THE NSW branches of the Royal Australian College of GPs (RACGP), the Pharmacy Guild of Australia, the Pharmaceutical Society of Australia (PSA) and the Australian Medical Association (AMA) have called on the NSW Government to act on rogue operators prescribing and dispensing medicinal cannabis.
In a joint letter to NSW Health Minister Ryan Park, the peak bodies have warned of poor regulatory oversight, major conflicts of interest around prescribing and dispensing, inappropriate prescribing, and a focus on profit over quality healthcare.
The group noted that the number of patients using medicinal cannabis products has grown dramatically, from 18,000 in 2019 to more than a million by Jan last year.
Yet questions remain around its efficacy and safety, and despite being legalised almost 10 years ago, only two medicinal cannabis products have been registered with the Therapeutic Goods Administration (TGA) and included in the Australian Register of Therapeutic Goods (ARTG).
None of the 500 unregistered and unapproved medicinal products currently available have been evaluated, with the bodies arguing that product manufacturers should be responsible for investing in rigorous trials to provide evidence of their safety and efficacy.
The health organisations noted that most cannabis clinics rely on telehealth rather than face-to-face consultations, and said there is evidence of "rogue clinics circumventing proper procedures and best practice".
They outlined a process where a patient registers online, briefly consults a nurse, and is then referred to a doctor, where a prescription is nearly always provided.
"Patients are apparently learning the answers they need to guarantee a script," they said.
Another major concern was the "closed-loop" prescribing and dispensing model, whereby the telehealth prescriber sends the prescription to a dispensary owned by the same operation.
This leads to an incentive to prescribe and dispense as many of these products as possible - and if the patient opts to use their regular pharmacy, a surcharge is applied.
The letter also pointed to strong concerns regarding inappropriate prescribing, with reports some clinics are prescribing these products to people being treated for opioid dependence and mental health issues.
The representative health organisations have welcomed the TGA's upcoming review of the safety and regulatory framework for medicinal cannabis products, and in the mean time have asked to meet with the NSW Health Minister and his department to discuss policy solutions.
"The current system for prescribing and dispensing medicinal cannabis is not working as it should for patients, pharmacists, or prescribers," said NSW Guild President Mario Barone.
"Aggressive marketing tactics undermine the integrity of the health system, and the proliferation of online clinics and vertically integrated models fragment care, bypassing a patient's regular healthcare providers.
"Community pharmacists are committed to supporting patient health," Barone continued.
"Prescribing and dispensing arrangements must put patient safety, clinical evidence, and continuity of care first." KB
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