Eminent representative health organisations have joined forces calling on the New South Wales Government to act on medicinal cannabis prescribing and dispensing as the number of people using these products continues to explode.
The NSW branches of the Royal Australian College of GPs (RACGP), the Pharmacy Guild of Australia, the Pharmaceutical Society of Australia (PSA), and Australian Medical Association (AMA) have written to NSW Health Minister, the Hon. Ryan Park MP, calling for reform. The letter warns of:
poor regulatory oversight, particularly in the context of the rise of "vertically integrated" cannabis clinics
medicinal cannabis clinics operating predominantly via hasty telehealth consultations
"closed loop" arrangements facilitating a clear conflict of interest and "cannabis only" clinics effectively acting as a production line for the supply of these products
inappropriate prescribing of medicinal cannabis and cynical promotion of these products to patients
strategies demonstrating a singular focus on profit over quality healthcare, which risks fragmenting patient care.
The number of patients using medicinal cannabis products has grown dramatically, from 18,000 in 2019 to more than a million by January last year. Australia's medicine and therapeutic goods regulator, the Therapeutic Goods Administration (TGA), is set to review the safety and regulatory framework for medicinal cannabis products, a move welcomed by the health bodies.
Most of the cannabis clinics rely on telehealth rather than face-to-face consultations, and there is evidence of rogue clinics circumventing proper procedures and best practice. A patient registers online, briefly consults a nurse, and is then referred to a doctor and a prescription is nearly always provided. Patients are apparently learning the answers they need to guarantee a script.
Many of these clinics operate a "closed loop" system whereby the telehealth prescriber sends the prescription to a dispensary owned by the same operation. So, there's an incentive to prescribe and dispense as many of these products as possible. This is highlighted by the fact that if the patient opts to use their regular pharmacy a surcharge is applied.
The letter also maintains that product manufacturers should be responsible for investing in rigorous trials to provide evidence of their safety and efficacy. Medicinal cannabis use was legalised almost 10 years ago and, since then, only two medicinal cannabis products have been registered with the TGA and included in the official public database of therapeutic goods. Of the 500 unregistered and unapproved medicinal products currently available, none have been assessed for safety, quality or efficacy.
The health organisations too remain unconvinced that cannabis-only pharmacies should be allowed to be approved as a "pharmacy" when they only supply medicinal cannabis products as part of closed loop arrangements. The letter states that medicinal cannabis products should be dispensed at community pharmacies, just like any other medicine.
Analysis conducted by the Australian Health Practitioner Regulation Agency (Ahpra), found that eight medical practitioners issued more than 10,000 scripts each for the highest-strength THC products over just a six-month period. One doctor issued more than 17,000 scripts in that same timeframe, equating to a script every four minutes. The regulatory body's analysis identified one pharmacist who dispensed 959,000 cannabis products in a single year, which equates to 2,600 products a day.
The letter also points to strong concerns regarding inappropriate prescribing, with reports some clinics are prescribing these products to people being treated for opioid dependence and mental health issues. One patient who received medicinal cannabis and experienced a psychotic episode was then constantly sent messages from that clinic about obtaining another prescription.
The letter
