Germany, facing a similar explosion in medicinal cannabis, has now moved to mandate in-person consults before the drug can be prescribed.
The RACGP’s submission to a medicinal cannabis inquiry calls out a lack of ethical guidance and professionalism among some providers, zeroing in on cannabis-only prescribing services just as players like the Pharmacy Guild ramp up their rhetoric.
In a submission to the TGA’s review of the safety and regulatory oversight of unapproved medicinal cannabis products last month, the GP college spoke to an “urgent need to fund the development of living clinical practice guidelines to mitigate the provision of low value and potentially harmful care”.
While acknowledging the need for a robust public health campaign to address “permissive attitudes” toward cannabis in the community, the RACGP submission focussed mainly on the dangers of cannabis-only prescribing services and the broader regulatory environment.
Like the AMA and Pharmacy Guild of Australia submissions before it, the RACGP supported more stringent labelling standards, a two-year transition period to allow medicinal cannabis sponsors to apply for ARTG listing and restrictions on Category 5 THC dominant products.
It took particular aim at single-issue clinics.
“The vertical integration business models used by many direct-to-consumer cannabis companies is highly problematic and must be stopped,” the submission said.
“Prescribing practices must embrace safe prescribing guidelines.”
Australia is not the only country facing down a boom in potentially inappropriate medicinal cannabis prescriptions; since relaxing regulation of the drug in April 2024, imports of medicinal cannabis have increased by more than 400%.
According to Germany’s federal ministry of health, the increase is not attributable to a greater need among seriously ill patients.
German cabinet has now approved an amendment to the Medicinal Cannabis Act that mandates an in-person consult before doctors can write a medicinal cannabis script.
For ongoing prescriptions, in-person consults are required at least once a year.
The so-called “mail-order sale” of medicinal cannabis is now prohibited, with the exception of pharmacy delivery services.
The Pharmacy Guild of Australia believes this could work in Australia.
“Changes in how medicinal cannabis is prescribed and dispensed are overdue,” a guild spokesperson said.
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“We strongly believe there need to be more stringent safeguards in place to ensure patient safety – face to face consultations with a patient’s regular health care practitioner is a way of ensuring patients receive the most appropriate treatment and support.”
RACGP addiction specific interest group chair Dr Hester Wilson told The Medical Republic that the college was less concerned with the method of consultation and more concerned with the way doctors were approaching assessments: “it’s not the tool, it’s how you do it”.
“The issue is not virtual care itself, but the actual business models [where doctors are] … only doing cannabis, short consultations, not liaising with other healthcare providers and not considering the risks and benefits of the cannabis product,” she said.
“To my mind, and maybe it’s different in Germany, but in Australia, if you’re going to say ‘no, you have to have a face-to-face appointment’, that makes it really tricky for people living in rural or regional areas.”
AMA president Dr Danielle McMullen also said that Australia’s geography would likely make a total telehealth medicinal cannabis ban unfeasible.
“Telehealth has, in general terms, been a really fundamental improvement to our healthcare system,” she said.
“But it’s really important that we maintain those professional standards and that our regulators are ready for how we manage this explosion of telehealth, particularly outside of Medicare and the PBS.
“We are not supportive of the widespread prescribing that’s happening at the moment through these online industries, and … regulators need to really consider stricter measures around medicinal cannabis to make sure that it’s safe for the population.”
