Talking to your patient
In NSW, there is no predetermined list of conditions for which a cannabis medicine can be prescribed. We strongly encourage NSW medical professionals to work in partnership with their patients regarding cannabis medicines.
Considerations for prescribing
The only cannabis medicine currently on the Australian Register of Therapeutic Goods (ARTG) is nabiximols (Sativex®) approved for the treatment of spasticity in multiple sclerosis. All other cannabis medicines are experimental and their effects are still being studied. As a result, 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 trialled 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 or, on some occasions, you may feel that 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 health professional in NSW is under an obligation to prescribe an unapproved cannabis medicine. You can however seek reputable clinical advice through the NSW Cannabis Medicines Advisory Service if you are considering prescribing a cannabis medicine or seeking more information.
There are a number of practical considerations for patients to consider if being prescribing a cannabis medicine. These include:
- The product may not have been approved in Australia by a medicines regulator
- The possible benefits of treatment and any known risks and 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
- THC use is incompatible with driving and some workplaces. Using cannabis as a medicine is not a defence for traffic offenses.
Health professionals should discuss these issues with their patients before prescribing a cannabis medicine. Obtaining written consent from your patient is best practice.
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.