Two of Australia’s leading medical bodies have claimed medicinal cannabis telehealth providers are poorly regulated and some put profits before patient care, while also casting doubt over the efficacy of the medicine.
Royal Australian College of General Practitioners (RACGP) vice president Dr Michael Clements told the ABC a potential conflict of interest exists for telehealth firms that employ their own in-house doctors.
He claimed those doctors may be incentivised to swiftly issue medicinal cannabis prescriptions, irrespective of the patient’s needs.
“We shouldn’t be able to profit or make money from the treatment we’re recommending,” Dr Clements said.
“These companies solely exist for the purposes of mailing out the cannabis product, so you don’t have to try very hard to convince a doctor that that’s the product for you,” he added.
“As long as you press the right buttons… you’re going to end up with a script for a product that you ask for, and that just doesn’t sit with us well as GPs.”
Dr Clements further alleged that some telehealth companies use cryptic language in their advertisements, such as ‘leaf-based medicine’ and ‘green therapies’, to circumvent Australia’s advertising rules, which prohibit the promotion of prescription products.
He said he had seen claims about the benefits of medicinal cannabis on social media which were not supported by scientific evidence and expressed concern that doctors could make untrue or unproven statements about the medicine in order to cash in on demand.
Meanwhile, Australian Medical Association (AMA) president Professor Steve Robson said while there was some evidence supporting the efficacy of medicinal cannabis for conditions such as epilepsy and palliative care, the evidence for its benefits in post-traumatic stress disorder and chronic pain was “very flimsy”.
The AMA’s stance echoes previous concerns from the Faculty of Pain Medicine about the efficacy of the medicine in treating chronic non-cancer pain.
And Dean of the Faculty Professor Michael Vagg claimed last year that the widespread prescribing of cannabis for chronic pain was “ethically more concerning” than that of opioids, which he claimed had at least proven to be effective.
Professor Robson said alternative medications may be more effective or suitable for patients.
He also alleged that internet cannabis suppliers can bypass Therapeutic Goods Administration (TGA) quality and safety standards claiming it was “impossible” to enforce the regulator’s guidelines on the internet.
“It is legal, but it’s not in any sense regulated with respect to quality and safety,” Professor Robson said.
“This has absolutely exploded from only a few years ago and it’s not clear who is using it, why they’re using it, what it’s being used for, and whether it actually works or not,” he said.
A TGA spokesperson told the ABC it had received more than 600 reports of adverse effects from medicinal cannabis users, typically nausea, diarrhoea, dizziness, drowsiness and headaches.
Montu, a company which has come in for some criticism regarding its alleged practices from others in the industry, denied its Alternaleaf doctors were financially incentivised to approve prescriptions for patients.
Company spokesperson Kelly King told the ABC its doctors were paid a flat fee per consultation which was not contingent on them issuing a prescription.
King also insisted Alternaleaf’s advertising – which includes a recent shirt sponsorship deal with NRL club the Dolphins – was legal as it promotes the clinic and its services, rather than any cannabis product directly.
While acknowledging the presence of bad actors in the industry, she maintained Alternaleaf follows the rules.
“It’s quite upsetting to us to see people who are wildly flouting the rules when it comes to providing a medical service,” she added.
Releaf Group chief executive Gary Mackenzie said telehealth helps provide access to medicine for patients unable to physically visit a clinic but agreed it “needs a little more regulation”.
Last year, the Australian Medicinal Cannabis Association (AMCA) and Medicinal Cannabis Industry Australia (MCIA) told the sector it needed to put its own house in order when it comes to regulatory compliance or risk alienating stakeholders and incurring the wrath of the TGA.
Responding to a second ABC report on the lack of testing of imported products, Professor Robson said: “We’re certainly hearing stories about quality issues and adverse responses, and that should trigger concern in the community. It certainly does among the medical fraternity.”
He claimed doctors did not have enough information about the quality of cannabis or how rigorously it was tested.
“There seems to be a very big demand and for that reason it’s really important that we get the regulatory and the other frameworks around quality and safety absolutely locked in,” he added.
At last month’s ACannabis conference, industry leaders called for a united voice to tackle the ongoing disparity between imports and exports with Australia branded a cannabis ‘honeypot’ by ECS Botanics MD Nan-Maree Schoerie.
The calls came after Cannabiz exclusively revealed in February that the TGA had yet to test a single batch of imported medicinal cannabis since introducing regulations to control the quality of overseas product.
