Ninety patients a day: Telehealth tick-and-flick cannabis scripts under fire

One Australian doctor prescribed cannabis scripts to 12,000 patients in one six-month period, the health watchdog says, as concerns are raised about the quality of telehealth appointments at the heart of the booming cannabis industry

The doctor’s feat – which amounts to prescribing cannabis to 90 patients a day in a typical working week – was an extreme example of what critics say is a business rather than a healthcare-driven approach from too many of the nearly 3000 approved providers in Australia.

In July, the Australian Health Practitioner Regulation Agency (AHPRA) launched a special “rapid regulatory response unit” to look at medicinal cannabis, alongside other surging lifestyle-led industries.

On Friday, the body said it had now uncovered some stark examples of doctors and nurse practitioners prescribing large amounts of cannabis to patients.

“We have evidence of significant prescribing volumes by medical practitioners and nurse practitioners,” a spokesman said. “In one example a single medical practitioner appears to have prescribed Category 5 [THC > 98% of cannabinoids] dried herb products to almost 12,000 patients in a six-month period.”

The half-billion-dollar industry began with legalisation in 2016, roaring into life in 2020 when the pandemic saw telehealth come to the fore. Any Australian with a medical script for chronic pain, anxiety, sleep issues or a range of other reasons can now get high-THC concentrate cannabis for smoking, vaping, taking as an oil, or as gummies home-delivered via an online cannabis clinic.

An investigation into the nation’s medicinal cannabis sector has raised serious concerns about the level of regulation, medical ethics and risks to consumers in the industry.

The investigation has also found jobs advertisements online from telehealth companies seeking GPs who can prescribe cannabis offering significant sums for doctors.

The advertisements promote wages of between $120 an hour at the lowest end, up to $350 an hour as the top rate for a doctor in a private cannabis practice willing to prescribe via telehealth.

Nicole Higgins, national president of the Royal Australian College of General Practitioners, said GPs working in cannabis telehealth clinics “is not a good use of their medical training”.

“We need these doctors out in the community using their generalist skills, not working in single-issue companies,” Higgins said.

“But these companies have made it very lucrative, and it’s much easier than being a GP working in patient care in the community. General practice struggles to compete with the pay on offer from these private telehealth companies.”

She said cannabis telehealth clinics offered access to only that one drug and were heavily marketed.

“It’s being used a sales opportunity not healthcare,” Higgins said.

Medicinal Cannabis Industry Australia executive officer Patty Holmes says telehealth plays an important role for patients unable to visit a doctor because of geographic, financial or mental health issues, “and when conducted properly, provide a reliable patient access pathway to medical care”.

“Unfortunately, some clinics used asynchronous web-based tools in the guise of telehealth, meaning that the patient had a text message ‘consultation’ with the healthcare practitioner, which is not good clinical practice,” she said.

AHPRA recently updated its telehealth guidelines for practitioners to ensure there are real-time consultations.

Ethical health practitioners have voiced concerns about the behaviour of some in the industry, and warn the sector must perform better if the drug is to achieve acceptance as a legitimate medicine.

Phoebe Macleod, managing director of Heyday Medical, started her business in 2020 with her GP brother Jim Connell after the pair saw their mother die with pancreatic cancer. A cannabis-centred treatment plan gave her respite and quality of life alongside her intensive chemotherapy treatment.

Heyday now has 7000 patients and focuses on the medical relationship with these patients. Macleod says she has seen the shift in public perception around this once heavily stigmatised drug.

She said many patients “have had very limited exposure to [cannabis] in their lifetime. Many of them are at the end of their tether with conventional treatments and are looking for an outside-the-box solution”.

“We are not a ‘tick-and-flick’ clinic, nor do we believe there is a place for such models in Australia,” said Macleod, who wants cannabis medicine to be complementary to mainstream healthcare, not a substitute.

Macleod’s GP brother Jim Connell is one of the country’s best-known and respected medicinal cannabis specialists.

When he started talking to the big players in the cannabis industry at the time about how this medicine could be better adapted to treat patients, he found “they all came from a business, marketing, IT and financial sort of background. There was no one actually from the health sector in these medical cannabis companies.”

Connell says Australia is in an excellent position to become the world standard for cannabis prescribing internationally.

“Even though we have these potentially bad players in Australia [in the cannabis industry] – doctors who are providing inadequate education to their patients – Australia probably has the most robust and safest medical cannabis program in the world.”

As part of the investigation into the industry, this masthead on Sunday revealed the sector’s biggest player, Montu, faced action from the Therapeutic Goods Administration over its marketing of medicinal cannabis. That case is due back in the Federal Court on Monday.

Montu is not connected to the doctor AHPRA says prescribed scripts to 12,000 patients in six months.

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