The Core Problem

Australia’s medicinal cannabis industry faces a stark contradiction: over one million people are now using products that lack the scientific evidence and quality controls routinely demanded of every other medicine on the market. What began as a compassionate access scheme for seriously ill patients has morphed into a billion-dollar industry where commercial interests increasingly overshadow clinical need, and where the prescribing patterns more closely resemble retail sales than medical practice.

The numbers tell a troubling story. In 2019, just 18,000 Australians used medical marijuana. By January 2024, that figure had exploded to over one million, a more than 50-fold increase in five years. But this growth hasn’t been driven by new scientific discoveries proving cannabis’s medical benefits. Instead, it reflects a system that has allowed commercial operators to exploit regulatory gaps, market aggressively, and prescribe at volumes that defy any reasonable medical standard.

When Doctors Become Dispensing Machines

The clearest evidence of systemic failure comes from data collected by the Australian Health Practitioner Regulation Agency during a six-month period. Eight medical practitioners each issued more than 10,000 scripts for the highest-strength THC products. One doctor alone wrote more than 17,000 prescriptions in that timeframe.

Let that sink in: 17,000 scripts in six months equals one prescription every four minutes, assuming the doctor worked every single day without breaks. This isn’t medical practice. It’s an assembly line.

These aren’t outliers in an otherwise functional system. They’re symptoms of structural problems that reward overprescribing. Many clinics both prescribe and sell cannabis products directly, creating an obvious conflict of interest. Patients report receiving emails and text messages from these clinics asking if they need another dose. This is the language of retail, not healthcare. Traditional medical practice would be unrecognisable to anyone encountering this model, where the prescriber profits directly from each prescription written.

The system has become so permissive that patients have learnt what to say in online consultations to secure prescriptions. The clinical assessment, the cornerstone of responsible medical practice, has been reduced to a checkbox exercise, a formality to satisfy before accessing what has effectively become a quasi-legal cannabis market dressed in medical language.

The Science Doesn’t Support Current Use Patterns

The vast majority of Australians using Australia’s medicinal cannabis are doing so for conditions where scientific evidence of benefit is weak, non-existent, or in some cases suggests it may cause harm.

The most comprehensive assessment of cannabis’s medical value came from a 2017 US National Institutes of Health review conducted by 16 professors and epidemiologists. After examining the available research, they found conclusive or substantial evidence for effectiveness in just three conditions:

Chronic pain: The evidence showed modest benefit at best. The review noted that ‘cannabinoids demonstrate a modest effect on pain’, yet chronic pain is the primary reason most Australians are seeking medicinal cannabis prescriptions. The submission to the TGA went further, stating that cannabis is ‘no better than placebo for chronic pain’. This represents a profound mismatch between prescribing patterns and evidence.

Chemotherapy-induced nausea and vomiting: Studies from the 1980s found certain cannabinoids superior to placebo and equivalent to antiemetics available at that time. However, cancer treatment has advanced considerably in the past four decades, and whether cannabis products compare favourably to modern antiemetics remains an open question.

Multiple sclerosis spasticity: The effect was modest, an average reduction of 0.76 units on a 0-to-10 scale. This is a measurable benefit, but a small one.

For everything else (cancers, irritable bowel syndrome, epilepsy as of 2017, Parkinson’s disease, Huntington’s disease, mental health conditions) the NIH review found no or insufficient evidence. As the TGA submission bluntly stated: ‘Once poorly designed and conducted trials were eliminated, there were very few conditions for which cannabis showed efficacy.’

This is the scientific reality that should be guiding medical practice. Instead, over one million Australians are using a substance that, for their particular condition, likely offers no proven benefit and may carry significant risks.

The Quality Control Problem: Would You Take Any Other Medicine This Way?

Beyond the question of efficacy lies an equally serious concern: what exactly are patients putting into their bodies?

Testing conducted in California found that 80% of medicinal cannabis products were contaminated when examined by Anresco Laboratories at a Hempcon event. The types of contamination documented included heavy metals (copper, nickel, lead), mould, yeast, and dangerous pesticides from grow sites.

The TGA submission emphasised that Australia’s medicinal cannabis products are frequently reaching consumers ‘without being tested for strength, purity and dose or testing via clinical trials’. This stands in stark contrast to how every other medicine is regulated. When you take a blood pressure medication or antibiotic, you know exactly what dose you’re receiving, that it’s been manufactured to pharmaceutical standards, and that it’s free from contaminants. The same cannot be said for most medicinal cannabis products.

Imagine if this were any other medication. Imagine if 80% of blood pressure tablets were found to contain mould and heavy metals, or if patients received pills of wildly varying strength without knowing the actual dose. The product would be recalled immediately, the manufacturers would face investigation, and prescribers would be sanctioned for continuing to recommend it.

Yet medicinal cannabis products marketed with names like ‘Joker Juice’ and ‘Gelato Sherbert’ (branding that sounds more suited to recreational products than medicine) circulate freely. These names aren’t just inappropriate; they reveal how far the industry has drifted from legitimate pharmaceutical standards. They’re designed to appeal, to market, perhaps even to attract younger users. This is not how serious medicine is branded.

The Harms of Regular Cannabis Use

The Australian Institute of Health and Welfare clearly states that ongoing and regular cannabis use carries significant risks. Users can become dependent. Withdrawal symptoms include anxiety, sleep difficulties, appetite disturbance, and depression (the very conditions many users are hoping to treat).

A 2009 review of 5,198 studies concluded that chronic cannabis use is associated with psychiatric, respiratory, cardiovascular, and bone effects, along with oncogenic (cancer-causing), teratogenic (birth defect-causing), and mutagenic (DNA-damaging) effects, all of which depend on dose and duration of use.

More recent population studies referenced in the TGA submission report associations with 33 cancer types (compared to 14 for tobacco), 89 of 95 birth defects tracked by European systems, serious mental illnesses including psychoses and depression, and premature ageing. The submission cited research from 2016 identifying mechanisms of ‘chromothripsis’, a process where cannabinoids can shatter or pulverise chromosomes. This is not a minor side effect; it’s fundamental cellular damage.

These findings paint a picture of a substance with far-reaching impacts across multiple body systems. The evidence base suggests cannabis’s harms extend well beyond the commonly acknowledged risks of dependence and mental health effects.

The Exception That Proves the Rule

There is one medicinal cannabis product that has met proper pharmaceutical standards: Epidiolex (also known as Epidyolex). This FDA-approved CBD medication for childhood epilepsy conditions like Dravet’s syndrome and Lennox-Gastaut syndrome underwent rigorous clinical trials, has standardised purity, strength, and dose, and is manufactured under strict quality assurance processes.

Epidiolex demonstrates what a legitimate cannabis-based medicine looks like. It followed the pathway every other drug must take: controlled trials, regulatory review, standardised manufacturing, and approval based on evidence rather than commercial pressure. The TGA submission recommended that Epidiolex should continue to be available given its proven efficacy and quality controls.

The existence of Epidiolex raises an uncomfortable question: if it’s possible to develop cannabis-based medicines that meet pharmaceutical standards, why are we tolerating a parallel market of unregulated products that don’t?

The Medical Establishment Speaks With One Voice

The united call for reform from major health organisations is unprecedented. The NSW branches of the Royal Australian College of GPs, the Pharmacy Guild of Australia, the Pharmaceutical Society of Australia, and the Australian Medical Association (bodies that often have competing interests and priorities) have come together to demand action.

NSW Pharmacy Guild President Mario Barone captured the frustration: ‘The current system for prescribing and dispensing medicinal cannabis is not working as it should for patients, pharmacists, or prescribers.’

These organisations identify several problems with Australia’s medicinal cannabis system:

Vertically integrated business models: When the same entity prescribes, dispenses, and profits from cannabis sales, clinical judgement becomes compromised. The financial pressure points towards more prescriptions, higher doses, and repeat customers, not towards careful evaluation of whether the patient actually benefits.

Fragmented care: Patients bypass their regular doctors and establish care with online clinics that specialise in cannabis prescriptions. This fragments their medical record, eliminates continuity of care, and means their primary physician may not know about a significant substance they’re using that could interact with other medications or affect other conditions.

Aggressive marketing: The tactics employed by some cannabis clinics (unsolicited messages asking if patients need refills, promotional campaigns, referral rewards) would be considered unethical if applied to any other prescription medication. Yet they’ve become normalised in this sector.

The TGA submission went even further, recommending that ‘all current cannabis medications coming from overseas should immediately become ineligible for Special Access, and only quality controlled Sativex and Epidyolex made available for end-of-life care for those conditions refractory to other treatments’. This represents a call to essentially restart the system with only products that have met rigorous pharmaceutical standards.

The Central Question: One Standard or Two?

The submission to the TGA poses the question that cuts to the heart of this issue: ‘Where any other medicine with adverse events and a side-effect profile like that of cannabis would have historically been removed from the market.’

This is not rhetorical. Throughout pharmaceutical history, drugs have been withdrawn when their risks outweighed their benefits or when quality control issues emerged. Thalidomide was withdrawn due to birth defects. Vioxx was removed over cardiovascular risks. Numerous antibiotics, pain medications, and other drugs have been pulled from the market when safety concerns emerged or when post-market surveillance revealed problems not apparent in clinical trials.

Cannabis-based medicines, with limited evidence of efficacy, significant risks, widespread quality control problems, and prescribing patterns that defy medical logic, would seemingly meet any reasonable threshold for market withdrawal or severe restriction. Yet not only do they remain available, but their use has grown exponentially.

The implication is that cannabis is being held to a different, lower standard than other medicines. Perhaps this reflects cultural attitudes, political pressure, or the powerful financial interests now invested in the industry. But from a scientific and medical regulatory perspective, there’s no justification for this double standard.

If we believe in evidence-based medicine (if we believe that treatments should be proven safe and effective before being widely prescribed) then Australia’s medicinal cannabis as currently practised fails to meet that standard. And if we accept that cannabis can bypass normal pharmaceutical requirements, we’re establishing a precedent that could undermine the entire regulatory framework that protects patients from ineffective or harmful treatments.

Protecting Patients, Upholding Standards

Over one million Australians are now using products that, in most cases, haven’t been proven to help their condition and may carry significant risks. They’re obtaining these products through a system that encourages conflicts of interest, fragments medical care, and tolerates quality control standards that would be unacceptable for any other medication.

Many of these patients are suffering from real conditions and seeking genuine relief. They deserve better than a system that prioritises commercial access over clinical evidence, that allows aggressive marketing of questionable products, and that tolerates prescribing patterns disconnected from scientific support.

The choice facing regulators is clear: either apply the same rigorous standards to cannabis that apply to every other medicine, or explicitly acknowledge that cannabis operates under different rules and accept the implications of that decision. What’s not sustainable is the current pretence that this is normal medical practice operating under appropriate oversight.

The submissions from major health bodies, the data from AHPRA, and the scientific evidence all point in the same direction. The question is whether regulatory authorities have the will to act before the system becomes even more entrenched, more commercialised, and more disconnected from the principles that should govern medical treatment: first, do no harm; second, prescribe only what evidence supports; and third, ensure that what patients receive is safe, pure, and of known strength.

Australia’s medicinal cannabis industry has grown explosively. The evidence suggests it has grown recklessly. Protecting patients from harm requires bringing this industry back under proper regulatory control, with the same evidence requirements and quality standards we demand of every other medicine. The time for action has arrived.

Source: tga.gov.au , Herald Sun