Sitting at the dining table of a small Brisbane unit, 26-year-old father, Jordan Cooper, picks up a small piece of cannabis and begins to grind it.
He places some of the herb in his vaporiser, heats it up and puts it to his lips.
"It's a full body relaxation," Jordan says after inhaling.
In the kitchen, his fiancee, Kel, is chopping carrots. Their nine-month-old child is playing in his highchair.
Jordan's supply isn't from the black market — it's medicinal cannabis, legally prescribed to him by a doctor to treat his insomnia.
He says it's been life-changing.
After spending years treating his condition with prescription medicines which left him feeling groggy the next day, Jordan decided to self-medicate with illegally-sourced cannabis. It worked well, without the side effects.
He then saw some stories about legal medicinal cannabis, and decided to go to his GP to seek a prescription.
"I didn't really think that I was going to be eligible," he says.
"It turns out I was."
While his doctor told him it's OK to try the treatment, they weren't comfortable prescribing it themselves.
So Jordan did a quick search online to try to find a doctor willing to prescribe cannabis.
One of the companies at the top of the search results was Australian business, Cannatrek.
Jordan's first prescription
Founded in 2015, Cannatrek was one of the first companies to receive a medicinal cannabis licence in Australia.
Today it is the most popular supplier on the market. According to pharmaceutical intelligence company, NostraData, around one third of medicinal cannabis products sold at retail pharmacies are Cannatrek products.
Jordan's experience with Cannatrek began with a referral service — Cannatrek Access. There, he was asked to fill in a questionnaire and put through an initial screening call in early 2021.
To be eligible he had to have had a chronic health condition for more than three months, have tried conventional treatments, and be an Australian resident.
Once he established he met the eligibility criteria, Cannatrek Access referred him to a clinic in Victoria which offered a 15-minute phone consultation with a doctor who prescribed him a cannabis flower and an oil.
By the end of the year, Jordan had spent $400 on virtual appointments with this clinic and $625 on five cannabis products — all of them from Cannatrek.
"I did ask about other brands and yeah, that doctor told me that they just solely do Cannatrek products," he says.
"It may have changed now."
Background Briefing contacted the doctor to ask him why he only prescribed Cannatrek products to Jordan. He said there was never any overt pressure to prescribe the brand, but the company was really helpful.
"If you have received a referral from a particular company, it's only fair to prescribe that product if it is appropriate for the patient clinically and economically," the doctor said.
'A very difficult interpretive minefield'
Cannatrek founder and CEO Tommy Huppert says the company does not pressure or incentivise doctors to prescribe its medications.
"The reason why we've been successful is we've made sure we've had inventory in the country, [plus] the quality and the price," he says.
Prescribing cannabis is not as straightforward as prescribing regular medication because unlike most drugs, it is not an approved therapy — this means it hasn't gone through rigorous clinical trials to prove that it is safe and effective.
So doctors have to get permission from the Therapeutic Goods Administration (TGA) to prescribe it. That's where Cannatrek can step in, by sponsoring doctors to become TGA-approved prescribers.
"[In Australia] we have … over 1,000 approved prescribers," Mr Huppert says.
"Cannatrek has educated and sponsored approximately 40 per cent of those approved prescribers."
While educating doctors may be one part of Cannatrek's success, others in the industry say the company's dominance is in part due to a willingness to push the TGA's advertising rules to the limit, or even past breaking point.
In Australia it is illegal to advertise certain therapeutic goods, like prescription drugs or unapproved medicines such as medicinal cannabis, directly to consumers.
That's because the decision to take prescription medication should be made with a doctor, not because of consumer advertising.
Background Briefing found several examples of Cannatrek advertising that appeared to be directed at potential patients, including social media posts, a crowdfunding campaign offering a free consultation and product discounts, and an advertorial through social news website LADbible Australia.
When we put some of the content to Mr Huppert, he said the company works collaboratively with the TGA and that the advertising rules were "a very difficult interpretive minefield".
"We believe that we have the responsibility to make the public aware of the category, and it just so happens that it is coming from our company," he says.
Less than a month after Mr Huppert's interview with Background Briefing, the TGA announced Cannatrek had been handed a $293,040 fine for 22 alleged advertising breaches.
From five grams a month to 90 grams
While Cannatrek had made it relatively simple for Jordan to find his first clinic, he gradually became frustrated with the advice he was receiving from the doctors.
"[They] weren't overly knowledgeable", he says.
"So, at that point, I wanted to see what else was out there."
Within weeks, Jordan found himself in a telehealth consultation with CDA Clinics – a specialist cannabis prescriber offering in-person appointments in Queensland and telehealth appointments across Australia.
During his first appointment, Jordan was told he might be eligible for the clinic's "special treatment program". Once in, he would gain extraordinary control over which cannabis products to order.
Previously, Jordan had been prescribed specific products chosen by his doctor. Now, he could pick and choose from an array of cannabis buds via an online catalogue, as long as he didn't go over a monthly ordering limit.
"I just called up and said I wanted to order, and paid," he says.
"I had full control."
Despite only using an average of five grams a month at his previous clinic, during his second appointment at CDA, Jordan was given an ordering limit of 60 grams of cannabis flower a month.
While that may seem excessive, Jordan says he had been unsuccessfully trying to get more products at the Cannatrek Access clinic.
When he asked to be sent a possession letter detailing his prescription ahead of a trip, he was surprised to find a doctor had further increased his monthly limit to 90 grams, without discussing it with him.
"It's odd," he says.
"To prescribe people a bunch more than what they're actually using is dangerous. It's just asking for it to be diverted to the black market."
This isn't just theoretical. Background Briefing has seen evidence of medicinal cannabis products being sold via encrypted messaging apps at up to four times the retail price.
In December 2021, CDA merged with ASX-listed company, Cronos.
A spokesperson for Cronos said the company was "not aware of such a site" but it took the onselling of its products in illegal markets "very seriously".
The spokesperson said the special treatment program was set up at a time when there were "serious out-of-stock issues compromising patient treatment" as an "effort to ensure more consistent supply" to patients.
They also said medical practitioners were "always overseeing the process and approving individual patient prescriptions".
In August, CDA tightened up the special treatment program, after the TGA made it easier to change products when there are stock outages.
Patients are now limited to four different cannabis flower products at any one time and can only make one product change per month after a medical review.
A potential conflict of interest
CDA makes money from the wholesale and distribution of products.
So the more products the company moves, the more money it makes.
And this raises a question about conflict of interest for doctors who happen to be both investors in the company and prescribers of its products.
A spokesperson for CDA's parent company told Background Briefing its doctors are required to prescribe using their own independent judgement.
"Our doctors are not incentivised in any way to prescribe one product over another. They are paid to provide a service," a spokesperson said.
"Everything we do is governed by transparency, accountability and adherence to the laws that govern the prescribing of medicines."
The potential for a conflict of interest has been particularly acute for CDA doctors who are also substantial shareholders in the company, such as co-founder, Dr Ben Jansen.
He has been described by the company as "arguably Australia's most experienced medicinal cannabis clinician, having been directly involved with the treatment of thousands of patients".
When Dr Jansen prescribed cannabis at CDA clinics,
most of the time, the company he co-founded made money.
Jordan had a few consults with Dr Jansen. He couldn't recall him disclosing this conflict of interest, but says it could have happened.
"They weren't long calls anyway … maybe a few minutes," he says.
Dr Jansen was also the clinician who signed the possession letter noting the increase in Jordan's order limit from 60 to 90 grams.
Background Briefing contacted Dr Jansen directly but he did not respond to questions.
However, a spokesperson for CDA's parent company, Cronos, said their doctors always disclosed their conflicts of interest.
"CDA patients are required to provide informed consent prior to treatment by signing a patient consent form, which states: I acknowledge that my cannabis doctor and this practice may have an interest in MC [Medicinal Cannabis] and hemp companies … Furthermore, I acknowledge that my prescription, treatments or recommendations may benefit the CDA Group and/or this practice," the statement said.
"This is also stated by the applicable doctor at the beginning of the consultation, verbally."
Gaps in the system
The Royal Australian College of General Practitioners (RACGP) has serious concerns about medicinal cannabis clinics being run by companies with a financial interest in cannabis products.
"The issue with it is that there might be some decisions that are made for commercial reasons rather than best patient care," RACGP addiction medicine specialist, Dr Hester Wilson, says.
Dr Wilson says where there are conflicts of interest they need to be clearly disclosed in appointments, not just in the fine print.
"My concern is that this potentially is a group of people who are quite vulnerable, they have significant illness, they may not have a great deal of money," she says.
"They also may not have all the information that they need to make informed choice, and really … we want there to be informed choice for people."
The RACGP believes if most medicinal cannabis products were registered pharmaceuticals not experimental unapproved therapies, these closed-loop set-ups wouldn't be accepted, even with clear disclosures.
"It's not done as far as I'm aware," Dr Wilson says.
"[It] is very concerning that these closed systems of only promoting your particular product are allowed to flourish because of the different way that cannabis is allowed into Australia.
"I am supportive of cannabis being available but it really needs to … be a very clear, transparent process."
A CDA spokesperson told Background Briefing, "Like many other Australian companies, we are working within the framework to provide patients in need with Medical Cannabis treatments".
'It does need some urgent action'
Medicinal cannabis advocate, Lucy Haslam, says while cannabis clinics have helped facilitate access, she now fears some are having a negative impact on patients.
"While you have patients that are basically being fleeced … it does need some urgent action," the Chair of the Australian Medicinal Cannabis Association says.
Ms Haslam is calling for greater transparency and more independent clinics, saying it will serve both patients and the industry.
"Where there is vested commercial interest or … prescribing of products that are not necessarily the best product for the patient, but based more on the financial interests of the prescriber, I think that doesn't sit well with anybody and it shouldn't be allowed to happen," she says.
Dr Laurence Kemp is Head of Medical at specialist cannabis clinic, Cann I Help, and a minor shareholder in its parent company. Like some of his colleagues working in cannabis clinics, he's calling for a tightening of the sector's regulation.
"I think more oversight and a set of standards that were specific to doctors working within cannabis care would be really useful," he says.
Dr Kemp is calling for the introduction of guidelines for cannabis clinicians, similar to those set by the RACGP for general practitioners.
"They make it really clear what's expected of care and how you set up a practice and how you run a practice," he says.
"I think what I would probably like to see within the cannabis industry is a similar set of standards about how practices are run."
In the meantime, for patients, finding quality cannabis care can be trial and error.
Jordan has now left CDA and isn't involved with another closed-loop cannabis clinic. Instead, he is seeing an independent cannabis doctor who does telehealth from Victoria.
"I felt confident that they knew what they were doing and that I was in much better hands."
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