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‘We need national reform’: Cannabis prescribing in focus
With one doctor reportedly issuing 17,000 scripts in six months, concerns are mounting over pressures to prescribe under ‘vertically integrated’ business models.
Hundreds of thousands of patients have ordered high-strength cannabis products over the past year, with concern mounting among health professionals.
An ABC exposé into the booming medicinal cannabis business has prompted new calls from healthcare professionals for urgent and systemic Australia-wide legislative change.
In a segment aired on ABC’s 7.30 on Monday, there was fresh insight into the growth of the industry in Australia, with regulators raising concerns about the ability of medical practitioners to meet code of conduct obligations under the current set up.
Legislation changed to allow medicinal cannabis prescription in 2016, and with the boom in telehealth, the number of scripts issued has skyrocketed. This includes hundreds of thousands of scripts annually for high-strength Category 5 tetrahydrocannabinol (THC).
New data revealed in the program, and confirmed by the Australian Health Practitioner Regulation Agency (AHPRA), shows treatment was initiated for 374,000 new patients for Category 5 products under the authorised prescriber scheme between July and December last year.
An additional 67,000 patients were treated under the special access scheme.
The AHPRA analysis also indicates that under the authorised prescriber scheme, eight health professionals issued more than 10,000 scripts for Category 5 products in six months, with a nurse practitioner responsible for 31,000 scripts in a year.
One doctor also reportedly issued 17,000 scripts in six months – a script every four minutes, 24 hours a day – while a pharmacist is also believed to have dispensed 959,000 products in a year.
In response, AHPRA has now formed a taskforce known as the Rapid Regulatory Response Unit (RRRU) to tackle the issue.
Associate Professor Vicki Kotsirilos, one of the first GPs to become an authorised prescriber, has previously shared her view on a business model she sees as deeply flawed.
‘The whole approach, the whole prescribing from a medicinal cannabis company employing doctors and nurses to prescribe medicinal cannabis is absolutely, totally unethical, has a huge conflict of interest, and it shouldn’t be happening,’ Associate Professor Kotsirilos told newsGP.
Noting the current complex regulation, she believes legislative change is ‘long overdue’.
At present, AHPRA is tasked with monitoring individual health practitioners, while the Therapeutic Goods Administration monitors prescriber approvals for medicinal cannabis, which itself is an unapproved product.
Meanwhile, state and territory drugs and poisons regulators monitor prescribing and dispensing.
Oversight is also hampered with much of the prescribing activity falling outside of the MBS and Pharmaceutical Benefits Scheme (PBS).
‘The bottom line is, there should be laws in place that stop this, a law to stop the medicinal cannabis sponsor companies from direct vertical integration prescribing,’ Associate Professor Kotsirilos said.
‘That applies not only to medicinal cannabis companies, but any pharmaceutical company who might be doing the same where it only leads to the prescribing of the particular product that they’re selling.’
Prescribing pressures
The 7.30 report included an interview with Dr Claire Noonan, a New South Wales GP who worked for medicinal cannabis company for a short time before stepping down due to ethical concerns.
She told newsGP that she noticed patients being prescribed quantities in excess of what she was told was the safe upper prescribing limit.
‘That just made me a bit uncomfortable,’ she said.
‘Even though I was happy with my prescribing, that’s one of the things that raised some red flags in my mind that the whole operation was not the most ethical.’
She says she also noticed a clause in her contract with her company, which she did not wish to name, making her pay contingent on providing prescriptions.
‘I said, “well, no, I can’t sign that, because what if I decide it’s not appropriate to prescribe?”
‘Even when I took that clause out, I still felt pressured to prescribe the way that the patient requested rather than what I thought was best.
‘So I imagine if you had signed it, that would be quite difficult. If it comes down to you prescribe or you don’t get paid, that is a bit of a trap for people.’
AHPRA also voiced similar concern through the organisation’s executive director of regulatory operations, Kym Ayscough.
‘Some prescribers and some dispensers are dealing in volumes where it is very difficult to understand how they could be meeting their professional obligations,’ Ms Ayscough told the ABC.
‘We would say that there is a risk that some practitioners are putting profit over patient safety.’
The regulator said that between 1 July 2019 and 28 February 2025, it received 336 notifications relating to medicinal cannabis about medical practitioners and 97 concerning pharmacists.
AHPRA said its taskforce’s ‘proactive approach to regulation has resulted in regulatory action being taken, even where a notification wasn’t received’.
For Associate Professor Kotsirilos, the surge in prescriptions for Category 5 THC products is a particular concern. Doctors have previously reported a rise in psychosis presentations to hospitals, which they believed are linked to rising prescriptions.
While she sees a role for THC products in specific clinical circumstances – she mentions palliative care, and to address nausea and vomiting associated with chemotherapy – in ‘many cases it is prescribed inappropriately’.
Associate Professor Kotsirilos said when prescribed inappropriately, THC can heighten anxiety and create a cannabis dependency problem.
‘Unfortunately, this sort of prescribing attracts patients from all over Australia who may have drug addiction or drug dependency problems,’ she said.
‘In a questionnaire, they may not fill it out appropriately or accurately or honestly with the aim to obtain medicinal cannabis.’
RACGP President Dr Michael Wright says the reporting highlights a clear need for reform to improve regulatory controls and standards.
‘Like many GPs, I have been alarmed to see the rapid rise of cannabis prescribing around the country,’ he told newsGP.
‘The rules for prescribing and monitoring these medications differ across states, and we need national reform as a priority to give us consistency around poisons and drugs regulations.
‘These drugs aren’t subsidised by Medicare, they’re not on the PBS, they are private medications, and most of these telehealth consultations won’t be eligible for a Medicare rebate, so they’re happening outside of our normally regulated health system.
‘There’s a real concern that it’s taking advantage of vulnerable patients and not giving them, or GPs, the protections that they need.’
As well as the RACGP, psychiatrists, emergency physicians, and pharmacists have expressed alarm over increasing patient harms.
In the meantime, Associate Professor Kotsirilos says she now advises GP colleagues not to work for vertically integrated companies.
‘Work with your colleagues,’ she said.
‘Join a general practice and try to see the patient face-to-face at least once a year, and work from a more holistic, comprehensive approach.’
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