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87TH LEGISLATIVE WRAP-UP 87TH LEGISLATIVE WRAP-UP

The State of Texas and Cannabis
The Effects

of Prior By John J. Seidenfeld, MD

Authorization Star “island.” Surrounded by the states of
Texas once again finds itself as the Lone
Oklahoma, New Mexico, Arkansas, Louisiana
By Ezequiel “Zeke” Silva III, MD
and the countries of Canada and Mexico that
have all agreed on medicinal use of cannabis
products (and adult use for some), we alone
limit compassionate medical use to a very few
patients in very few circumstances with
cannabidiol (CBD) and very small amounts
(</=1%) of tetrahydrocannabinol (THC).
We have misdemeanor penalties for posses-
sion of amounts starting at less than 2 oz. with
Prior authorization (PA) is intended to For these reasons and others, addressing PA the relevant six-month evaluation period. This
felony charges starting for possession of over
confirm the medical necessity and appropri- was a top priority for the TMA and BCMS physician would not be subject to PA require-
4 oz. This legislative session, we made minor
ateness of health care services that may be during Texas’ 87th regular Legislative Session. ments for that service after receiving gold card
adjustments to our compassionate use laws
emerging, experimental or infrequently per- The TMA and BCMS supported several leg- status (but the health plan may assess contin-
but continue to severely restrict medicinal
formed. The application of PA has been ex- islative PA reform bills, including bills requir- ued qualification for gold card status at cer- 1
prescribing and harshly penalize adult use.
panded over the past five years to now ing increased oversight of the health plans, tain intervals). HB 3459 also requires that
Who uses cannabis? Why should we be
include common procedures, therapies and greater transparency to the process and de- peer-to-peer review calls be conducted by a
concerned? People with conditions such as
medications. Despite this overuse, most creased burdens on physicians. BCMS mem- physician of the same or similar specialty as
emesis, epilepsy, Post Traumatic Stress (PTS),
services subjected to PA are eventually ap- bers provided House and Senate testimony the treating physician. Further, HB 3459
anorexia, glaucoma, pain with the goal of re-
proved by the health plans. However, ap- numerous times in support of these bills. would require that any physicians conducting
ducing opioid use, multiple sclerosis, Parkin-
proval often requires an extensive effort by These advocacy efforts yielded significant the peer-to-peer calls be licensed to practice
son’s and Huntington’s disease and cancer expansion. Just a few years ago, tobacco was more open to legalizing marijuana —
physicians and their staff, regularly necessi- progress in holding the health plans account- medicine in the state of Texas.
pain relief have been treated and studied with consumed in Texas hospitals, public buildings and not just for medical use.2/21/2017.
tating a peer-review process. The complaints able for the consequences of burdensome PA The health plans’ growing use of the PA 2
promising results. Journals such as the Jour- and other gathering places. Many of us R. Ramsey, University of Texas/Texas
among patients and physicians are growing practices. Several of our supported bills were process has gone too far. Physicians spoke up,
nal of Cannabis Research are now devoted to worked hard to show the advantages of a Tribune Poll.
and have been heard by the Texas Medical voted favorably out of the House Insurance and the TMA and BCMS heard our voices
the study of cannabinoids, cannabinoid ago- smoke-free environment, and today we all ap- 5. https://www.ptsd.va.gov/professional
Association (TMA) and Bexar County Committee. Ultimately, our legislative efforts loud and clear. HB 3459 will help protect our
nists and antagonists and metabolic pathways. preciate the smoke-free air in our workplaces. /treat/cooccurring/marijuana_ptsd_vets.asp
Medical Society (BCMS). resulted in HB 3459, by Rep. Greg Bonnen, practices and our patients from the harms of
Despite Federal controlled substance classifi- Someday soon, patients could be able to ac-
To better understand the effects of PA, in R-Friendswood, Rep. Penny Morales Shaw, excessive PA practice. Physicians should be
cation, research has never been more active in cess pills or edible cannabis products with as- John J. Seidenfeld, MD is the
February 2020, the TMA performed a PA D-Houston and Sen. Dawn Buckingham, R- proud of the progress we made in the 87th
this field. Likely, the field of therapeutics will surance of dosage and clearly labeled Chair of the BCMS Publications
physician survey. The results are telling. An Lakeway, with considerable support by Sen. Legislative Session to address PA burdens.
be enriched in years to come by this work. ingredients, as with most regulated therapeu- Committee.
astonishing 78% of physicians report that Jane Nelson, R-Flower Mound, passing
According to the CDC (Center for Disease tic agents.
PA had led their patients to abandon their through both the House and Senate. The bill Ezequiel "Zeke" Silva III, MD is 3
Control), 38% of youths have used cannabis.
course of treatment, and 38% report that PA goes into effect on September 1, 2021. a member of the South Texas Radi- References
Studies in The Texas Tribune note that 76% of
led to a serious adverse event, according to a HB 3459 requires that certain health plans ology Group and the TMA Council
Texans favor medicinal use of marijuana, and 1. https://guides.sll.texas.gov/cannabis
TMA reference. Subsequent AMA survey provide gold carding status for frequently ap- on Legislation. He is Chair of the AMA RVS 4
support has increased from 2015 to 2017. 2. http://bcms.org/SAM/2019/SAM
data from December 2020 found that, on av- proved services on a physician-by-physician Update Committee (the “RUC”) and is an ac-
Studies of veterans have shown 11% use and Dec2019/mobile/index.html#p=26
erage, physicians and their staff spend 16 basis. Gold carding status would apply to a tive member of the Bexar County Medical So- 5
veterans with PTS, up to 28%. 3. https://www.cdc.gov/marijuana/fact-
hours a week on PA, while 40% of practices physician who performs a service and has ciety.
While some see no likelihood of improve- sheets/teens.htm
employ full-time staff members who work preauthorization requests for that service ap-
ment in expanding the therapeutic armamen- 4. UT/TT Poll: Support for marijuana
exclusively on PA. proved no less than 90% of the time during
tarium, others argue that we could see growing like a weed in Texas. Texans are

24 SAN ANTONIO MEDICINE • August 2021 Visit us at www.bcms.org 25