Concern over telehealth firms supplying cannabis to veterans

Online-only medicinal cannabis telehealth clinics appear to have been directly targeting Australian Defence Force veterans.

---

GPs who treat veterans may be unaware that their patients are taking medicinal cannabis prescribed by online clinics, doctors have warned.

As reported by the ABC, telehealth clinics like VeteranCann have been advertising “natural therapy” directly to Australian Defence Force veterans on social media.

Medicinal cannabis is covered by the DVA as a treatment for specific conditions like chronic pain, chemotherapy-induced nausea and spasticity related to neurological conditions.

Prescribers must confirm to the DVA that the patient has been advised of contraindications, a mental health assessment has been completed in relation to medicinal cannabis and that the patient has no current substance use disorder.

“DVA continues to monitor and review its Medicinal Cannabis Framework in light of developing research and published evidence regarding the efficacy and safety of medicinal cannabis as a treatment for different conditions, and Therapeutic Goods Administration regulations,” a spokesman for the department said.

According to the ABC, there were multiple cases where veterans were prescribed medicines containing high levels of THC by online clinics, without their regular GP being informed.

RACGP vice president and Royal Australian Air Force veteran Associate Professor Michael Clements told The Medical Republic that he had personally been on the receiving end of ads from multiple telehealth companies.

Professor Clements has a special interest in treating veterans, who he feared made “the perfect economic target” for telehealth operators.

“Veterans are able to experiment more [with different prescriptions] …. because they’re not out of pocket and they are often dealing with more complex pain and, in many cases, more complex mental health issues than some of our other patients,” he said.

“They’re very keen to try products that are out there, so … if they’re searching Facebook or social media feeds regarding chronic pain or mental health, which many of them do, then the algorithms are going to send them these cannabis company advertisements.

“And it’s very deliberately targeted towards veterans, because veterans don’t have to pay for it.”

Often, the Townsville GP said, he won’t be aware that a patient is on THC or CBD until they present with a new pain condition or a deterioration in condition and mention it off hand.

“What worries me most is many of my veteran patients are dealing with complex PTSD or other mental health related disorders related to their service, which is often a contraindication to THC products,” Professor Clements said.

“And certainly, my patients tell me that when they’re talking to these [online cannabis clinics], they just don’t talk about their mental health.

“Their friends will say ‘don’t tell them that you’ve got any mental health issues, just so that you can bypass the rules’.

“I have seen it, and I’m particularly concerned.”

Bundaberg GP Dr Brad Murphy, who served in the Navy and has a special interest in veteran health, said the bottom line was that care became fragmented when single-issue telehealth clinics were involved.

“GPs should be the cornerstone for this, because it’s not just about chronic pain management,” Dr Murphy told TMR.

“People who have chronic pain have all sorts of major health issues because they have complex comorbidities, and they have often PTSD and other mental health considerations in the background – all of which need to be fine-tuned and managed together.”

Dr Murphy said he had good relationships with his veteran patients, but that it could be undermined in a fragmented health system.

“When you engage in the system as it’s intended, it really does reap great rewards,” he said.

“But I think preying on vulnerable [sections] of our community, whether that be our Indigenous population or our veterans, is really quite poor.

“And going to the core of this, it’s about fragmentation of care and distractions from coordinated comprehensive care by local GPs and their teams to develop long, therapeutic, trusting relationships.”

A spokesman for the Department of Health and Aged Care told TMR that the TGA is aware of, and concerned about, a rise in unlawful advertising of therapeutic goods to consumers.

“When assessing whether content amounts to advertising under the Act, we take into account a range of factors, including whether it only promotes a health service or a therapeutic good,” the spokesman said.

“The advertising of health services is not subject to the Act so long as the advertising of the services does not also promote a therapeutic good.

“However, materials that promote a health service (including telehealth) as a means to obtain a specific prescription-only medicine are likely to amount to advertising of prescription-only medicines and may be in breach of the Act.

“Similarly, if the content contains information that would draw a consumer’s mind to a particular therapeutic good and encourage them to seek out that good, then it is likely the information would be considered promotional rather than educational and may be unlawful.”

TMR also contacted AHPRA and VeteranCann for comment.

This article was updated on 14/11/24 with comment from the TGA.