The rise of medicinal cannabis prescriptions in Australia has raised significant concerns within the medical community, particularly as sales in the first half of 2024 nearly matched the entire total for 2023. While this increase reflects a growing acceptance and use of medicinal cannabis, it has sparked a debate about whether the surge in prescription rates is benefiting patients or driven by profit motives.
A Surge in Medicinal Cannabis Sales
Medicinal cannabis prescriptions in Australia have seen a dramatic rise in recent years. The latest figures from the Penington Institute reveal that 2.87 million units of medicinal cannabis were sold in the first half of 2024, surpassing the 1.68 million units sold in the latter half of 2023. This surge reflects a broader trend, with Australians reportedly spending around $402 million on medicinal cannabis in the first half of 2024. This is almost on par with the total $448 million spent in 2023, up from $234 million in 2022.
The cannabis market, including illicit sales, is now valued at over $5 billion annually, yet concerns remain about the motivations behind the increase in prescriptions, particularly those dispensed via telehealth services.
Growing Concern Among Prescribers
Associate Professor Vicki Kotsirilos, a pioneer in the prescription of medicinal cannabis, has expressed deep concern over the high-volume prescription models now emerging. Kotsirilos was the first GP in Australia to be authorised to prescribe medicinal cannabis back in 2018. She has seen firsthand the potential benefits of medicinal cannabis for patients who have exhausted other treatment options. However, she now warns that the model of prescribing large quantities of cannabis, often via telehealth, raises serious ethical concerns.
Kotsirilos argues that companies selling cannabis products directly to consumers, especially through telehealth, present a clear conflict of interest. She believes that this model prioritizes profit over patient care, emphasizing that it is crucial for the government to impose stricter regulations to curb such practices.
Industry Response and the Need for Regulation
The Penington Institute echoes similar concerns, calling for tighter regulation to ensure that the medicinal cannabis market prioritizes patient health over revenue generation. The Institute’s CEO, John Ryan, acknowledged that while most operators are acting ethically, the rise in high-volume clinics presents a risk to patient welfare. He stressed that stringent regulations are necessary to hold any violators accountable and to ensure that patient safety remains at the forefront.
The increasing use of telehealth services dedicated solely to prescribing medicinal cannabis has drawn the attention of the Australian Health Practitioner Regulatory Authority (AHPRA). Health officials are currently evaluating whether existing regulations strike the right balance between providing access to medicinal cannabis and protecting patients from inappropriate prescribing practices. In recent reports, AHPRA raised concerns about emerging models of care, particularly those focused on high-volume prescriptions.
Risks Associated with High-THC Products
Another growing concern highlighted by Kotsirilos is the rise in prescriptions for high-THC cannabis products, particularly those in Category 5, which contain the highest levels of THC. Kotsirilos notes that these products carry significant risks, including addiction, heightened anxiety, and even psychosis, especially in vulnerable individuals. Despite the growing popularity of these products, particularly for conditions like chronic pain and anxiety, there is insufficient regulation surrounding their prescription, she argues.
As it stands, only two medicinal cannabis products have been thoroughly evaluated for safety and efficacy by the Therapeutic Goods Administration (TGA). The majority of cannabis products in Australia are imported, largely from Canada, and are supplied under the TGA’s Special Access Scheme and via Authorised Prescribers.
The Role of General Practitioners
Kotsirilos emphasizes that GPs are in a unique position to offer appropriate management and continuity of care for patients using medicinal cannabis. GPs are trained to consider all treatment options, ensuring that medicinal cannabis is only prescribed when other treatments have failed. If medicinal cannabis is deemed necessary, she advises starting with cannabidiol (CBD), a non-toxic phytocannabinoid, and only gradually incorporating THC in low doses, with close monitoring.
Unfortunately, many patients are turning to telehealth services when they cannot access medicinal cannabis through their GP. This trend highlights the need for greater GP involvement in managing medicinal cannabis prescriptions to ensure patient safety and well-being.
The rapid increase in medicinal cannabis prescriptions is raising red flags among healthcare professionals who worry that the focus is shifting away from patient care and towards revenue generation. While there are clear benefits to medicinal cannabis for certain patients, especially those with chronic conditions, the industry’s rapid expansion calls for tighter regulations and a more cautious approach to prescribing, particularly for high-THC products. With the market continuing to grow, it is critical that both health officials and medical professionals ensure that patient safety remains the top priority.
