How regulatory capture, commercial greed, and political cowardice created a cannabis prescription mill masquerading as healthcare
Australia’s medicinal cannabis system stands as a damning indictment of what happens when politics trumps science, profit overrides patient safety, and regulatory agencies abandon their fundamental duty to protect public health. What began in 2016 as a compassionate response to desperate families seeking treatment for children with intractable epilepsy has devolved into what critics accurately describe as a “commercial monster” – a barely regulated cannabis prescription mill where doctors write cannabis scripts every four minutes and patients receive industrial-strength THC products after cursory phone consultations.
The statistics alone reveal a system utterly divorced from medical oversight. In 2024, the Therapeutic Goods Administration (TGA) authorised at least 979,000 prescription applications for medicinal cannabis through its “specialised access” pathways – mechanisms originally designed for occasional, case-by-case use of unapproved drugs that have now become mainstream distribution channels for cannabis products.
The Regulatory Door Left Wide Open: The TGA’s fundamental failure lies in creating loopholes that allow “unapproved medicines” to bypass the rigorous safety, quality, and efficacy testing required of legitimate pharmaceuticals. By establishing Special Access Scheme (SAS) and Authorised Prescriber (AP) pathways that circumvent normal drug approval processes, the TGA essentially abdicated its primary responsibility to protect public health.
Most medicinal cannabis products available in Australia – save for two with TGA approval – lack the evidence demonstrating safety, quality, and efficacy required of registered pharmaceuticals. These products rely on what regulators euphemistically call “compassion” and “exceptionality” – code words for abandoning scientific standards in favour of political expediency.
The TGA openly admits that “unapproved therapeutic goods accessed through these pathways have not been evaluated by the TGA for safety, quality and efficacy.” Yet regulators continue to permit the prescription of these untested substances to vulnerable patients, including those with serious mental health conditions. This represents a two-tiered medical system where cannabis receives special treatment unavailable to any other therapeutic substance.
The Prescription Mill Reality: The transformation of medical practitioners into what one doctor described as “glorified cannabis dealers” represents a fundamental corruption of the medical profession. Eight practitioners issued more than 10,000 medicinal cannabis prescriptions in just six months, whilst one appeared to have issued over 17,000 scripts in the same period. These numbers make adequate patient care mathematically impossible.
A single pharmacist dispensed nearly one million cannabis products annually – that’s 2,600 products every single day for an entire year without respite. These statistics don’t reflect a carefully managed medical programme; they reveal a cannabis prescription mill operating under the thin veneer of healthcare legitimacy.
Dr Claire Noonan’s experience exposes the insidious pressure applied to healthcare providers: “There was a bit of pressure to be, perhaps more of a dealer… it’s more being used for my signature on a script.” When doctors earn money based on the number of prescriptions they write, when companies pressure practitioners to override their clinical judgment, and when nurses without medical training conduct “consultations,” the system ceases to be medicine and becomes a sophisticated drug distribution network.
Evidence Deficit: The TGA’s Own Damning Admissions: Despite over 11,420 studies on cannabis THC alone costing $4.877 billion, the evidence remains woefully inadequate. The TGA’s own clinical guidance, last comprehensively updated in 2017, starkly acknowledges the paucity of solid evidence supporting medicinal cannabis use across most conditions.
For chronic pain – the most common reason medicinal cannabis is prescribed in Australia – the evidence quality ranges from “low to moderate” to “very low.” The TGA guidance explicitly states there is “insufficient information to make a conclusion about cannabinoids for the treatment of pain associated with arthritis and fibromyalgia,” yet these are amongst the most common prescribing indications.
In multiple sclerosis, five of ten studies showed some benefit, but the other five were “inconclusive or did not show that treatment with cannabinoids had any positive effect.” For palliative care, the guidance is damning: “there is little evidence of any benefit to advanced cancer patients with chronic pain” and “no evidence that medicinal cannabis has any anti-cancer activity in human studies.”
Most tellingly, the guidance emphasises that “there is no information available on the most effective or safe dose for various conditions and symptoms.” This fundamental knowledge gap hasn’t prevented the mass prescribing of products containing up to 34% THC – concentrations the guidance would classify as dangerous for most patients.
Dosing in the Dark: The Knowledge Vacuum: Perhaps the most damning indictment of the current system lies in the TGA’s own admission: “There is no information available on the most effective or safe dose for various conditions and symptoms.” This fundamental knowledge gap renders the entire prescribing enterprise experimental at best, dangerous at worst.
The clinical guidance emphasises that “starting doses should be low and increased over time until patients respond positively or the negative effects outweigh the perceived benefits.” It specifically warns that “low start doses are particularly important for people with memory and thinking difficulties, liver and kidney disease, and weakness and wasting of the body due to severe chronic illness. Low start doses are also important for young people and the elderly.”
Yet the reality described by patients and practitioners reveals a system doing precisely the opposite. Doctors routinely prescribe high-strength products after brief consultations, often disregarding the “start low, go slow” principle, which is the only safe approach given our limited knowledge.
The guidance explicitly acknowledges that “most of the studies reported in the medical literature have either used purified pharmaceutical substances or smoked cannabis” rather than the “whole plant products that are currently available.” This means practitioners are essentially prescribing products that haven’t been studied, at doses that haven’t been established, for conditions where efficacy hasn’t been proven.
The Side Effects Catalogue: Known Dangers, Ignored Warnings: The TGA guidance provides an extensive catalogue of known side effects that reads like a litany of reasons for caution. For CBD and THC products combined, documented side effects include “fatigue and sedation, vertigo, nausea and vomiting, fever, decreased or increased appetite, dry mouth, and diarrhoea.”
For THC-containing products specifically, the warnings are more severe: “convulsions, feeling high or feeling dissatisfied, depression, confusion, hallucinations, paranoid delusions, psychosis, and cognitive distortion.” The guidance notes that “in general, the side effects of CBD-rich products are less than those for high-THC products, but because the required doses for CBD can be quite high in conditions such as paediatric epilepsies, a proportion of patients encounter side-effects with these CBD doses.”
These aren’t theoretical concerns. The guidance emphasises that “patients with neurological conditions may be more likely to experience negative effects from medicinal cannabis” and that there is “very limited evidence to show how medicinal cannabis reacts with other approved medications.”
The TGA guidance specifically warns that THC products can cause convulsions, feeling high or dissatisfied, depression, confusion, hallucinations, paranoid delusions, psychosis, and cognitive distortion. It explicitly states that doctors should not prescribe medicinal cannabis to people with an active or previous psychotic disorder or an active mood or anxiety disorder yet these are precisely the conditions for which they now routinely prescribe it.
The Mental Health Catastrophe: Perhaps most damning is the mounting evidence of mental health catastrophes directly linked to these prescribing practices—outcomes that experts could have easily predicted based on the TGA’s own safety warnings. The clinical guidance explicitly states that medicinal cannabis is “not appropriate for people with an active or previous psychotic or active mood or anxiety disorder,” yet doctors now routinely prescribe it for exactly these conditions.
Patients like Rohan Dawson, who received 27% THC cannabis that left him feeling “on Pluto” and significantly worsened his anxiety, represent predictable outcomes when profit trumps patient safety and clinical guidance is ignored. Recent reports document significant increases in hospitalisations due to psychosis amongst patients prescribed medicinal cannabis. Some patients with pre-existing mental health conditions experience severe relapses, with documented cases of patients developing psychosis requiring hospitalisation and tragically, at least one suicide following medicinal cannabis prescription.
The irony is palpable: the TGA guidance acknowledges there are “currently no studies that compare medicinal cannabis products to the most effective and commonly used medications for MS pain and spasticity” and that “current studies show no evidence that medicinal cannabis can improve overall quality of life or physical functioning.” Yet practitioners continue prescribing high-THC products for conditions where safer, proven alternatives exist.
Professor Ian McGregor’s warnings about high-THC products prove prophetic: “Higher-THC products appear to be more linked to mental health adverse outcomes, precipitation of severe anxiety and paranoia in vulnerable individuals, perhaps schizophrenia and manic attacks.”
Driving Under the Influence: A Public Safety Crisis: The TGA guidance contains a stark warning that has been systematically ignored: “Patients should not drive or operate machinery while being treated with medicinal cannabis.” It specifically notes that “measurable concentrations of THC can be detected in urine many days after the last dose” and that “it may take up to five days for 80 to 90 per cent of the dose to be excreted.”
With nearly one million prescriptions authorised in 2024 alone, Australia now has hundreds of thousands of people potentially driving whilst impaired by prescribed THC products. The guidance explicitly states that “drug-driving is a criminal offence” and advises patients to “discuss the implications for safe and legal driving with their doctor.” Yet there’s no evidence this crucial safety counselling is occurring in the high-volume telehealth consultations that dominate the industry.
Marketing Manipulation and Commercial Exploitation: Despite the evidence deficit and clear safety warnings, aggressive marketing campaigns would make pharmaceutical executives blush. Research examining 54 private medicinal cannabis clinic websites found widespread examples of aggressive and misleading marketing, including unsubstantiated health claims, self-assessment tools that “coach” patients on which conditions might warrant prescriptions, and promises of same-day delivery with no GP referrals required.
Companies run over 170 active advertisements monthly across Facebook, Instagram, and Threads, targeting young people as young as 18 with cryptic messaging such as “we can’t shout about it, but our patients are smiling” paired with wellness-themed imagery. One advertisement promises “real doctors, real care” and “fast approvals & express delivery” with consultations at just $19.
The Subscription Model of Dependency: Most sinister is the industry’s adoption of subscription models that ensure patients continue receiving cannabis products regardless of their medical needs or outcomes. Patients like Rohan Dawson, who discontinued treatment due to adverse effects, continued to receive automatic shipments and bills: “Despite never having another appointment, he continued to be billed under a subscription model and more cannabis arrived at his door.”
This isn’t healthcare – it’s a drug dealing operation with automatic billing. When prescription cannabis achieves “cost parity with illicit products,” and when practitioners boast about convenience rather than efficacy, the medical pretence becomes impossible to maintain.
The Research That Never Happened: The TGA guidance concludes with a stark admission that there is “a significant need for larger, high-quality studies to better explore the potential benefits, limitations and safety issues associated with medicinal cannabis treatment across a range of health conditions and symptoms.” The guidance acknowledges the need for research to:
- Increase the amount and quality of evidence to either support or contradict the use of medicinal cannabis
- Give a more detailed understanding of the most effective cannabis products, doses and administration methods
- Compare medicinal cannabis with standard first line medication options
- Build a strong knowledge base on how medicinal cannabis interacts with other drug treatments
This research agenda, outlined in 2017, remains largely unfulfilled seven years later. Instead of conducting the necessary studies to establish safety and efficacy, the system has allowed mass prescribing to proceed based on commercial pressure rather than clinical evidence.
Australia has essentially conducted an uncontrolled population-level experiment with nearly one million cannabis prescriptions, whilst simultaneously failing to collect the data necessary to determine whether the experiment is succeeding or causing harm.
Regulatory Capture and Political Cowardice: The current crisis stems from what the Dalgarno Institute correctly identifies as the “vote for medicine” protocol – a deliberate strategy to bypass rigorous clinical trials and scientific evidence in favour of emotional manipulation and political pressure. The Victorian Law Reform Commission’s 2014 consultation exemplified manufactured consent, drawing from merely 99 submissions and poorly attended public hearings dominated by cannabis advocates.
The Australian Health Practitioner Regulation Agency’s (Ahpra) recent announcement of a “crackdown” on unsafe prescribing represents too little, too late. By merely repeating existing rules rather than tightening them, Ahpra has missed a crucial opportunity to safeguard patients’ health.
International Warnings Ignored: Australia’s headlong rush into medicinal cannabis occurred despite mounting international evidence of problems. North American reports of rising cannabis-related disorders amongst older adults, increasing emergency department visits, and growing recognition of cannabis use disorder should have provided cautionary lessons. Instead, Australian policymakers chose to ignore these warnings in favour of industry lobbying and political expediency.
The parallels with the opioid crisis are unmistakable: aggressive marketing of high-potency products, regulatory capture, medical professionals pressured to prescribe against their better judgement, and systematic downplaying of addiction risks.
A System Beyond Salvation: Australia’s medicinal cannabis industry represents one of the most egregious failures of medical regulation in the nation’s history. The evidence was always there. The warnings were clear. The outcomes were inevitable. What’s inexcusable is that it was allowed to happen anyway.
The current system fails on every metric that matters: patient outcomes, medical ethics, regulatory oversight, and public health protection. Until Australia acknowledges that its medicinal cannabis programme has become a cannabis prescription mill masquerading as healthcare, more patients will suffer the predictable consequences of prioritising politics over patient safety.
The transformation from compassionate access programme to commercial monster didn’t happen by accident. It resulted from deliberate policy choices that favoured industry profits over patient welfare, political expedience over scientific rigour, and regulatory capture over public health protection.
The only question remaining is how many more casualties this system will claim before sanity prevails. The cannabis industry’s corruption of Australian healthcare represents not just a policy failure, but a moral catastrophe that demands immediate and comprehensive reform. Anything less condemns more vulnerable patients to become casualties of a system that has forgotten its fundamental duty: first, do no harm. (Source:WRD News)
