Christopher Strauch is managing director of cannabis education and access company Montu. He has been with the business since 2019 and was previously managing partner at investment firm Alice Capital.
Montu recently signed a big deal with Western Australian health clinic network Jupiter Health to work with the network’s GPs to educate and guide them on all things medical cannabis. Cannabiz sat down with Christopher to discuss GP education, investing in cannabis and Australia’s rapid rise on the global industry stage.
Cannabiz: How did the deal with Jupiter Health come about and what are some of your aims?
Christopher Strauch: I met Michael Gendy, the co-founder and director of Jupiter health, in October last year. Early on, we started speaking to some of the large clinic groups to understand where they’re at in terms of medical cannabis, how much they know, how much they understand what is going to happen in the market.
Michael was certainly one of the people that we met that was very clear and understanding of the trends in the market, especially since mid-2019 in terms of patient numbers. The exciting part for us is with 300 doctors in the network and 30 clinics, it’s really a way for us to fast track the education process of a large cohort of doctors. This is the way to significantly improve patient access, in this case specifically in Western Australia.
Something that always comes up is the education of GPs and that’s what needs to happen to start to improve patient access. So what are some of the biggest concerns GPs have when it comes to medical cannabis?
It’s very interesting. I think it’s very mixed. We have mostly one-on-one discussions, because it’s such a strong difference in terms of people and where they’re at and what misperceptions they might have.
Overall, I don’t necessarily think there are huge barriers as such for doctors. It’s just a general case of innovation. In any market or in any industry, when you innovate and when you ask people to change their habits, there’s always resistance. And that’s what we see here as well.
It’s a mixed bag of misunderstanding or a lack of awareness of the research that is available or how it works. But overall, I would put it all in a bucket of: how comfortable am I with change?
On the one hand, you have the doctors now in our network that are early adopters, that are interested in finding new, innovative ways of helping their patients.
Then you have others that are just more conservative. They generally understand everything, they generally agree with what we have to say. They see the evidence, they see the patient numbers growing, but they just don’t feel comfortable yet.
When do you think we’ll be at that tipping point where it won’t be an unusual thing for a GP to prescribe medical cannabis, it’ll just be quite a regular, everyday thing to do?
I think it will happen very fast actually, because the important tipping point is happening or already happened in 2019. The market has been open since, since 2016, essentially. And yes, there was a lot of red tape, but in 2017 and 2018 it was already possible to prescribe.
But at that point, the seeds were not planted yet. There was not enough awareness, the media hadn’t picked it up yet. There wasn’t a critical mass of doctors prescribing – that really happened in 2019. That’s where you really saw patient numbers shooting through the roof from one month to another. And that trend has continued.
Now that we’re on that path and the inflection point in people understanding what it can do, it’s going to unfold very, very quickly. So I would say if I put a timestamp to it, probably in the next 12 to 24 months we’re going to be in a situation where… not everyone’s going to be prescribing, but it’s not going to be a huge issue to find a doctor anymore that that is able to prescribe.
And what about when it comes to patients themselves, are you finding that a lot of patients are still wary of cannabis or unsure? And if so, how can we better educate them and start to remove some of the stigma that might still be attached?
There’s much less [of a stigma] on the patient side. We’re actually seeing that it’s very much a patient-driven evolution. We see patients being very aware and very well educated, because frankly there is enough information out there, especially if you look at the US and Canada, there’s tons of information online, with various established sites that have very detailed information.
So we find that the patients that are interested in it are very deeply educated. Their problem is finding a doctor that is on the same level, and is as forward-thinking as they are. There’s awareness creation in the sense that there is actually the ability to access it fairly easily.
The reality is, if you find the right doctor, it’s a very simple process. In our network, we see that within two to three days you have access to medication after the consultation. So there’s no real process barrier anymore. But it’s just the awareness that it exists and finding the doctor in the first place.
Your deal was a Western Australia deal. Do you think that’s becoming a bit of a hotspot, or is it really picking up all around the country?
It’s picking up all around the country and frankly from a legislation perspective, Western Australia was a bit behind. The patient numbers in Western Australia were behind. So that deal certainly helps them to fast track them forward, but it’s really finding the pockets of growth and the pockets of people that are interested and giving them the tools they need in order to prescribe. That’s just going to continuously bring every state across the country forward.
Now price is obviously something that remains a bit of a barrier for patients. Does that ever come into it from a GP perspective? Do you think GPs are ever a little unsure whether they should offer medical cannabis, knowing how expensive it is, or should that really not come into a medical context?
That’s a conversation we always have with doctors. As we first onboard them, there’s still a big misperception about how expensive it actually is. When the market started and there were only a few players, prices were insanely high. We’re talking $700 to $1,000 dollars. And then, in the pharmacies as well, it wasn’t really regulated, so the few pharmacists that offered it put a huge margin on it. So it ended up with prices that were unaffordable for anybody.
But now with more and more pharmacies dispensing and more and more players in the market, we’re really coming down to prices that are very sensible. What we’re seeing is $150 to $300 on a monthly basis for a patient.
It’s not perfect, but it’s no longer a huge barrier. If you imagine that you’re in chronic pain and no other medication works for you, and there is a medication that can potentially help you, then that is not a lot.
But having said that, I agree with the point that doctors should allow patients to make that decision. Oftentimes doctors see cost as a barrier and therefore they don’t want to speak to the patient about it, which I think is the wrong way to approach it. Fundamentally, it should be: give the patient a choice, and inform them, because maybe they don’t know that medical cannabis exists. Maybe they don’t know it might be relevant for their condition. And so just by giving them the option, they can then make the decision on whether $300 is something they can afford or not.
The Royal Australian College of General Practitioners (RACGP) have highlighted that there is a need for further research on medical cannabis. Do you think many GPs share this view and is it a potential barrier for a GP who might want to start prescribing?
My background is not in pharma, it’s in innovative spaces, from e-commerce to fintech to crypto. We see this in every industry and every time there’s a change in habits, people just don’t feel comfortable immediately changing. It’s the same with the research.
The way the medical industry works is it’s always been based on clinical trials, then looking at the research, then testing it for a long time, and then they feel comfortable prescribing it. The way the medical cannabis market developed is so patient-driven. Now we’re seeing real-world evidence day in, day out.
That’s the conversation that we need to have with doctors, explaining to them that the information is there. In fact, there are now increasing numbers of proper clinical trials, but even if you just look at the patients that are already being treated today, there’s so much effective real-world data in place. And it’s so strong, the results that we’re seeing with our patient group in terms of limited side effects and really good results in controlling symptoms.
Your doctor has to go back to considering harm versus benefit. Since there are such limited side effects, the harm level is very, very low, significantly lower than compared to any of the existing medications these patients take. And beyond that, the results are also very, very positive. So I think a change of mindset is required.
You’ve covered so many different industries, as you say. What was it about cannabis that really intrigued you and made you want to start working in the industry yourself?
We started out being founders ourselves, and we founded a couple of businesses before we then gradually moved into an investor position where we started investing in different portfolio companies and started looking at the world from a high level and really trying to identify: what are the trends in the world and where do we see things going? And medical cannabis kept coming up.
Once you are established in the industry, you start getting more and more pitch decks. As early as 2014, 2015 we started receiving the first decks. Back then we didn’t even properly look at it because at the time, and even now I think for many people, it’s the idea of someone trying to make their hobby into their job.
Most of the people that you come across that are heavily involved in the industry are extremely passionate, which on the one hand is a good thing. But on the other hand, it’s also to their detriment because they’re so passionate and so over-exaggerated about the industry and their beliefs that people don’t take them seriously.
But then when Canada’s development happened over 2016 and 2017, we started listening a bit more. Then we made the first investments in some of the Canadian companies in 2017. That was the moment we really started paying attention. And as we started reading into the research, we started understanding what cannabis can do and the fact that across the globe regulation is starting to change.
The prohibition phase is ending across the world, this is a trend that is unstoppable and Canada was just one of many, many more countries to come. At that point, looking into the numbers and the ways it can affect the entire medical industry, it became clear this was something we wanted to be involved in.
And from an investment perspective, how do you see the Australian market? How does it compare on the world stage?
It’s probably the fastest growing market in the world. You have North America and Canada, which are obviously two established markets that have been around for a very long time. Then outside of that, in terms of patient numbers, you really only have Germany and Australia at this moment. I think Australia really made the change in 2019. Since then, patient numbers are actively growing and it’s at that unstoppable point. That’s the inflection point where we will see ongoing growth over the next five to 10 years in Australia.