This week’s media coverage of over-the-counter CBD has caused a surge in enquiries that healthcare professionals are struggling to cope with. Martin Lane investigates.
Hyped-up press coverage about the availability of over-the-counter CBD has left pharmacists and GPs dealing with an unprecedented wave of disappointed customers, according to an investigation by Cannabiz.
February 1 saw new regulations come into force making low-dose CBD available without a script, but products will require TGA approval and inclusion on the Australian Register of Therapeutic Goods (ARTG) along with a number of other restrictions.
Based on the requirement for ARTG registration, no CBD medicine is currently available which could be supplied over the counter and it may take another 12 months for that to happen.
However, stories in the mainstream media this week – some including commentary from cannabis companies themselves – inevitably focused on the availability of CBD rather than the nuances of the TGA’s decision.
In doing so, the coverage created a surge in demand that pharmacists have been unable to fulfill.
Lisa Nguyen, founder of Astrid Dispensary, a green dispensary specialising in cannabinoid medicines in South Yarra, Victoria said “every second customer” has asked about over-the-counter CBD. Other pharmacists have also contacted her asking what they should tell customers.
“My patients are very confused. They’ve seen on the news that CBD is available over the counter and we have to explain the nuances of the TGA to them,” Nguyen said. “They say ‘what’s the TGA?’. It’s not what they want to hear.”
Nguyen said when staff refer customers to their GP for help, the response is often ‘my doctor doesn’t want to [prescribe CBD]’ or ‘my doctor doesn’t know how’.
She said frustrated and confused customers are left feeling ‘that’s too hard, I can’t be bothered’, causing potentially far-reaching damage to the industry’s reputation.
“We are trying to legitimise the industry and things like this don’t help. It makes it go backwards by raising patient expectations high and not delivering.”
Nguyen said she has had several calls from other pharmacists asking for advice on how to manage customer enquiries.
“Pharmacists have not received enough training, if any, on Schedule 4 medicines. They are hardly in a position where they are ready to understand Schedule 3 CBD, let alone convey to the patient what this means for them, and manage their expectations regarding timelines given there is no registered product available any time in the near future.”
GP and medicinal cannabis specialist Matty Moore said his patients in Dunsborough, WA have been contacting him to ask why they still need a script.
“I’ve had four today [Tuesday], two on the phone and two face to face, saying ‘why do I have to see you, why do I need a script, it’s going to be in pharmacies now?’ They’re gobsmacked when I explain it to them because it’s all over the news.”
Moore said because his patients are already using medicinal cannabis and seeing the benefits, they tend to “shrug their shoulders” when the registration process is explained to them.
However, he feared would-be patients without access to a knowledgeable GP who have been hoping to buy medicinal cannabis over the counter might now be tempted on to the black market.
“Black market [operators] are loving it because they’ve got another couple of years before they have to give up their business,” he added.
Moore told Cannabiz he planned to spend time on social media explaining the situation to patients in order to help manage expectations and steer them away from the illicit market.
Executive director and head of strategy and business development at MedReleaf Australia, Nathan Davis, called on all stakeholders to work together to inform patients what the new rules mean.
He said groups representing GPs and pharmacists should step up to the plate: “The RACGP [Royal Australian College of General Practitioners] should have a position on this, the Pharmacy Guild should have a position, because it’s affecting their members.
“The TGA has done a great job regulating a medicine that’s suffered from prohibition for 100 years, but maybe they should put out [information] to the mainstream media explaining it.”
Davis added it was hard for individual businesses to correct misinformation in the press when they are prevented from advertising their products to consumers.
Instead, MedReleaf is urging patients to see their doctor for a script rather than head for the black market and pointing them to the TGA’s YouTube channel and flyers for further information.
“There needs to be a clear and precise message, the awareness campaign is not over,” he warned.
Medicinal Cannabis Industry Australia (MCIA) chair Peter Crock said the body has been working through the recently established Healthcare Practitioner/Patient Advisory Council (HP/PAC), headed up by former Federal Green Party leader Dr Richard Di Natale, to explain the new rules to healthcare professionals and patients.
Crock said the Council, which is independent rather than commercially driven, had worked with the TGA to increase the maximum daily dose from 60mg to 150mg in its final decision, to give companies a better chance of registering product and fulfilling consumer demand in the future.
“It would have been worse if it was 60mg, companies wouldn’t have got registration at such a low level,” he added.
Crock said MCIA will be conducting a workshop with the TGA in early March on the rules around advertising of medicinal cannabis and will use that to “address the positioning statements some companies are putting out in the media that aren’t helpful”.
Di Natale told Cannabiz patients’ expectations are not being met due to a lack of clarity around the approvals process.
He said: “Until products become available as they are in other countries you are going to get pressure on pharmacists, doctors and healthcare professionals because expectation has been created.”
He added the HP/PAC will be engaging with the TGA to look at streamlining the registration process to meet pent-up demand.
“The TGA’s role is to ensure safety for patients, that’s important as a regulatory body. Unfortunately, the approval process can take months because companies need to ensure they have appropriate data. One hopes there’s some flexibility, [but] people are going to have to be patient.
In the meantime, Di Natale warned: “It’s important that all stakeholders don’t raise patient expectations because reform in this area has been painfully slow.”
The Australian Medicinal Cannabis Association (AMCA) secretary Teresa Nicoletti said the industry has a duty of care to provide accurate information to patients via the media.
“The general public don’t understand the registration process and we can’t expect journalists to delve into the regulatory framework and understand what the finer details are. They rely on the industry to provide the right information.”
She said the problem was fuelled by some companies being new to the space, and not fully understanding the regulatory framework themselves, and others using media coverage to boost their profile in the market.
“While companies need to answer to their shareholders and have a vested interest in any developments in the regulatory regime which help their share price and market capitalisation, they must be careful to ensure that any news coverage, in this case about over-the-counter CBD, is accurate and balanced, and does not mislead or misinform the public.”
Cannabiz editor-at-large Rhys Cohen said: “No CBD products are currently available over the counter. At the earliest some may become available in one to two years.
“This is a complex issue, and companies operating in the medicinal cannabis sector have an obligation to the public, not to mention their investors, to ensure the information they release is accurate, complete and reasonable.”
“In the meantime, all this ‘CBD is available’ news coverage is going to send thousands of people to their pharmacy where they will be disappointed, jump online and buy unregulated CBD instead, exposing them to products with no quality or safety controls.”
Cannatrek CEO and co-founder Tommy Huppert said the company had seen a spike in enquiries after the announcement of its landmark deal to supply Chemist Warehouse with CBD products and services.
Huppert welcomed this week’s media coverage on down scheduling but said it was incumbent on the industry to work within the TGA guidelines to get products registered on the ARTG and meet latent demand.
“There’s a framework set for the industry now and the hard work is in front of us. But there’s a pipeline of patients that want help over the counter and that’s fantastic.”
He added: “Any positive news is good because it’s creating awareness for the category. Doctors are talking about it. People ask for S3, you explain S4 is available and they say ‘I didn’t know it was legal’. You can ring your doctor, get a script and go to your pharmacy, so nothing’s changed really.”
“Our news is commercial news but it’s evidence that the industry is mainstream.”
Cannabiz has approached the Pharmacy Guild of Australia for comment.