Half-Baked Regulation Sees 100,000 Australian Patients Turn to Black Market Cannabis

Over 3,100 medicinal cannabis prescriptions have been approved by the Therapeutic Goods Administration (TGA) in the March 2018 to January 2019 period.

Officials from the TGA claim that there have been zero rejections thus far, with application coming in from sufferers of a wide range of conditions, including epilepsy, nerve pain, chemotherapy-induced nausea, and anorexia.

Members of the healthcare sector are also beginning to get on board, and in October last year the Pharmaceutical Society of Australia (PSA) published an official position statement in support of the medical use of cannabis and cannabinoids. The Federal Government has even promised to introduce a streamlined process for TGA applications, which will allow approved patients to gain access to the drug within 48 hours.

Advocates of medicinal cannabis have been celebrating the increased patient uptake, which is highly encouraging when compared the Australian medical community's initial underwhelming response. Figures from the TGA show that by July 2018 only 1059 people had been approved for the scheme since medicinal cannabis was initially legalised, which means that prescription rates have almost tripled in the last year.

However, according to a psychopharmacologist at Sydney University, Iain McGregor, there may be more than 100,000 people in Australia who are still turning to cannabis sold on the black market to treat persistent medical problems.

"They're self-medicating with cannabis that they get from friends or grow themselves," McGregor said.

"There's this massive discrepancy between what Australians are doing covertly and the overt approved system which, so far, I would say, is probably not delivering."

"This prohibition that we have over the years is really stymieing progress in terms of learning the therapeutic effects of the plant."

Hippocratic Growth

One major hurdle that is keeping patients away from medical cannabis are healthcare professionals who are still unwilling to consider it as a treatment option.

A Sydney-based GP, Dr Teresa Towpik, admitted that she dismissed the drug's therapeutic potential at first. Despite initially being sceptical, after conducting her own research she has since begun prescribing cannabis to her chronic pain patients.

"I was quite ignorant and arrogant as well. I saw it as a drug of addiction, a gateway drug," Towpik said.

"At least half of my patients have been able to reduce their pain medication or some of them even stop it. They are not asking for more, or exhibiting any drug-seeking behaviour."

Although the system for legally acquiring cannabis and cannabis-based medicine is becoming easier to access, it can still only be prescribed by a medical practitioner on a case-by-case basis. General medical practitioners can apply to the TGA for approval for a script for individual patients, or they can bypass this requirement by becoming part of the Authorised Prescriber Scheme.

Unfortunately, there are currently only 54 Authorised Prescribers of cannabis in Australia who have the authority to prescribe unapproved medicinal products without approval from the TGA.

Health officials have also confirmed that they are unable to provide data how many of these doctors are practicing in regional Australia—if any—due to the small number participating in the scheme.

This means that there may potentially be thousands of Australian patients who are incapable of accessing medicinal cannabis due to geographically-limited treatment options.

The president of the Royal College of GPs, Dr Bastian Seidel, expressed frustration that the number of patients being prescribed medicinal cannabis was still so low.

"The hurdles are still in place. It is frustrating for us because medicinal cannabis might be an option of last resort for patients where we've tried absolutely everything in the book," Seidel said.

"Certainly this is not what patients expect. That's not what should be in place when it comes to medicinal cannabis."

"If your GP thinks you would benefit from medicinal cannabis as a treatment of last resort, then your GP should be allowed to prescribe it."

Older Australians Go to Pot

Research has shown that senior citizens are increasingly turning to cannabis medication as a form of pain management, regardless of whether it violates the law. One such patient is 70-year-old pensioner, Paula Vam Vas, who tore the meniscus cartilage in her right knee following a serious fall. After being placed on a public hospital waiting list for surgery, she decided to try using cannabinoid oil to help deal with the injury.

"It was really painful and the option my doctor gave was [Panadeine] Forte and other opiates for the pain and for sleeping. I didn't want to take them, but the pain was quite severe," she said.

"Until I took it, I wasn't convinced that it was going to work … it hurt so bad. But it put me to sleep, while I was asleep the pain stopped, and during the day I took it at different times when I could feel the pain coming on and it gave me really good relief."

While she would prefer to access the drug legally, Vam Vas claims that currently this is not a viable option, forcing her to acquire CBD oil from the black market. Additionally, while the cost of medical cannabis has declined over the last year, more growers are still needed to bring down prices, as Australian patients still pay roughly 25 percent more than black market buyers.

"My doctor doesn't want to know about it and the doctors that can prescribe it are few and far between, and it's very expensive. What I would pay $90 a month for, would be around $200," Vam Vas said.

According to a researcher from the Sydney University Institute for Cannabinoid Therapeutics, Rhys Cohen, the high cost of medicinal cannabis is likely being driven by a lack of supply chain transparency.

"There might be a cultivator overseas, a manufacturer, an international distributor, a local distributor and a pharmacy … all taking their cut," Cohen said.

"I think it's fair to say Australians are getting gouged by some opportunists."

While the healthcare community may still have hold reservations about medicinal cannabis, a 2016 study by the Australian Institute of Health and Welfare, 85 percent of Australians were found to be in favour of its use. However, thus far there is still only one cannabis product—which is approved for patients with multiple sclerosis—on the Australian Register of Therapeutic Goods.

The president of the Hemp Embassy, Michael Balderston, argues that the system for accessing legal cannabis products provided by the Australian government is still far too restrictive.

"It's extremely hard to get permission through your doctor, [there are] lots of forms, two levels of doing it in some states, so I think doctors aren't inclined to do it and it has to be a really serious condition," Balderston said.

"They made it a tiny gateway … it's like the chain is still on the gate."

"So, people are finding ways to access it across Australia."

This sentiment was echoed by the director of Cannabis Access Clinics, Dr Sanjay Nijhawan, who said that many doctors are unaware of the therapeutic benefits of medicinal marijuana due to a lack of education on the subject.

"We have not educated our GPs, the medical schools don't know enough about it … at the moment it's pretty raw, it's early days," Nijhawan said.

Is the Australian Government Blowing Smoke?

Although the medical use cannabis is starting to become more widespread, it still has a long way to go in terms of patient access and acceptance from the healthcare community.

Many people feel that the Australian government has failed to keep pace with the growing demand for medicinal marijuana, and as a result, patients are being left behind. Amid calls for the establishment for an independent regulatory body, medicinal cannabis campaigner Lucy Haslam described the laws surrounding the drug as "bitterly" disappointing.

"I used to be proud of what we'd done but nothing much has changed for patients. We find that the Government's trying to put a lot of spin on it and claim it's been victorious, but it's been a disaster," Haslam said.

"Every other country with a sophisticated cannabis program has elected to set about doing it through an independent regulator. That's what we should've done."

It seems clear that while the cannabis sector may be continuing to expand, local regulators and healthcare officials are still stuck playing catch-up with their overseas counterparts.

Until then, it seems likely that many Australian patients will continue turning to black market cannabis medication as a form of pain relief.

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Hugo Gray
Hugo Gray

Hugo Gray is a Melbourne-based journalist with a body of work that covers a diverse range of topics, including immigration law, sex technology, and now the rapidly expanding cannabis industry.

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