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Buying legal marijuana is as easy as picking up the phone. Here’s how I did it

Top-quality legal cannabis can be in your letterbox within days. And prescriptions have soared by almost 4000 per cent.

Australian Natural Therapeutics Group CEO Matthew Cantelo among marijuana plants in NSW. JANIE BARRETT

Australians’ use of medicinal cannabis is surging, driven by easy over-the-phone prescriptions and products that are better quality, more reliable and cheaper than the illegal “green” market.

In 2018, there were fewer than 3000 prescriptions. Last year, more than 120,000 were issued, federal government data shows, mostly for chronic pain, anxiety and sleep disorders, but also for cancer, ADHD and migraines.

Yet as the industry evolves, even its most ardent supporters say it has a long way to go. It is hampered by issues ranging from driving prohibitions, cost and lingering stigma, to a lack of rigorous evidence, scepticism from the medical community, and concerns about cowboy prescribers who have a financial interest in giving it to patients too easily.

Medical cannabis prescriptions

The loose approach by some medical clinics is also raising suspicions of a booming de-facto recreational market; the biggest growth in prescriptions since 2020 has been high THC plant products for men aged between 18 and 31, traditionally the stoner demographic. “This isn’t Amsterdam, mate,” one doctor said in response to the subset of his patients seeking boutique products.

Users swear by the medical benefits of cannabis.

Cannabis flowers are often prescribed through a telehealth consultation. JANIE BARRETT

Surfing used to leave former rugby league player Andrew Johns feeling like the tin man from The Wizard of Oz. Injuries from his footy days left him unable to run for the best part of 10 years. Sleep eluded him, too. “My pain in my neck would drive me crazy, I’d be so locked up and stiff,” he says.

Now he can run around the park and kick a football with his son. He gets eight to nine hours of sleep a night. “I’m back exercising,” he tells The Sydney Morning Herald andThe Age. “I’m living.”

Since he began using an oil product 18 months ago, Johns says he has “hardly had an inflammatory”. Other former footballers are using it too. “One in his 60s, a well-known guy, who’s had a lot of arthritic problems, said, ‘mate, I’m back walking’.”

I’m back walking’: Rugby league Immortal Andrew Johns credits medicinal marijuana with his recovery from injuries. NRL PHOTOS

Sydney-based 24-year-old Ash Richardson uses it in flower form – she vapes it – to help her post-traumatic stress disorder. “You don’t get high, you get normal,” she says. “I am able to get out of bed, run an organisation, leave my house.”

Obtaining a prescription for medicinal cannabis is easy. I know because I got one. At 10am one Tuesday, I did an internet search for “authorised cannabis prescribers in Sydney”. Four hours later, I was in a consultation room talking about whether I should use it for insomnia.

The doctor was thorough. He required my medical history. We discussed alternatives at length, which I’d already tried. We also discussed risks; for me, being picked up in a random drug driving test was chief among them. There is no legal exemption for cannabis, as there is for other medication.

Ash Richardson uses cannabis to combat the effects of PTSD and insomnia. JANIE BARRETT

He also talked me through the dizzying array of products on the market, mostly in oil or flower form, and told me that if I had been under 25, he would not have given me a prescription due to concerns that young brains are still developing. I signed a declaration that I had been informed of the risks.

Then he gave me a prescription for an oil containing equal but low amounts of cannabidiol, or CBD, which does not cause a high, and tetrahydrocannabinol, or THC, which does. A balance of the two - which flower products can’t achieve - reduces the effect of THC.

As a so-called authorised prescriber, his scripts do not need to go through the Therapeutic Goods Administration (TGA) as other doctors’ do (there were 430 like him nationwide at the end of last year). I went to the website, uploaded the documents, and paid $90 for 30ml over the phone. It arrived a few days later.

The three questions a cannabis clinic will ask you:

1).Do you suffer from a chronic health condition that has lasted more than three months?

2).Have you tried conventional treatments for your condition?

3).Do you reside in Australia?

A colleague, also struggling with his sleep, was inspired to try, too. He went through an online clinic that specialises in cannabis prescriptions, with around-the-clock access to a GP via a toll-free number. He was told that if he got a prescription, the clinic could also fill it, or he could find his own chemist.

Over a phone call, he discussed his symptoms with a doctor, who prescribed THC oil. He used the in-house chemist.

He was not required to provide a medical history; all the information he gave was voluntary. The all-THC product arrived within three days. He didn’t have to leave his house.

My experience was gold standard. My colleague’s wasn’t. Experiences such as his have raised concerns that obtaining prescriptions for medicinal cannabis can be too easy.

Lucy Haslam and her husband, a former drug squad officer, became advocates for medicinal cannabis after watching it help their son during his cancer treatment. But she fears patients are not getting “the best level of care” under the online clinic model.

“I’ve heard of patients that have gone to clinics and walked away with six or seven or eight products after very little clinical evaluation,” she says. “They’ve spent more money than they’ve needed to, they’ve been prescribed things they don’t need, and it’s cost them a small fortune.”

Medicinal marijuana campaigner Lucy Haslam. PETER RAE

There are also concerns some clinics have a profit motive; because they also have a pharmacy licence, they claim the doctor’s consult fee and the chemist’s mark-up on the product. Some doctors prescribe products in which the clinic they work for has a financial interest.

Medicinal cannabis by numbers

Active patients: from near-zero in 2018 to more than 100,000 in 2021. An estimated 670,000 are predicted by 2030.

Market value: $230 million in 2021, forecast to exceed $400m in 2022.

Production: Australia could need 147,000kg of dried plant matter by 2030.

Ailments: Pain (63.23 per cent), anxiety (14.03), insomnia (5.11 per cent)

Source: FreshLeaf analytics, TGA

“[A system in which clinics] have a vested commercial interest in a product they’re prescribing is going to be fraught with danger,” Haslam says. “That gives the industry a bad reputation, particularly when you’re trying to get conservative medical practitioners on board. They think it’s just a bunch of cowboys, and are reluctant to get involved.”

A medical specialist, speaking on condition of anonymity, says, “if you are feeling lethargic you don’t go to a thyroid dispensary clinic, you go to your GP. Not everyone needs medical cannabis - 50 per cent of people should be told they don’t need it. That is not happening.”In a statement, the TGA said it had not turned down a prescription application since August 2020. Between 2015 and 2020, seven were refused. There is no data on how many doctors refused to write scripts. "Medico-legal responsibility for prescribing an unapproved product rests with the prescriber," it said.

Flower powerIain McGregor, the academic director of Sydney University’s Lambert Initiative for Cannabinoid Therapeutics, says most clinics are doing a good job, but there are pockets of inappropriate prescribing.“The [TGA] doesn’t quite have the mechanisms in place to deal with that,” he says. “I don’t think we’re at the point where we need to shut the system down because of unscrupulous individuals, but there are legitimate concerns about what’s going on.”

The first company to start producing cannabis oil will have an advantage in the highly lucrative market. JANIE BARRETT

The lack of medical rigour among some clinics is also fuelling suspicions that recreational users are now obtaining their cannabis through doctors.

The rise in popularity of flower products backs the theory. While oil products can have equal mixes of THC and CBD, which balances the intoxicating effect of THC – allowing users to, as one doctor put it, “hold down a job and look after kids” – flower products have a ratio of about five parts THC to one of CBD.

In mid-September, ASX-listed cannabis producer Althea said dried flower was the fastest-growing category in the country and now made up half the market. “The dried flower market is primarily [driven] by highly-concentrated THC product,” it said in a statement to the stock exchange

A report from FreshLeaf analytics found that by the third quarter of 2021, medicinal flower was cheaper per gram than so-called “green market” flower.

In an interview with Cannabiz magazine, Byron Bay doctor Jamie Rickcord said the word was out “that medical stuff is far superior and many people want access to it. They are using a medical condition to get legal access to the best flower they have ever seen.

“People say I want to try the Blueberry Haze or the Purple Haze or whatever and I’m like, bollocks, this isn’t Amsterdam, mate ... THC is an amazing compound and a fabulous medicine, but it’s not there to get us all stoned.”

Some argue chasing prescriptions for recreational use undermines the medical legitimacy of the drug. It’s not what the TGA had in mind when, back in 2016, it created a system under which it would approve applications from doctors.

But others say it’s not a bad thing; at least these users, who may have been self-medicating conditions such as anxiety with illegal products, have some kind of medical oversight. “You have people getting a quality-assured product, they’re getting secured supply, although some of the consultations may not be great, and they’re at least seeing a medical health professional,” says McGregor.

On Tuesday, the TGA issued 73 infringement notices worth almost $1 million to three medical cannabis companies, including Cannatrek, for promoting prescription-only products. Some of the advertising also allegedly referred to the treatment of serious illnesses and implied that particular products were recommended by a government authority.

Cannabis is placed inside a vape. JANIE BARRETT

Ash Richardson, who runs pro-legalisation lobby group Green Revolution Australia, suffered abuse as a child, and used to self-medicate with cannabis before she sought out a prescription for the medical version in 2020 for her PTSD (it’s also used by war veterans with the same condition).

She vapes the Sativa species, “the less couch-cooked kind”, in the morning, and the Indica species at night. “I was having really severe flashbacks and panic attacks for a long time before I started using medical cannabis,” she says. “I haven’t had a panic attack in about seven months. It certainly helps with anxiety.”

The Age and Herald spoke to many people about their cannabis use; Richardson and Johns were the only ones willing to speak on the record, although the late Olivia Newton-John, who used it for cancer, and basketballer Lauren Jackson, who used it for pain management, have also been open about it.

“In this society, it’s still people being scared of the repercussions of their job, their family, the driving laws,” Richardson says.

The containers dried buds are stored in. JANIE BARRETT

Medical cannabis is what’s known as an unregistered medicine, which means that, despite the many users who swear by its benefits, its efficacy has not been proven through robust medical tests.

Telehealth turbocharge

There are a few reasons for the rapid growth in cannabis prescriptions from 2020, but the biggest one is the telehealth revolution driven by COVID-19. Previously, people had gone to GPs, most of whom didn’t know much about it or didn’t trust it as a drug.

“Telehealth allowed people to find a prescriber who is motivated to consider medical cannabis,” says Rhys Cohen, an industry expert, speaking on behalf of Medicinal Cannabis Industry Australia. “It’s easier to do that by Googling ‘cannabis doctor’ rather than cycling through various GPs in the community.”

It’s expensive, but the costs are slowly falling. A FreshLeaf Analytics report found the average monthly spend by patients has fallen from more than $400 a month in the first quarter of 2020 to $278 a month in the third quarter of 2021, even as the average dose increased.

There’s no Pharmaceutical Benefits Scheme subsidy for the vast majority of its uses, but there is for multiple sclerosis and for a form of paediatric epilepsy; the Department of Veterans Affairs will also subsidise it for pain, and some private health insurers give rebates.

Technically, products with low doses of cannabinoid oil can now be sold in Australian pharmacies but there are still none available on shelves because, unlike vitamin products, the manufacturer must supply robust evidence that it works.

It’s more expensive than other drugs, yet the rules around growing and manufacturing are so stringent that most of the growers and manufacturers that have sprung up in Australia are yet to make a profit. Imports are cheaper. Share prices are tanking.

You’ve got a bizarre situation in which you can grow opium poppies behind a farm fence, but if you grow cannabis you need [secure] facilities and dogs,” says McGregor. “Perhaps in retrospect it was a bit too demanding, the restrictions on cultivation. If they could grow a crop the way they could soybeans or maze, it might make the industry more financially viable.”

Next year, new laws will require imported products to meet the same manufacturing standards as local ones, which the industry hopes will create a level playing field for local products, even though questions remain about how the laws will be policed.

Despite Harmer’s reservations about the industry, she still believes in the product. “People are sticking with it despite the high costs, you don’t do that if it’s not working,” she says. “More and more doctors are becoming strong advocates.”

Pain specialist Professor Marc Russo is a convert. He saw the benefits for people with neuropathic pain (caused by nerve damage). “I wasn’t able to ignore the evidence in front of my eyes on these patients,” he says.While it does not seem to diminish the pain much, Russo says it helps their sleep and “also appears to decrease patient distress whilst leaving them quite clear-headed and cognitively intact”.

Unless Australia legalises recreational use, the key to the future of a viable, respected medicinal cannabis industry is research. Only hard evidence will win over cautious general practitioners and get CBD oil onto chemists’ shelves.

Much of the research is coming out of the Lambert Initiative for Cannabinoid Therapeutics at the University of Sydney. Dozens of trials have begun since 2016, including high doses of cannabidiol for spinal cord injury pain, if cannabis can ease anxiety linked to anorexia, and how different combinations help sleep.

The Lambert Initiative is also investigating the effectiveness of some other compounds found in the cannabis plant, such as cannabinol or CBN, a form of non-intoxicating aged THC, for sleep, and cannabigerol (CBG), derived from younger plants, for osteoarthritis.

It’s in the industry’s interest to participate in research, where it can afford to.

However, if cannabis becomes legal, that interest could fade. “What you’ve seen in Canada since 2018, when they legalised recreational use, is that a lot of the companies just exited [research and development],” says McGregor. “We have to be careful about that.” The legalisation in Canada has also led to about $CAD15 billion ($16.8 billion) worth of taxes.

My bottle of cannabis oil sat locked in the medicine cabinet until I was game to try it. One night when I had no need to drive the next day and no responsibility for children, I measured 2ml in a dropper and tasted that distinctive flavour under my tongue.

There was no intoxication. I slept beautifully for half the night then woke up at 4am unable to get back to sleep. On a few more occasions, the same thing happened. Medical cannabis dosing is an inexact science; as the doctor warned me, it takes a while to work out what works.

For me, messing about with dosage was not worth the potential downsides, such as putting my driver’s licence at risk.

I’ll wait for a while, perhaps for a time which Cohen hopes is not too far away, when medical cannabis is accepted to the level that it is boring and “there are evidence-based medicines that are registered, that are proven, and doctors can consider them like any other medicine”.

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