- all forms of epilepsy and other seizure disorders
- autism
- multiple sclerosis
- spasticity
- amyotrophic lateral sclerosis or ALS
- terminal cancer
- other neurodegenerative disorders such as Alzheimer’s and Parkinson’s disease, and more
For a deeper dive on medical cannabis and these conditions, Compassionate Cultivation has compiled a complete repository of condition-specific medical studies here. Other important changes in the program were, removing the requirement for a second qualified medical opinion, and eliminating the 10% by weight ‘floor’ for CBD content in products. Removing this restriction allows medical CBD producers to offer a variety of CBD:THC ratios that are more tailored to individual patients and their specific conditions. For patients, the passage and expansion of the Compassionate Use Program (CUP) meant that, through their physician, they could now have access to a new medical regime to potentially impact symptoms such as pain, spasms, lack of appetite, restlessness and many others. For physicians, the Texas Compassionate Use Act provides them with another medicine to help their patients deal with some of the most severe conditions. Understanding Ratios and Formulations Medical cannabis products are produced in a number of formulations with varying ratios of CBD and THC. To properly address some of the new conditions approved under the state of Texas’ Compassionate Use Program, licensed producers in this state are only allowed to produce cannabis extracts containing up to 0.5% THC by weight, which includes only what are referred to as High-CBD and Balanced (but not High-THC) formulations. High-CBD formulations have much higher CBD content by weight – up to 20 times the amount of THC. Clinical research suggests that High-CBD formulations can have a positive impact on symptoms associated with conditions including epilepsy, other seizure disorders, and autism. Balanced formulations have relatively similar levels of CBD and THC by weight. Clinical research suggests that balanced formulations can have a positive impact on symptoms associated with conditions such as ALS, terminal cancer, and many other neurodegenerative disorders. Some patients may experience several symptoms that could respond to either High-CBD formulations or balanced formulations, or a combination of both. How Does a Doctor Register to Prescribe Medical Cannabis in Texas? The process of registering with Texas’ medical cannabis program is understandably new to most physicians, but it’s relatively straightforward and typically takes only a few minutes. To start the process, visit the Texas Department of Public Safety Compassionate Use Registry Portal at https://curt.dps.texas.gov/app/application/physicianEmailInvitation.xhtml. To start, enter your name and email address – this will generate an email including a link to the online application form. To register, you will need 1.) the Texas Medical Board License number, 2.) your American Board of Medical Specialties number and 3.) your Texas Driver’s License audit number. Upon completing this application, you will receive a confirmation email and tracking number. Note that verification by the Department of Public Safety can take between 1 – 10 business days. For more on registering, visit here. How Should a Physician Approach Dosing? Like most new medications, dosage recommendations for cannabis medicines are best established according to existing scientific research, careful integration of high-quality anecdotal evidence, and incorporation of individual patient outcomes. The process of finding the correct dose will be different for each patient, determined through a titration process guided by their physician. As more patients join the program and the knowledge base for physicians grows, prescribers will gain a better understanding of efficacy and how patients tolerate medical cannabis treatment. Clinical studies show the starting dose for 3:1 for most targeted conditions/symptoms will range from 2.5-5mg of THC per day. For the 20:1 formulation, the starting dose for most targeted conditions/symptoms will range from 50-100mg of CBD per day in adults and 0.5-1 mg/kg/day in children. The most important consideration in dosage and administration is to start at a very low dose and increase the dose slowly to determine the correct dose for you and to minimize side effects. People with no prior experience using cannabis medicine should be especially careful to follow this guidance. Medically sensitive patients, such as children under two, or those taking multiple concomitant seizure medications, should be started at a lower dose and titrate more slowly. Less sensitive patients can be started at a somewhat higher initial dosage. For best delivery of medication, a prescribed dose of the medication should be placed inside the mouth between the cheek and gums or on the tongue and allowed to be absorbed. The medication can be swallowed rather than absorbed in the mouth, but less medication will reach circulation due to first-pass hepatic metabolism. The patient will usually feel an effect within 1-2 hours and the effect will usually last 4-6 hours, or longer. Medical cannabis can sometimes have a “biphasic effect,” where at low doses there may be one effect (wakefulness) and at higher doses the opposite effect (sleepiness). This is why titration is so important. Where Can I Learn More About Prescribing Medical Cannabis in Texas? We have compiled an excellent repository of research on medical cannabis as it relates to the conditions approved by the Texas legislature here. For more information, please contact the dispensary at (512) 614-0343. Welcome to the program! Dr. Karen Keough is a board-certified pediatric neurologist who specializes in treating intractable epilepsy at Child Neurology Consultants of Austin. She initiated the child neurology residency program at Dell Medical School at the University of Texas at Austin and continues to serve as faculty. Sign up here to receive the latest news and updates from Compassionate Cultivation.
