Saturday 16th October 2021
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Medicinal cannabis may finally be entering the mainstream thanks to the TGA down-scheduling CBD, growing acceptance among Australian doctors and support from the global tech giants, according to industry consultancy FreshLeaf Analytics.
In an upbeat H2 2021 report due for release tomorrow (Friday October 15), FreshLeaf will claim down-scheduling repositions cannabis as a ‘medicine of the masses’, while the increase in Authorised Prescribers indicates the GP community is getting the message at last.
Meanwhile, tech behemoths such as Amazon and Apple are taking a stewardship role internationally with the former publicly calling for law reform in the US, while Apple is now allowing in-app sales of cannabis in US states where it is legal.
Industry commentators believe that endorsements from such household — and generally well-regarded — brands will only accelerate acceptance of cannabis both recreationally and as a medicine.
Yet frontline access to cannabis medicine is where the immediate short-term difference is being made, with FreshLeaf citing the increase in Authorised Prescribers as evidence of more widespread acceptance of legal medicinal cannabis among patients and healthcare professionals. The number of active patients is forecast to hit 100,000 by the end of the year.
The rise in numbers is reflected in the financial performance of the sector in Australia, with FreshLeaf increasing its 2021 revenue projection from A$200m to $230m and sales tipped to reach $400m in 2022.
The growing popularity of flower, the move by some cannabis companies into the adjacent psychedelics sectors, and the first over-the-counter CBD products coming on stream are further reasons for optimism in 2022.
According to data released by the TGA, there are now 430 Authorised Prescribers, a three-fold increase on the same month last year and double that of six months ago.
The growth is understood to have been partially fuelled by new streamlined processes that allow Human Research Ethics Committees (HREC) to provide prescribers with endorsements for a broad range of products, although product-specific approval is still required by the TGA.
The total number of cannabis prescribers, which includes those using the Special Access pathway in addition to APs, is also steadily rising. While still only representing a minority of GPs, 2,448 medical practitioners turned to medicinal cannabis in the first nine months of 2021, up from 2,248 during the whole of 2020 and almost double the number in 2019.
Education, education, education
FreshLeaf’s report comes amid ongoing efforts to educate doctors about the possibilities presented by medicinal cannabis. In the latest move to enlighten practitioners, prominent GPs and academics, including Dr Vicki Kotsirilos and the Lambert Initiative’s Iain McGregor, compiled a review of the scientific evidence relating to medicinal cannabis and chronic pain.
The paper, which appears in this month’s Australia Journal of General Practice (AJGP), a title published under licence by the Royal Australian College of General Practitioners (RACGP), notes the doubts raised by specialist pain colleges towards cannabis and accepts that evidence of its efficacy remains mixed.
But it also counters the scepticism by suggesting real-life experiences of patients cannot be ignored.
“Despite the fact that current supportive evidence is of low overall quality, there are tens of thousands of patients with chronic pain being prescribed medicinal cannabis products in Australia, and hundreds of thousands using illicit cannabis products to self-medicate chronic pain,” the authors state. “Many have legitimate lived experiences of lasting pain reduction with cannabis that is not easily disregarded.
“There is clearly a disconnection between the pronouncements of specialist medical colleges and current prescribing and community use of cannabinoids in Australia. It is to be hoped that the results of the next generation of clinical trials of cannabinoid products and pain will help resolve this tension.”
Dr Kotsirilos said that awareness of medicinal cannabis is on the rise.
“There is evidence of a greater demand for GPs to learn more about the role and evidence for medicinal cannabis,” she told Cannabiz. “The explosive rise in TGA SAS-B permits issued over the past year, and rising number of Authorised Prescribers, are a reflection of the important role medicinal cannabis is playing in the potential treatment of our patients for various conditions when all other treatments fail.”
However, Dr Kotsirilos stressed more could be done to ease the administrative burden on prescribers.
“I do believe we can simplify SAS-B permits further across all states of Australia to the current model being used in Queensland, where no S8 permits are required unless the patient has a drug addiction,” she said.
Dr Orit Holtzman, chief medical officer at Compass Lifestyle Clinics and vice president of the Australia and New Zealand College of Cannabinoid Practitioners, agreed that headway is being made in articulating the benefits of medicinal cannabis.
GPs, as well as specialists, appear to be embracing cannabis “more and more”, she said.
“As an educator, the events I facilitate are well attended and our college is thriving,” she said. “As a prescriber, many more patients now have their GP or specialist’s support and in some cases it was on the advice of one of their other doctors that they decided to pursue treatment with medicinal cannabis.
“While some stigma and other barriers such as the driving issue and cost still exist, cannabis is definitely making its way into the mainstream.”
Dr Holtzman echoed FreshLeaf’s assertion that the down scheduling of low-dose CBD will further accelerate widespread acceptance. But she stressed that the medical application of cannabis goes beyond cannabidiol.
“It’s important that both doctors and the public are better educated on the therapeutic role of THC and other cannabinoids as well,” she said. “Medicinal cannabis is not just CBD. Legalising driving for cannabis patients can play a huge role in this.”
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