United call for action on medicinal cannabis regulation

Peak health bodies in New South Wales have joined forces to call on the State Government to act on medicinal cannabis prescribing and dispensing, following concerns over the growing number of people using these products.
 
The NSW branches of the RACGP, Pharmacy Guild of Australia, Pharmaceutical Society of Australia and Australian Medical Association have written to NSW Health Minister, Ryan Park, calling for reform.
 
It comes as figures show the number of patients using medicinal cannabis products has grown dramatically, from 18,000 in 2019 to more than a million by January 2024.
 
Writing to Minister Park this week, the health leaders raised several concerns, including poor regulatory oversight, particularly in the context of the rise of vertically integrated cannabis clinics, and that medicinal cannabis clinics were operating predominantly via ‘hasty telehealth consultations’.
 
They also flagged potential conflicts of interest in ‘closed loop’ arrangements, whereby the telehealth prescriber sends the prescription to a dispensary owned by the same operation, as well as the rise of cannabis-only clinics.
 
These can lead to inappropriate prescribing and promotion of medicinal cannabis to patients, and business approaches that take a singular focus on profit over quality healthcare, the group said.
 
Representative health bodies also raised concerns about the marketing of these products, saying the promotion of Schedule 8 substances shouldn’t be happening at all.
 
Earlier this year, practitioners who prescribe medicinal cannabis were put on notice by the regulator in response to growing concerns over patient safety and over-servicing.

The Australian Health Practitioner Regulation Agency (AHPRA) clarified its expectations in firm new guidance, emphasising that prescribers be as careful and diligent when prescribing medicinal cannabis as they are with other drugs of dependence.
 
The stern warning came as an AHPRA analysis of prescribing data raised several red flags, including eight practitioners who issued more than 10,000 scripts in a six-month window and one practitioner who appears to have issued more than 17,000 scripts, equating to a script every four minutes.
 
The analysis also identified one pharmacist who dispensed 959,000 cannabis products in a single year, which equates to 2600 products a day. 
 
The TGA is also set to review the safety and regulatory framework for medicinal cannabis products, in a move welcomed by the health bodies. 
 
RACGP NSW&ACT Chair Dr Rebekah Hoffman said while medicinal cannabis is suitable for some patients, the prescribing and dispensing of these products must be done so safely and with the patient’s health and wellbeing front of mind. 
 
‘We’ve asked to meet with the Minister and his department to discuss policy solutions,’ she said.
 
‘Profit-driven moves such as the rise of vertically integrated cannabis clinics risks fragmenting patient care. In many instances, a patient’s GP is unaware the patient has been given medicinal cannabis.  
 
‘Any prescribing of medicinal cannabis, just like any prescription drug, should be managed by the patient’s regular GP and dispensing should occur at their regular pharmacy. Patient care and safety must come ahead of profits.’
 
NSW Pharmacy Guild President Mario Barone said community pharmacists are committed to supporting patient health.
 
‘Aggressive marketing tactics undermine the integrity of the health system and the proliferation of online clinics and vertically integrated models fragment care, bypassing a patient’s regular healthcare providers,’ he said.
 
‘Prescribing and dispensing arrangements must put patient safety, clinical evidence, and continuity of care first.
 
‘The current system for prescribing and dispensing medicinal cannabis is not working as it should for patients, pharmacists, or prescribers.’
 
President of the Pharmaceutical Society of Australia’s NSW branch, Luke Kelly, there is a place for medicinal cannabis products, ‘but we need to prioritise the tools and regulatory environment that promote their safe and appropriate use’.
 
‘More needs to be done to curtail online and remote services that, in many cases, don't have adequate structures, checks and balances needed to deliver safe care.’ 
 
A NSW Health spokesperson said the TGA is responsible for regulating prescribers’ access to unregistered medicinal cannabis products via either the Authorised Prescriber or Special Access Schemes.
 
‘The TGA is currently conducting a public consultation to review the safety and regulatory oversight of unapproved medicinal cannabis products. NSW Health supports this review and is committed to maintaining a balance between access and safety of medicinal cannabis,’ the spokesperson told newsGP.
 
They added that NSW Health’s Pharmaceutical Services Unit routinely investigates the prescribing and dispensing of Schedule 8 medicines, including medicinal cannabis, to ensure compliance with the state’s legal requirements.
 
‘The Pharmaceutical Services Unit may take action, against health practitioners who prescribe medicinal cannabis where there are concerns their practice contravenes NSW’s Poisons and Therapeutic Goods Regulation,’ the spokesperson said.
 
In these cases, action is ‘carefully considered and undertaken in the interests of public health and safety’ and can include referrals to the relevant professional councils at the independent Health Professionals Councils Authority, they added.
 
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