Australian Senate Committee tables recommendations from inquiry into barriers to medical cannabis
The Community Affairs and References Committee tabled their report today (25/3/20) on the inquiry into barriers to medical cannabis patient access in Australia.
The committee came up with 20 Recommendations. Some are more interesting and relevant (in our opinion) than others so we won’t be addressing each one. The full report with all 20 recommendations is available to download here and is worth a read.
Recommendations 1-4 and recommendation 6 relate to education and information resources for medical doctors and they are very encouraging. For example, the Committee has recommended that education on the endocannabinoid system and medical cannabis products be made a compulsory part of medical school curricula.
Also of note is the recommendation that the AMA, RACGP, and other specialist bodies develop cannabis-specific educational and public awareness programs to increase the knowledge of doctors and reduce the stigma associated with medical cannabis. It’s also recommended that the Department of Health chip in to help pay for doctor education on cannabis medicines. This was something that Tony Bartone AMA President, expressed support for during the public hearings.
Patient access regulation
Recommendation 5 is worth restating in full:
“The committee recommends that, if after 12 months from the tabling of this report the Commonwealth Government through the Therapeutic Goods Administration has failed to address the barriers to appropriate, regulated patient access to medicinal cannabis in Australia, a new Independent Regulator be considered, using the Regulator of Medicinal Cannabis Bill 2014 as a basis.”
You could almost lift a perfect copy of Richard Di Natale’s fingerprint from this paragraph, and it’s the clearest example of the Greens’ influence in this Committee. It’s also a good example of how we should be framing these recommendations: as just that. There is, for better or worse, no force in law requiring anyone to action any of these requests.
Recommendations 8 and 9 included some quite practical suggestions for improving the current patient access scheme, including allowing SASB applicants to be approved for multiple products within the same approval; and/or allowing a SASB approval to cover all cannabis medicines, as opposed to specific products. However these changes are deceptively simple and would possibly require a change in legislation.
At the public hearings, many witnesses explained that the TGA requires patients to have exhausted all conventional treatments before attempting medical cannabis. Yet representatives from the Department of Health claimed this interpretation was not accurate, and that cannabis need not be a ‘last line’ therapy. The TGA’s own website says:
“It is expected that the prescribing health practitioner will have considered all appropriate treatment options that are included on the ARTG and available in Australia prior to considering accessing an unapproved good under the SAS for their patient(s).”
Recommendation 7 calls for this to be clarified as there is clearly much confusion about the clinical justifications required for a SASB approval.
And Tasmania was appropriately singled out in Recommendation 11 for being the only Australian jurisdiction to not sign up to the medical cannabis SASB approval system. It’s hard to imagine what else needs to be done to convince Tasmanian politicians to change their minds.
Recommendation 10 is that the COAG Health Council develop a national framework for medical cannabis to better harmonise access schemes, which would be a tremendous idea.
Other Recommendations include supporting the WHO ECDD recommendations about amending international drug laws (Rec. 16); looking into a Commonwealth compassionate access scheme and encouraging States/Territories to implement and/or expand existing compassionate access schemes (Rec. 19); and reviewing, via COAG, State/Territory criminal law regarding personal possession for legitimate medical use and driving laws (Rec. 20).
Once again, these may seem like heroic victories for medical cannabis folks (the government says we should expand compassionate access schemes!), but it’s important to remember these are the recommendations of one Senate committee. They do not (currently) reflect the position of the current Government, nor the opposition. Shining a light on these issues is a necessary first step but none of the recommendations in this report are a done deal.
There were two pricing related proposals that are worth unpacking further. First, Recommendation 17, regarding Medicare rebates for doctor visits.
In 2018, a Committee within the Medicare Benefits Scheme recommended that visits to the GP which last an hour should attract a specific rebate to ensure doctors can take the time to consult with complex care patients. This recommendation is being considered and a decision should be made mid-2020.
If approved, this could be transformative for medical cannabis patients, as doctors who are interested but time poor would not be financially penalised for taking the time required to consider cannabis medicines.
The second pricing-related proposal is Recommendation 18, which encourages peak industry bodies (the MCC and MCIA) to coordinate with members to develop compassionate pricing models for special case patients. This is currently occurring in an uncoordinated way, with product companies making individual decisions about patient eligibility for compassionate pricing. This would be a wonderful way to build industry solidarity and help the most vulnerable. The execution would be devilishly hard, but the pay-off would, we believe, be worth it.
FreshLeaf Analytics, a division of Southern Cannabis Holdings, is the leading supplier of data about the medicinal cannabis industry in Australia. We have access to medicinal cannabis product, pricing and clinical data sets from some of Australia’s leading healthcare companies and organizations including healthcare clinics, pharmacies, product suppliers and the TGA. The FreshLeaf Analytics team provides custom research, analysis and consulting services in the Medicinal Cannabis market in Australia. The FreshLeaf Analytics team can be contacted on +61 2 8203 8741 or firstname.lastname@example.org