Medicinal Marijuana & Cannabis

Medicinal Marijuana or Cannabis explained for patients

By Dr. Aparna Hegde,
Cosmetic & Integrative General Practitioner, Educator A5M & ACAAM, Advisory Panel Member A5M
MBBS, FRACGP, MPH & Tropical Medicine, Dip Aviation Med, ACAAM

Cannabis-Based Products (CBPs) are available to be prescribed and dispensed in Australia under strict guidelines.
There is a lot of confusion as to what is available and the indications for use by both doctors and patients.

I'm hoping this article will clarify the situation for you.

Each State in Australia is different in the requirements. I'm going to concentrate on WA as this is where I practice. There are two types of CBPs that can be prescribed for medical reasons and no CBPs are listed on the PBS. Availability of CBPs is still a problem in Perth so even though the relevant approval may have been obtained and you have a script, your pharmacist may not be able to source it. None of the CBPs are cheap and affordable, but they are legal which means you won't be in trouble with the law for using them, they are controlled by regulations so you know exactly what you are getting and in some cases such as with chronic pain when we have run out of other therapeutic options, they are worth trialling. 

One type which is listed as Schedule 4 is mainly cannabidiol (CBD) and minimal (less than 10%) of delta- 9tetrahydrocannabinol (THC) which is the psychoactive component or the part that gives the "high" of cannabis. At present, there no Schedule 4 CBPs registered as therapeutic goods in Australia and so even these medications require the appropriate paperwork and approval under the Special Access Scheme from the Therapeutic Goods Administration (TGA). As per the TGA, approvals may be given for chemotherapy induced nausea and vomiting, refractory paediatric epilepsy, palliative care, cancer pain, neuropathic pain, spasticity from neurological conditions, anorexia as wasting due to chronic illness such as from cancer. The TGA is a federal organisation and unfortunately approvals for indications other than mentioned are hard to get. In my experience, approval for Schedule 4 CBD has required a specialist letter indicating the CBD was not being used as first line treatment, that it was indicated as treatment for the condition and that there were studies backing this up. Still quite an onerous process for the doctor requesting the approval to start, let alone for the patient to then get the script filled. Once there is a Schedule 4 CBD product that is registered in Australia with the TGA, this complicated process should become a simple matter of the doctor writing a script and the patient getting it filled at the pharmacy such as with any other medication. 

The other type of CBPs are listed as Schedule 8 medications as they are mainly THC and are controlled drugs that require the WA Department of Health approval. There are Schedule 8 CBPs that are registered with the TGA and so further approval here is not needed if these are prescribed. The paperwork and approval process is fairly straight forward if there is a supporting specialist letter and the indications are for chronic pain and spasticity, sleep disorders, nausea and vomiting due to chemotherapy, weight gain in HIV infection or seizure disorders. 

My approach to use of CBPs is to first establish if the condition can be helped by the use in the medical literature, discuss other options available on the PBS for the condition as these will always be easier to obtain and more affordable for the patient, assess if there are any excluding conditions such as liver problems or illicit drug use, decide on which type of CBP would be indicated, go through the paperwork requirements with the patient including that of a supportive specialist letter, written and agreed treatment plan and follow up over a 3 month trial period and then submit the paperwork to the appropriate regulatory authorities. Once the approval is through I review the patient every 2 weeks to check for therapeutic effect such as a pain score as well as for side effects and order investigations as clinically indicated. Once the 3-month trial period has been completed, I discuss with the patient as to the efficacy and willingness for ongoing treatment and either cease the CBP or apply for ongoing approval as appropriate. 

Please note consultations for Medicinal Cannabis will not be bulk billed at Azure Medical due to the complexity and time involved.

Not many doctors, in particular specialists, are familiar with the use of CBPs and it is important to establish contact with a GP who is experienced in this field.

Published by A5M with permission from the author

Dr Aparna Hegde can be found at Azure Medical in Perth, WA.
She is a UWA (1994) graduate who has specialised in General Practice and Aerospace Medicine. Aparna completed her certification in Anti-Ageing Medicine with A5M in 2017 (ACAAM). She has a special interest in Women's Health, she is experienced in the use of bio-identical hormones and supplements to restore normal physiology. Aparna was in the RAAF full time for 11 years and is still in the specialist reserves.

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