We’ve Expanded Medicinal Cannabis Access. Now What?

According to recent data, around 800,000 people have accessed medicinal cannabis in Australia since it was legalised in 2016. The proliferation of telehealth, specialty clinics and dispensaries as well as delivery services, have provided greater ease of access to cannabinoid therapy. This is genuine progress in a relatively short amount of time. But access is only a measure of whether someone can obtain treatment. It is not necessarily a measure of whether they are well supported while using it. There is reason to argue that the access infrastructure has expanded faster than the support infrastructure needed around treatment.

The wider context of care

Access tends to ask whether someone can obtain the medicine.

Clinical care tends to ask whether treatment has been appropriately assessed, prescribed and monitored.

But care also has a wider context: it asks whether the patient actually understands what is happening, if they know where to turn when something changes, or if they feel supported navigating the process? The wider context is important, because medicinal cannabis treatment frequently involves ongoing navigation. For many patients, this can involve a great deal of trial-and-error. It also requires navigating supply issues, changing products, questions, uncertainty, variable doses, side-effects, administration devices and more.

Then there is the understanding of how medicinal cannabis treatment is actually integrated into daily lives; patients still need to navigate driving laws, workplace or travel issues and stigma.

“People need more than just access to a prescription or dosage instructions.”

For clinics, systemic time constraints can lead to this wider context of care (such as education, uncertainty, personal circumstance and ongoing support) receiving less space in a consultation. A script could be issued during an appointment. But questions, product-changes, side-effects and uncertainty often arise later.

More than access

People therefore need more than just access to a prescription or dosage instructions.

They need enough context to interpret their own experience: what might be expected, what warrants concern, where to seek help and how to respond when circumstances change. These forms of sense-making are harder to accommodate within a system that is primarily structured around assessment and prescribing. The clinical process can be completed while the human experience remains unresolved.

And surely, 800,000 patients using medicinal cannabis sounds like success. So what problem remains?

Patient and prescription numbers only demonstrate access and demand. They do not tell us much about the quality of the experience surrounding treatment. High access can still exist alongside poor continuity, weak education, unresolved stigma, fragmented responsibility or inadequate follow-up. This can place reliance on informal community spaces for knowledge-gaps (at best), or a return to an illicit supply (at worst).

Closing the gap

Lately, this is where our work has increasingly focused: not just on whether care has been accessed, but on understanding the quality and experience of navigating the system around it. We believe the next phase of this industry and the clinical services around it, require an emphasis on education, building trust and closing the gaps between clinical care and lived experience. We believe this can occur in a few ways:

Education - Helping people understand treatment, expectations, uncertainty and change. This requires practitioners to develop and effectively communicate this knowledge, beyond prescribing or dispensing.

Continuity - Providing clear pathways for what happens between or after appointments.

Communication - Making room for questions, health literacy and different lived experiences.

Feedback - Creating safe mechanisms for patients and communities to identify and relay recurring problems. Those insights can then inform education, services and clinical systems.

“Specialty services create an expectation of special capability.”

Beyond access

As medicinal cannabis becomes an established part of Australian healthcare, specialty service providers should increasingly be judged not only by whether they facilitate access, but also by the quality of the experience surrounding that access.

Specialty services create an expectation of special capability. That requires staff, practitioners and pharmacists working in specialty clinics or dispensaries to have an effective understanding of cannabinoid therapies, dosage forms, devices, common areas of uncertainty and — critically — how to communicate effectively with people navigating treatment.

Good care helps people develop realistic expectations of treatment, recognise uncertainty and know how to navigate problems when they arise. Access to medicine matters. But access alone does not mean good care.