Medical cannabis has huge potential if kinks can be worked out
Technically, medical cannabis has been legal in Australia for more than three years now. Ask growers and many patients seeking prescriptions, however, and you might not know it. Australia aims to be the world’s top exporter of medical cannabis, but it’s hard to come by domestically. The number of approved patients has been steadily increasing since the introduction of the single application in March 2018 allowed people to apply for a prescription for any medical condition. The new world of legalised cannabis presents a huge business opportunity, the chance for much sought-after relief for the sick, and a coming to terms with social stigmas about drug use.
‘The Hurdles Are Still in Place’
Whilst medical cannabis is legal, it’s not something you can buy over the counter. You need a prescription. As of Jan. 31, there were 54 doctors in all of Australia registered as approved prescribers. More doctors are approved through the Therapeutic Goods Administration’s Special Access Scheme, but it is a lengthy process that approves individual patients on a case-by-case basis and can take years. As one might suspect, that makes it difficult for prescription-seekers to get medicine.
“The hurdles are still in place,” Bastian Seidel, president of the Royal College of GPs, told the ABC last July. “It is frustrating for us because medicinal cannabis might be an option of last resort for patients where we’ve tried absolutely everything in the book. Certainly, this is not what patients expect. That’s not what should be in place when it comes to medicinal cannabis.”
Even after legalisation, patients have been leaving the country for places such as Canada and the US, where acquiring medicine is an easier process to navigate. Stephen Taylor of Winmalee, NSW, pleaded guilty to cultivation for growing and juicing cannabis to treat his daughters’ Crohn’s disease. Though no conviction was recorded or jail time served, he told the ABC he was considering taking his family to the US for treatment. Iain McGregor, a psychopharmacologist at the Lambert Initiative For Cannabinoid Therapeutics at Sydney University thinks there are 100,000 people in the country self-medicating.
One obstacle to societal acceptance of medical cannabis has been traditional negative attitudes toward cannabis use and misunderstanding of the different properties of the plant. Tetrahydrocannabinol (THC) is the main psychoactive property that produces the “high” associated with smoking, but it is just one of 113 known cannabinoids. Cannabidiol (CBD), which is not psychoactive, is used to treat a variety of maladies. Hemp seed, from a strain of cannabis that is low in THC, has been legal as a food ingredient since late 2017, and is thought to have many health benefits.
Taylor was growing cannabis for juicing. McGregor told the ABC juicing “gives a very different cannabinoid profile than smoking cannabis.”
“In many ways, juicing is a positive thing to do because you don’t get nearly as much of the intoxicating element, which is THC, and you get another component of cannabinoid, which is THCA (tetrahydocannabinolic acid), which has very strong anti-inflammatory properties in the gut,” he said. “Proper clinical trials on THCA have not been done and this is one of the generic problems that we have with medicinal cannabis. This prohibition that we have over the years is really stymieing progress in terms of learning the therapeutic effects of the plant.”
The Therapeutic Goods Administration has found that CBD products can reduce seizures in epileptic children by up to 50 per cent. It reported CBD showed a “low to moderate” effect on pain in multiple sclerosis sufferers. Proponents of CBD, commonly taken in the form of oil, say it is a safe alternative to opioids. NSW resident Simon Sweeting used to take 10-15 pills daily for chronic pain. After getting a prescription for CBD oil, Sweeting is pain-free. “I take the oil daily, orally in a liquid form that tastes a bit like grapeseed oil,” he told the Australian Associated Press. “It’s changed my life.”
A four-year University of NSW study on non-cancer pain patients that wrapped in 2018 concluded that cannabis was less likely than opioids to reduce pain and anxiety. Interestingly, whilst the patients treating their pain with cannabis reported higher levels of pain anxiety than opioid users did, the cannabis patients said they thought it was effective. The scientists conducting the study said that may be because cannabis helps people sleep, which is key to overall health. “Chronic non-cancer pain is a complex problem,” Dr. Gabrielle Campbell, the lead author of the study, said. “For most people, there is unlikely to be a single effective treatment.”
Paula Vam Vas began taking CBD oil after tearing the meniscus in her right knee. “It was really painful, and the option my doctor gave was (Panadeine) Forte and other opiates for the pain and for sleeping,” she told the ABC. “Until I took (the oil), I wasn’t convinced that it was going to work … it hurt so bad. But it put me to sleep, while I was asleep the pain stopped, and during the day I took it at different times when I could feel the pain coming on and it gave me really good relief.”
Researchers agree that cannabis’ effectiveness on various diseases merits more study. “In many cases the TGA guidelines state that good quality evidence has not been done in a particular area,” McGregor said. “That’s a very different outcome to good quality studies have been done and cannabis was ineffective.”
Growing and Growing
Little Green Pharma became the first Australian grower producing medical cannabis for domestic patients. Co-founder Fleta Solomon told the ABC the company was selling at a loss in hopes of turning a profit when more patients are approved. It and Medifarm hope that being domestic producers they will be able to lower the high costs approved patients currently face as the vast majority of product is imported. MYM Australia is opening a 50-hectare cultivation facility in New South Wales and anticipates expanding in the near future.
Whilst domestic sales have been slow going, health minister Greg Hunt sees exports as a way for Australian growers to flourish. “By helping the domestic manufacturers to expand, this, in turn, helps to ensure an ongoing supply of medicinal cannabis products here in Australia,” Hunt said in a statement last year when exports were legalised.
Althea is amongst the companies doing just that, partnering with Aphria to supply products for a market of nearly 3 million patients in the UK. “The UK government’s positive regulatory change represents another major milestone in the advancement of medical cannabis around the world,” said Althea CEO Josh Fegan, whose company has about a 20 per cent share of the Australian market.
Since the introduction of the single application just over a year ago, the number of patients approved has steadily risen. The Special Access Scheme had seen around 3,500 patients approved, with another 500 or so receiving medicine through authorised prescribers as of late February. New Frontier Data expects an exponential rise as GPs become more familiar with the process and legal hurdles are flattened, predicting there will be 330,000 medical cannabis patients in Australia by 2025.
“The key now is to apply further pressure on global pricing — achieved by driving the right economies of scale with producers, suppliers, and manufacturers,” Michael Horsfall, president & CEO of PUF Ventures Australia and Terra Hemp Co., told Marijuana Business Daily.
Prohibition Partners valued the Australian medical cannabis market at $17.7 million annually last year but expects that figure to rise to $1.2 billion by 2024 and $3 billion by 2028. Should recreational use be legalised, that market would be worth nearly $9 billion annually, Prohibition Partners estimated. Public pressure for legal recreational use in Australia could easily mount if a referendum on recreational use in New Zealand passes next year.