Why doctors are the linchpin for the Texas medical cannabis program

Why doctors are the linchpin for the Texas medical cannabis program

By Karen Keough, MD

As a child neurologist who specializes in intractable epilepsy, I have witnessed firsthand the efficacy of medical cannabis for many of my patients. And now that an estimated additional 1.8 million Texans qualify for a medical cannabis prescription, we’re moving swiftly into a new era.

The sheer volume of Texas patients newly eligible after the enactment of House Bill 3703—including those with all forms of epilepsy, seizure disorders, multiple sclerosis, spasticity, amyotrophic lateral sclerosis, autism, terminal cancer, and neurodegenerative diseases—means that their physicians are facing some urgent questions.

I’m calling on my fellow physicians to get educated now about the protocols of the state Compassionate Use Program and the ways medical cannabis applies to their field so they are fully prepared to work with patients for whom medical cannabis holds potential as a complementary treatment for their care. It’s important to note that physicians must enroll in the Compassionate Use Registry of Texas, or CURT, to issue prescriptions for low-THC medical cannabis products.

Addressing skepticism head on

Because medical cannabis is relatively new in Texas and research in the United States has thus far been limited, many doctors are unfamiliar with cannabinoids—the key components of the cannabis plant such as cannabidiol—and some are skeptical about this plant-derived medication.

I understand this skepticism, because I myself harbored it. When my patients and their families first came to me years ago asking whether they should try CBD, my initial reaction was to say, “Don’t believe everything you’re seeing in the news.” I worried that all the media attention on “medical marijuana refugees” gave patients false hope.

But in the interests of my patients and my practice, I learned more about it. I thoroughly researched prior studies on CBD and epilepsy—clinical, laboratory-based, observational and anecdotal—to understand the potential benefits and risks.

My approach with patients included careful documentation of their progress and outcomes. As with any medication, there is no 100% success rate; however, the results have far exceeded my expectations.

Low-THC medical cannabis is one of the most impactful new therapies to come into my practice in the last decade, and I am grateful to have this option, particularly for severely ill patients who have exhausted available courses of treatment.

Physician participation critical

Here’s what I want Texas physicians to understand: The CUP is a legitimate medical program, one that requires our buy-in and participation to succeed. In some states, patients have a one-time consultation with a doctor to get their “card” so they can make purchases at a dispensary, no medical supervision or treatment plan required—not so in Texas.

In fact, the prescription process for rigorously regulated Texas-made medical cannabis products closely resembles the traditional process for prescribing FDA-approved drugs—which makes doctors gatekeepers for the patients who seek access to such treatment. Like any other prescription pharmaceutical, doctors must decide on a case-by-case basis whether the potential benefits would outweigh any harms.

Other benefits: Expanded knowledge

Supporting qualifying patients with a new modality will require more preparation by doctors, who typically don’t have ample spare time. But in my experience, joining the CURT registry holds other useful applications.

CURT connects physicians who are pursuing carefully monitored treatment plans. Equally important, it allows physicians to collaborate and learn from each other, expanding our collective knowledge base to determine what’s working, what’s not, and which patient populations stand to benefit most.

Informed feedback on patient outcomes with medical cannabis is invaluable. Texas physicians have a singular opportunity to contribute to the growing body of medical research on cannabis’ potential to help patients with debilitating and life-threatening conditions.

We doctors must do the work of educating ourselves and registering with the state to facilitate patient access. Our patients, particularly those with terminal conditions and others who have found no relief through traditional courses of treatment, are counting on us.


Dr. Karen Keough is a board-certified child neurologist and epileptologist with fellowship training in neurophysiology. She specializes in treating intractable epilepsy at Child Neurology Consultants of Austin, and serves as Chief Medical Officer at Compassionate Cultivation, a medical cannabis provider.