Getting your hands on medical cannabis in Australia is not as simple as telling your doctor you get headaches when you think about regular weed being illegal.

The rules around patient access are tight, vary from state to state, and are a critical hurdle the industry is bumping into as it grows.

“At the moment it’s very difficult to get products into consumers’ hands,” says Bod Australia CFO Craig Weller.

“Skin care products are hard to get in, there’s a glitch in the system there. Doctors are reluctant [to prescribe]… and access is different in every state.”

Bod (ASX:BDA) has a licence to import cannabis products and hopes to sell oils through doctors. It is developing cannabis-based cosmetics with Swiss company Linnea.

In October, Professor Iain McGregor from the Lambert Initiative for Cannabinoid Therapeutics wrote in the SMH that about 254 people had been allowed access to medical cannabis products under the Special Access Schemes and through authorised prescribers since the law changed in April 2016.

But he estimates the number of people with medical conditions who currently use illegal cannabis could be as high as 100,000.

There are 21 listed cannabis and hemp companies in Australia and over 60 in total with interests in the space.

Although only four of the listed ones have products to sell in Australia now, the small number of patients is a problem for an industry that, until last week, was told it had to grow domestically before it could expand globally.

How do you get medical cannabis?
Federally, the terminally ill can apply to use medical cannabis products under Special Access Scheme A and people with illnesses from chronic pain to epilepsy under Special Access Scheme B. Doctors can become authorised prescribers for a group of patients with the same condition.

The executives we spoke to agreed these processes are fairly streamlined.

However, once a patient has Federal approval, the state regulator weighs in using its own separate criteria and they may reject an already-approved application.

“The problem comes because every state health department has its own way of handling special access scheme applications,” says LeafCann CEO Elisabetta Faenza.

“[For example] in NSW while they say they have a call line to help people, they seem to be taking the line that there’s not enough information [to approve applications for conditions] except for Multiple Sclerosis and epilepsy.”

Ms Faenza says South Australia is the most advanced state: Federal approval will guarantee a state okay.

Medical Cannabis Council general manager Blaise Bratter is hopeful Western Australia will streamline its processes this year.

Ms Faenza believes negotiations around legislation to allow exports of Australian-made products will result in loosening of other regulations too, such as for terminally ill people: right now they are permitted to use medical cannabis but no one has been given an import licence to supply the kinds of drugs they need.

She also says that once the raft of clinical trials this year begin turning into real products, regulators will feel more comfortable approving applications because they will have real data to hand on how cannabis affects various medical conditions. Right now there is a dearth of credible clinical data to rely on.

Where money can be made
These issues are barriers for companies trying to grow in Australia, but also creating opportunities in the patient access sector.

The Hydroponics Company (ASX:THC) is setting up a series of clinics they’ve dubbed ‘National Access Cannabis’, based on Canadian-style dispensaries.

Health House in Western Australia and HL Pharma are two of seven importers that are setting themselves up as conduits for people who are allowed to use it – and companies wanting to start marketing their brands.

MMJ Phytotech (ASX:MMJ) and MGC Pharma (ASX:MXC) both have partnerships with HL Pharma.

Growers such as Auscann (ASX:AC8) which are yet to start manufacturing products, or importers like THC, are launching educational programmes to not only inform doctors but win them over to their brands, in much the same way big pharmaceuticals companies market drugs and create relationships.

Others, including Ms Faenza, believe Australia’s chemist chains will move into the space since all cannabis drugs must go through pharmacies anyway, and growers and manufacturers are unlikely to want to move into the retail sector.