Texas Expands Medical Marijuana Access with HB 46

Texas has taken a significant step forward in the field of medical cannabis with the passage of House Bill 46 (HB 46). Signed into law by Governor Greg Abbott on June 21, 2025, HB 46 broadens the scope of the Texas Compassionate Use Program (TCUP) to include chronic pain as a qualifying condition for medical marijuana. This makes Texas the 40th medical cannabis state with a comprehensive medical cannabis program.

For thousands of Texans managing long-term pain, this legislative change provides an overdue opportunity to seek alternative treatment, especially for those who have not found relief through conventional methods. The law takes effect on September 1, 2025.

What Does Texas HB 46 Change?

HB 46 Texas medical marijuana introduces several changes to the state’s Compassionate Use Program, expanding patient eligibility and how cannabis products can be prescribed and dispensed.

Expanded Qualifying Conditions

In addition to previously covered diagnoses, Texas HB 46 adds several new qualifying conditions:

• Chronic pain, defined as continuous or intermittent severe pain lasting more than 90 days

• Crohn’s disease

• Traumatic brain injury

• Terminal illnesses

• Hospice and palliative care

This expanded list is a major development for patients who previously had limited legal access to cannabis therapies under the state’s strict framework.

Broader Product and Delivery Options

Texas HB 46 also allows for a wider range of medical cannabis formulations and delivery methods. New product formats now permitted include:

• Lotions

• Transdermal patches

• Suppositories

• Non-smoked pulmonary inhalation devices, such as nebulizers, inhalers, and vaporizers

These devices must be approved by the Texas Department of State Health Services and prescribed under the direction of a qualified physician. However, smokable cannabis, including raw flower, remains prohibited under state law.

Adjusted THC Limits

The bill replaces the outdated cap of 1% THC by weight with a more clinically relevant limit:

• Up to 10 milligrams of THC per dose

• No more than 1 gram of THC per package

This shift allows for more precise dosing and aligns Texas more closely with product standards in other states.

Prescription Validity and Refills

Medical cannabis recommendations will now be valid for up to one year. Each recommendation may include four 90-day refills, which can be partially filled during each 90-day period, offering flexibility for patients and providers.

Expanded Dispensary Licensing

To improve access across the state, Texas HB 46 directs the Department of Public Safety to issue 12 new licenses, bringing the total number of dispensing organizations to 15.

• Each organization must become operational within 24 months of receiving a license.

• Approved dispensaries will be allowed to establish satellite retail locations, expanding physical access to patients statewide.

Compliance, Monitoring, and Privacy

Several additional safeguards are built into the bill:

• The Texas Board of Pharmacy will monitor cannabis dispensing activity through the Prescription Monitoring Program

• Individuals with 10% or more ownership in a dispensing organization must submit fingerprints for background checks

• Patient records in the Compassionate Use Registry are confidential

• Only the Department of Public Safety, registered physicians, and licensed dispensaries may access them.

• Patients may request a copy of their own data or authorize a designated individual to receive it.

Chronic Pain: A Long-Awaited Addition

The inclusion of chronic pain stands out as the most impactful change brought about by HB 46 Texas medical marijuana. In the United States, nearly 50 million adults live with chronic pain, according to data from the Centers for Disease Control and Prevention (CDC), and about 7% suffer from pain that severely limits their daily activities. 

This equates to one-third of the population who may be dealing with ongoing pain, yet only a third of these patients have access to 50% pain relief from existing therapeutics. Instead, they have often been directed toward prescription opioids and other pharmaceuticals that carry significant side effects and a high risk of dependency.

According to an article, the original Senate version of the bill included a requirement that patients must have used opioids for 90 days before becoming eligible. That clause was later removed, following pushback from patient advocates and medical professionals concerned about opioid overuse risks

Under Texas HB 46, doctors can recommend low-THC cannabis for patients whose pain has persisted for more than 90 days and has not responded adequately to other treatments.

What This Means for Texas Patients

For patients in Texas, the passage of HB 46 brings several meaningful changes. With more qualifying conditions now recognized, many individuals who were previously ineligible for medical cannabis can now seek relief through the Compassionate Use Program. 

The updated THC dosage limits also allow for more effective symptom management, particularly for those dealing with conditions like degenerative disc disease or spinal neuropathy, where the previous restrictions may not have provided sufficient relief. 

Moreover, the law introduces new delivery options such as patches, lotions, suppositories, and inhalation devices like nebulizers and inhalers. These alternatives make it easier for patients to medicate in ways that are both discreet and comfortable. 

Perhaps most importantly, the planned expansion of dispensaries across Texas will significantly improve access, especially for those in rural or underserved areas who have long faced barriers due to travel distance.

What Texas HB 46 Will Mean for Employers

The passage of HB 46 on Texas medical marijuana expands access to medical cannabis for patients, but it does not alter the rights or responsibilities of Texas employers. Under current law, companies in Texas still retain the authority to conduct drug testing, disqualify candidates who test positive for THC, and uphold zero-tolerance workplace policies. 

Despite the changes introduced through Texas HB 46, including increased patient eligibility and expanded dispensary access, there remains no legal obligation for employers to accommodate medical marijuana use, even when prescribed under the Compassionate Use Program. Cannabis remains illegal at the federal level, and qualified patients have no employment protections under HB 46.

What may shift in the near term is the frequency with which employers encounter job applicants or employees who are legally using low-THC cannabis. With broader qualifying conditions and increased public awareness reported across Texas marijuana news and covered widely in weed news from Texas, businesses should anticipate a potential rise in positive THC test results. 

Drug policies must remain well-documented, consistently enforced, and compliant with state and federal regulations to mitigate risks and ensure fair treatment.

A Turning Point for Pain Relief in Texas

The passage of HB 46 on Texas medical marijuana marks a historic shift in how the state supports patients suffering from chronic pain. Adding long-overdue qualifying conditions and modernizing the Compassionate Use Program means that Texas is finally opening new pathways for those who have had limited treatment options.

Backed by companion legislation like HB 6 Texas and HB 19 Texas, the law reflects a growing consensus in state policy: health care access should be based on need, not outdated restrictions.

At TXMMD, we help Texans explore these options safely and responsibly. If you or someone you care about is struggling with chronic pain, learn more about our services, try our comprehensive or schedule an appointment today.