A few pharmacies around the country have been scrambling lately to replace a doctor who has been banned from prescribing cannabis by the Medical Board of Australia.
The doctor, Justin Welsh, is appealing against the decision, which he describes as “totally disproportionate”, and the ban is set to be reviewed today. It was apparently triggered by Western Australia’s chief pharmacist raising concerns that Welsh had exceeded the state’s 30 gram per month limit.
Some chemists I know have had to ring hundreds of customers to move them to a new prescriber so their prescriptions remain valid.
You see, Welsh only prescribes cannabis. He told The Age: “This year alone, I have written 14,711 prescriptions. That’s 102,977 cannabis products worth an estimated $9,782,815 to the cannabis industry.”
That’s about 65 scripts a day, which is good, steady cash flow. You can see why pharmacies are keen to replace him.
How does he write so many? Telehealth.
Welsh is, or was, one of a band of specialist telehealth cannabis prescribers and clinics that are part of a very efficient, very profitable $1 billion a year cannabis supply chain that has materialised since the drug was legalised for medicinal use by the Coalition government in 2016.
Most of it is being imported from Canada for some reason.
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A source of revenue
The system of legalised dope dealing has become so efficient and lucrative, that a growing number of pharmacies have come to rely on the revenue from it, and the Australian Medical Association, the Pharmacy Guild, the Therapeutic Goods Administration and the Labor government are alarmed about it.
But they don’t really know what to do.
Well, the AMA and Pharmacy Guild know — they want it to be controlled like other prescription medicines, instead of through the “special access regime” established by the Coalition in 2016 that allows cannabis to be prescribed by GPs and supplied by pharmacies without having gone through the usual trials to establish quality, safety and efficacy.
The non-profit drug research and advocacy group the Penington Institute, on the other hand, says it should be legalised, and has published a 21-point plan to do so, as well as a major report on the Australian cannabis industry late last month.
The problem with treating it like other TGA-approved medicines is that, unlike other medicines, it competes against a well-functioning illegal market, which the Penington Institute estimates is worth $5 billion, and also against customers who can grow their own.
No pharmaceutical company is going to pay for expensive trials knowing it will have to compete against home-grown products and a lot of crooks, and only ever get access to about 15 per cent of the market.
But full legalisation is fraught as well. In a lot of places that have decriminalised it completely, medical bodies are pushing for it to be made illegal again, especially psychiatrists and neurologists.
Also, cannabis is stronger than it was in the 1970s. I remember buying a joint in an Amsterdam cafe a few years ago and smoking it while walking back to the hotel like it was 1975 again. It was so strong that by the time I got there I was catatonically stoned and chundered in the hotel bath. Never again.
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A push for tighter controls
In Australia it’s fair to say the medical establishment is dead against it being legalised and instead wants much tighter controls.
AMA president Danielle McMullen told me in a statement: “We recognise medicinal cannabis can be useful for some patients with specific conditions supported by evidence, such as epilepsy, chemotherapy-induced nausea, or muscle spasticity in multiple sclerosis.”
“However, there is little, or no evidence base for many of the conditions for which it is being prescribed, such as anxiety, insomnia or depression,” Dr McMullen said.
“We welcome the action taken to date by regulators including updated prescribing guidance, but urgent action is needed to ensure medicinal cannabis is prescribed, dispensed and regulated in the same manner as other registered drugs of dependence.”
Pharmacy Guild president Trent Twomey said: “We are seeing a system that is being exploited, with prescriptions issued without proper clinical oversight and patients bypassing their regular GP and pharmacist.”
“What began as a special pathway for medication has now become the norm, with thousands of products prescribed without safety, quality or efficacy controls,” Professor Twomey said.
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Mack trucks through loopholes
Therapeutic Goods Administration chief medical adviser Robyn Langham was more blunt.
In a speech last month, reported by The Age but no longer online, she said: “What’s happened in the last couple of years has been really an abuse of this access pathway. We’re now seeing patterns of recreational access to a drug rather than medical access.”
She said companies were driving “Mack trucks” through the loopholes in the regulations.
In other words, people are getting cannabis through the health system simply to get high.
And why not? You’d be crazy to buy weed of unknown quality from a dodgy dealer if you can spend five minutes on telehealth with a “prescriber”, tell them you’ve got a bit of anxiety, or pain, or can’t sleep, and the pharmacy will deliver it to your door the next day.
Where this is heading from here is hard to tell.
There doesn’t seem to be much political mileage for the government to do anything at all — either to crack down and force cannabis users back onto the black market, or fully legalise it like the Netherlands, Canada and Germany and 24 American states, against an outcry from the nation’s doctors and pharmacies, some of whom, it must be said, have a conflict of interest.
When there’s no political mileage in something, it generally doesn’t happen.
Alan Kohler is finance presenter and columnist on ABC News and he also writes for Intelligent Investor.
