While governments spend billions fighting road deaths, overdose deaths receive regulatory barriers instead of harm reduction solutions

The Australian Health Practitioner Regulation Agency (AHPRA) has recently released new guidance targeting medicinal cannabis prescribing, citing concerns about patient safety and over-servicing. While patient safety should always be paramount, the restrictive nature of these guidelines raises important questions about resource allocation and harm reduction priorities in Australian healthcare policy.

The Numbers That Demand Attention

Australia's approach to public health emergencies reveals some striking contradictions. In the 12-month period ending June 2024, 1,310 people died on Australian roads. This tragic toll prompted continued investment in road safety campaigns, infrastructure improvements, and enforcement programs - representing billions in government spending and public attention.

Yet during 2022, overdose deaths claimed 2,356 lives - almost double the road toll. Unlike road safety, which receives comprehensive government response including education, infrastructure, and harm reduction measures, drug policy often focuses on restriction and control rather than evidence-based harm reduction.

This disparity in response becomes particularly relevant when examining AHPRA's new cannabis guidance, which may inadvertently contribute to the problem it seeks to solve.

The Regulatory Response: Restriction Over Harm Reduction

AHPRA's July 2025 guidance indicates the regulator will investigate practitioners with high rates of prescribing any scheduled medicine, including medicinal cannabis, even without receiving complaints. This approach creates what many healthcare professionals describe as a chilling effect that may discourage doctors from exploring medicinal cannabis as a treatment option, even when it could benefit patients.

The guidance emphasizes that medicinal cannabis should "never be a first-line treatment" and should only be prescribed "when other treatments have not worked." This approach appears to prioritize treatment hierarchy over individualized patient care and may not consider the relative safety profiles of different treatment options.

The Opioid and Benzodiazepine Reality

While regulatory attention focuses on cannabis prescribing, Australia faces well-documented challenges with medications that cannabis could potentially replace. The overdose statistics that dwarf our road toll are largely driven by pharmaceutical medications rather than illicit drugs.

Benzodiazepines, commonly prescribed for anxiety and sleep disorders, carry documented risks including:

• Physical dependence that can develop within weeks
• Severe withdrawal symptoms that can persist for months or years
• Cognitive impairment and increased fall risk in elderly patients
• Potential for overdose, particularly when combined with alcohol or opioids

Similarly, opioid medications present significant risks:

• High potential for addiction and dependence
• Respiratory depression that can be fatal
• Tolerance requiring increasing doses over time
• Significant withdrawal symptoms upon discontinuation

Research suggests that medicinal cannabis may offer a safer alternative for many conditions currently treated with opioids or benzodiazepines, including chronic pain, anxiety, and sleep disorders.

The Evidence and Safety Question

The guidance states that "there is little evidence to support the use of medicinal cannabis" beyond specific conditions. This position raises several considerations:

Research context: Cannabis research has historically faced legal and regulatory barriers, making large-scale clinical trials challenging to conduct.

Emerging evidence: While high-level evidence may be limited in some areas, observational studies and patient reports consistently indicate benefits for various conditions.

Comparative safety: The safety profile of medicinal cannabis, while not without risks, is generally considered more favorable than that of opioids or benzodiazepines. Cannabis has not been associated with fatal overdoses when used alone, and physical dependence, while possible, is typically less severe than that seen with traditional pharmaceuticals.

Treatment hierarchy concerns: Requiring other treatments to have "not worked" before considering cannabis may place an unnecessary burden on patients, potentially exposing them to harmful side effects from conventional medications.

Policy Implications and Resource Allocation

The current regulatory approach may have several unintended consequences:

Delayed access to potentially safer treatments: Patients may be required to try multiple conventional treatments before being considered for medicinal cannabis, potentially prolonging suffering and exposure to harmful side effects.

Maintenance of high-risk prescribing patterns: By focusing restrictions on cannabis rather than addressing systemic issues with opioid and benzodiazepine prescribing, the guidance may inadvertently maintain prescribing patterns that contribute to the overdose crisis.

Resource mis-allocation: Regulatory resources directed toward restricting a potentially safer treatment option may be better allocated toward addressing the medications actually driving Australia's overdose statistics.

Practitioner deterrence: The threat of investigation may discourage doctors from becoming authorized prescribers or from prescribing cannabis even when clinically appropriate.

Learning from Road Safety Success

Australia's approach to road safety offers valuable lessons for drug policy. Rather than simply restricting vehicle access, governments have invested in:

• Comprehensive education campaigns
• Infrastructure improvements
• Evidence-based safety measures
• Harm reduction strategies (seatbelts, airbags, safer road design)
• Ongoing research and data collection

A similar approach to addressing overdose deaths might include:

• Evidence-based prescribing guidelines that consider relative risks and benefits
• Investment in research to build the evidence base for alternative treatments
• Education programs for prescribers about safer alternatives
• Harm reduction measures rather than blanket restrictions
• Focus on addressing the medications actually driving overdose statistics

The Path Forward

The medical community and patient advocacy groups may wish to consider whether current regulatory approaches adequately address Australia's overdose crisis. While concerns about appropriate prescribing are legitimate, policy responses should be proportionate to the evidence and focused on reducing overall harm.

Healthcare regulation should aim to provide the safest, most effective treatment for each individual patient. When regulatory guidelines create barriers to potentially beneficial treatments while maintaining easy access to demonstrably harmful ones, they may not serve the interests of patients or public health.

The conversation about medicinal cannabis prescribing could benefit from:

• Developing evidence-based guidelines that consider the risks and benefits of all treatment options
• Supporting research into medicinal cannabis to build the evidence base
• Ensuring that regulatory actions don't inadvertently increase patient harm
• Focusing on education and support for prescribers rather than punitive measures

A Question of Priorities

As Australia continues to grapple with both road safety and overdose deaths, the difference in response is notable. Road deaths receive comprehensive, well-funded, evidence-based interventions focused on harm reduction. Overdose deaths - occurring at twice the rate - often receive regulatory restrictions rather than harm reduction solutions.

The current approach to medicinal cannabis regulation appears to reflect this broader pattern. Rather than focusing on the medications actually driving overdose statistics, regulatory attention is directed toward restricting access to a potentially safer alternative.

This raises important questions about resource allocation, evidence-based policy making, and whether current approaches adequately serve the goal of reducing harm and protecting public health.

The debate over medicinal cannabis regulation should be grounded in evidence, patient outcomes, and a genuine commitment to reducing harm. The current guidance deserves examination in the context of Australia's broader public health priorities and the stark reality of overdose deaths that far exceed our road toll.