Australia has a love-hate relationship with the facilitation and regulation of illicit drugs. It might be surprising for some to know, however, that medical marijuana is already legal in Australia.
According to Dr Alvin Lee and Danniella McGowen from Deakin University, ‘Many are unaware that medicinal marijuana has been legally accessible in Australia for some years. However, delays in the international supply chain thwarted easy access, resulting in a call to develop a domestic supply to fill the vacuum,’ they explain.
This slow-down in the supply chain is perhaps the reason why many are unaware of its accessibility. In early 2016, the domestic medicinal cannabis scheme was announced in an attempt to speed up the availability supply. This meant that those interested in cultivating and manufacturing the drug for medicinal purposes could apply for permits from the Therapeutic Goods Administration (TGA) to do so.
Dr Lee and McGowen explain that the intention of the scheme is to limit the time between visiting the doctor and obtaining the prescribed product, by having a domestic supply that is readily available. However, beyond the premise of cultivation and supply, there are still a few gaps.
According to Dr Lee and McGowen, there are three main barriers stopping doctors from prescribing medical marijuana:
Barrier 1: Concept versus product
‘Although the concept of medicinal marijuana is legal, associated cannabis products are not registered on the Australian Register of Therapeutic Goods (ARTG). This means marijuana is a medically-unapproved therapeutic good,’ they say. And currently, there is not enough evidence to support the benefits of medicinal marijuana on a factual basis, which impedes the availability of registration.
But what about overseas where such products are already legal? ‘Results show, at best, low-moderate results. A number of adverse effects from use and inconsistencies in patient response to the drug have been reported. These reports also point to gaps in the evidence needed for registration.’
Barrier 2: Prescription confusion
There is still confusion among doctors about the format in which the drug should be prescribed (for example, pill or liquid form). Doctors are also unsure of the recommended dosage to prescribe and how long it should be prescribed for.
‘The lack of this general guidance for marijuana products creates a knowledge barrier on how to use this treatment, and therefore encourages doctors to prescribe registered medicines that have been rigorously tested and proven to be high quality, safe and effective over one that yields inconsistent and unconvincing results.’
Barrier 3: Prescription access systems
The process behind securing medicinal marijuana for patients is also not very straight-forward. As Dr Lee and McGowen explain, ‘While there are many pathways available for accessing medicinal marijuana products, Australia lacks a “standard” pathway. These may, at times, be difficult to navigate and onerous for time-poor health professionals.’ Currently, access pathways are only available through clinical trials, special access schemes, and authorised prescribers:
- Clinical trials: As simple as it sounds, this pathway refers to the clinical trials currently conducted to monitor and build evidence for the production of medicinal marijuana products. It is a tightly controlled process with a risk of side-effects.
- Special access scheme category B: This pathway involves the doctor applying to the TGA for medicinal marijuana on behalf of the patient, because other registered drugs are not effective enough. But according to Dr Lee and McGowen, ‘Given that medicinal marijuana’s effectiveness is unconvincing and not extensively documented, this can be a challenge.’
- Authorised prescriber: Dr Lee and McGowen explain that ‘This is where a doctor becomes an authorised treatment prescriber of medicinal marijuana to a specified class of patients. This negates the need for onerous case-by-case applications. Typically, this narrows the operational scope of prescription (e.g. a specialist treating children with epilepsy).’
- Special access scheme category A: For patients to receive medicinal marijuana via this pathway, they must be seriously ill and likely to die prematurely. ‘This is a notification scheme and “approval” is not required by the TGA.’
Where to from here?
For medical marijuana to be more readily and easily accessible, Dr Lee and McGowen indicate that doctors and medical professionals need to be provided with greater education and understanding of the benefits, side-effects, and pharmaceutical properties.
‘Clinical trials have shown that medicinal marijuana can be extremely effective for one person but elicit extreme side-effects in another, causing doctors to err on the side of caution.’
There is also the matter of prescription: ‘A simple and robust prescription access system that does not bewilder busy physicians, coupled with solid evidence, information and understanding of the treatment will help in its adoption.’
Originally published on this.