Editorial. A Case for Comprehensive Cannabis Reform in Australia.

Australia legalized medical cannabis at the federal level in 2016. This was done through amendments to the Narcotic Drugs Act 1967. Under this framework, cannabis remains a controlled substance. However, authorized medical practitioners are permitted to prescribe cannabis products for therapeutic use.

The Therapeutic Goods Administration (TGA) oversees the regulation of medical cannabis products. They do this through two main schemes: the Special Access Scheme (SAS) and the Authorised Prescriber Scheme.

Three things are very important.

1. Patients need to obtain a valid prescription from an authorized doctor to access medical cannabis.
2. The doctor must believe the treatment is appropriate for the patient's condition.
3. There is no obligation on a doctor to prescribe anything other than what the doctor decides to prescribe. (Patient choice is limited.)

Unsurprisingly, specialized cannabis clinics have emerged in response to the complex access process. These clinics aim to simplify patient access to medical cannabis. Some patients have indeed found it easier to obtain prescriptions through these clinics. However, their rise has also introduced new and significant concerns.

These clinics operate on a profit-driven business model.

This approach often seems to prioritize revenue over patient care. Issues raised include high consultation fees and potential over-prescription. There's also a notable lack of long-term follow-up care in many of the cases you can read in the Australian medical cannabis subreddits.

A major problem is the vertical integration within some clinics. They often have financial ties to specific cannabis producers, importers or distributors. This creates a conflict of interest. Patients complain that doctors only prescribe from a limited range of products that the clinic has an incentive to prescribe.

This practice severely limits patient choice. Patients may not have access to the full spectrum of available options. Some of these other options might better suit their medical needs. This also raises serious ethical questions about the quality of care provided.

Some clinics have faced criticism for operating more like dispensaries than medical practices. There are reports of prescriptions being issued after only brief consultations. These often lack thorough medical assessments. This approach compromises patient safety and the integrity of medical cannabis treatment.

Although it offers some kind of contrast, the conventional GP access model has it's own set of problems.

Many GPs are reluctant to prescribe medical cannabis, and of those that are willing to prescribe it, continue to find the requirements of the scheme to be onerous and take too much time away from other patients. If we look to the regular GPs who do prescribe, they do so from a similarly restricted subset of products as the clinics. More a function of how the conventional system of pharma marketing works than anything else, but it does highlight the issue of a restricted supply and how the current system isn't providing equitable access for patients to products.

Adding to these concerns is the significant financial burden on patients. Most medical cannabis products are not subsidized under the Pharmaceutical Benefits Scheme (PBS). In fact, only one cannabis-derived drug has a PBS listing: Epidyolex. This medication is also only approved for very specific conditions.

For all other medical cannabis products, patients must bear the full cost. This makes treatment with medical cannabis a very expensive exercise, especially when combined with high clinic fees.

The current state of Australia's medical cannabis system raises significant concerns. These include issues of equity and quality of care. The system, despite its intentions, often fails to prioritize patient needs and medical best practices.

There's a clear need for reforms to ensure better patient care, increased product choice, elimination of conflicts of interest, and improved affordability through broader PBS coverage and improved access provisions with home grow and social clubs.

Australia's Medical Cannabis System is Fundamentally Flawed.

Australia's current medical cannabis system, while a step forward from complete prohibition, falls short of meeting the basic human rights and healthcare needs of patients. Drawing parallels with the human rights arguments that shaped Canada's MMAR and ACMPR systems, we can identify several critical flaws in the Australian approach:

1. Right to Health and Appropriate Treatment:
   • Australia's system, with its limited PBS coverage and restricted access, fails to fully recognize patients' right to health and appropriate treatment.
   • Unlike Canada's systems, which evolved to ensure broader access, Australia's approach still treats cannabis as a last-resort option, limiting its potential therapeutic benefits for many patients.
2. Dignity and Autonomy in Healthcare Decisions:
   • The current clinic-dominated model, with its potential conflicts of interest and limited product ranges, infringes on patients' dignity and autonomy in making healthcare decisions.
   • Patients often can't freely choose their treatment options, contrasting with the Canadian approach that emphasized patient choice and self-production rights.
3. Equality and Non-Discrimination:
   • High costs and limited PBS coverage create a two-tiered system where only affluent patients can afford ongoing treatment.
   • This economic barrier to access stands in stark contrast to the principles of equality that underpinned Canada's medical cannabis regulations.
4. Protection from Cruel, Inhuman, or Degrading Treatment:
   • By maintaining high barriers to access, Australia's system potentially subjects patients to unnecessary suffering when effective cannabis treatments are available but inaccessible.
   • This echoes arguments made in Canadian courts about the right to access pain relief and symptom management.
5. Right to Privacy:
   • The current system, with its emphasis on specialized clinics, may compromise patient privacy and confidentiality.
   • Unlike Canada's evolving systems, which increasingly normalized cannabis as a medical treatment, Australia's approach still stigmatizes its use.
6. Freedom from Arbitrary Detention:
   • While medical use is permitted, the narrow access pathways and limited product range may push some patients to access cannabis illicitly, risking criminal penalties.
   • This contrasts with Canada's approach, which recognized the need to protect patients from criminalization.
7. Right to Scientific Progress:
   • The limited range of approved products and restrictive prescription practices hinder patients' rights to benefit from scientific progress in cannabis medicine.
   • Unlike Canada's system, which fostered research and development, Australia's approach may be stifling innovation and limiting patient access to cutting-edge treatments.

These flaws in Australia's medical cannabis system not only mirror the human rights concerns that shaped Canada's more progressive approaches but also highlight issues specific to the Australian context, such as the problems with vertically integrated clinics and limited product ranges. By addressing these fundamental human rights issues, Australia has the opportunity to create a more just, accessible, and effective medical cannabis system that truly serves the needs of patients.