How Do Texas Doctors Handle Pot Smoking Patients? Carefully.

Even as Texas gets ready to put the Compassionate Use Act into action and allow some medical marijuana in the state, Texas doctors are still left without a way to prescribe or even legally discuss marijuana with patients.
Even as Texas gets ready to put the Compassionate Use Act into action and allow some medical marijuana in the state, Texas doctors are still left without a way to prescribe or even legally discuss marijuana with patients. Photo by Mark/Flickr
Brian woke up handcuffed to a hospital bed, his stomach muscles still aching from when he was forced to vomit up the pills he'd used to try to kill himself. He knew it was time to see a psychiatrist and get over his fear of how a doctor would react to the fact that he smoked weed.

For years, Brian, a Houston-area resident in his early twenties who asked that his last name be omitted, avoided seeking help for his depression and anxiety because he was afraid a doctor would either insist that Brian quit smoking pot or refuse to treat him entirely.

He had smoked to help keep his anxiety in check since he was a teenager, and the idea of having to choose between medical treatment that he was unsure would work and the pot that he knew at least helped him deal with the paralyzing fear that came at irregular, unpredictable intervals was so daunting that he couldn't convince himself to even make an appointment.

But during a bout of depression that jeopardized his relationship and left him unable to hold down a job, Brian tried to commit suicide with a huge quantity of pills, and got so violent that his boyfriend called EMS and the police.

After his stomach had been pumped, it was clear that he had two choices: Either seek professional medical help for his depression or be done with life as he knew it.

Brian went to the doctor. As he ticked off his symptoms, the psychiatrist asked him if there were any medications he was taking or any other substances he was using. Brian tried to sound nonchalant as he said, “Well, I smoke pot just about every day.”

The doctor nodded and wrote some things down on a medical chart. Once he'd ascertained that Brian was using marijuana specifically to deal with his anxiety disorder, the doctor gave a diagnosis and outlined the medications he was going to prescribe. The doctor was going to prescribe around the marijuana, he explained to Brian. “I am not encouraging marijuana use on paper, but as you are not displaying anxiety at this time, we are not going to treat you for it. Keep the anxiety at bay however works for you,” Brian recalled the doctor saying.

That may seem like a strange approach, but in Texas it is one of the only options physicians have. If a doctor prescribes or even recommends that a patient use marijuana in Texas right now, the doctor risks losing her prescribing rights or her medical license entirely.

More than 20 states have already legalized marijuana in some form, and most people believe Texas will eventually follow suit. But right now discussing marijuana use with patients is complicated for doctors, even in states like Oregon, where pot use is legal. This is even trickier for physicians in Texas.

Why? Because while the states have been gradually legalizing marijuana in some form in recent years, the U.S. Drug Enforcement Agency has considered marijuana a Schedule I narcotic since 1970. Because of this, any doctor found to have recommended pot use to a patient risks losing her prescribing rights or her license entirely.

This is ridiculous on a lot of levels, marijuana advocates claim. For one thing, as the Texas Medical Association pointed out during the most recent legislative session, a lot of people use pot. Pragmatically speaking, due to the fact that so many states allow doctors to prescribe medical marijuana to non-residents (and the sheer amount of recreational pot that is moving around the country), Texas physicians have to assume that at least some of their patients, particularly those who are suffering from debilitating illnesses, are already using marijuana.

The Schedule I issue has created another problem when it comes to marijuana. In 2015, the Texas Medical Association conducted a review of the research and clinical indications of marijuana use and the potential risks and therapeutic benefits of the drug.

Ultimately, the association found that there was not enough scientific information about the medical effects of marijuana available to give physicians enough of an idea of how and when marijuana might be helpful to patients. Proponents celebrate the drug as some sort of cure-all, but the research on the subject is far less conclusive.

So this leaves Texas doctors in a sticky situation. The Compassionate Use Act, which will allow the sale of medical marijuana with very low THC levels in Texas to a limited portion of the population, goes into effect in September, but right now doctors are barred from prescribing or even recommending marijuana use to patients.

There was an attempt to change the law to allow Texas doctors to actually prescribe pot or to at least not be penalized for discussing marijuana use with patients, during the 85th Biennial State Legislative Session this spring, but neither bill made it through the legislative bowels before the end of the session.

The bill aimed at allowing prescribing, now dubbed House Bill 85, has been filed again during the special legislative session that just began, but the odds are slim that the bill — which is not one of Governor Greg Abbott's 20 priorities for the 30-day session — will actually get anywhere.

So Texas will soon — sort of — have medical marijuana. Doctors just won't be legally allowed to prescribe it or even talk about it. Maybe the state Legislature will finally get on board with legal marijuana during the 2019 session. Or maybe not.
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Dianna Wray is a nationally award-winning journalist. Born and raised in Houston, she writes about everything from NASA to oil to horse races.
Contact: Dianna Wray