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A Guide to the Texas Medical Cannabis Program Under the Texas Compassionate Use Act, only physicians who are board-certified as epileptologists or neurologists may sign up in the state registry to prescribe medical cannabis. HOW TO GET REGISTERED 1. Go to the Texas Department of Public Safety online porta l for the Compassionate Use Program, then click the "Licensing" tab. Select the link for "Physician Registration" in the Compassionate Use Registry of Texas (CURT). 2. Follow the prompts to submit your full name and email address. Once submitted, you should receive an email that contains a link providing access to the "physician registration wizard." 3. After submitting your application through the registration wizard, you'll receive a confirmation email with a tracking number, and the department will review your application and verify your qualifications. 4. Once you're registered, use CURT to enter patient demographics, treatment plans and prescriptions. INFO ON PRESCRIBING MEDICAL CANNABIS + To qualify for CBD treatment, patients must be permanent residents of Texas and must be diagnosed with intractable epilepsy, defined as failure to achieve control with trials of two appropriate medications at adequate doses. + After the treating neurologist registers a qualified patient, a second CURT-registered physician must concur with that assessment and attest independently that the patient qualifies for treatment. + There is a three-step process for entering patient information into the CURT database to process prescriptions, including treatment plan details, such as duration of therapy and dosage instructions and amounts; prescription dos - age instructions and amounts; and information about baseline and ongoing seizure types, duration and frequency. + To fill the prescription, the patient (or guardian) will contact a licensed dispensing organization by phone to confirm the order details and set up a time for pickup at the dispensary or schedule a delivery. A growing volume of research is show- ing the efficacy of CBD in treating epilepsy. GW Pharmaceuticals, a British com- pany operating in the U.S. as Greenwich Biosciences, has conducted multiple clini- cal 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 per- cent of the patients reported a reduction in seizures of more tha n 50 percent, versus 27 percent of the placebo group. And 5 percent of the CBD-treated patients became seizure-free. A n o t h e r s t u d y f u n d e d b y G W 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, gastrointes- tinal 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 doc- tors who are working within the auspices of the law in prescribing locally made CBD medication. The Texas program is finding its foot- ing. As of late June, 43 physicians had registered to prescribe medical cannabis to patients, according to the public list on CUP. 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 Texa s, DBA Knox Medica l, 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 can- nabis 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 informa- tion about Compassionate Cultivation, visit texasoriginalcc.com, email info@ texasoriginalcc.com or call 512-467-4118. n M D N E W S . C O M /// M D N E W S S A N A N T O N i O ■ 2 018 1 9