The High Cost of Relief: How Medical Cannabis Pricing Leaves Patients Behind
Sarah Chen* winces as she reviews her bank statement. Another $450 gone this month for her medical cannabis prescription—money she can barely afford on her disability pension.
Sarah's one of more than a million Australians now using medicinal cannabis, part of a staggering 5,455% increase since 2019. But while regulatory bodies focus on reining in questionable prescribing practices, patients like Sarah face a different crisis: the prohibitive cost of legal access.
This week, leading health organizations including the Royal Australian College of GPs, the Pharmacy Guild of Australia, the Pharmaceutical Society of Australia, and the Australian Medical Association united to call on the NSW Government to address serious concerns about medicinal cannabis prescribing and dispensing. Their joint letter to NSW Health Minister Ryan Park highlights troubling practices: doctors issuing prescriptions every four minutes, pharmacists dispensing thousands of products daily, and vertically integrated "closed loop" clinics that profit from both prescribing and dispensing.
The health bodies are right to sound the alarm about rogue operators. Evidence shows some clinics circumvent proper procedures, with patients learning the right answers to guarantee a script after brief consultations. One pharmacist dispensed 959,000 cannabis products in a single year. One doctor issued over 17,000 scripts in six months. These statistics paint a picture of an industry prioritizing volume over patient care.
But there's a crucial element missing from this regulatory conversation: why are patients flocking to these questionable clinics in the first place?
For many, it's not just convenience—it's economics. Medical cannabis products in Australia remain expensive, often costing patients hundreds of dollars monthly for conditions ranging from chronic pain to chemotherapy side effects. Unlike many prescription medications, these products receive no Pharmaceutical Benefits Scheme (PBS) subsidy, placing them out of reach for pensioners, low-income workers, and those whose conditions prevent them from working.
The regulatory framework compounds this problem. Of the nearly 1000 unregistered medicinal cannabis products currently available in Australia, none have been assessed for safety, quality, or efficacy by the Therapeutic Goods Administration. Only two products have achieved full TGA registration since legalization nearly a decade ago. This lack of registration means no PBS listing, which means no subsidies for patients who need them most.
The health organizations correctly note that "closed loop" systems—where telehealth prescribers send scripts to their own dispensaries—create perverse financial incentives. These clinics even charge surcharges if patients want to use their regular pharmacy instead. But this vertical integration also allows some operators to offer slightly lower prices through bulk purchasing and direct-to-consumer models, making them attractive to cost-conscious patients despite the fragmented care.
The call for reform raises valid patient safety concerns. Reports of inappropriate prescribing to people with opioid dependence and mental health issues are alarming. One patient who experienced a psychotic episode after receiving medicinal cannabis was then bombarded with messages about obtaining another prescription. Aggressive marketing using names like "Joker Juice" and "Gelato Sherbert" treats Schedule 8 substances like consumer products rather than serious medicines.
The solution proposed by health bodies—routing all prescribing through regular GPs and dispensing through community pharmacies—would certainly improve continuity of care and oversight. Dr. Rebekah Hoffman, RACGP NSW & ACT Chair, emphasized;
"patient care and safety must come ahead of profits."
But without addressing affordability, this reform risks pushing vulnerable patients further to the margins. Those who can't afford higher prices at traditional pharmacies may simply go without treatment, return to inadequate alternatives, or turn to unregulated sources.
Any meaningful reform must balance multiple imperatives: rigorous safety standards, continuity of care, professional oversight, and—critically—patient access. This means:
- Accelerating TGA assessment and registration of quality products
- Creating pathways for PBS subsidy of evidence-based medicinal cannabis treatments
- Ensuring community pharmacies can competitively dispense these products
- Maintaining GP involvement while acknowledging that many traditional doctors remain reluctant to prescribe
- Addressing the evidence gap through properly funded clinical trials
- Exploring home cultivation programs for medical patients
The Home Cultivation Solution
One option conspicuously absent from the Australian debate is medical home cultivation—a model successfully implemented in Canada that could simultaneously address affordability, over-prescribing, and vertical integration concerns.
Under Canada's Access to Cannabis for Medical Purposes Regulations (ACMPR), patients with prescriptions can register with Health Canada to grow their own cannabis, with the number of plants permitted calculated based on their prescribed daily dosage. The formula is straightforward: the higher the prescription in grams per day, the more plants a patient can legally cultivate.
This model offers several advantages for addressing the issues raised in the health bodies' letter:
It eliminates profit-driven over-prescribing. When a doctor knows their patient will be growing their own medicine, there's no financial incentive to prescribe excessive quantities. The patient bears the cultivation effort, creating a natural check on prescription amounts.
It breaks vertical integration. Home cultivation completely removes the closed-loop problem. There's no clinic-owned dispensary, no surcharge for using your regular pharmacy, no financial pipeline from prescriber to product sale. The profit motive that drives questionable clinic practices evaporates.
It dramatically improves affordability. While there are upfront costs for equipment and ongoing costs for electricity and supplies, home cultivation can reduce per-gram costs by 80-90% compared to pharmacy prices. For patients on fixed incomes like Sarah Chen, this could mean the difference between affording treatment and going without.
It encourages appropriate GP involvement. A patient seeking authorization to grow cannabis plants at home would naturally turn to their regular GP who knows their full medical history. This addresses the fragmented care concern where GPs remain unaware their patients are using medicinal cannabis.
It provides quality control transparency. Patients know exactly what they're growing and consuming. No questions about unregistered products or unclear supply chains. The concerns about products named "Joker Juice" become irrelevant.
The Australian context would require careful implementation. Safeguards would be essential: secure cultivation sites, plant count limits tied to legitimate prescriptions, restrictions on sale or diversion, and perhaps mandatory registration with health authorities. The model wouldn't suit every patient—many lack the space, ability, or inclination to cultivate plants. But for those who could and would, it offers a legitimate alternative that serves patient interests rather than corporate profits.
Critics might argue home cultivation risks diversion to the black market. Yet Canada's experience suggests this concern can be managed through proper oversight. And honestly, the current system—with doctors issuing scripts every four minutes and pharmacists dispensing thousands of units daily—hardly represents a bulwark against diversion.
The upcoming TGA review of the safety and regulatory framework for medicinal cannabis presents an opportunity to get this right. The explosive growth from 18,000 to over one million users in five years demonstrates genuine patient need. These aren't all people gaming the system—many are desperately seeking relief from debilitating conditions.
Sarah Chen shouldn't have to choose between questionable online clinics and going without treatment. Nor should she face financial hardship to access medicine that improves her quality of life.
Perhaps with a medical prescription and registration, she could legally grow her own plants—eliminating both the exploitation and the financial burden.
As regulators crack down on rogue operators—and they should—they must ensure the system that replaces this wild west doesn't simply price out the patients who need help most.
The conversation about medicinal cannabis in Australia has matured beyond whether these products should be available. Now we must ensure they're available safely, appropriately, and affordably. Home cultivation for medical purposes deserves serious consideration as part of that solution. It's worked in Canada. It could work here.
Anything less fails the million-plus Australians who have turned to these medicines, often as a last resort.
*Sarah Chen is not a real patient name. Privacy is important.