Australia’s medicinal cannabis system is under scrutiny as experts call for urgent reforms to address its confusing structure and inequitable access for patients. In 2024 alone, the Therapeutic Goods Administration (TGA) granted at least 979,000 prescription applications for medicinal cannabis through its specialized access pathways. Originally intended for occasional use of unapproved drugs, these mechanisms have become commonplace, raising questions about their effectiveness and safety.
The current landscape presents a challenge for healthcare professionals. Doctors report feeling overwhelmed by the lack of coherent guidelines, leading to concerns about patient safety and the efficacy of treatments. The Australian Health Practitioner Regulation Agency (Ahpra) has indicated plans to strengthen regulations around unsafe prescribing practices, but many argue that this is insufficient given the rapid expansion of medicinal cannabis prescriptions.
Medicinal Cannabis: Intended Uses and Current Practices
Legalized in Australia since 2016, medicinal cannabis includes various forms such as oils, capsules, and dried flowers, with key components including THC (tetrahydrocannabinol) and CBD (cannabidiol). Initially, the TGA specified that medicinal cannabis should be reserved for patients with severe, treatment-resistant conditions, including those receiving palliative care and individuals suffering from intractable epilepsy or chronic pain.
Despite these guidelines, prescriptions have increasingly been issued for more common ailments like chronic pain and anxiety, straying from the original intent of the program. A recent TGA review highlighted that while some studies suggest medicinal cannabis may reduce pain for certain patients, the evidence remains inconsistent and often lacks the rigor of traditional clinical trials.
Challenges in Evidence and Access
Unlike traditional medicines that undergo stringent clinical testing, most medicinal cannabis products—aside from two approved by the TGA—do not meet the same standards for safety and efficacy. This lack of oversight leaves healthcare providers in a precarious position, often prescribing without comprehensive knowledge of product effectiveness or appropriate dosages.
The TGA oversees these access pathways but does not provide the clinical support needed for prescribers, further complicating the situation. Many prescriptions are issued via telehealth services, raising concerns that some practitioners prioritize quantity over quality of care. For instance, reports indicate that some doctors have issued more than 10,000 medicinal cannabis prescriptions within a six-month period, prompting calls for more thorough evaluations of prescribing practices.
Access to these treatments also poses significant challenges, particularly for patients in rural or underserved areas. Limited digital access can hinder their ability to navigate the complex prescribing process. Furthermore, costs remain prohibitively high for many. For example, the TGA-approved product Sativex, used for managing muscle stiffness in multiple sclerosis, is not subsidized by the Pharmaceutical Benefits Scheme, costing patients between A$700 and A$800 for a six to eight-week supply.
Addressing these issues will require coordinated action across multiple fronts. Advocates suggest the need for robust, real-world data to track how medicinal cannabis is prescribed and its outcomes. This data is crucial for understanding both the benefits and risks associated with these treatments.
A proposed national accreditation model for practitioners would ensure that those prescribing medicinal cannabis are adequately trained and informed about the evolving standards of care. This model could draw parallels to existing accreditation requirements for immunization providers.
Additionally, tackling inequities in access is essential. Introducing government subsidies for TGA-approved medicinal cannabis products could help alleviate financial burdens, ensuring that patients do not have to choose between affordability and safe treatment options.
Dr. Christine Hallinan, a senior research fellow at the University of Melbourne, has been actively involved in research on the pharmacovigilance of medicinal cannabis. Her insights highlight the need for a more evidence-based regulatory framework that can adapt to the rapidly changing landscape of medicinal cannabis use in Australia.
As the debate over reform continues, the focus remains on creating a system that prioritizes patient safety and equitable access while providing healthcare professionals with the support they need to make informed prescribing decisions.
