Texas’ Compassionate Use Program (TCUP) was created in 2015, and in 2018, Texas Original became the first operator licensed to serve patients within the program. For most of the decade that followed, the TCUP provided meaningful access to medical cannabis for thousands of Texans with qualifying conditions, though eligibility and treatment options remained more limited than they are today. As patient participation continued to grow and the benefits of the program became increasingly clear, lawmakers expanded access so more Texans could benefit from medical cannabis.
Enter House Bill 46. When the law took effect on September 1, 2025, it marked the most significant expansion in the history of the Compassionate Use Program. One year later, the impact is measurable, but the work of improving access for Texans is far from complete. The momentum continued at the federal level. In April 2026, the U.S. Department of Justice reclassified state-legal medical cannabis from Schedule I to Schedule III, recognizing its accepted medical use and creating new opportunities for research, physician education, and patient access. For Texas patients, the change represented another step toward broader understanding and acceptance of medical cannabis as a legitimate treatment option.
What HB 46 Changed
The law opened the program to Texans living with chronic pain, with no requirement to try opioid medication first. It also added inflammatory bowel disease, Crohn’s disease, traumatic brain injury, and terminal illness or hospice care to a program that already served Texans with cancer, PTSD, autism, neuropathy, spasticity and more than 150 other qualifying conditions.
HB 46 also transformed how patients can access and use their medicine. The 1% THC cap gave way to a 10 mg per dose limit, allowing more concentrated products with fewer fillers. Pulmonary inhalation became legal, making vaporization available to patients who needed fast-acting symptom relief. Dispensaries gained the ability to store medicine at satellite locations approved by the Department of Public Safety, and the number of licensed dispensing organizations expanded from three to 15.
Building for What Came Next
Texas Original built for the expansion before the demand arrived. The company moved from a 7,700-square-foot facility to a 75,000-square-foot headquarters in Bastrop, where it harvested the state’s first greenhouse-grown medical cannabis cultivated with natural sunlight, and converted its former South Austin site into one of the state’s first satellite locations under HB 46. It now operates six approved satellite locations and 13 pickup sites statewide.
The investment matched growing patient demand. Registry enrollment increased from 120,437 patients in July 2025 to 162,216 in July 2026, adding nearly 42,000 Texans and representing 34.7% growth in the law’s first year.
That growth still leaves a gap. Texas enrolls roughly 0.5% of its population, compared with a national average near 2.1%.
“HB 46 expanded access in ways Texas patients had been waiting for, but access only matters if people know it’s available,” said Nico Richardson, CEO of Texas Original. “The next phase of this program’s growth is education, helping patients and physicians understand who qualifies, how it works, and where to get started.”
How Expanded Access Is Changing Lives
Austin resident Elizabeth Diamond was diagnosed with degenerative disc disease at 36. Sixteen years and seven spinal surgeries later, she was taking 180 Norco a month along with fentanyl patches and had become physically dependent on them.
Although she already qualified for the program through neuropathy and PTSD, Elizabeth spent years searching for better ways to manage her symptoms and reduce her dependence on prescription opioids. She carefully explored medical cannabis before deciding to incorporate it into her treatment plan.
Today she estimates that medical cannabis manages about 80% of her pain. She practices yoga and spends more time outdoors than in bed.
“I can pick up my grandkids again. That may sound like a small thing to some people, but to me, it is everything.”
Israel Smyly of Willis was already enrolled in the program. A veteran managing PTSD, he now uses the medical vaporization device Texas Original launched in June thanks to HB 46, which delivers a metered 3 to 5 mg per draw. These devices are changing patient lives by providing the TCUP’s fastest medication onset from minutes instead of hours.
“It is reliable, easy to use, and delivers predictable effects, making it easy to gauge my dose.”
Their experiences reflect two important outcomes of the program’s evolution: expanding awareness among eligible patients and delivering new treatment options that better meet patient needs.
What Expanded Options Change in Practice
Expanded eligibility and new products mean little if patients cannot find a physician to prescribe them.
Texas has roughly 80,000 board-certified physicians. Nearly 1000 are registered to prescribe through TCUP.
Dr. Matthew Brimberry, medical director of the Texas Cannabis Clinic in Austin and a member of Texas Original’s medical advisory board, is one of them. He did not register until 2019, when the program expanded beyond intractable epilepsy to include terminal cancer.
His experience reflects a broader trend: physicians are more likely to participate when more of their patients become eligible for treatment.
He has pointed to two obstacles. Registering patients means learning another electronic portal on top of the systems physicians already manage, and medical cannabis receives little attention in medical training. As he told the Texas Tribune, “you aren’t going to recommend something you don’t know about.”
Where This Goes From Here
The distance between 0.5% and 2.1% is not a supply problem. Capacity has grown, product options have expanded, and new pickup locations continue to open.
What has not kept pace is awareness, among Texans who may not realize they now qualify and among physicians who have yet to register to prescribe through the program.
Two developments should help. DPS has issued conditional licenses to nine new operators, with more to follow, bringing additional locations and options across the state. And in April 2026, state-licensed medical cannabis moved to Schedule III under federal law, a shift expected to reduce stigma, open the door to more research, and give physicians more confidence in prescribing.
The measure of the next year is not simply how much the program grows. It is whether the Texans who already qualify are able to find, access, and benefit from treatment.
