Limited Options
The patient continued using dronabinol until 2022, further explaining that “everything was going so well that I eventually dropped all the pharmaceutical medications except for the dronabinol…. I went into what was called a relapsing-remitting course, with little to no pain. I was technically in remission for years, only to have it resurface in late 2024.”
“Little did I know, in late 2023, a shortage of dronabinol had emerged,” the patient said. “Here I was in the early part of 2025, with a valid prescription from a reputable physician, and could not get it filled.”
As a result, the patient was put on prescription drugs, including opioids.
“It was like I was being pressed to take prescribed drugs that had horrible side effects to simply function. The result left me even more anxious,” she said. “I hated it.”
Turning to THC and the Legal Risks
During an office visit in early 2025, the patient’s physician advised that dronabinol remained unavailable due to persistent supply chain shortages and apologized for the lack of additional treatment options.
With her prescribed medication unavailable and unaware of the Texas Compassionate Use Program, the patient said she turned to out-of-state THC products despite knowing they carried legal risks. “I needed to function,” she said, adding that she “did not have the mental or physical bandwidth to keep circling down the pharmaceutical drain.”
A Program Few Doctors Mention
Unbeknownst to the patient and even to the doctor, there was another alternative: the Texas Compassionate Use Program.
In December of 2025, the doctor appeared frustrated that the patient had not been taking the prescribed medications, with the doctor stating that she was “okay” with the THC edible solution until the dronabinol became available. However, the doctor didn’t know when, if ever, dronabinol would become available and suggested that the patient try additional prescribed medications.
“It was almost as if the doctor didn’t know how to process that I was genuinely better just on the THC gummies I was using — I didn’t want or need the drugs she was taught in med school to push,” the patient told DX.
“It was in this conversation with the doctor that I asked why Texas doesn’t have a medical marijuana card that would enable me to legally purchase from dispensaries that offer the grade and quality I need.”
“The doctor looked perplexed. She didn’t know but said she would look into it for me,” the patient told DX.
“I realized the issue was multifaceted: neither the doctors nor I fully understand the resources available, many doctors prefer prescription medications over natural alternatives, and some doctors may benefit—directly or indirectly—from relationships with pharmaceutical companies, even if legal and without outright kickbacks.”
“The doctor eventually told me she had heard of doctors who could prescribe TCH products from Texas dispensaries, but she wasn’t one of them,” the patient told DX.
“That was all I needed to hear. The rest was incumbent upon me,” she said. “I was dumbfounded that I had seen this doctor and many others over the years, yet not one of them ever mentioned this to me… they just let me drown in prescribed medications that had to be tweaked or changed often. The cost—financially, physically, mentally, and in terms of sheer time—is beyond words.”
What the Texas Compassionate Use Program Allows
The Texas Compassionate Use Program (TCUP), Texas’ limited medical cannabis initiative established in 2015 under Senate Bill 339 and administered by the Texas Department of Public Safety (DPS), remains relatively unknown to many eligible patients and healthcare providers.
Reasons for this are predominantly due to its historically restrictive scope, low enrollment (approximately 123,308 patients as of August 2025 in a state of over 30 million, a significant increase from previous years, but still a small fraction of potential users), limited physician participation (a 2023 evaluation found 32% of relevant physicians unaware of TCUP, with few registered prescribers due to federal conflicts, training barriers, minimal public outreach, confusion with unregulated hemp-derived Delta products, and ongoing stigma.
This perception has persisted despite expansions, including House Bill 46 in 2025, which added chronic pain and other conditions (now over 100, such as cancer, PTSD, epilepsy, multiple sclerosis, ALS, autism, traumatic brain injury, Crohn’s disease, and terminal illnesses – the full list can be found here), removed the 1% THC-by-weight limit (replacing it with caps like 10 mg per dose and 1,000 mg per package), approved new delivery methods (vaporizers, lotions, patches, suppositories), and increased dispensaries from three to up to 15.
TCUP allows Compassionate Use Registry of Texas (CURT)-registered physicians to prescribe low-THC products; patients qualify as permanent Texas residents with approved diagnoses after a physician evaluation (benefits outweigh risks), typically costing $50–$200 for a consultation.
In Texas, there is no legal requirement for patients to possess a physical medical marijuana card to take part in the Texas Compassionate Use Program (TCUP). However, many of the participating clinics offer a “TCUP printable medical cannabis card” along with a certification letter. You can typically access these documents digitally through a patient portal within 5 to 7 days after your appointment.
Interested individuals can search within the Compassionate User Registry of Texas to locate a physician in their region authorized to prescribe cannabis.
The process involves finding a registered doctor, consultation, CURT prescription entry, dispensary purchase, and follow-ups, valid for up to 1 year. For additional details, visit the DPS Compassionate Use Program Overview.
Access, Cost, and Delivery Barriers
“Within one hour of my telehealth visit with Texas Cannabis Clinic, I had qualified for the use of medical cannabis to treat symptoms related to a chronic qualifying condition, for an illness under the Texas Compassionate Use Program, and was entered into the Texas Compassionate Use Registry of Texas,” the patient told DX.
“I was shocked. Why isn’t this more widely known? I kept thinking about all the medications I had been prescribed, the on-and-off again on pain pills, the illegal mailing of THC products across state lines, not being able to get the dronabinol prescription filled, and the lack of knowledge from numerous doctors throughout the years…. This process was easy compared to the nightmare I had been navigating, so much in fact that, at first, I thought it was a hoax.”
“After finishing my telehealth appointment, I placed my first order through a licensed dispensary over the phone. The only thing that I didn’t understand initially was the delivery process through Texas Original,” the patient said.
Texas Original is one of the three original licensed dispensing organizations in TCUP, as confirmed by the Texas Department of Public Safety.
Under TCUP, home delivery is available statewide from licensed dispensaries like Texas Original, but it is limited to patients who live more than 10 miles from a pickup location or are unable to leave home/drive (eligibility can be confirmed by calling the dispensary).
Deliveries are performed by licensed drivers from a central facility (e.g., South Austin), with no mailing option due to federal law; orders require a minimum of $200 (no delivery fee), and payment is accepted via debit (chip and PIN), cash, checks, money orders, or Aeropay (credit cards not accepted) at the time of delivery.
Patients receive email notifications ~72 hours after ordering, with text updates for their scheduled window. This information is based on Texas Original’s delivery guidelines (as of the article’s publication).
“A driver is traveling several hours to deliver my first order of medical cannabis right to my door,” the patient told DX.
“The process feels unusual, but what truly disheartens me is how many people in Texas are still suffering — trapped in the cycle of opioids and other prescription medications that often lead to dependency, tolerance, escalating doses, severe side effects, and a diminished quality of life—when an alternative like the Texas Compassionate Use Program exists and so few even know it’s an option.”
