Companies ‘drive a Mack truck’ through telehealth loopholes

In striking contrast to the usual dry language of health bureaucracy, a senior Therapeutic Goods Administration (TGA) official has described how regulation changes to expand access to medicinal cannabis have been exploited.
 
In comments first reported in The Age, the TGA’s Chief Medical Advisor Professor Robyn Langham said companies were able to find holes in the rules around medicinal cannabis prescribing ‘and then basically drive a Mack truck through it’.
 
The remarks surfaced in a now-removed video of a Melbourne University Health Law and Ethics Network seminar in October, in which Professor Langham referenced misuse of the system.
 
‘What’s happened in the last couple of years has been really an abuse of this access pathway,’ she said.  
 
‘We’re now seeing patterns of recreational access to a drug rather than medical access.’
 
With the rise in vertically integrated clinics in recent years, Professor Langham also reportedly said ‘the real elephant in the room for us is the telehealth model that is causing a lot of this really low-value care’.   
 
The comments come at a time when significant change is either being considered or already underway in the regulation of medicinal cannabis products and the approach towards prescribers.
 
In October, the TGA closed a consultation prompted by growing concerns around the safety risks posed by some medicinal cannabis products.
 
The Australian Health Practitioner Regulation Agency (AHPRA) has also signalled a more proactive approach to dealing with risks.
 
In response, a Department of Health, Disability and Ageing (DoHDA) spokesperson said the TGA has received ‘a large number’ of submissions on the use of unapproved medicinal cannabis products.
 
‘These submissions are currently undergoing a detailed review and analysis,’ they told newsGP, with stakeholder workshops to develop ‘any necessary regulatory reform options for further public consultation’ scheduled to take place by the end of March 2026.
 
The DoHDA said while the TGA shares concerns around unsafe prescribing practices expressed by AHPRA, its consultation is focused on the regulatory framework of unapproved medicinal cannabis products under its remit.
 
‘Other parts of [DoHDA], with key stakeholders, are exploring how this prescribing issue can be addressed,’ they said.
 
Dr Owen Bradfield is a GP and Chief Medical Officer at the Medical Indemnity Protection Society and spoke alongside Professor Langham at the now-removed Monash University seminar.
 
While he says medicinal cannabis prescribing has been a source of claims and complaints, he has noticed a shift.
 
‘We were seeing complaints or claims arising from practitioners including GPs who had prescribed medicinal cannabis through an asynchronous telehealth model,’ Dr Bradfield told newsGP.
 
‘Certainly, the claims that we see don’t tend to involve those issues anymore, and the telehealth that is provided is real time.’
 
He believes the Medical Board of Australia’s telehealth guidelines, which came into force in September 2023 and clearly stipulated the need for a real-time consultation, has played a big part in this.
 
‘They’re not legal obligations, but they play a very important role in helping boards decide whether treatment or allegations meet the threshold for professional misconduct,’ Dr Bradfield said.
 
He also points to differences in prescribing regulations across Australia as a common stumbling block, with prescribers based in one place not turning their minds to prescribing obligations in the patient’s location.
 
Complaints from health practitioners about inappropriate medicinal cannabis prescribing are another factor, with Dr Bradfield giving the example of a patient taking psychotropic medication who may have risk factors for psychosis.
 
‘In those circumstances, we’ve seen other practitioners such as the treating GP refer the medicinal cannabis prescriber to AHPRA because they thought the prescribing was inappropriate,’ he said.
 
The risk of fragmented care is a familiar issue for Associate Professor Vicki Kotsirilos, who was one of Australia’s first authorised GP prescribers, and has long voiced her concerns about unintended consequences of the boom in telehealth on medicinal cannabis access.
 
She describes how she discovered a patient she had previously prescribed cannabidiol (CBD) was taking a more potent tetrahydrocannabinol (THC) product through a telehealth prescriber – and she only found out by chance.
 
‘Had he not mentioned that in that one consultation, despite seeing him multiple times, I wouldn’t have even known he was on THC products,’ she told newsGP.
 
‘That’s the problem – patients may not disclose it to their GP, so there’s that lack of continuity of care.
 
‘I could have given him some other medications that might have interacted, there’s driving issues.
 
‘The area of telehealth-prescribed medical cannabis is like a can of worms. There are so many problems.’
 
Last month the Penington Institute released a report suggesting the exponential growth in medicinal cannabis prescribing has slowed – albeit with the 3.71 million units reported in the first half this year still way beyond the levels anticipated when access rules were changed.
 
It said the cause is unclear, but ‘may reflect clinical practice adjustments by previously high-volume authorised prescribers in response to negative media coverage and pointed statements from regulatory bodies about healthcare professionals’ legal and ethical obligations’.
 
It also notes that one area of potential reform raised by the TGA is a transition period allowing companies to see their products gain approval on the Australian Register of Therapeutic Goods.
 
For Associate Professor Kotsirilos, medicinal cannabis is by no means the only area of concern for telehealth, despite it often being in the spotlight.
 
‘There are other pharmaceuticals that are also prescribed through telehealth that are not as obvious,’ she said.
 
‘Where other drugs are also being prescribed through telehealth, for example obesity drugs, and there are many others, the level of prescribing data is not available, so we don’t even know what’s happening with other areas.
 
‘Even though the focus is on medicinal cannabis, it’s likely that the same issues probably apply to other areas.’
 
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