Although medical cannabis has been legal in Australia since 2016, it can only be prescribed by registered medical practitioners, specialists and nurse practitioners in most states. Laws governing medical cannabis differ by state or territory, affecting the prescription and dispensing process, as well as who can prescribe cannabis medicines. While the process of obtaining a medical prescription may vary slightly by state, doctors, specialists and nurse practitioners who prescribe medical cannabis must be registered and be familiar with the application process specific to their state. It is illegal to procure medical cannabis from anyone who is not an authorised prescriber. Little Green Pharma offers free online webinars presented by experts, tailored to healthcare professionals who are new to prescribing medical cannabis as well as a range of specialised webinars.
How can a patient obtain a medical cannabis prescription?
Before explaining the steps to obtaining a medical cannabis prescription, it’s important to note that while any doctor can prescribe medical cannabis in theory, medical cannabis is different to the majority of other types of prescription medications in Australia. Almost all cannabis medications currently available are not registered and are therefore considered ‘unapproved therapeutic goods’. Meaning, doctors prescribing medical cannabis need to gain approval via the Special Access Scheme (SAS) first before they can issue a script. In contrast, most other standard prescription medicines have been through clinical trials and a registration process so can be prescribed immediately.
Consulting a GP
In order to obtain a medical cannabis script, a patient needs to consult with their doctor or registered prescriber to determine their eligibility. During this consultation, the doctor will review the patient’s medical history and family health background, taking into account their current medications and any past issues with other medications. Using evidence-based practices, the doctor will then make an informed decision regarding the most suitable treatment pathway.
A patient can obtain a medical cannabis prescription through their regular specialist, GP, or nurse prescriber as long as that registered medical professional has received approval from the TGA to prescribe cannabis.
If the doctor submits their request via SAS B pathways, they should hear back from the TGA within 72 hours, with approval or a request for further information. However, some doctors already have pre-approval and are Authorised Prescribers so can write a script immediately for their patients.
Patients should ideally visit their regular GP or specialist as a first step as they will have full knowledge of their medical history, and will be best placed to determine how to treat them. Despite medical cannabis being legal in Australia, patients may hesitate to discuss it as a treatment option with their regular GP for fear of the stigma previously attached to cannabis and not knowing their GP’s opinion on this treatment.
As medicinal cannabis is still a fairly new treatment option, not all prescribers are educated or experienced regarding this medication and may suggest patients find an Authorised Prescriber to help them with medical cannabis rather than prescribe themselves.
Consultation with an Authorised Prescriber
A patient can see a doctor who has already applied to the TGA for authorisation to prescribe medical cannabis and become an authorised prescriber (AP). Authorised medical cannabis prescribers do not need to apply to the TGA every time they want to prescribe.
Required documentation and medical history
Medication history is an important requirement in determining whether a patient qualifies for medical cannabis treatment under the guidelines of the Therapeutic Goods Administration (TGA). Medical practitioners assess each patient individually based on their medical history and previous treatment outcomes. The TGA requires that eligibility is based on a patient having a chronic condition lasting over three months, which has not responded to other standard treatments or if those treatments have caused side effects. Therefore, thorough consideration of a patient’s medical history is essential.
What types of medical cannabis products are available by prescription?
In Australia, medical cannabis products available by prescription are regulated by the TGA and meet stringent quality and safety standards before being prescribed to patients. Medical cannabis products can come in a variety of forms for their therapeutic purposes including oils , dried flower, cartridges, capsules, creams, gummies, and other edibles. The specific form of medical cannabis prescribed to a patient is determined based on the prescribing doctor’s evaluation of its suitability. Since different products have different therapeutic goals, it’s essential for patients to follow the doctor’s advice, as each case is assessed individually.
In addition to different delivery forms, there is much variation in the active ingredients within each type of medical cannabis product available by prescription. Each product can have a different ratio of CBD to THC , which means that each medication has the potential to cause different effects. Some doctors are hesitant to prescribe a medical cannabis strain that contains high levels of THC, due to its potency. It can also impair a patient’s ability to drive, which is why it is illegal to drive with any THC in your system in most states, even with a prescription.
Cannabidiol (CBD) products
Many cannabis medicines contain a combination of cannabinoids, however some products are made by extracting just one of these cannabinoids and therefore contain mostly THC or CBD. CBD only medications which are extracted to ensure no THC is included are also known as CBD isolates.
Research suggests that CBD products, interact with the cannabinoid (CB1 and CB2) receptors in your endocannabinoid system and are thought to influence several bodily functions, including:
- appetite
- memory
- mood
- pain perception
- inflammation levels
It is worth noting that even products that are classed as ‘CBD’ may still contain traces of THC. Patients should discuss this with their prescriber, should their occupation or lifestyle require them to drive or operate heavy machinery, to ensure their medication won’t interfere with their workplace drug testing policy.
Tetrahydrocannabinol (THC) products
Although THC interacts with CB1 receptors and CB2 receptors like CBD, it binds much more strongly to CB1 receptors, which can alter the function of a patient’s brain function. The temporary effects that this causes are seen as psychoactive, which is why it is illegal to drive in Australia with THC in your system.
Before prescribing a product containing CBD, a doctor will account for a patient’s medical history and factor lifestyle and working requirements into their assessment of the patient’s needs.
Why is monitoring and follow-up care important when using medical cannabis?
As with any prescription medication, it is vital for doctors to follow up on their patient’s condition, and the impact that the treatment is having on them.
Tracking treatment progress and side effects
Patients should be made aware that the known side effects from medical cannabis, including both THC and CBD) can be fatigue, vertigo, nausea, dry mouth, nausea, vomiting and diarrhoea. THC has also been linked with depression, confusion, psychosis and hallucinations, among other conditions, so patients must be monitored carefully. Doctors can encourage patients to keep a dosing diary, in order to track the impact that the medical cannabis may be having on them. Follow up appointments are also required for both the doctor and the patient to ensure the treatment is providing the desired effects without unwanted side effects, so they can change the prescription, as required.
Adjusting dosage and treatment plan as needed
Doctors should be advised to start a prescription with a low dosage of medical cannabis and to instruct their patients to introduce the prescription slowly. If the dosage is not having an impact, it is easier for a doctor to increase it, so that it does have an effect, rather than reducing it due to unwanted side effects.
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