Five out of five said no.
You can have an online consultation, be prescribed medicinal cannabis, and have it sent directly to your home, in a seamless operation. This one-stop-shop certainly sounds convenient.
But not everyone’s happy.
Industry observers, doctors and pharmacists call these one-stop-shops “vertical integration”. That’s when the person who prescribes medicinal cannabis or the clinic that employs them has a financial relationship with the manufacturer of the product and/or the business that dispenses it.
Critics say it’s where prescribers – GPs, specialist doctors or nurse practitioners – can feel pressured to prescribe what will make money for clinics, pharmacies and suppliers. It’s a system where patients can be prescribed medicinal cannabis, despite good clinical reasons not to. It can also lock in patients to specific products or pharmacies.
So should clinics be allowed to prescribe medicinal cannabis if they have financial links to the supplier or dispenser?
We asked five experts. Five out of five said no.
It’s a major conflict of interest
Barbara Mintzes, Professor in Pharmaceutical Policy, University of Sydney:
“No. Sales need to be separated from prescribing.
“Treatment should be based on impartial judgements of benefits and harms of available options, and individual patient needs. So if prescribers work for a clinic that also sells medicinal cannabis it’s a major conflict of interest.
“This type of business arrangement has contributed to the situation we have today – many, short consultations for products we aren’t sure work or are safe, using a regulatory system that doesn’t reflect how medicinal cannabis is prescribed today.
“The Australian Health Practitioner Regulatory Agency describes consultations for medicinal cannabis lasting seconds and practitioners issuing more than 10,000 prescriptions in six months.
“More than 99% of medical cannabis products provided in Australia have not been approved by the Therapeutic Goods Administration (TGA), meaning less is known about their safety and effectiveness.
“Most medicinal cannabis is provided via the TGA’s Special Access Scheme, category B. This is a hodge-podge involving neither seriously ill patients (category A) nor well established products (category C).
“Vertically integrated “pay to prescribe” models should be banned.”
We need to separate prescribing of medicinal cannabis from its supply
Christopher Rudge, Lecturer in Law, Deputy Director, Sydney Health Law, University of Sydney:
“No. Vertical integration – where a single entity prescribes and dispenses medicinal cannabis – creates conflicts of interest that aren’t merely personal but structural.
“The Australian Health Practitioner Regulation Agency acknowledges this problem. It states conflicts are ‘inherent’ when a practitioner works in an organisation that both prescribes and dispenses a single medication, and that simply declaring the conflict on a website is ‘not sufficient’.
“Yet the regulatory response has targeted individual practitioners – not the businesses they work for. The regulator simply has no power to act against those businesses.
“Under current arrangements, vertically integrated businesses have no obligation to ensure doctors are prescribing appropriately or to have robust internal oversight.
“Some business models actively embed financial incentives to prescribe – for instance, waiving consultation fees if a patient is found ineligible for medicinal cannabis.
“Australian health regulation already recognises this conflict elsewhere: state pharmacy ownership laws restrict corporate control of dispensing. The ban on direct-to-consumer prescription drug advertising also addresses commercial pressure structurally.
“The same logic should apply here. Prescribing medicinal cannabis should be separated from its supply.”
Harm is not always minimal
Wendy Lipworth, Professor of Bioethics, Macquarie University:
“No. Commerce and medicine have always been entangled, raising enduring concern about undue influence and conflict of interest.
“Commercial culture can also distort clinical practice even if prescribers don’t benefit financially.
“IVF is a telling example. Research documents widespread use of costly, unproven ‘add-ons’ driven not by evidence, but by corporate culture and marketing pressure. Patients pay and outcomes do not improve.
“In sectors such as reproductive medicine, we accept some commercial influence because three conditions are met:
- clinical value is reasonably established or harm is minimal
- commercial relationships are disclosed and managed
- regulation is robust enough to detect and correct major distortions.
“Australia’s medicinal cannabis sector meets none of these conditions. Clinical value varies, harm is not always minimal, many products and indications are not evaluated, and regulation is weak.
“Under these circumstances, clinics should not prescribe medicinal cannabis that they also supply.”
Convenience does not justify engaging in a financial conflict of interest
Betty Chaar, Pharmacist and Professor in Professional Ethics in Pharmacy, University of Sydney:
“Vertical integration – where prescribing, dispensing and product supply are financially linked – can be convenient.
“But with medicinal cannabis, these conflicting financial arrangements can inadvertently encourage overuse or inappropriate supply.
“It can pressure clinicians to prescribe medicinal cannabis more frequently, to favour specific products or to bypass careful assessment. This can lead to a perceived or real conflict of interest, and a loss of patient trust.
“When it comes to medicinal cannabis, the Australian Health Practitioner Regulation Agency states good patient care is: ‘recognising potential conflicts of interest, informing patients about the conflict and not allowing any financial or commercial interest to adversely affect the way you treat patients. Conflicts of interests are inherent if you are working in an organisation that prescribes and dispenses a single medication’.
“We need to separate prescribing from supply. Whether that becomes a legal requirement one day, or we simply trust health-care professionals, transparency is crucial. It is important providers offer open and honest disclosure, and allow the patient to make an informed choice. Convenience does not justify engaging in a financial conflict of interest.
“As a patient, you need to be able to trust that what you’re prescribed is the right medicine for you, and the safest. Your best interests should be front and foremost. It should not be about what makes more money for proprietors of interconnected businesses.”
Click-and-prescribe models may prioritise profit over patient welfare
Christine Mary Hallinan, Senior Research Fellow, University of Melbourne:
“No. These click-and-prescribe models can make access easier. However, regulators have warned these models can create incentives that may prioritise profit over patient welfare, and introduce conflicts of interest in clinical care.
“Regulators are concerned about high-volume medicinal cannabis prescribing, very short one-off consultations, and poor coordination with a patient’s usual doctor.
“These issues can arise wherever companies involved in supplying medicines also influence how they are prescribed.
“There are similar challenges internationally, including in the United States, Canada and the United Kingdom, where growth of medicinal cannabis has outpaced monitoring and safety systems. In Australia, these risks may be amplified in emerging click-and-prescribe models, where prescribing can occur outside a patient’s usual care team.
“Safe prescribing depends on more than access. It takes time, careful clinical judgement, continuity of care and shared decision-making.
“High-quality care also depends on patients being actively involved in decisions about their choice of medicine. Clear information about medicines helps patients make informed decisions and supports safe care when moving between providers.”
Barbara Mintzes, Professor in Pharmaceutical Policy, School of Pharmacy and Charles Perkins Centre, University of Sydney; Betty Chaar, Pharmacist and Professor in Professional Ethics in Pharmacy, University of Sydney; Christine Mary Hallinan, Senior Research Fellow, Department of General Practice and Primary Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne; Christopher Rudge, Lecturer in Law, Sydney Law School, University of Sydney, and Wendy Lipworth, Professor of Bioethics, Macquarie University
This article is republished from The Conversation under a Creative Commons license. Read the original article.