Pediatric neurologist Scott Perry is optimistic he’ll soon be able to answer some questions that have been on the minds of his epilepsy patients and their families.
“I don’t think I go a day without the majority of patients actually asking about it,” Perry said. “If I don’t mention it myself, they’ll say, ‘What’s going on with it? What about it?’”
The “it” is cannabidiol, or CBD, an oil extracted from medical cannabis plants. Unlike conventional marijuana, cannabidiol doesn’t produce a high but has shown promise in treating a variety of ailments, including epileptic seizures.
A form of CBD tailored to treat seizures is on the cusp of becoming available in Texas, but only for a small segment of people suffering from a rare form of epilepsy — and only if directed by a doctor. Two of the three CBD dispensaries granted licenses under the state’s narrow 2015 medical cannabis law, called the Compassionate Use Act, are either in the process of arranging initial deliveries of their products or expect to be ready to do so soon.
Cansortium Texas, located in Schulenburg, has its CBD oil — which it has branded as “Zeltor” — ready to dispense, while Compassionate Cultivation, based in Manchaca, is harvesting its first crop of medical cannabis and expects to have refined products available by early February.
The pending start of CBD sales in Texas comes in the wake of a recent policy change by the Trump administration that could lead to an increase in federal marijuana prosecutions in states that have legalized it, because marijuana remains illegal under federal law.
The policy change — prompted by Attorney General Jeff Sessions and a potential reversal of what has been a hands-off federal stance — is injecting uncertainty into the marijuana-legalization push nationwide. But a number of observers said they expect it to mainly affect states such as California and Colorado that have legalized marijuana for recreational purposes, noting that the Texas law is restrictive even by the standards of medical marijuana.
CBD oil produced and sold under the Texas law can contain no more than 0.5 percent tetrahydrocannabinol, or THC, which is the chemical in marijuana that produces a high. For comparison, marijuana for recreational purposes generally contains from 9 percent to more than 30 percent THC.
Perry and some of the dozen or so Texas doctors who have registered with the Texas Department of Public Safety to prescribe CBD now that it’s becoming available in the state say they’re hopeful it can provide relief to some patients and are eager to start collecting data on how they respond.
But they’re also having to temper expectations, telling patients that CBD isn’t a panacea. People prescribed CBD will be closely monitored through follow-up visits, they said, and only patients with so-called intractable epilepsy — meaning those for whom two mainstream seizure drugs have proved ineffective — are eligible for it under the Texas restrictions.
“Everybody wants to try it,” said Perry, whose practice is in Fort Worth. But “I really don’t think it’s the magical answer for everyone.”
Austin pediatric neurologist Karen Keough agreed, saying she’s identified about 30 patients — or less than 10 percent of those in her practice — as potential CBD recipients initially.
“Patients have a very high level of expectation (for CBD) that I try to put in perspective,” said Keough, who also is chief medical officer for Compassionate Cultivation. “Everyone, of course, hopes for the possibility that their child will be a big responder. (But) the only way we’ll know is to try.”
Some doctors also are warning that CBD treatment likely will be expensive, because it isn’t covered by insurance and because they will require their patients who use it to schedule extra appointments so their progress can be tracked.
Scott Klenet, a spokesman for Cansortium Texas, a division of Florida-based Cansortium Holdings, said his company is charging $90 for a 30-milliliter vial of Zeltor containing 600 milligrams of CBD. The neutral-flavored oil produced by the company, which operates under the name Knox Medical, is intended to be administered by placing drops under the tongue — with about 1,200 drops per vial — although a patient’s precise daily dosage will be determined by their doctor, Klenet said.
Compassionate Cultivation isn’t announcing prices or brand names for its CBD oil yet, but CEO Morris Denton said the company initially will sell two varieties, with choices of two sizes and three flavors — neutral, cherry and mint. Additional varieties are planned, he said.
“We want to offer our customers the choice in strains, cannabinoid profile and flavor,” Denton said.
Executives with the state’s third licensed dispensary — Surterra Texas, a division of Atlanta-based Surterra Wellness — haven’t responded to requests for comment. Surterra Texas initially intended to locate its facility on Wells Branch Parkway in North Austin, but it subsequently moved to Hergotz Lane in East Austin and was only granted a final license enabling it to start growing a crop on Dec. 15, compared with last fall for Cansortium Texas and Compassionate Cultivation.
The Texas Department of Public Safety, which is overseeing the state’s compassionate use program, previously has said it will only license three dispensaries for the time being.
DPS spokesman Tom Vinger said the potential new federal stance regarding federal marijuana prosecutions hasn’t prompted any changes to how his agency is regulating the Texas CBD rollout.
“We have not received official communication from our federal partners regarding this issue,” Vinger said. “However, as always, we will review any changes in federal policy to determine the impact, if any, on our department’s programs.”
Still, some Texas doctors on the forefront of the state’s program said the legal issues are worrisome, even as they opt to participate.
“We all have to be concerned (because) there is still so much ambiguity that nobody can feel with 100 percent confidence that they’re in the clear completely,” Perry said.
“But if I (prescribe) it, I’m going to be (prescribing) it for a kid where, what else are we going to do” because nothing else has worked, he said. “So I’m ethically OK with that.”
Meanwhile, he and others said they expect more Texas doctors to register to prescribe CBD if it proves effective. The Epilepsy Foundation Texas has pegged the number of Texans with intractable epilepsy at around 150,000, but only about a dozen Texas doctors have registered.
“If it really turns out to be effective, clearly there aren’t enough doctors to prescribe it,” said Michael Newmark, a Houston neurologist who has signed up for the program. “But as time goes by and it looks like it is effective, there are going to be plenty of doctors who prescribe it” because more will sign up.