Last verified: April 2026
What Is TCUP?
The Texas Compassionate Use Program (TCUP) is the state's medical cannabis system, created by SB 339 in 2015 and governed by Tex. Occ. Code Chapter 169 (physician prescriptions) and Tex. Health & Safety Code Chapter 487 (dispensary licensing and regulation). The Texas Department of Public Safety (DPS) oversees the program.
SB 339 was sponsored by Sen. Kevin Eltife (R-Tyler) and Rep. Stephanie Klick (R-Fort Worth). The original program was one of the most restrictive in the nation: only intractable epilepsy patients qualified, THC was capped at 0.5% by weight, two neurologists had to concur, and only three dispensary licenses were authorized for the entire state of Texas.
Four successive legislative expansions have transformed TCUP from a symbolic gesture into what the Marijuana Policy Project (MPP) now counts as the 40th state with a "comprehensive" medical cannabis program.
Legislative Timeline
SB 339 — Program Created
The Texas Compassionate Use Act created TCUP for intractable epilepsy patients only. THC was capped at 0.5% by weight, two neurologists had to concur on the diagnosis, and only three dispensary licenses were authorized statewide. It was one of the most restrictive medical cannabis laws in America.
HB 3703 — First Expansion
Rep. Stephanie Klick expanded qualifying conditions to include multiple sclerosis, spasticity, ALS, autism, and incurable neurodegenerative diseases. The two-neurologist requirement was dropped. The THC cap was raised from 0.5% to 0.5% by weight (unchanged numerically, but the measurement standard was clarified). The patient pool began to grow.
HB 1535 — Cancer & PTSD
Added all forms of cancer and PTSD as qualifying conditions. Raised the THC cap from 0.5% to 1% by weight. Enrollment surged — from approximately 6,000 patients in mid-2021 to 77,000 by early 2024, driven largely by the PTSD and cancer additions.
HB 46 — The Breakthrough
The largest single expansion in TCUP history. Authored by Rep. Ken King (R-Canadian), HB 46 passed the Texas House 122–21, passed the Senate unanimously, and was signed by Gov. Abbott on June 21, 2025. The bill added chronic pain, Crohn's disease, traumatic brain injury, degenerative disc disease, terminal illness, and hospice patients. THC limits were restructured from a percentage to 10mg per dose / 1,000mg per package. Dispensary licenses expanded from 3 to 15. New product forms authorized including vaporizers, patches, and suppositories.
Patient Enrollment Growth
TCUP enrollment has grown exponentially since the 2021 PTSD and cancer expansion:
| Period | Registered Patients |
|---|---|
| Mid-2021 | ~6,000 |
| February 2024 | 77,000+ |
| April 2025 | 112,495 |
| End of 2025 | 135,470 (32% YoY growth) |
Despite this growth, Texas's enrollment rate of 0.44% of the state's 31 million residents remains far below the 2.1% national average for states with medical cannabis programs. The HB 46 chronic pain expansion is expected to drive significant additional enrollment through 2026 and 2027.
Program Structure
Unlike most states, Texas uses a prescription model rather than a recommendation model. Physicians enter prescriptions directly into the Compassionate Use Registry of Texas (CURT), which DPS maintains. There is no separate patient application, no state fee, and no physical card. Patients verify their identity at the dispensary.
This prescription model is legally notable because federal law prohibits prescribing Schedule I substances. Most states avoid this conflict by using "recommendations" or "certifications." Texas's approach has not been challenged federally, but the legal tension remains.
Despite its growth, TCUP remains more restrictive than most medical cannabis programs. Smokable flower is still prohibited. Only three dispensaries are currently operational, though 12 more are in the licensing pipeline. And fewer than 1% of Texas physicians are registered to prescribe.
What Comes Next
The 2025 expansion set multiple changes in motion that will unfold through 2026 and beyond:
- New dispensaries: DPS selected 9 new licensees in December 2025 and 3 more in April 2026, but none are operational yet — each must complete due diligence and become operational within 24 months
- Vaporization products: DSHS rules were due October 1, 2025; products expected early-to-mid 2026
- Chronic pain enrollment: As the single largest qualifying condition, chronic pain could double or triple TCUP's patient base
- 2027 legislative session: Advocates will push for further expansion, including higher THC limits and smokable flower
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