Policy Analysis of The Texas Compassionate Use Program

BACKGROUND: The Texas Compassionate Use Program was established in 2015 to provide regulated access to low-tetrahydrocannabinol (THC) cannabis products for qualifying medical conditions in Texas. Although the program has expanded through recent legislative reforms, it remains one of the most restrictive medical cannabis programs in the United States. OBJECTIVES: This policy analysis evaluates the effectiveness, limitations, and public health implications of the Texas Compassionate Use Program, with a particular focus on patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) undergoing dialysis. Dialysis patients experience high rates of chronic pain, nausea, insomnia, depression, and opioid exposure, creating a need for alternative symptom management strategies. RESULTS: Existing evidence suggests medical cannabis may improve quality of life and contribute to opioid reduction; however, limited clinical guidance, restrictive THC caps, and lack of dialysis-specific inclusion create barriers to access and implementation. This analysis examines policy effectiveness, gaps, clinical considerations, and implications for substance use and misuse. CONCLUSION: Recommendations include expanding qualifying conditions, improving provider education, increasing access, and integrating harm reduction strategies into policy implementation. Refining the program may improve outcomes for medically vulnerable populations while balancing patient safety and substance misuse prevention.