Medicinal cannabis prescribing practices under scrutiny after scripts issued 'every 4 minutes'
Former police officer Rohan Dawson turned to medicinal cannabis when he was looking for relief from PTSD after years with the force. (ABC News: Emily Jane Smith)
In short:
Regulators are concerned practitioners are putting profits over patient safety, with some writing more than 100 medicinal cannabis scripts a day.
An ABC investigation found some doctors saying they felt they were being treated as drug dealers, pressured to write scripts and paid contingent on scripts being provided during consultations.
What's next?
The medical practitioner regulator says it has started a task force to look at issues with medicinal cannabis prescribing.
Australian medical practitioners are writing scripts for high-strength medicinal cannabis products with alarming speed, raising concerns some are putting "profit over patient safety", according to the regulator.
Since medicinal cannabis was legalised in 2016, the industry has exploded, with cannabis telehealth clinics fuelling a rapid increase in prescriptions of products that contain THC, the psychoactive substance that causes a "high".
More Australians are accessing medicinal cannabis in smokable flower form with THC content above 20 per cent and in some concentrated forms as high as 98 per cent THC for conditions such as insomnia, chronic pain and anxiety.
That is despite what some experts describe as "surprisingly weak" clinical trial evidence that high-strength THC products are the most suitable treatments for those conditions.
New data from the Australian Health Practitioner Regulation Agency (AHPRA) revealed eight medical practitioners appeared to have issued more than 10,000 scripts each for the highest-THC-strength products over a six-month period.
The agency said one doctor appeared to have issued more than 17,000 scripts in six months, equivalent to a script every 4 minutes in a working day.
Using multiple data sources, AHPRA's analysis also identified one pharmacist who dispensed 959,000 cannabis products in one year, which equates to more than 2,600 products per day — for 365 straight days.
The data also revealed a nurse practitioner who appeared to have issued 31,000 scripts over a year.
Kym Ayscough says it is hard to understand how some prescribers are meeting their professional obligations. (ABC News: Craig Hansen)
AHPRA's executive director, regulatory operations, Kym Ayscough, said the findings amounted to evidence some prescribers were dealing in volumes where it was "very difficult to understand how they could be meeting their professional obligations".
"It does seem unusual to see those very high volumes of prescriptions and dispensing from a small number of practitioners," Ms Ayscough said.
The Therapeutic Goods Administration (TGA) collates figures related to medicinal cannabis applications and approvals from doctors but the figures do not reflect the number of individual patients who ultimately receive scripts.
AHPRA combined data from the TGA with dispensing data from state and territory poisons regulators to find treatment was initiated for 441,000 new patients for the strongest — category five — cannabis products between July and December 2024.
High-strength THC products are of particular concern to regulators because they are schedule eight medications like opioids and have greater risks for abuse and harm.
Telehealth the 'one-stop shop'
AHPRA says the high volumes are being fuelled by a rise in telehealth prescriptions — in some cases, provided after only a brief consultation with either a doctor or a nurse.
An increasing number of clinics operate a one-stop-shop model that pays the doctors who write the scripts — before selling and shipping the prescription cannabis products to patients.
The system presents an obvious conflict of interest for doctors, who are required to act in the best interest of patients.
"We would say that there is a risk that some practitioners are putting profit over patient safety,"Ms Ayscough said.
"It is very clear in the codes of conduct for registered practitioners that patient safety is to be their number one concern."
A 7.30 investigation found multiple medicinal cannabis clinics advertising free phone-only consultations and some patients prescribed high-strength THC-containing cannabis by doctors they had never spoken to, after brief phone consultations with a nurse.
Doctors, not dealers
Claire Noonan, a GP from Orange in NSW, was looking for more flexible work when she decided to sign up to be a medicinal cannabis prescriber with a telehealth company in late 2022.
There were red flags from the moment she got her contract. She wrote to the company saying she was concerned that pay was contingent on writing scripts.
Claire Noonan, a GP from Orange in NSW, signup to be a medicinal cannabis prescriber with a telehealth company in late 2022. (ABC News: Craig Hansen)
"I didn't think it was conducive to ethical medical practice," Dr Noonan explained.
She negotiated for the contract to be changed and started doing telehealth consultations with patients around the country.
Her prescribing mantra was to start low and go slow, usually starting patients with cannabidiol or CBD, a cannabis compound that does not cause a high.
"Some patients expressed a strong preference for THC preparations and would try and convince me to prescribe those for them, which, yeah, I didn't want to do on a first visit," Dr Noonan said, adding that some patients also "seemed to have a careful script" for how to try and get certain medications.
Doctor Claire Noonan said there were red flags from the moment she got her contract, (ABC News: Craig Hansen)
She said on one occasion, after she declined a patient request for a THC prescription, she received a call from the telehealth company asking her to reconsider because the patient had complained.
"We had to have a discussion about how I wasn't prepared to prescribe against my own clinical judgement.
"There was a bit of pressure to be, perhaps more of a dealer … it's more being used for my signature on a script,"she said.
Dr Noonan quit soon after.
She does not want to name the company, which did not respond to requests for comment from 7.30.
She said the CEO of the company was not a doctor and could not be blamed for wanting to run a profitable business.
While Dr Noonan says she sees a place for medicinal cannabis in health treatment, she is concerned other doctors, especially young graduates and those without specialist GP training, might be more easily pressured to make poor prescribing decisions.
More Australians are accessing medicinal cannabis for conditions such as insomnia, chronic pain and anxiety. (ABC News: Emily Jane Smith)
While AHPRA regulates individual medical practitioners and the TGA regulates the advertising of medicinal cannabis, these businesses are operating in a regulatory grey area.
While medicinal cannabis is legal, most products are still categorised as "unapproved medicines", which means they aren't on the Australian Register of Therapeutic Goods nor are they monitored for safety, quality or efficacy by the TGA.
That means it is entirely up to doctors to ensure the drugs are prescribed appropriately.
'Chernobyl-strength' cannabis being rolled out to patients
Former police officer Rohan Dawson was looking for relief from flashbacks, nightmares and anxiety caused by PTSD after years with the force.
Cannabis was a treatment he had never considered until the keen gardener saw an advertisement for "free cannabinoid therapy consultations" at his local hydroponic gardening shop.
"[I] had a 10 or 15-minute phone consult with a lady who wasn't a doctor, and all of a sudden there was dope heading to my door. So it's really as simple as that."
Rohan Dawson said he had no idea how strong the medicinal cannabis was. (ABC News: Emily Jane Smith)
Within days, he was shipped a vape and a tub of dried cannabis flower, marketed as "slurricane", containing 27 per cent THC.
He never spoke to the doctor whose name appeared on his script and had no idea how strong the product was.
"I went and sat on the couch and thought, 'Holy shit. Like, you know, I'm on Pluto here'. For the short amount of time that I was using it, it certainly increased my anxiety,"he said.
He stopped taking it when his mental health deteriorated and he went to see his regular GP.
Rohan Dawson said he never spoke to the doctor whose name appeared on his script. (ABC News: Emily Jane Smith a)
"The advice was that THC stuff and your medication are not good bedfellows at all," he said.
Despite never having another appointment, he continued to be billed under a subscription model and more cannabis arrived at his door.
"I was alarmed by how efficient it is. Like, I thought, 'Shit, these companies, they know how to roll this stuff out'. You can't criticise them for not being organised," he said.
"I don't know why they would be wanting to have this, you know, Chernobyl-strength stuff sent out to people … it's most probably not necessary unless you're on death's door."
The company he used is called Dispensed, and it advertises free consultations through bong shops, tobacconists and hydroponic stores with appointments booked through iPad kiosks.
Patients can make appointments through Dispensed by using iPads found in selected stores. (ABC News: Patrick Rocca)
Store owners told 7.30 they were paid a percentage commission when patients signed up.
It is illegal to advertise medicinal cannabis and the TGA has handed out more than 190 infringement notices totalling over $2.5 million in fines since 2020.
But many companies use coded language — like "alternative" or "natural" health care and plant-based imagery — to ensure patients know what they provide.
The TGA said it was "aware of, and concerned about, the rise of unlawful advertising of therapeutic goods … including through touch-screen kiosks".
Last year, the founding pharmacist of telehealth provider Dispensed, and two of its prescribing doctors, were banned from supplying or prescribing medicinal cannabis after two patients with mental health conditions were supplied with medicinal cannabis.
One was hospitalised for psychosis and the other took his own life.
In a new statement to 7.30, Dispensed said the action was taken against the practitioners directly and the company "reviewed its systems, including to provide additional support to health practitioners and improve the quality of patient care".
Dispensed added that the onus was on doctors and that it "expects practitioners to comply with their legal and professional obligations" and that when deciding whether to prescribe to patients, they should consider "the type of medication that may be appropriate (including the strength)".
'An arms race to get the strongest product'
Professor Iain McGregor from the Lambert Initiative at the University of Sydney has been studying the potential for cannabinoid compounds to be used to treat health conditions for more than a decade. He was an early supporter of legalising medicinal cannabis.
Professor Iain McGregor is from the Lambert Institute at the University of Sydney. (ABC News: Craig Hansen)
"Even the initial advocates, the people that urged action back in 2015/2016, are now somewhat perplexed that it's turned into a bit of a commercial monster with the bar set too low for patient access and … some unethical prescribing going on," he said.
He points out medicinal cannabis can be a very effective treatment backed by good evidence, especially for patients with epilepsy, chemotherapy side effects and in palliative care, but the research has not caught up with the "very large number of conditions where medicinal cannabis is being applied where we don't have high-quality evidence."
"That's not to say that the evidence won't emerge and there are clinical trials going on all the time, and we're running quite a few of them," he said.
It was important to remember medicinal cannabis was generally well tolerated and the vast majority of those using it as prescribed would not see negative side effects, Professor McGregor said.
However, he said he was concerned some of the THC products on the market were more than double the strength of home-grown cannabis.
"There's a bit of an arms race to try and get the strongest possible product out there,"he said.
"The concern is that within the literature on cannabis, we know that higher-THC products appear to be more linked to mental health, adverse outcomes, precipitation of severe anxiety and paranoia in vulnerable individuals, perhaps schizophrenia and manic attacks."
Another factor driving an increasing uptake in medicinal cannabis is that prescription products are now, in many cases, cheaper than buying illegal cannabis through a drug dealer.
That is something Professor McGregor believes is not necessarily a bad thing from a harm-reduction perspective.
"There's the quality control. It means they have to talk to a doctor before they access the product, and it means that they have security of their products over time.
"The downside is maybe that doctors don't necessarily want to be servicing the non-medical market.
"I think they maybe didn't study medicine to become, you know, a glorified cannabis dealer," he said.
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