Photo: Eric Limon/ 1234RF
A senior Massey University public health researcher says the medicinal cannabis scheme in New Zealand has transformed dramatically since it was implemented in 2020.
Marta Rychert said the supply of such products had increased 14 times compared with four years ago.
In addition, most prescriptions were now for high-potency, dried cannabis flowers rather than oils or oral liquids, and prices were now comparable to the black market.
In the study, Rychert and co-author Chris Wilkins wrote private cannabis clinics had improved access and care for patients needing medicinal marijuana, but they raised concerns about the commercial imperative for those clinics to sell only one product, regardless of patient need.
The warning came after the Royal College of General Practitioners also raised concerns about conflicts of interest when a clinic was set up to prescribe only one type of product.
Medicinal cannabis doctor on concerns sector is becoming too lax
Rychert told Nine to Noon host Kathryn Ryan the focus on just one treatment option was "very unusual in a healthcare context".
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Although medicinal cannabis as a product could not be promoted in this country, the clinics were actively marketing their services on social media, radio and billboard advertising, she said.
The researchers looked at how the medicinal cannabis scheme had changed over the four years of implementation, examining data from clinics and Health NZ.
They found when the scheme first launched in 2020, the treatments were CBD-based, and taken taken orally via oils.
Four years later, however, over 60 percent of approved products were THC-dominant, and many of those were highly potent, made up of 25 percent dried cannabis flower.
High-potency THC flower products were not typical of medicinal cannabis prescriptions world-wide, she said.
"When people think about medicinal cannabis use, they think about quality-assured, balanced products with lower THC concentrations. They don't need to be that high."
In the 2020 cannabis legalisation referendum - which was narrowly defeated - the maximum potency recommendation was 15 percent, she said.
"There is no good evidence to support use of some of these high-THC flowers; in fact, there's been some clinical trials ... that found lower THC products can be similarly effective with helping with some pain conditions, and they do have less side effects."
The researchers also raised concerns about clinics that both prescribed the products and supplied them.
That may influence doctor's clinical judgement, and mean they were not prescribing treatments more appropriate for individual patients, she said.
"Some clinics operate their own dispensary and as you can imagine, they directly profit from sales of these products."
In response, Dr Afraz Adam, chief medical officer at Ponsonby-based clinic Cannaplus, told Ryan the research raised valid concerns, for example around profit-driven clinics, and he was "fully behind" greater accountability in the industry.
"This kind of scrutiny is exactly what we need if we are serious about putting patients first."
Before any consultation at Cannaplus, patients had to complete a detailed screening questionnaire to ensure that medicinal cannabis was not a first time treatment, he said.
On average, patients had been trying other treatments for 12 years before turning to cannabis, and the first, intensive consultation was designed develop a personalised treatment plan.
Adam pointed out that not every Cannaplus patient who came to a consultation left with a prescription for medicinal cannabis.
"If [it] isn't right - for instance, if you've got severe heart issues, if you're pregnant, a history of mental health issues, schizophrenia - our doctors will suggest alternatives.
"We do decline patients, and it's all about responsible prescribing. We do ensure that patient safety is first and foremost."
Kathryn Ryan pointed out the Companies Register showed Cannaplus was 100 percent owned by "health and wellness company" Elysian Pharmaceuticals, but the latter had "zero role in the day-to-day running of Cannaplus", and did not have any products listed for sale in New Zealand, he said.
Medicinal cannabis at the clinic was most often prescribed for chronic pain, palliative care, cancer patients and multiple sclerosis.
Patients had to be seen every three months to get a repeat prescription, and even then were only given a one-month supply, he said.
"Our approach is always to 'start low, go slow', so we always start with our lowest percentage THC flowers."
Based on the patient's tolerance, that level was reviewed after one month for negative side effects, and if the treatment changed, again, they were given a one-month supply only, he said.
"We do have a very strong system for picking up red flags... if we believe that a patient is double-dipping with another clinic, or is hiding what they're doing with their GP... we pick up the phone, we give the GP a call and have a direct discussion with them before doing any prescriptions."
The study highlighted a "troubling reality", with many turning to the black market for medical reasons, and exposing themselves to "unsafe products".
There were clinics in New Zealand that had "questionable practices", he said, which became evident when their patients came to Cannaplus.
Some clinics were co-owned by doctors, who had a financial interest in the business, "potentially incentivising a higher volume of prescriptions", or had financial ties to specific suppliers. At Cannaplus, on the other hand, there was a "strict separation" between the clinical and financial side of the business.
Massey University's Marta Rychert said the industry was maturing, with "more and more new players coming into this market".
"I think we're at a time where we're really at the crossroads of this scheme , and we really need to be observing [closely], scrutinising the industry and if we have to, pull it back a little bit."
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