Talking to your doctor
We encourage patients to discuss their interest in cannabis medicines with their treating doctor, as they will be in the best position to provide advice regarding prescribing a cannabis medicine. This is because they will be familiar with their patient's medical condition and family history, as well as having knowledge of existing medications or other therapies their patient is currently prescribed or undergoing. Patients do not need to be referred to a 'cannabis clinic'.
Who can prescribe a cannabis medicine?
Any doctor in NSW can prescribe a cannabis medicine to their patient if they believe it is an appropriate treatment option and they have obtained the relevant authorities.
If the doctor prescribing a cannabis medicine is not the patient's usual treating doctor, it is expected that they will have a good working relationship with their usual doctor. This is to ensure the patient's safety, because there are significant risks involved in administering an unregistered, experimental cannabis medicine. Unknown factors include whether the cannabis medicine will react in a harmful way with any existing medicine being taken, and the nature and severity of possible side effects.
To prescribe an unregistered Schedule 8 cannabis medicine, a doctor must apply to the Australian Government’s Therapeutic Goods Administration (TGA) for an authority to prescribe. A doctor will also need to apply to NSW Health if they are seeking to prescribe or supply such a medicine to a child or a drug dependent person. Neither the TGA nor NSW Health charge doctors or patients for making an application to prescribe a cannabis medicine.
Why are some doctors reluctant to prescribe a cannabis medicine?
A doctor’s first duty of care is to ensure their patient’s safety. To feel confident prescribing any new medicine, a doctor requires evidence – high quality clinical research, where carefully designed studies are conducted in humans – showing the medicine is safe and effective.
Despite widespread anecdotal claims that cannabis is a natural, benign product, a cannabis medicine, like any experimental medicine, has potential risks. These include the way it interacts with other medicines, as well as uncertainty about its possible side effects. For doctors, anecdotes do not equal evidence.
Controls on prescribing cannabis medicines in NSW are in line with the restrictions for many other substances, including some severe acne medications, medicines for Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy, as well as medicines for persons with an established drug dependency. It is important that patients disclose if they have already been prescribed a cannabis medicine or if they have an ongoing drug dependency being managed by another doctor. This ensures better coordination of care for the patient under their treating doctors.
There are a number of practical considerations which patients should discuss with their treating doctor and consider before being prescribed a cannabis medicine. These considerations include:
- The product may not have been approved in Australia by a medicines regulator.
- 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. Cannabis medicines are not normally funded by hospitals or local health districts due to the lack of evidence.
- Their privacy and consenting to share information with any cannabis company-sponsored websites.
- Whether they 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.
Who can doctors speak to if they want advice about cannabis medicines?
In NSW, expert clinical guidance and cannabis medicine prescribing advice for general practitioners, community pharmacists and rural health practitioners is available via the John Hunter Hospital Pharmacy Department.
The service can assist with:
- understanding the latest evidence around cannabis medicines
- understanding the regulatory requirements for cannabis prescription
- considering tools to monitor a patient’s progress whilst using cannabis medicines
- provision of protocols to facilitate cannabis medicine prescribing.
The John Hunter Hospital Pharmacy Department can be contacted by email at HNELHD-JHHPharmacy@health.nsw.gov.au.
Public health practitioners working in metropolitan local health districts should consult their local medicines information services for clinical guidance and prescribing advice.