Mental health tragedy sparks questions on medicinal cannabis oversight

Long after Dominic McCabe died, the packages kept coming. Month after month, as his family grieved his suicide, the small tubs in plain packaging would keep arriving at his house.

His family asked that they stop, but they kept coming. His bank account was repeatedly debited, his family sent the packages back. But still they kept coming.

Dominic McCabe took his life in February. He struggled with mental health and was on prescription medicines. Unbeknownst to his regular GP and psychiatrist, he was also prescribed cannabis by Melbourne-based provider Dispensed. His mother says better checks are needed on medicinal cannabis. The NSW coroner is considering investigating the case.

Inside the packages was medicinal cannabis from Melbourne firm Dispensed. McCabe’s family now questions whether the 41-year-old should have been able to so easily access cannabis when he was already taking other drugs for his mental illness.

His case has thrown a spotlight on the booming but little-policed cannabis industry now being accessed by hundreds of thousands of Australians – the vast majority of whom see a doctor or nurse only via telehealth.

A New South Wales Coroner’s Court spokesman said the court was now “waiting on a final post-mortem report to determine whether an inquest will be held” into McCabe’s death.

McCabe, from NSW, had been diagnosed with bipolar disorder and schizophrenia, and neither his GP nor his psychiatrist was aware of the cannabis prescriptions. His family only discovered he was receiving medicinal cannabis when the tubs kept arriving.

Images taken from Reddit of cannabis products sold and delivered by Melbourne-based medicinal cannabis company Dispensed.Credit: Reddit

“A couple of weeks after he took his life, we received a package of medicinal cannabis in the mail, which we went to the post office and we returned, taking note of where it had come from,” McCabe’s mother Ann said.

“I emailed the pharmacy concerned, informed them that my son had passed away and that he would no longer be requiring that medication.

“The medication arrived another month later. And then another month later. Which meant that they were taking money out of his account after he had died because it was a private prescription worth several hundred dollars. Each time, we sent it back.”

Dispensed is majority owned by Melbourne pharmacist Adam Riad Younes, who runs two Priceline chemists in suburban Melbourne.

Younes was in August suspended from dispensing cannabis. Health authorities declined to outline the reason, pointing only to the conditions having been imposed “using immediate action powers” under national laws.

The prohibition does not prevent Younes owning a stake in a cannabis business.

Adam Younes is a founder and co-owner of telehealth cannabis business Dispensed. AHPRA has banned him from dispensing medicinal cannabis.Credit: LinkedIn

The Medical Board of Australia also suspended two doctors who worked for Dispensed the same month, using the same powers.

Dispensed is a medium-sized player in an industry with 3000 approved Australian prescribers of medicinal cannabis.

The country’s medicinal cannabis industry began modestly in 2016 after parents of children across Australia with epilepsy and cancer fought to have the drug legalised for medical use.

It has since grown into a scheme used by hundreds of thousands of people to access cannabis legally with a doctor’s script.

There are growing concerns over the ease of access to medicinal cannabis particularly via online clinics like Dispensed, which allow those seeking the drug to get it delivered in the mail, usually after a telehealth appointment. Some clinics do not require customers to participate in a telehealth session.

The industry is now worth more than $500 million dollars annually in Australia, with local corporations like Montu and Cannatrek turning over revenue of $100 million-plus a year.

Most prescriptions are for the treatment of chronic pain, followed by anxiety, sleep disorders, post-traumatic stress disorder and cancer pain management.

Dispensed allows customers to have cannabis products – with names such as Devil’s Driver, Amnesia Haze and McFlurry – posted to their door. An industry source, speaking anonymously to detail confidential information, said it claimed privately to have about 30,000 subscribers across Australia.

Dispensed’s website describes itself as “incredibly affordable with $0 in set-up and upfront fees”. To get cannabis delivered, patients fill out an online form and then do a telehealth consultation, after which the drug is delivered.

Dispensed’s business model relies on subscribers paying a monthly fee. “Subscription costs start from $155 per month, which includes monthly medication, ongoing clinician consultations, express delivery and LiveChat patient support”, its website says.

An email from a Dispensed patient, sent in March this year and unrelated to Dominic McCabe, shows the company, after six months of prescribing cannabis to a customer, telling them they need do nothing to continue receiving the drug. It offers to have a doctor simply “prepare your new script/s and your plan will continue monthly”.

Dispensed launched in 2021, proclaiming itself “Australia’s easiest-to-use online platform for access to therapy with medicinal cannabis”.

In August, the Pharmacy Board of Australia imposed conditions on Younes blocking him personally from selling cannabis. The same month, the Medical Board of Australia suspended two doctors – Geon Oh and Ji Woong Yoo – over their work as prescribing doctors for Dispensed. Neither Yoo nor Oh could be reached for comment, and it is not known whether either doctor intends to challenge the suspension.

Company searches show Younes this month stood down as a director of Dispensed.

Younes did not respond to requests for comment. This masthead also attempted to reach Dispensed itself for comment but was unsuccessful.

Contacted in August by cannabis industry news site Cannabiz, Younes said he was “engaging with regulators” on his issue but could not comment further.

Dominic McCabe’s mother Ann said her son had “rather strong reactions to [cannabis] so it wasn’t a product that would agree with him”.

McCabe held degrees in horticulture and accounting and a graduate diploma in agriculture. His mother said his mental health condition had been diagnosed as “bipolar at some stages; at other stages, they called him schizophrenic”, and that he had attempted suicide before February.

She said her son was already taking some medicines which are required to be registered on the national SafeScript website. Cannabis is a schedule-eight drug, and prescriptions must also be registered on SafeScript.

Under Australia’s health rules, pharmacists and doctors are meant to access the SafeScript system to ensure a patient is not on conflicting medicines or “script shopping”.

She said medicinal cannabis could be useful for some people, “but the system’s not got all the checks and balances it needs”.

Ann McCabe said while the medicinal cannabis industry needed attention, more widely, there was nowhere near enough mental health support for people like her son. “The whole mental health system is stuffed. There are nowhere near enough people in the industry.”

Penington Institute chief executive John Ryan.

John Ryan, chief executive of public health and drug research centre Penington Institute, said there were potential harms and benefits from medicinal cannabis that needed to be balanced.

He said that legal cannabis was relatively new in Australia’s medical system and while most cannabis prescribers acted responsibly, some didn’t, and this bad behaviour had to be targeted. “Tragically, sometimes the system only becomes aware of that at the most dreadful time.”

He said it was not just medicinal cannabis where patients suffered from bad health practices.

The Australian Health Practitioner Regulation Agency set up a rapid regulatory response unit in July to look at the medicinal cannabis, weight loss medication, vaping products and cosmetic injectables industries.

Unit director Jason McHeyzer would not comment directly on the Dispensed case but warned cannabis clinics providing access to the drug at “high volume and high speed” could expect possible regulatory action.

Jason McHeyzer is national director of the Australian Health Practitioner Regulation Agency’s rapid regulatory response unit. Credit: Australian government

He said doctors prescribing cannabis for an illness as part of a range of treatments, following a thorough patient consultation, had nothing to fear.

Clinics offering only one medicine – cannabis – while simultaneously failing to adequately consult the patient faced disciplinary action.

“Medicinal cannabis is no different to a bunch of other controlled drugs like oxycodone and other opioids, where there are patients you would never give that drug to because it’s not going to be good for them, let alone treat their condition,” McHeyzer said.

“There are other examples where patients have serious health concerns and the only intervention is a prescription of medicinal cannabis, without the prescriber linking to their treating team, and without talking to them about their mental health and other potential issues.

“The only thing the prescriber says is ‘Hey, you know what, I’ve got a box of hammers, so I’ll give you a hammer’ because that is the only treatment in their toolkit.”

If you or anyone you know needs support call Lifeline 131 114, Beyond Blue 1300 224 636 or Kidshelpline 1800 551 800.

Start the day with a summary of the day’s most important and interesting stories, analysis and insights. Sign up for our Morning Edition newsletter.