Medicinal cannabis should be treated as a medicine and practitioners need to be as careful and diligent when prescribing it as they are when prescribing other drugs of dependence.
That is the message from Ahpra and the National Boards following reports of patients presenting to emergency departments with medicinal cannabis induced psychosis.
The regulator stepped in to provide additional guidance to practitioners who prescribe medicinal cannabis after evidence suggested poor practice had led to significant patient harm.
Ahpra and the National Boards released a statement to remind practitioners to put patients’ wellbeing above profit following data that showed prescriptions for medicinal cannabis had soared.
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“This, combined with evidence of over-servicing and ethical grey areas around single-purpose dispensaries, has led the regulator to clarify the expectations of practitioners working in the industry,” the statement said.
Practitioners were reminded that safe prescribing of medicinal cannabis includes assessing patients thoroughly, formulating and implementing a management plan, facilitating coordination and continuity of care, maintaining medical records, recommending treatments only where there is an identified therapeutic need, ensuring medicinal cannabis is never a first line treatment, and developing an exit strategy from the beginning.
Medical Board of Australia Chair Dr Susan O’Dwyer said patient demand was not an indicator of clinical need.
“We don’t prescribe opioids to every patient who asks for them, and medicinal cannabis is no different,” she said.
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The guidance addressed the regulator’s concern that profits were being prioritised over patient safety and aimed to support practitioners to provide safe care, particularly for those patients at most risk of harm.
Ahpra chief executive Justin Untersteiner said practitioners were also warned of the inherent conflict of interest for those working in an organisation that prescribed and dispensed a single medicine.
“Some business models that have emerged in this area rely on prescribing a single product or class of drug and use online questionnaires that coach patients to say, ‘the right thing’ to justify prescribing medicinal cannabis,” he said.
“This raises the very real concern that some practitioners may be putting profits over patient welfare.”
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Ahpra and the National Boards are working with other regulators including the Therapeutic Goods Administration (TGA) and state and territory authorities to understand prescribing patterns and stay ahead of emerging trends.
Current prescribing data raised red flags that some practitioners were not meeting their professional obligations. This included eight practitioners who had issued more than 10,000 scripts in a six-month window and one practitioner who appeared to have issued more than 17,000 scripts.
“We will investigate practitioners with high rates of prescribing any scheduled medicine, including medicinal cannabis, even if we have not received a complaint,” Mr Untersteiner said.
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Ahpra shared a long list of cases of poor practice in prescribing medicinal cannabis which included:
- Consultations lasting between a few seconds and a few minutes, making a proper assessment impossible
- Prescribing without a legitimate indication, including because the patient requested it
- Failing to fully assess a patient’s mental health and history of substance use disorders
- Not checking the identity of the patient, including prescribing for people under the age of 18.
Other cases involved prescribing excessive quantities of medicinal cannabis in each prescription, not coordinating care with a patient’s other treating practitioners, self-prescribing or prescribing for family members, and only prescribing the product supplied by the company the practitioner is associated with.
The full guidance on medicinal cannabis prescribing is published on the Ahpra website.
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