Only one prescription for medical marijuana has been issued by a doctor in the Northern Territory, according to Minister for Health Natasha Fyles.

In a submission to the Senate inquiry into barriers to patient access to marijuana, Fyles said “a number” of Territorians were going to doctors in other states to get prescriptions.

The minister attributed the low take up to marijuana medications being expensive, saying a six to eight week course can cost over $750, limited evidence so far for its use in successfully treating different medical conditions or on effective dosages, a lack of doctors registered to prescribe, and the ease of access to illegal marijuana.

The Northern Territory example mirrors many of the comments being sent to the inquiry, which is codifying complaints that have lingered around the sector since its inception in 2016.

The Medical Cannabis Users Association (MCUA) notes that almost four years since medical cannabis was legalised, there are still no Australian grown and manufactured products regularly or readily available to Australian patients at affordable prices.

While there has been some limited local growing and manufacturing, Cann Group (ASX:CAN) and its partner IDT Australia (ASX:IDT) are the first companies to start making products at commercial scale and from a variety of different plants, and those products aren’t due on the market until late March.

Cost of consultations and the high cost of the products were problems. The MCUA quoted feedback from a patient who worked out the total cost of accessing and buying the products they needed for a month to be about $4000.

The MCUA said finding doctors who would prescribe was also a major issue.

“Without any warning or training, doctors suddenly found themselves as the ‘gate keepers’ to a drug that many had been telling patients for decades was dangerous, addictive, illegal and caused mental health issues,” the MCUA said in its submission.

“Concerns were raised about being known as the Pot Doctor and being inundated with ‘pot smoking hippies’.”


Why are there so few registered drugs?

While clinical trials are being undertaken now, including in Australia by companies like Medlab Clinical (ASX:MDC) into cancer pain and Zelira Therapeutics (ASX:ZLD) into insomnia, opioid use reduction and autism, there is still very little scientifically-accepted evidence for what marijuana can actually do.

LeafCann, a private company led by Elisabetta Faenza, says the biggest barrier towards registration of medicinal cannabis products is the fact they are more difficult to patent.

Companies are unwilling to spend millions of dollars on clinical trials if they can’t patent the end result, hence why businesses like Botanix (ASX:BOT) are using synthetic versions of cannabinoids in formulations that can be patented.

“One option is to develop a category for medicinal cannabis in which the burden of clinic trials is not as onerous, given the safe history of use,” LeafCann said.

“The industry is prepared to work with the TGA towards a solution for ensuring safe, effective medicines can be registered while at the same time ensuring sub-par products do not enter the system.”


By the (Ministry’s) numbers

By the end of December 2019, the Office of Drug Control (ODC) had issued 100 licences to grow marijuana and manufacture products, of which 92 were “currently in effect”, the Ministry of Health said in its submission to the inquiry.

This includes 31 growing licences, 20 for research, and 41 for manufacturing. Licence holders are, collectively, authorised to annually produce more than 35,000kg of dry flower.

However, lobby group Medical Cannabis Industry Australia says delays and inefficiencies in the processes to access licences and permits is not only hindering patient access, but hurting consumer confidence in the industry.

Ministry data shows a total of approximately 30,000 approvals to access medicinal cannabis products have been written in Australia to the end of 2019, and about 70,000 prescriptions written in Australia.

However, those numbers do not reflect prescriptions written but not filled, and some approvals are for more than one product for the same patient or for product changes, where the original product prescribed wasn’t available.

More than 18,000 patients have been approved to access medicinal cannabis products and more than 1400 individual medical practitioners, in every state and territory, have received approvals to prescribed medicinal cannabis to treat more than 130 different medical conditions, the Ministry said.

“While most prescriptions so far have been written for unapproved products, the government’s ultimate goal is to have a wider range of medicinal cannabis products included in the Australian Register of Therapeutic Goods (ARTG) as registered medicines,” the Ministry of Health submission said.

One drug, Sativex, is included on the Australian Register of Therapeutic Goods (ARTG). Epidiolex for epilepsy is under review.