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MEDICAL YEAR
IN REVIEW

CANNABINOIDS

A Modern Doctor’s

Dilemma

By J.J. Seidenfeld, MD

Background
In 2019, Texas Gov. Greg Abbott signed antiepileptic drugs” before seeking treatment of the patient’s particular medical condition.
into law a bill that lets Texas farmers grow with low-THC cannabis. DPS also can decide if the physician’s clini-
hemp – and allows the sale of products such Because HB 3703 expanded the conditions cal practice is dedicated to evaluating and
as CBD oil as long as they contain less than qualifying for treatment with low-THC treating a “significant portion” of patients
.3% of the psychoactive element in mari- cannabis, it also, consequently, expanded the with the particular condition being treated.
juana THC. HB 3703 made the following specialty physicians qualified to recommend
major changes to the 2015 Compassionate treatment. To recommend treatment, a physi- The Dilema
Use Act to include additional conditions: cian must register with DPS’ Compassionate While the jury is out on these issues for
HB 3703 amended the Compassionate Use Program, and the physician must: medical professionals, law makers and en-
Use Act by adding conditions that may qual- • Be licensed, forcement officials, the public already has
ify for treatment with low-THC cannabis. • Be board certified by a specialty board ap- experience with these substances in large
Now, the following conditions may qualify proved by the American Board of Med- numbers, using it to reduce suffering and
for treatment: epilepsy, seizure disorder, mul- ical Specialties or the Bureau of make the world a seemingly friendlier place,
tiple sclerosis, spasticity, amyotrophic lateral Osteopathic Specialties in a medical spe- while there is suffering from abuse in some
sclerosis, autism, terminal cancer and “incur- cialty relevant to the treatment of the pa- cases. Cannabis sativa, popularly known as
able neurodegenerative diseases” (INDs). tient’s particular medical condition, and marijuana, is a source of cannabinoids most
INDs are diseases designated by rule of the • Dedicate a significant portion of his or notably CBD (cannabidiol) and THC
executive commissioner of the Texas Health her practice to the evaluation and treat- (tetrahydrocannabinol). CBD containing
and Human Services Commission. Also note ment of the patient’s particular condition. products for ingestion such as gummy bears
that HB 3703 changed “intractable epilepsy” or brownies, vaporized liquids, raw plant
to just epilepsy. Now, patients should no Notably, DPS still has discretion to ap- material for smoking and skin lotions as well
longer have to wait until they have been prove or deny the application. That means as body products are available at state-sanc-
treated unsuccessfully two or more times by DPS can decide if the physician’s board-cer- tioned (NOT in Texas) and licensed dispen-
“appropriately chosen and maximally titrated tified specialty is relevant to the treatment saries where laws have legalized such use.

26 San Antonio Medicine • December 2019