Until this barrier is overcome, medical cannabis products will never become mainstream in Australia.
Earlier this year, Australia's Capital Territory made Australia's history when it legalized cannabis possession and cultivation for adult use, leading many to believe that Australia was beginning its journey to all-out cannabis legalization. Though as many will know, the ACT's legalization of cannabis wasn't exactly a great forward leap for the Land Down Under. While adults can now grow up to two plants, individuals cannot buy or sell cannabis or seeds, meaning that the country is still a ways off from having a recreational market that can generate tax revenue and shrink the black market.
As a result of this piecemeal legislation, a recent poll of over 1,300 Australians revealed that just 2.5% of respondents sourced their cannabis legally. Precisely how indicative this poll is of the total condition of Australia's cannabis industry is uncertain, though at the very least it shows that Australia has a long way to go before cannabis can be considered "mainstream."
Though it isn't all doom and gloom, as Australia's cannabis industry has definitely been making strides in recent years, with June seeing a record-high level of Special Access B approvals for patients to be prescribed cannabinoid medicines. Moreover, until the country has some kind of recreational market, Australia's medicinal cannabis market is where we must place our attention.
This is why it's important to the potential barriers to the prescription of cannabis medicines, to see what might be holding the industry back from growing further. In fact, barriers to prescription are precisely what was discussed at the Senate Inquiry in March this year, which resulted in the tabling of 20 recommendations that, if implemented, should improve the conditions of the Australian medical cannabis industry.
One of the primary barriers, as is to be expected with any nascent industry, is pricing. Currently, cannabinoid medicines aren't subsidized through the Pharmaceutical Benefits Scheme (PBS), which means that patients aren't able to get access to the financial rebates that come with other medicines. Additionally, if cannabinoid medicines do eventually become subsidized within the PBS, they will first need to be approved by the Therapeutic Goods Administration (TGA), which can cost millions in order to undergo the necessary R&D. These costs will inevitably find their way to the consumer, and act as an incentive for consumers to go to the black market for a cheaper, albeit lower quality product.
Though over time, the legislation will improve, and as more players enter the medicinal cannabis space, the costs of production will continue to drop – we're already seeing this occur. However, all of this is irrelevant if we don't also overcome another barrier: doctors.
Are Doctors Preventing the Prescription of Cannabis Medicines?
One of the other recommendations tabled during the senate inquiry into barriers within the medical cannabis industry was a lack of education on the part of healthcare professionals. Understandably, if a prescriber isn't on board with cannabis medicines, it's much less likely for patients to receive a prescription for them, which becomes even less likely if the patient doesn't proactively ask for medical cannabis in the first place.
Though it isn't as simple as obstinate doctors who are unwilling to try new things, but rather, it's often the case that doctors haven't done any research into cannabis and its medicinal properties. Given how new medicinal cannabis is, and the fact that it isn't yet a mainstream medicine, it's rare for the subject to be broached in contemporary medicine classes at university, let alone the classes from decades ago. And if you're a doctor currently, the chances are that you don't exactly have a lot of free time to be doing homework on medicinal cannabis and its effects. In fact, in 2017, the Australian Medical Association found that one in two doctors were working 'unsafe' hours, with some doctors working over 100 hours per week.
In order to remedy this for emergent doctors, some of the recommendations tabled during the inquiry included incorporating "education on the endocannabinoid system and medical cannabis products be made a compulsory part of medical school curricula."
But what can be done for current medical professionals?
A popular method for Australians to be prescribed cannabinoid medicines is via cannabis clinics, who employ teams of doctors that specialize in cannabis-derived medicines. Not only do cannabis clinics offer a pathway for patients to learn more about medicinal cannabis products and potentially gain access to them, but they also provide educational services for healthcare professionals who are interested in learning more themselves.
There is a growing range of cannabis clinics throughout Australia, with prominent players such as Cannvalate, Cannabis Doctors Australia, Emerald Clinics, and Cannabis Access Clinics, who each aim to simplify the process of being prescribed cannabinoid medicines.
Though there's one newcomer that's vying for top spot on the Australian cannabis clinic scene.
Compass Lifestyle Clinics
Founded in 2019 by Dave Martyn, Compass Lifestyle Clinics currently have two clinics in Sydney, Australia, and thanks to a recent cap-raise campaign on Birchal, the company now has $1.3M to help them develop and implement telehealth services to adapt to the ongoing COVID-19 lockdowns.
Having expanded the Compass Clinics operations from Canada, Martyns told The Green Fund that he "could see that Australians were underserved when it came to safe access to medicinal cannabis. At the same time, from an economic standpoint, we've seen what an incredible job creator the cannabis sector has been in Canada. We've been fortunate to partner with some of the top cannabis leaders in Australia to play a part in ensuring safe patient access while also helping to grow the industry at large."
Despite being a newcomer, Compass Cannabis's revenue for 2019 was $2,180,402 across it's Canadian and Australian operations, exceeding many of its Australian cannabis-related peers. Now, with a proven track record and a working business model in both Australia and Canada, Compass intends to not only continue expanding its operations in both those countries but to also make a play for the New Zealand cannabis market should the country vote "yes" in its upcoming referendum.
Compass Clinics offers healthcare professionals the option to refer patients to them if they feel their own cannabis knowledge is insufficient, or alternatively, healthcare professionals can enter into a partnership with Compass Clinics, where they will gain access to workshops, seminars and e-learning materials to help them better understand cannabis.
The Future for Doctors
A major hurdle for the medicinal cannabis industry starts with education and ensuring that cannabinoid medicines become a part of the learning curriculum provided to aspiring medical professionals. Until learning institutions recognize the medicinal values of cannabinoid medicines, students and future medical professionals will remain uneducated about cannabis and this means that people who might benefit from cannabis medicines won't gain access to them as easily.
Additionally, it is just as important that resources are provided to existing healthcare professionals to ensure they can prescribe cannabis-derived medicines where necessary. For example, early studies have shown that cannabinoid medicines, as well as those containing CBD, can provide effective relief from chronic pain and reduce the necessity for opioid painkillers.
Given the potential for the misuse and abuse of opioids, which can lead to addiction and fatality, having cannabinoid medicines in a doctor's toolkit can only be a good thing – particularly given their general safety.
As such, cannabis clinics are a great tool to normalize cannabinoid medicines and make them more accessible for both patients and doctors alike.
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