Cannabiz editor-at-large Rhys Cohen identifies the five issues holding the Australian cannabis industry back – and over-the-counter CBD isn’t one of them.
It has been a hell of a year … and it’s only October. But if you can, I invite you to cast your mind back to the heady days of February 2020. There was choking smoke in the air, COVID was but a distant hypothetical threat, and the Senate inquiry regarding barriers to patient access to medicinal cannabis was having public hearings in Melbourne.
I remember sitting there in a room full of politicians, activists, bureaucrats and executives, listening to stories of suffering and hardship experienced by sick and dying Australians just trying to find relief. It felt like an important moment. Here were a whole bunch of powerful people, in the same room as Australia’s most knowledgeable cannabis people, discussing the big issues.
And there are a lot of big issues.
But you know one issue that wasn’t raised by a majority of patients, advocates, scientists, doctors or executives in the lead-up to the inquiry? Making low-dose CBD available behind-the-counter at pharmacies. In fact, if you’d surveyed the people in that room just a couple of months earlier, pharmacist-only access to low-dose CBD wouldn’t even have registered as a concern.
It was the Department of Health, in their submission to the inquiry just a couple of months prior, that first raised the topic at such a high level. During the hearings, they indicated that such a move was on the cards and, subject to an ongoing review of the safety literature, would be acted on with priority by the Department. This would allegedly increase access, reduce costs etc.
But let’s get real here.
People with epileptic children weren’t asking for this. Neither were cancer patients, doctors, or drug law reform advocates. Access to these sorts of products is unlikely to meaningfully improve anyone’s lives, at least according to all currently available clinical evidence, including the TGA’s own literature review. That’s assuming this reform actually ends up translating into products being accessible, which is far from a sure thing.
But the promise of a shiny new regulatory change, and the chance of meaningful revenues, captured the attention of the whole sector. And since February it seems we have been incapable of discussing anything else.
There are much more important issues that deserve our attention and energy. So, in case you’ve forgotten, here are five major issues with medical cannabis in Australia that are more important than low-dose, over-the-counter CBD.
1. It’s still too expensive
Your average medical cannabis patient is still paying around A$400 per month for their medication, not including the private fees charged by cannabis clinics which can add several hundred dollars per year on top.
That’s totally unaffordable for your average Australian.
Product prices are coming down, but average patient consumption is going up, so average expenditure remains the same and indicates that people are not taking as much medication as they need, but only as much as they can afford.
The Pharmaceutical Benefits Scheme (PBS) can’t help because none of these products have yet been proven to be better and cheaper than currently available medicines. Some private insurance companies are starting to cover the costs of consultations and medication, but they haven’t gone so far as to broadly publicise that.
Paediatric epilepsy patients are expected to fork out $20-60,000 per year for medication, depending on the dose. The idea of most people affording that kind of expense is ludicrous. Some states and hospitals have funded compassionate access for limited numbers of patients, but many people are still missing out.
These compassionate access programs should be expanded, but the key to making these products affordable long term is large-scale local cultivation and manufacture, and a thriving local industry. This has been prevented by badly designed and executed legislation and regulation, which I’ll get to soon.
2. Sick people are still being criminalised
If you’re living with cancer or some other serious condition, you’re entitled to some peace and dignity. If you don’t have thousands of dollars to pay for private treatments, and your friend wants to make you some edibles or roll you some joints to take the edge off, neither you nor your friend should face criminal charges.
That, unfortunately, is still a controversial position to take in Australia.
According to most governments in this country, you would be a criminal and so would your friend, and you should both be punished for breaking the law. Perhaps you should be arrested and fined. Maybe even imprisoned. A criminal is a criminal, after all.
We should decriminalise personal cultivation (within reasonable limits), consumption (in private), and supply (as a gift, not a sale) of cannabis. That would be a good start.
In the meantime, take a look at the NSW Government’s Medicinal Cannabis Compassionate Use Scheme. Why don’t we have one of these in every state and territory? Why can’t we expand this to people with non-terminal but serious and chronic illnesses, and people under 18 years of age? This is all well within the scope of our current political climate.
3. Legal patients still can’t drive
If you are taking medication that impairs your driving ability, you must not drive while impaired. But here’s the thing – imagine you’re prescribed, for example, oxycodone (that’s the hard-core opiate) and you take that at night to help your pain while you sleep.
You get up in the morning and drive to work. You’re not impaired, but a cop pulls you over for a random roadside drug test. You test positive to the presence of opiates. But it’s okay, because you were taking your prescribed medication as your doctor recommended. So, if the police want to take you to court, you have a legal defence you can use, and you’ll probably be fine.
This is the case for every drug – every prescription drug – in Australia. Except for medical cannabis.
Now the cops don’t test for opiates at the roadside. And the roadside tests for THC are inaccurate, insensitive, and incapable of proving impairment. But that’s beside the point.
If you are taking your legally prescribed medication as recommended by your doctor, and you are not impaired, you should be entitled to the same level of legal protection as someone prescribed oxycodone. Anything less than that is discrimination in law and should offend anyone with a moral compass.
In some positive news, the Victorian government has just announced that they have formed a working group to address this issue specifically. It is expected that by 2021, Victoria will have harmonised their drug driving laws so cannabis patients are no longer subject to this inequity. Hopefully this will spur other States and Territories to follow suit.
4. Doctors still don’t know about it
In 2017, most patients couldn’t find a doctor prepared to consider cannabis for love nor money. In response to that unmet need, Australia now has more than a dozen medical cannabis clinics where, if you have enough cash, you can guarantee seeing a doctor who (most of the time) knows what they’re talking about.
We will know enough doctors are educated about medical cannabis in Australia when these clinics cease to operate. Their presence is necessary because patients are still unable to have these conversations with their regular doctors.
The number of non-clinic doctors prescribing medical cannabis continues to increase, largely thanks to the costly business development strategies of some of the larger product companies. But there is a risk that these doctors will tend to prescribe the products made by the company employing the person who educated them. And this may not always be the best thing for their patients. (Admittedly, this is also the situation with many drugs).
All Australian doctors should have access to free, online, government-approved educational materials about how medical cannabis works, how to use it in clinical practice, and how to pursue a prescription via the SAS-B pathway. And doctors should be proactively made aware not only of these resources, but also that medical cannabis is legal, which sadly is something many doctors remain ignorant of.
In addition to this, doctors sorely need a government-maintained database of products including their level of quality compliance, supporting clinical evidence, price and current availability. There are more than 150 products available for doctors to prescribe, and the expensive ones can be more than double the price of the cheap ones, despite containing the same amounts of the same ingredients. How on earth can we expect doctors to know which one is most suitable, or most affordable, for their patients without this information?
5. Industry is still struggling to get on its feet
It’s been a solid four years since legalisation and we now have a grand total of two companies supplying products that are completely Australian grown and manufactured. This is largely due to badly designed legislation and regulation and the lack of resources at the Office of Drug Control (ODC).
Fundamental and serious issues affecting the performance and efficiency at the ODC – including gross underfunding – have been evident to the Commonwealth for years. This was extensively covered by an internal government audit that was concluded in September 2017. But it wasn’t until December 2018 that the government allocated some additional funding.
Then in September 2019, another comprehensive review – this time by Professor John McMillan AO – was tabled. It clearly showed that much more needed to be done to fix the existing issues, let alone put the Australian industry in a position where it could thrive.
The McMillan review produced 26 recommendations, which the government accepted ‘in principle’ back in September 2019. How many of those recommendations have been implemented?
Not all of the blame lies at the feet of the government and regulators. The most significant barrier to products getting onto the PBS is getting them registered on the Australian Register of Therapeutic Goods (ARTG). That requires a lot of money, time and pharmaceutical expertise. And the desire to conduct appropriately rigorous clinical trials.
Very few of the companies operating today, both here and globally, are professionally capable of pursuing drug registration. And of the ones that are, few are prepared to put their money where their mouth is because they can more easily sell pseudo-medical and recreational products.
There’s nothing wrong with that necessarily, but if we ever expect cannabis medicines to be truly affordable (and for an Australian that means $41 per month with the rest covered by the government), companies must do clinical trials and prove these products are worth subsidising.
If product companies are choosing not to invest in clinical trials, they should think twice before complaining about how difficult it is to turn a profit.
At the end of the day, this system was meant to create a healthy local industry capable of supplying high-quality and low-cost medical cannabis products to Australians and the world. I think it would be fair to say we are not there yet.
Products are too expensive, sick people are being criminalised, legally prescribed patients can’t drive, doctors don’t know how or what to prescribe and the industry is still struggling to get on its feet.
These issues have not gone away. And they will not be addressed by low-dose, over-the-counter CBD. So please, can we get back to focusing on the big issues?
- Rhys Cohen is a cannabis industry thought leader and consultant to the industry. This article also appears on rhyscohen.com.
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