A Promising New Option: Texas Medical Cannabis and CBD for Epilepsy Patients: What You Need to Know About Treating Texas Patients with Medical Cannabis and Prescribing CBD Medicine

By Karen Keough, MD
Thursday, July 19, 2018

Texas entered a new era in 2018: Medical cannabis is now legal.

In February, the state saw the first sales of medical cannabis, nearly three years after Gov. Greg Abbott signed the state’s medical cannabis law, the Compassionate Use Act.

The Compassionate Use Program (CUP) allows qualified physicians to prescribe low-THC medical cannabis to patients diagnosed with intractable epilepsy. Despite increasing numbers of medications and technological advances, prospective studies show that today’s conventional treatments fail to control seizures in roughly 30 percent of people with epilepsy, according to the Epilepsy Foundation.

Here are the basics on the newly implemented law: It allows the state’s three licensed medical cannabis dispensaries to cultivate plants and create cannabis oil extracts containing specific amounts of psychoactive tetrahydrocannabinol (THC) and the nonintoxicating compound cannabidiol (CBD), which has been shown in clinical trials to help patients with certain types of epilepsy. By law, such products can only come in nonsmokable forms — typically ingestible oils and tinctures — and must contain at least 10 percent CBD and less than 0.5 percent THC.

Texas is the only state to require that CBD treatment be prescribed by physicians. In response to patient interest, compelling results from clinical trials and a legalized state program, physicians are starting to get acquainted with locally made, state-regulated CBD.

As the Chief Medical Officer for Compassionate Cultivation, one of only three medical cannabis dispensaries licensed by the state of Texas, I have been working to help my colleagues learn more about CBD and how it can help their patients. In an op-ed published in The Texas Tribune’s TribTalk, I explained that doctors need to be pragmatic about this new treatment option for their eligible patients: To the Texas doctors who will write recommendations for their patients partaking in the state’s limited medical cannabis program, I offer this: CBD is a pharmaceutical, and while it is not a cure-all or a one-size-fits-all remedy, it does offer the possibility of relief for many patients.

A growing volume of research is showing the efficacy of CBD in treating epilepsy.

GW Pharmaceuticals, a British company operating in the U.S. as Greenwich Biosciences, has conducted multiple clinical trials while developing cannabinoid therapeutics. The firm has submitted a purified CBD product called Epidiolex for approval by the FDA to treat certain forms of epilepsy. In a landmark study published in May 2017 in The New England Journal of Medicine, 120 children and young adults with Dravet syndrome participated in a double-blind, placebo-controlled clinical trial. During the 14-week trial, 43 percent of the patients reported a reduction in seizures of more than 50 percent, versus 27 percent of the placebo group. And 5 percent of the CBD-treated patients became seizure-free.

Another study funded by GW Pharmaceuticals published in January in The Lancet employed a randomized, double-blind, placebo-controlled trial and found that CBD improved seizure control in patients with Lennox-Gastaut syndrome. In these studies and others, remarkably consistent side effects were reported, with drowsiness, gastrointestinal upset and diarrhea being the most commonly experienced.

In Texas and elsewhere, the political climate on cannabis continues to evolve. Congress has put protections in place for the medical cannabis industry to operate free from federal interference in states where it has been legalized, and the Texas legislation was written to protect doctors who are working within the auspices of the law in prescribing locally made CBD medication.

The Texas program is finding its footing. As of late June, 43 physicians had registered to prescribe medical cannabis to patients, according to the public list on CUP.

Karen Keough, MD

Of the three licensed CBD providers, Texas-owned Compassionate Cultivation was the first dispensary location to open its doors and welcome in patients, and it offers delivery statewide. Cansortium Texas, DBA Knox Medical, provides medication via delivery. Surterra Texas has yet to open.

When early media reports created public interest in 2014, I was initially skeptical about CBD, but my mindset has changed and I urge physicians to research the cannabis compound. Like any new medication, a measured approach and setting realistic expectations for patients are key, but the potential benefits could be life-changing.

Karen Keough, MD, is a board-certified child neurologist and epileptologist with fellowship training in neurophysiology, who specializes in treating intractable epilepsy at Child Neurology Consultants of Austin. Dr. Keough is also the Chief Medical Officer for Compassionate Cultivation, a Texas medical cannabis organization that in February 2018 opened the state’s first licensed dispensary location. It is based in the Austin area. For more information about Compassionate Cultivation, visit texasoriginalcc.com, email info@ texasoriginalcc.com or call 512-467-4118.