The Texas Compassionate Use Program (TCUP) has tripled in patient numbers in 2022 from 16,403 to 43,056. The registered medical cannabis physician numbers increased from 501 to 667 in 2022. Although the increase in the registered TCUP patient numbers sounds significant, at the moment the program is faltering. The program itself needs an immediate, significant, and responsible expansion to properly address the needs of the patients, physicians, and businesses.
“…TCUP patient numbers include all patients registered from the first day of the program’s inception. The true source of the information are the providers who know the numbers and consumption schedules of their patients.”
In analyzing the results from 2021 and 2022, it is evident that the most significant growth in patient numbers occurred right after the legislative changes - a raised 1% THC limit in edible products and an expanded list of qualifying conditions - around September of 2021. In that month, there was a big jump in the monthly percentage rates of registered patients - 33%. Subsequently, Q3 and Q4 of 2021 saw the highest average month over month growth rates (18% and 14%, respectively). However, this bounce did not last long, and the average growth rates have declined steadily, only to end 2022 Q4 with an average 5.5% monthly increase. As a result, the medical cannabis patient numbers tripled in 2022, but the overall monthly growth rates declined by almost three times since 2021. It is also unknown how many of the registered patients are actually active patients. Active patients can fairly be defined as those who have purchased cannabis in the last six months. At the moment, TCUP patient numbers include all patients registered from the first day of the program’s inception. The true source of the information are the providers who know the numbers and consumption schedules of their patients.
“The manufacturers and producers had to create market alternatives with its excess biomass that would be palpable and sell to the general public, hence the explosion of semi-synthetic cannabinoid products.”
Several reasons may account for why TCUP growth has slowed down. First, the increased presence of hemp derived natural cannabidiol (CBD) and delta-9 tetrahydrocannabinol (Δ-9 THC), as well as a variety of synthesized cannabinoids - Δ-8/10 THC, HHC (hexahydrocannabinol), etc., purportedly made from hemp-derived CBD and Δ-9 THC. In essence, during the CBD boom and bust, there was an excess of CBD produced in the US and throughout the world. The manufacturers and producers had to create market alternatives with its excess biomass that would be palpable and sell to the general public, hence the explosion of semi-synthetic cannabinoid products. Simply put, the conversion and synthesis of the plant-derived molecules (CBD) took shape on the market in the form of Δ-8/10 THC, HHC (hexahydro cannabinol) and other semi-synthetic molecules. As reported earlier, these products are less expensive than the regulated state products. Second, continuous expansion of medical (Louisiana, Oklahoma) and adult-use (New Mexico) cannabis programs in neighboring states keeps impacting Texans and coincides with the lowest growth in TCUP over the fall and winter holiday timeframe. Third, the major urban centers have decriminalized cannabis and there is an abundance of illicit products advertised via open social media channels, festivals, and not so secret marketplaces. Finally, the most important reason for the slowdown of TCUP growth is the lack of growth in the program itself. There are still just two operational businesses in Texas with a minimal selection of edible products. One way to address this issue in Texas is to change the regulations of the existing program. This entails expanding the list of qualifying conditions, including chronic or even intermittent pain, lifting the 1% THC cap limit in the products, and allowing for the sale of cannabis flower via hundreds of licensed providers.
Regarding the last statement about cannabis flower, it is potentially the most controversial in Texas. Elsewhere and in most medical (and later adult-use) programs, cannabis flower was allowed first, followed by the edible/ingestible products because most of the complications with cannabinoids come from edibles. Even in Florida, which now has a robust medical cannabis program, the regulators were compelled to add cannabis flower on the product list in 2019. This resulted in a significant boom of the program, for patients, physicians, and businesses because most cannabis users still consume and buy mostly cannabis flower (New Frontier Data). Even though combustion is not the preferred method medically to consume a product, low temperature heating and vaporization of flower is a healthier way to consume medical cannabis.
Hopefully, the 2023 legislative session will allow for the further expansion of TCUP, reducing the need for those patients and others to seek out unregulated, decriminalized, or illicit products; and thrust TCUP into a robust and transparent medical cannabis program.
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*TCUP numbers are drawn from the Texas Department of Public safety reports.