Legislation for medicinal cannabis use in Australia was introduced in 2016. Since then there have been incremental changes to how it is prescribed and who can prescribe it.
The third Cannabis as Medicine Survey (CAMS) published in the Harm Reduction Journal last month asked 1600 cannabis users whether they were using solely illicit cannabis, prescribed cannabis or both for any medical condition.
It showed a jump in use of medicinal cannabis from 2.5% in 2018 to 37% in 2021.
The survey also showed that 67% of users only used illicit cannabis, pointing to the fact most cannabis use for medical conditions is illicit.
Dr Nicholas Lintzeris, lead researcher from the Faculty of Medicine and Health at the University of Sydney, told newsGP most patients using medicinal cannabis do so for the conditions of pain, mental health and sleep conditions.
‘[These ailments] traditionally have been medicated with opioids, benzodiazepines, antidepressants and antipsychotic medications,’ he said.
‘In my own practice I see many patients reducing their use of opioids and benzodiazepines after starting medicinal cannabis.’
Most prescribed- and illicit-cannabis users in the survey did not intend to continue illicit use, suggesting a transition away when commencing medicinal cannabis.
Dr Brian Walker, a GP in Western Australia and cannabis prescriber, agrees with this assessment.
‘Most people using cannabis illicitly are using it for self-treatment, things like PTSD, pain and anxiety,’ he told newsGP.
‘But there’s still a dichotomy. Some people feel they are about to use a dangerous drug, while others just see it as a medication.’
According to Dr Walker, many patients using the illicit form are not concerned by changing to the medicinal product.
‘Illicit cannabis can have a dubious quality and you’re relying on criminals,’ he said.
‘Many people notice an improvement in quality of their conditions when changing from illicit to medicinal.’
One of Australia’s first Authorised Prescribers of medicinal cannabis, GP Dr Matty Moore, told newsGP the increased number of cannabis prescriptions is multi-factorial.
‘There is better access for patients and doctors are more comfortable prescribing this form of medication as they gain confidence,’ he said.
‘Plus, for the most-prescribed condition [of] “chronic pain” there aren’t many options and of those available, patients have side effects, dependency, or toxicity. Therefore, it’s key to give them another viable option.
‘Furthermore, there are also patients that are already accessing cannabis on the black market for their conditions, and doctors are likely converting them over to the legitimate medical-model.’
Dr Moore says prescribed cannabis is different to that accessed via the black market.
‘We know exactly what is in it [and] what has been removed. Patients deserve this consistency for their individual indications,’ he said.
‘The TGO 93 certification process is legitimate and makes the medicines on the market standardised and safe without the ochratoxins, bacteria, fungus, and pesticides.
‘You can’t say that about black-market cannabis.’
Survey respondents reported positive outcomes of medical cannabis use, with 95% reporting their health improved.
Dr Lintzeros says prescribed medicinal cannabis has many benefits compared to when the drug is sourced illicitly.
‘[It provides] certainty about dose and cannabinoid composition, certainty of access [and] safer routes of administration,’ he said.
‘Engaging patients into the healthcare system and more open discussion between patients and health providers about how they manage their health problems [are other positives].’
Dr Walker reports many benefits in using medicinal cannabis for pain, diabetic neuropathy, PTSD, ADHD and dementia.
‘I also have patients coming off opiates and doing marvellously just on medicinal cannabis,’ he said.
But one issue he encounters a lot is related to driving.
‘I had a patient using prescribed cannabis who had a random breath test and was fined and then unable to drive,’ he said.
‘She had planned to move to Canada but was told because of her crime she would need to enter a five-year rehabilitation program so she couldn’t go, even though cannabis is prescribed there.’
The other issue is cost, as medicinal cannabis is not on the PBS and can set patients back an average of $79 per week – a barrier that has led Dr Walker to petition for change.
Meanwhile, Dr Lintzeris would like to see training programs for cannabis prescribing that are accredited and delivered by reputable organisations – but also acknowledges that GPs’ ‘huge workloads’ may be a barrier to participation.
‘When so many feel exhausted and overworked, it is difficult to get them to engage in new things,’ he said.
‘Also, when you look at the conditions being treated with medicinal cannabis such as pain, mental health and sleep [issues], these are not easily done in six-minute medicine that Medicare funding has driven GP practice towards.
‘These conditions take time and doctors do not feel comfortable simply handing out prescriptions for complex health conditions.’
The explosion in medicinal cannabis use would suggest it will become an increasing part of Australia’s healthcare system in coming years, but given much of it is still sourced illegally rather than from registered outlets, it appears much needs to be done to remove barriers to access.
‘What we need is education of doctors and health bureaucrats to make access easier,’ Dr Walker said. ‘People are dying and suffering as a result of inaction.’
For Dr Moore, the training colleges and governing bodies will also need to implement some curriculum in order to train GPs around its use.
‘And we’ll also need them to come out and support its use … with campaigns to reduce opiates and benzodiazepines, which are highly addictive and toxic,’ he said.
‘Cannabis may be the answer to the opioid epidemic as more and more positive data is coming out for withdrawal protocols and cessation.
‘Australia is in the infancy of its cannabis medical model but I think we’re going about it in the right way. Safety and efficacy data is important and will be the only way for some practitioners to finally adopt it and negate their own biases taught to them over the last century.’
SOURCE: News GP