The Medical Republic reports that in 2018, two years after medicinal cannabis was legalised in Australia, it remained a medicine in the shadows: products were scarce, doctors weren’t interested and patients barely knew it was a treatment option.
In that year, just 2560 medicinal cannabis prescriptions were approved through the “B” pathway of the Special Access Scheme (SAS), the mechanism by which unapproved medicine is supplied in Australia.
That was then. The story now is very different.
In 2023, the Therapeutic Goods Administration rubber-stamped 132,000 SAS-B applications from 2565 medical practitioners. Many more prescriptions not captured by the SAS data were written by more than 2500 Authorised Prescribers of medicinal cannabis. In 2019 there weren’t even 30.
All told, anywhere between 300,000 and 500,000 Australians are estimated to have received a prescription for medicinal cannabis.
Multiple factors lay behind the growth, not least the tireless campaigning of advocates. Indeed, it was they, not then-health minister Greg Hunt, who could legitimately claim responsibility for its legalisation in 2016. The Turnbull government may have written the new laws, but it was campaigners who provided the pen.
Yet even though prescription numbers were subdued in those early days, and a 2020 Senate inquiry explored the reasons why, an industry was taking shape. Legal access to medicinal cannabis may have escaped the attention of Australians – advertising its legality and availability was, and remains, off limits – but business brains were whirring.
Before long, specialist clinics started to open. Product sponsors sprung up, facilitating the import of overseas products. Meanwhile, Australian cultivators slowly came online, producing homegrown medicine.
Furthermore, and critically for the nascent industry, consumers woke up to the possibilities of medicinal cannabis.
The industry that has evolved over the past five years, though, has not been without its issues and controversies. And as the sector continues to expand, and prescription numbers keep rising, those issues are becoming endemic.
VERTICAL INTEGRATION
Notwithstanding the conflicting opinions on the therapeutic merits of medicinal cannabis – the GP colleges remain generally sceptical – the vertically integrated business models which have developed have raised eyebrows. And that’s putting it mildly.
Critics, of whom there are plenty from within the sector itself, observe with alarm the practices and behaviours that are widely understood to take place. Manufacturers and producers own clinics, they control distribution, prescribe their own products and, in some cases, dispense it. There are no regulations preventing such business models, but it’s a model that raises clear conflicts of interest and, as some have argued, is the antithesis of patient care.
Furthermore, the sometimes rapid and low-cost nature of patient consultations has fuelled suspicions that some clinics are facilitating a quasi-audit use market rather than treating patients with genuine medical needs.
At an industry conference last August where the subject of ethics took centre stage, former Victoria state MP and cannabis advocate Fiona Patten warned that the industry risked a day of reckoning if it continued along its current path.
“When legalisation was passed we said we didn’t want a situation where an 18-year-old could walk into a clinic, say he’s got a sore thumb and score 10g of high-THC flower,” she told the conference. “But we are fast going down that track and it will negatively affect us for a long time to come.”
And maybe that day of reckoning isn’t so far away. Regulators, after constant nudging from some in the sector, recently met in Melbourne. It was, AHPRA said, the “first step” in dealing with the “challenge of protecting the public from harm and inappropriate prescribing while allowing for legitimate access to medication”.
SCRIPTS WITH STRINGS ATTACHED
One of the issues regularly raised on social forums – Reddit in particular lights up with discussion of medicinal cannabis – is that of prescriptions. Stories of patients being charged a fee to release their scripts are plentiful as clinics adopt measures to keep them in their vertically integrated family of brands and the financial benefits that flow from that.
It is a practice clearly at odds with guidelines and codes of conduct published by the AMA and AHPRA, which stress the importance of patients’ freedom to take their script wherever they choose.
Not that cannabis clinics own pharmacies outright – that is strictly forbidden – “but there are various ways to skin a cat as far as commercial arrangements with pharmacies are concerned”, as one commentator tells The Medical Republic.
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