Australian Medicinal Cannabis Association (AMCA) general manager Gail Wiseman reflects on last week’s strategic meeting of industry stakeholders and identifies the next steps in the fight to improve patient access.
Last week, industry stakeholders met to discuss the key issues that continue to restrict access to medicinal cannabis for patients.
As well as representatives from AMCA, the Society of Cannabis Clinicians Australian Chapter (SCCAC) and United in Compassion, attendees included the Lambert Initiative, Medicinal Cannabis Industry Australia, Epilepsy Action Australia, the Penington Institute, universities, healthcare professionals and industry bodies.
The all-day meeting provided a forum to identify the challenges and develop potential solutions to take to the new Labor government.
The meeting of 30 thought leaders, experts and advocates, moderated by Dr Teresa Nicoletti, was the first of its kind since the Australian Medicinal Cannabis Alliance met in 2018. That meeting had a significant impact on improving regulations and access for patients to medicinal cannabis but, four years on, there is still much work to do.
Six key areas of concern were highlighted, many still unaddressed or only partially addressed since the Current Barriers to Patient Access to Medicinal Cannabis in Australia Senate Inquiry reported its findings and recommendations in March 2020:
• Driving laws
• Cost and affordability
• Industry concerns
• Prescribing issues
• Down scheduling
AMCA chair and co-founder Lucy Haslam said: “Although the Senate Inquiry made some very important and sensible recommendations, few of them have been actioned.
“We noted those that still require action, so we could focus on those for which this group of experienced individuals could develop potential solutions to take to the new government.
“Too often, problems are taken to government, but we agreed that we would endeavour to offer actionable solutions.”
Adjunct senior fellow at the University of Adelaide’s School of Psychology Dr Michael White presented on the challenges that patients who are legitimately prescribed cannabis face if they drive. Even a trace of THC in the saliva or blood can result in a fine and/or loss of licence.
Dr White reported on a recent study by Wickens et al. (2022) which advised that cannabis should be considered to be a mood-altering rather than an impairing drug, while alcohol has the opposite effect.
The group discussed various options on which to lobby including:
- seeking equity with opioids or benzodiazepines (which are not included in roadside testing)
- switching testing from presence to impairment (there is little correlation between blood or saliva levels and impairment)
- exemption, for example as recently introduced in New Zealand, where patients need to demonstrate impairment as well as having detectable THC in their saliva or blood to be penalised.
Stakeholders identified the lack of supporting data and harmonisation between states, as well as the significant stigma still evident, as other factors contributing to impeded access for patients even when legitimately prescribed medicinal cannabis.
Cost and affordability
While access to medicinal cannabis has improved markedly since the Alliance meeting in 2018, affordability remains an issue for many patients.
Recommendations from the Senate Inquiry focused on the industry implementing compassionate pricing models and the Commonwealth establishing a compassionate access subsidy scheme, but neither have happened.
The Compass compassionate use program was announced by AMCA board member and ANTG chief scientific officer Justin Sinclair at the UIC symposium in May. At last week’s meeting, funding options for Compass were discussed, ranging from tax-deductible industry support to approaching insurers and government.
Although there was recognition of the need for Compass, stakeholders agreed that addressing affordability in the longer term will require significant changes to support the industry, reduce costs and drive prices down.
A vibrant session on the many issues still facing the Australian industry led by AMCA board member Emily Rigby provided a clear picture of the challenges and opportunities ahead.
Although the regulatory pathway has improved over the past few years, the burden on Australian producers continues to be significant, with expensive delays still experienced in the issuing of licences and permits.
Processing times and service levels need to improve significantly to realise the full potential of the Australian industry. Further down-scheduling of both CBD and THC will also be high on the agenda when lobbying the new government.
With Australian producers increasingly looking to export opportunities and rapidly growing adult-use markets around the world, and the potential for a legal adult-use market in Australia, Rigby highlighted the opportunity for Australia to lead the world in high-quality cannabis products.
“Australia has a very well respected global reputation and branding, we need to be producing high-end, Australian-grown cannabis to supply both local and international markets,” she said.
The local industry has a narrow window of opportunity to realise its potential. Removing restrictions to enable Australian producers to supply high quality adult-use, as well as medicinal, products will allow them to supply into more overseas markets as regulations evolve around the world.
The session also highlighted the need for more efficient production, education and collaboration and the importance of genetic selection in meeting patient and industry needs.
Access to quality cannabis genetics will provide the industry with chemovars that can increase quality and yield, with diverse cannabinoid and terpene profiles, while improving production efficiencies. This will allow Australia to better compete against cheap exports in global and local markets.
The ongoing importation of sub-standard products continues to impact the Australian industry, despite TGA regulations now requiring overseas producers to meet GMP standards.
Other suggestions made were to develop branding for Australian grown products (a tick of approval), strengthen supply chains and to address the lack of progress in developing the veterinary market.
The significant number of healthcare practitioners who participated in the meeting agreed that continuing stigma is one of the key barriers to access for patients in need.
The Senate Inquiry outlined the need for the Department of Health, in collaboration with the Australian Medical Association, the Royal Australian College of General Practitioners and other specialist colleges and health professional bodies, to develop targeted education and public awareness campaigns to reduce the stigma around medicinal cannabis within the community.
However, none have transpired.
Nor have medical colleges and peak bodies supported the development and delivery of accredited face-to-face and online training programs on medicinal cannabis.
AMCA clinical board director and SCCAC advisory panel member Dr Tamara Nation said SCCAC, with support from the industry, is already stepping in to fill this void.
It has developed an independent, industry-supported, RACGP-accredited online educational program for healthcare practitioners.
Strategies to decriminalise cannabis will also go some way to reducing stigma among healthcare practitioners, the community and politicians.
Another key concern raised by healthcare practitioners was the inappropriate relationship between some doctors, clinics and companies resulting in professional conflicts of interest.
Concerns were also expressed at short patient review times, the utilisation of nursing staff to undertake medical consultations, and insufficient documentation and liaison with patients’ other clinicians.
The meeting agreed the development of ‘duty of care’ prescribing guidelines for medical practitioners and a code of conduct for prescribers, clinics and the industry would help to ensure higher quality healthcare and avoid adverse outcomes for patients.
Recommendations and potential solutions arising from the meeting are currently being prioritised through a survey sent to attendees that will be synthesised into a consensus statement to guide lobbying and other activities.