Texas lawmakers have approved a significant expansion of the state’s medical marijuana program, directly challenging the current federal crackdown on THC products. House Bill 46, which took effect September 1, 2025, adds new qualifying conditions including Crohn’s disease and traumatic brain injury while increasing dispensary availability. This bipartisan legislation represents a stark contrast to the restrictive policies emerging elsewhere, positioning Texas as an unexpected leader in medical cannabis access. The timing raises questions about how federal enforcement will respond to this bold state-level defiance.
After years of incremental changes, Texas has enacted its most notable medical marijuana expansion through House Bill 46, which took effect September 1, 2025. The legislation represents the largest expansion in the program’s history, making thousands of new patients eligible for medical cannabis treatment while receiving bipartisan support in the state legislature.
The expansion introduces several new qualifying medical conditions that greatly broaden patient access. Chronic pain now qualifies as a condition without requiring prior opioid use, though prescriptions remain tied to medical definitions of chronic pain and often connect to patients already receiving opiates. Additionally, Crohn’s disease, Inflammatory Bowel Disease, traumatic brain injury, terminal illness, and hospice care join the existing list of qualifying conditions, which previously included epilepsy, cancer, PTSD, ALS, autism, multiple sclerosis, and over 100 other incurable neurodegenerative diseases.
Patient access procedures have been streamlined, though the program maintains controlled entry requirements. More registered physicians can now prescribe medical cannabis, but patients must still consult doctors specifically registered in the Compassionate Use Program to establish eligibility. While enrollment has become easier, the system does not operate as completely open access, maintaining medical oversight for patient safety and regulatory compliance.
Texas medical cannabis access remains controlled despite streamlined procedures, requiring patients to consult specially registered physicians for program eligibility.
The product options available to patients have expanded considerably beyond the previous limitations to oils and tinctures. Approved medical cannabis now includes patches, lotions, inhalers, and prescribed vaping devices, giving patients and physicians more treatment flexibility. These vaporized and aerosol products represent a notable shift in how medical cannabis can be administered in Texas. The new milligram measurement system replaces the previous 1% THC cap with a 10 mg per dose limit, allowing up to 1,000 mg per package.
Dispensary access will improve through mandated licensing changes and infrastructure expansion. The law requires an increased number of dispensary licenses, with satellite locations introduced to boost accessibility, particularly for veterans. A second batch of dispensaries is scheduled to open in April 2026, further expanding the retail footprint. Despite these improvements, licensed dispensaries remain fewer in number compared to registered physicians. The total number of dispensaries will increase from 3 to 15, significantly improving patient access across Texas.
Public opinion data strongly supports the expansion, with surveys showing 91% consumer support for cannabis to treat chronic pain. Among users, 65% find cannabis “very effective” for pain management, while 26% report it as “mildly effective.” Federal data indicates over two million Texans are regular cannabis users, creating substantial legislative pressure for program expansion.
The legislative process demonstrated rare bipartisan cooperation, with the Senate providing nearly unanimous support. Seven amendments were added during passage to address specific concerns about product forms and patient eligibility. Lawmakers particularly focused on veterans’ needs through targeted license expansion and satellite dispensary sites. While the medical program expands, Texas cannabis businesses still face effective tax rates of 40-80% due to Section 280E restrictions at the federal level.
This expansion may have broader implications for Texas cannabis policy, as it could restrict highly accessible non-prescription THC products in favor of regulated medical cannabis. The program’s growth reflects changing attitudes toward medical marijuana while maintaining the controlled framework that has characterized Texas’s cautious approach to cannabis policy reform.
