Where are all the Australian cannabis doctors?
The medicinal cannabis scheme was introduced in the ACT in 2016, following a decision by the Therapeutic Goods Administration (TGA) to reschedule cannabis from a prohibited substance to a controlled drug.
The scheme determines the guidelines for the prescription, distribution and use of medicinal cannabis.
Under Australian law medicinal cannabis is only able to be prescribed by an authorised prescriber; “medical practitioners who are approved to prescribe unapproved therapeutic goods for a particular condition or class of patients in their immediate care without further TGA approval.”
Authorized prescribers must “have the training and expertise appropriate for the condition being treated and the proposed use of the product; be able to best determine the needs of the patient” and “be able to monitor the outcome of therapy.”
At the time the guidelines were released, ACT Assistant Health Minister Meegan Fitzharris said, "There comes a time, after all the inquiries and investigations are done ... when a decision must be made.
"This framework gives the ACT an opportunity to implement a scheme with clear, regulatory oversight that protects both patients and public health."
Doctors were sceptical of the move.
Australian Medical Association's (AMA) ACT President, Steve Robson said at the time, "We all want to help patients, we all want to help people get better, but we're not really sure what we're doing at the moment."
Flash forward to 2019 and it seems things are yet to progress.
An article published by ABC News suggests doctors are fearful of the stigma surrounding prescribing medicinal cannabis, although the view of the AMA seems to have changed slightly with a new President.
The ABC reports that while AMA ACT President Antonio Di Dio was disappointed the scheme had failed to take off in Canberra, doctors had issues with finding the time to undergo training and accreditation.
"Anecdotally, we've identified a lot of GPs who are interested in doing it. But unfortunately, in relation to training, most GPs are very busy people," he said.
More worryingly, Chronic Pain Australia's executive director Benjamin Graham believes that many doctors just aren’t comfortable with it. He says there is a stigma with being known as “Dr Pot”.
"Medical cannabis is very different to street cannabis as well, so this notion that everyone's just going to get high is actually quite wrong," he said.
Graham went on to say that, “[Patients] hit a brick wall when they see their GP. The GP either doesn’t know too much about it. They really aren’t comfortable about it, or they say there’s no research or evidence to support medical cannabis.”
In their defence, perhaps medical practitioners and the community at large don’t understand that the THC element is not a medicinal cannabis ingredient. But that seems a flimsy argument.
The lack of prescribing doctors is causing further issues.
According to thegrowthop.com, the lack of prescribing doctors in the ACT, where medical cannabis is legal, is forcing people to purchase medication from street vendors – the very thing this legislation was supposed to avoid.
This is not a problem unique to Australia.
An international panel of advocates and experts at the Business of Cannabis Medical Cannabis conference held in Toronto in May this year, posited that Medical cannabis patients still face too many practical barriers to access in countries where the drug is legal.
Canada’s legal framework has been in place since 2001, however barriers include high taxes and high costs.
Gerald Major, president of Canadians for Fair Access to Medical Marijuana believes that patients on a fixed income, without health insurance are at a major disadvantage.
“We are already underdosing because we can’t afford the medication. We are currently massively underdosing on CBD,” said Major. And a big part of that relates to affordability, the number one problem, he said.
“So we have to do a better job at policy,” said Major. "This would include rethinking laws that enforce where you can use cannabis, for example, which might force medical cannabis users from housing being designated as smoke-free.”
The Growth Up reports that in Germany, patients are legally allowed to have a prescription, and that prescription must be reimbursed by public health insurers, but it can sometimes be rejected for reimbursement because of high requirements, Becker said.
Germany and Australia are similar.
Australian patients require a medical specialist to provide a thorough clinical justification to have a prescription for cannabis approved.
“Needless to say, if you’re a patient in Australia you’ve got a big problem,” said Diane Scott, CEO of the Jamaican Medical Cannabis Corporation.
It’s time for Australia to step, but that may take time.
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