We spoke with FreshLeaf Analytics cannabis consultant Rhys Cohen about the recent Senate Hearing on the Australian Medicinal Cannabis Industry.
On Wednesday 29th of January, the Australian Senate recently held a hearing dedicated to exploring the barriers to patient access to medicinal cannabis in Australia. The hearing involved many politicians as well as those involved in medicinal fields, in the hopes that officials may be able to identify some of the key restrictions for patients hoping to access medicinal cannabis.
The seminar centered around four major obstructions to medicinal cannabis prescriptions, which were state and Territory restrictions, Doctor Access, the cost of marijuana medicines and Driving laws.
State and Territory restrictions
While Australia is indeed making strides when it comes to its medicinal cannabis prescriptions, there are many restrictions that still act as a handbrake for the industry at large. The most blatant case of this is Tasmania, who's medicinal cannabis laws Rhys describes as "highly restrictive." This is evident when one looks at the Tasmanian prescription figures, which are far behind the rest of Australia.
Since Tasmania approved medical access to patients in 2017, a mere seven patients have been prescribed medical cannabis products. Some of Tasmania's slow rate of prescription growth, when compared with other states, can be attributed to the fact that Tasmania doesn't allow patients to process their applications online.
Instead, GP's have to refer patients to a relevant specialist, who then has to apply to the Department of Health and Human Services for authorization to prescribe medicinal cannabis. Put simply, there are many, many layers of red tape preventing patients from accessing medicinal cannabis.
Contrastingly, in April 2019, Queensland amended its patient access process making it easier for doctors to write prescriptions. Since then, almost all QLD doctors have only required Federal approval, speeding up processing times and reducing paperwork.
This had an almost immediate impact on the number of QLD approvals. Although we saw modest monthly increases across all States/Territories this year, QLD went from 284 approvals in February to 1,311 approvals in August.
Evidently, a similar process needs to occur in Tasmania, and the senate inquiry may have just started that process.
Finding a Doctor
Occurring alongside the excessive red-tape surrounding Australia's medicinal cannabis industry is the fact that many doctors simply don't have the time to do research on the benefits of medicinal cannabis.
Previously, Rhys explains, the Royal Colleges which represent doctors would accredit third party courses in order to validate information surrounding medicines. Though doctors are "time-poor," and rarely have time to attend such courses when it comes to cannabis.
"Dr. Tony Bartone, the head of the Australian Medical Association requested the government consider providing public funds to educate doctors on medical cannabis. To hear that coming from the head of the AMA is quite encouraging. It shows they're taking this very seriously." Rhys Cohen, Principal Consultant for Freshleaf Analytics
Though it's not all doom and gloom, Rhys explains, as there have been over 1400 different doctors that have prescribed cannabis at least once to a patient, which Rhys states "is quite a small number but given how niche cannabis is, it's exciting. It's clear the SAS-B portal is working quite well."
The third, and "biggest" barrier to patient access in Australia with regards to medicinal cannabis is cost.
"Cannabis medicines are unregistered. You need to go through SAS to be prescribed, and you don't get PBS discounts," stated Rhys.
"To be considered for the Pharmaceutical Benefits Scheme, you need to apply for the PBS advisory committee, with evidence that your medicine is better than any other alternative medicine, in terms of cost and efficacy. Sativex tried this and was rejected."
Aside from being largely ineligible to be subsidized through the PBS, a huge contributor to the excessive costs that patients face when purchasing cannabis medicine is the fact that very little cannabis is grown on Australian soil.
The good news with regards to home-grown cannabis is that as of the end of 2019, Australian cultivators are permitted to cultivate 35,000kg of medical cannabis.
"That doesn't mean 35,000kg is available today, but in 6-12 months' time, we'll start to see a significant portion of Australia's medicinal products locally sourced."
This should significantly reduce costs for patients, who are currently "spending $5-15 per day on cannabis medications, and that's not including epilepsy patients. Epilepsy patients are spending $50 or more per day."
Another barrier when it comes to Australian medicinal cannabis prescriptions is Driving. Freshleaf Analytics has previously identified that doctors are reticent to prescribe patients out of fear they'll be pulled over while driving and arrested for marijuana intoxication.
This a valid fear, as we've covered previously, as there currently is no working breathalyzer system to test for THC levels in the blood. Furthermore, determining intoxication based on THC levels is even harder. As it currently stands, police can only determine whether or not patients have THC in their systems, regardless of the amount.
For this reason, many doctors seek to avoid prescribing THC products and will instead prescribe CBD products which don't intoxicate users and allow them to drive without fear of arrest. Currently, there is little movement on how to overcome the issues with driving while on a cannabinoid-based medicine.
The down-scheduling of CBD in Australia
As we covered recently, a focal point for the inquiry was also the potential down-scheduling of CBD that has been hinted at by the Australian Government. As it stands, CBD products are schedule 4 products, while other cannabis medicines containing THC are schedule 8 products.
Pure CBD is less controlled than non-CBD cannabis products. They are, however, still prescription based. This is different from the US, the UK and many other European countries where you can access CBD in chemists, truck stores and elsewhere.
In Australia CBD is very tightly regulated. The TGA is currently reviewing the literature on the safety of low-dose CBD, meaning 15-100mg of CBD per day.
Should the inquiry come back with a clean bill of health, they will consider initiating a review process that may result in CBD being made schedule 3 or 2, meaning it may be available either over the counter or off the shelf.
"At the moment, CBD is available only by doctors prescription, and CBD medicines make up 40% of total prescribed cannabis products. It's in high demand," Rhys mentioned.
"At the hearings yesterday, John Skerritt said it should be completed in March, and should they find it to be safe, they'll consult the public and ask if they'd like it to be down-scheduled. It's likely this will lead to down scheduling."
"If that happens, it doesn't mean CBD will be immediately available, companies would still need to register their CBD drug as a schedule 3 which requires them to produce safety and efficacy data, and that can take time."
"If everything goes well, by the end of this year we could have executed on down-scheduling CBD. It's not impossible that by the end of 2021 we have CBD products for people to purchase at a pharmacy behind a counter." Rhys Cohen, Freshleaf Analytics' principal Consultant
Australian Medicinal Cannabis in 2020
Since 2016, there have been 30,000 prescriptions for medicinal cannabis in Australia. If monthly growth rates continue at their current rate, we can expect roughly 70,000 prescriptions by the end of 2020.
Though the number could be end up being much higher, Rhys explains, as "Freshleaf's forecast is about double that, about 140,000 prescriptions by the end of 2020."
Given the current trajectory of Australia's medicinal cannabis prescriptions, combined with the recent inquiry, it's looking like 2020 is shaping up to be a stellar year for the industry.
"The results from the inquiry should come out in February which should be exciting. Fingers crossed we get some meaningful changes in Tasmania."
"We will also see the implementation of recommendations of the Narcotics Act Review, including changing the way the license system works, moving from having one license to three licenses, while raising the cost of the license. This is an objectively good thing, as it will make things easier for the Office of Drug Control, while at the same time, increasing revenues."
You can access the entire seminar on the inquiry with Rhys here.
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