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As the Texas medical cannabis program continues making headway in its second year of patient participation, the important role of Texas physicians in making diagnoses, prescribing medical CBD and analyzing the data around dosages and outcomes for patients cannot be overstated. At this point, the amount of U.S. research on medical cannabis is unsatisfyingly scant due to onerous federal restrictions. As I’ve shared before, the clinical studies that currently exist, added to the mountain of existing anecdotal evidence, makes it clear the non-intoxicating plant compound cannabidiol (CBD) can be successful in treating many neurological conditions such as intractable epilepsy, the condition lawmakers specified in the 2015 Texas Compassionate Use Act (CUA). Because the risks associated with low-THC, high-CBD products are incredibly small—as confirmed by the World Health Organization in a comprehensive CBD report released in 2018—it is our responsibility as medical professionals to make sure we are getting this medicine into the hands of our patients who have not experienced success with traditional medications and who may benefit from this alternative approach. Simply put, access and appropriate utilization of medical grade CBD therapy in Texas doesn’t happen without the physicians. Unfortunately, there’s a record of reluctance among many Texas neurologists in prescribing CBD oil.What’s Stopping Qualified Texas Neurologists from Prescribing CBD Medicine?
As of December 2018, fewer than 600 patients were registered with the Texas medical cannabis program, as reported by San Antonio Express-News. That’s a far cry from the estimated 150,000 Texas residents diagnosed with intractable epilepsy who might benefit from regulated CBD products. Perhaps unsurprisingly, these low patient numbers are associated with low physician numbers. Roughly 45 qualifying physicians—mostly located in urban centers—had registered with the state Compassionate Use Program, according to the Express-News. I see three distinct components responsible for this hesitation among Texas physicians:- legal and professional implications;
- the early stage of cannabis research; and
- fear of the unknown.
Legal and Professional Implications in Prescribing CBD Oil
One common roadblock for Texas physicians who practice in private firms or HMOs, or those who practice in an academic- or research-oriented setting, is that often there are formally implemented policies or institutional guidelines prohibiting the prescribing of medical cannabis or derivative products. Since most physicians need to support their institutional policies, that means they’re predictably opting out because potential consequences to their employment or professional privileges. This is true even for doctors who personally see the value of CBD medicine. Beyond this, many physicians in my network say they fear the professional risks in prescribing CBD oil, despite legal protections for physicians that are set forth in the CUA. (I have also discussed the CUA protections in an op-ed in the Austin American Statesman.) It’s important to understand there are safeguards in place to protect physicians who participate in state-sanctioned medical cannabis programs. From a federal standpoint, those protections include a key provision in the annual federal spending bill that prevents the U.S. Department of Justice from using federal funds to prosecute businesses and patients in states that have medical cannabis programs when parties adhere to state laws. In addition, the Texas medical cannabis program is one of the most rigorously regulated programs in the country, and is a national leader in terms of implementing clearly defined oversight. And there’s absolutely no indication that federal authorities have any plans to crack down on the Texas Compassionate Use Program. I call on my fellow physicians to take the initiative when it comes to addressing restrictive institutional policies and continue to put patients’ needs at the forefront in the case-by-case consideration of alternative treatments.*****
Check back for parts two and three of this series, where I will continue examining the physician’s important role in the Texas medical cannabis program, and I’ll address two more key components causing hesitation among Texas physicians: the fact that cannabis research is in its early stages, and fear of the unknown.
