Two years later, ill Texans still haven't been able to...

AUSTIN - The first doses of medicinal marijuana will be available for purchase in Texas as early as December, ending a wait of more than two years since lawmakers approved use of cannabidiol for people who suffer uncontrollable epileptic seizures.

But the projected 150,000 people who qualify may not get fast or affordable access to the medicinal oil, if they can get it at all, critics say.

Just three companies - two in Austin and one in Schulenberg - are set to supply the entire state. It means most patients will have to get the drugs through over-the-road delivery, a potentially expensive service for people in far-flung regions because the oils can't be transported by air or by mail because of federal regulations.

Then there's the issue of getting physician permission to use the cannabidiol in the first place. The Texas law authorizing use of the drug puts physicians on murky legal ground, critics say, because the certified epileptologists and neurologists must prescribe the drug, instead of recommend it, a phrase other states have used to sidestep federal marijuana prohibitions.

"There will be very little to any participation in the program by physicians, and there will be very few patients that will be served by the program," predicted Paul Armentano, deputy director of the National Organization for the Reform of Marijuana Laws.

Leaders of companies set to grow and distribute medical marijuana in Texas say the rollout of any new industry takes time, and they pledge to make the product accessible. Patients are already clamoring for the medicine, and at least one Austin doctor says she will start prescribing cannabidiol as soon as possible, in spite of any legal risks.

"We're optimistic," said Morris Denton, CEO of Compassionate Cultivation, one of the three companies that has preliminary approval to produce the drug. "We know this medicine works, so it's just a matter of trying to get it into the hands of people who need it."

Texas approved the use of cannabidiol, a medicine derived from marijuana, in 2015. Though the move marked the first time the state loosened penalties for cannabis-related substances, the Compassionate Use Program is highly restrictive. It allows the use of cannabidiol with only trace amounts of THC, the component that gives marijuana users a high. Patients can get a prescription only if they suffer serious intractable epileptic seizures that can't be treated by traditional medicines.

Major cities excluded

And it's an expensive proposition. Companies that grow, produce and sell the medicine must be licensed by the state and pay a fee of nearly $490,000 to start. The cost to renew a license in two years is about $320,000.

Despite getting applications from more than 40 companies this year, the Texas Department of Public Safety picked only three, the minimum number allowed by law.

At this point, no dispensaries are set to be in the state's major population centers of San Antonio, Dallas and Houston.

Cansortium Texas, the first of the three companies to get an official license, is based in Schulenberg, about 100 miles west of San Antonio on Interstate 10. Denton's company and Surterra Texas, expected to get final authorization any day, are both in the Austin area.

DPS expects most patients to get the medicine by over-the-road delivery - that's how Cansortium Texas plans to begin distribution in December. But it could be a pricey prospect for patients, who already have to pay out-of-pocket for medicinal marijuana because insurance doesn't cover it.

Delivery questions

Under program rules, the cannabidiol has to be driven on deliveries by a company employee - a trip from Austin to El Paso is more than eight hours. While DPS strictly regulates most aspects of the program, it doesn't have oversight of the prices.

The cost is Terri Carriker's biggest concern. She has already seen the wonders cannabidiol can do for her 15-year-old daughter Catherine, who went days without a seizure while using the oil, which the family got illegally from Colorado. Before the therapy, Catherine suffered six to eight "nasty" seizures a night, when her legs went stiff, her eyes darted to the side and she shook all over.

"That was really hard for us to get the bill passed and then to … wake up tomorrow and we still have to wait two years," said Carriker, who lives in the Austin area. "I am very anxious for product to be available so we can find out how much it will cost, and how well the system is going to work."

Few price details have been publicized. Cansortium Holdings CEO Jose Hidalgo said product costs in Texas will line up with the prices it charges in Florida, where a 300-milligram bottle of cannabidiol costs $45.

We're "serious about our commitment to providing patients access to the best medicine," Hidalgo said. "We fully intend to fulfill that promise."

It's too soon for Cansortium Texas to know delivery fees, the company said.

Denton said his delivery service "will not be a profit center."

"We will do our best to keep any delivery charges to a minimum," he said.

Surterra representatives didn't return requests for comment.

Some are not convinced that the cost of delivery will be workable for the dispensaries and the patients. Recently, 10 companies that weren't awarded medicinal marijuana licenses signed a letter to DPS urging another round of applications.

"We view this as a failure," said Michael Blunk, executive director of the Texas Cannabis Industry Association and a signatory on the letter. "The fact (DPS) didn't authorize a single company in two of the largest metro areas in the country shows they are not really looking out for patients' needs."

Another concern is whether doctors might face legal trouble for prescribing the drug. At the federal level, marijuana is still classified as a Schedule I drug, alongside heroin and Ecstasy.

Texas is the only state, out of more than two dozen nationwide with medicinal marijuana programs, that requires a doctor to prescribe cannabis, instead of recommending it, according to Armentano. States use that language to get around federal prohibitions on prescribing restricted drugs, he said.

A spokesman for the Drug Enforcement Administration didn't respond to questions about whether it would punish doctors in Texas for prescribing cannabis.

A tricky situation

Rep. Stephanie Klick, R-Fort Worth, who sponsored legislation creating the Compassionate Use Program said the wording isn't a problem because the law defines prescription as an entry in the statewide registry, not a typical doctor's order on paper.

"We wanted a tightly regulated medical program. We did not want something that was medicinal in name only," she said. "Frankly, I have talked to physicians on this, and they really do not see it as a problem."

Dr. Karen Keough, a child neurologist in Austin who is affiliated with Compassionate Cultivation, admits the situation is a tricky one. But she plans to start prescribing the cannabidiol on day one "without hesitation."

"Is it completely risk-free? Probably not," Keough said. "But I am doing what's right for my patients."