Talking to your patient
NSW medical practitioners can legally prescribe a cannabis medicine if they believe it is an appropriate treatment option for their patient’s health condition and they have obtained the relevant authorities.
In NSW, there is no predetermined list of conditions for which a cannabis medicine can be prescribed. We strongly encourage medical practitioners to work in partnership with their patients regarding cannabis medicines.
Considerations for prescribing
Currently two cannabis medicines are registered on the Australian Register of Therapeutic Goods (ARTG). These include Sativex® (nabiximols), approved for the treatment of spasticity in multiple sclerosis, and Epidyolex®, for treatment of Dravet and Lennox-Gastaut syndromes. As all other cannabis medicines are experimental and their effects are still being studied, the decision to prescribe should be taken carefully and cautiously.
You might consider prescribing a cannabis medicine when:
- therapies with better evidence for use and/or safety have been trialed or are contraindicated and high quality clinical evidence of efficacy, or high quality clinical evidence of efficacy for a similar condition, is available, or
- a significant number of case reports with good pre-clinical evidence of likelihood of efficacy are available.
You should also consider the complexity of a patient’s medical condition, as well as their prescribed medications, medical history, and ability to manage side-effects and dependence. Patients who are already self-medicating using cannabis may wish to legitimise their use. On some occasions, you may feel it is clinically justified (e.g. palliative care).
If, on review of the considerations for prescribing, you are not comfortable about a cannabis medicine, be frank and open about your concerns with your patient. No medical practitioner in NSW is under an obligation to prescribe an unapproved cannabis medicine. General practitioners, community pharmacists and rural health practitioners who are considering prescribing a cannabis medicine and would like more information can contact the John Hunter Hospital Pharmacy Department by email at HNELHD-JHHPharmacy@health.nsw.gov.au for support. Public health practitioners working in metropolitan local health districts should consult their local medicines information services for clinical guidance and prescribing advice.
There are a number of practical considerations patients should consider before being prescribing a cannabis medicine. These include:
- The product may not have been approved in Australia by the medicines regulator (i.e. the TGA).
- The possible benefits of treatment, any known risks and/or adverse effects.
- The possibility of unknown risks and late adverse effects.
- Any available alternative treatments using registered products.
- The ongoing cost being variable depending on the condition and dose required. In addition, given the lack of evidence, cannabis medicines are not normally funded by hospitals or local health districts.
- A patient’s privacy and consenting to share information with any cannabis company-sponsored websites.
- Whether the patient will be able to drive and/or work. It is illegal to drive whilst taking some cannabis medicines, as explained in the Driving section of this website. Using cannabis for medicinal purposes is not a defence for driving offences.
Medical practitioners should discuss these issues with their patient before prescribing a cannabis medicine. It is best practice to obtain written consent from the patient where a medicine is unregistered or use is experimental.
A patient’s current treating medical practitioner, with whom there is an established therapeutic relationship, is the most appropriate person to prescribe, and subsequently monitor outcomes of, a cannabis medicine.
If applicable, this should be in a shared care model, following consultation with and, ideally, consensus with other treating medical practitioners in the patient’s care team. All members of the patient’s care team should be aware of a trial of therapy with a cannabis medicine.
Patients do not need to be referred to a 'cannabis clinic'.
- Clinical trials
- Talking to your patient
- Prescribing pathways
- Information and support for prescribers
- Clinical guidelines
- Children and vulnerable people
Residential aged cared facilities