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Medicinal cannabis

Medicinal cannabis products are legal, high quality medicines that can be prescribed for people by their doctor. Medicinal cannabis is derived from cannabis plants and can be used to treat the symptoms of certain medical conditions, and the side effects of some treatments.

There are different medicinal cannabis products available to treat different conditions.

The active ingredients in medicinal cannabis are called ‘cannabinoids’. There are between 80 and 100 cannabinoids in medicinal cannabis, and researchers are still investigating how they all work.

At the moment, most medicinal cannabis products contain the cannabinoids cannabidiol (CBD) and tetrahydrocannabinol (THC).

What medicinal cannabis products are available?

Medicinal cannabis products vary, depending on the symptoms or condition they are designed to treat. The way that you take them can vary too. Your doctor will need to assess your needs, and make a decision about whether there is an appropriate medicinal cannabis product for you.

The majority of products are available through import, but more locally available products are expected to become available as the Australian medicinal cannabis industry becomes more established.

What can medicinal cannabis be used for?

While cannabis, or marijuana, has been around for a long time, there is still not much formal evidence for doctors to rely on if they are thinking about prescribing a medicinal cannabis product to a patient.

There is some evidence that certain medicinal cannabis products may be useful in treating the following conditions:

The Commonwealth Government has released documents

which summarise the evidence so far that medicinal cannabis may be useful in treating some conditions.

A doctor or specialist can apply to the government for approval to prescribe medicinal cannabis for any medical condition. However, the doctor may have to provide evidence that shows that medicinal cannabis may be effective for the particular condition being treated. The Office of Medicinal Cannabis has information and resources

to help support medical professionals prescribing medicinal cannabis.

How can I access medicinal cannabis in Victoria?

You can only access legal medicinal cannabis products via your treating doctor or specialist, and only if they believe medicinal cannabis will help treat your condition.

The first step is to discuss medicinal cannabis with your doctor. If they agree medicinal cannabis is appropriate, they will need to decide which medicinal cannabis product to prescribe to you, and get any necessary government approvals.

Once your doctor has received the required approvals, they may issue a prescription to you. You may then take this prescription to any pharmacy to have your medicinal cannabis product dispensed (see Figure 1). More information on accessing medicinal cannabis can be found on the Department of Health and Human Services website

Figure 1: How to access medicinal cannabis in Victoria

How much does medicinal cannabis cost?

In Australia, most medicines prescribed by your doctor are subsidised by the Commonwealth Government under the Pharmaceutical Benefits Scheme (PBS). There are currently no medicinal cannabis products subsidised by the PBS. The cost of medicinal cannabis varies depending on the type of product and the dose recommended by your doctor. As these products are not subsidised by the PBS, you must fund the cost yourself.

The Victorian Government has a ‘compassionate access scheme’ that funds medicinal cannabis products for a limited number of children with severe intractable epilepsy. If you are a parent or carer of a child who may be eligible for this scheme, speak to your child’s paediatric neurologist to find out more.

Can I drive while taking medicinal cannabis?

Driving is not advised while taking medicinal cannabis. THC, one of the common active ingredients in medicinal cannabis, causes impairment in drivers. Unlike alcohol, it is not known what dose of THC will cause impairment in most people.

Even if you believe you are not impaired, it is illegal to drive in Victoria with any THC in your system. Consuming alcohol while taking medicinal cannabis also results in more severe impairment, and carries greater penalties for driving offences.

While CBD on its own is not known to cause impairment, it may occur if the CBD interacts with other medications.

Patients using medicinal cannabis products should seek their doctor’s advice before driving or operating machinery.

Can I bring medicinal cannabis to Australia?

If you are travelling to Australia, you are able to carry up to a 3 months’ supply of medicinal cannabis for yourself or a passenger in your care, provided you have the relevant prescription from a medical practitioner. To learn more, please visit the Office of Drug Control

Information for health professionals

In Victoria, any registered medical practitioner or nurse practitioner can prescribe medicinal cannabis for any patient with any condition, if they believe it is clinically appropriate and have obtained any required Commonwealth and/or state approvals.

Prescribing medicinal cannabis follows the same process as for all other pharmaceutical medicines, with requirements dependent on 1) whether the product is registered on the Australian Register of Therapeutic Goods (ARTG)

, and 2) the Schedule of the product on the Australian Poisons Standard.

All products not registered on the ARTG require approval from the Commonwealth Therapeutic Goods Administration (TGA) to be prescribed. This approval can be obtained through either the TGA’s Special Access Scheme

has been published on the TGA’s website.

Irrespective of registration on the ARTG, medicinal cannabis products containing over 2 per-cent tetrahydrocannabinol (THC) are Schedule 8 drugs of dependence and prescribers will require a Victorian Schedule 8 treatment permit before a prescription can be issued. Exemptions from the requirement for treatment permits exist if the patient is in hospital, an aged care service or prison, or the indication for treatment is palliative care.

Victorian (Schedule 8) and Commonwealth (TGA) approvals can now be sought together via the TGA’s single online application

Prescribers and pharmacists are also required to check SafeScript

, Victoria’s real-time prescription monitoring system, prior to prescribing and dispensing Schedule 8 medicinal cannabis products.

Who can prescribe medicinal cannabis?

In Victoria, any medical practitioner can prescribe a medicinal cannabis product for their patient, if they believe it is clinically appropriate to do so. Medical practitioners do not need to gain accreditation, nor be specialists in a particular field. Nurse practitioners are also able to prescribe both Schedule 4 and Schedule 8 medicinal cannabis products, if doing so is within their scope of practice.

Clinical evidence

Currently, the scientific literature supporting the use of medicinal cannabis to treat a range of conditions is limited, but there is some evidence to support its use for patients suffering from chronic or terminal illnesses who don’t get relief from other medicines. Currently, most research and evidence on medicinal cannabis products have come from five clinical conditions – multiple sclerosis, palliative care, epilepsy, nausea and vomiting, and chronic non-cancer pain.

Recognising that many doctors know very little about medicinal cannabis, the Commonwealth, together with Victoria and other States, developed a series of clinical guidance documents to assist doctors and patients to understand the potential uses for medicinal cannabis.

These documents provide information on the available evidence and guidance on how to prescribe medicinal cannabis. Patients and doctors can use these documents to guide decisions on whether medicinal cannabis is appropriate for their condition.

These documents can be accessed via the TGA website

Additional resources to assist prescribers in determining whether medicinal cannabis may be appropriate for their patient can be found in the data and resources section

Choosing a medicinal cannabis product

Product types

Medicinal cannabis refers to quality-assured pharmaceutical products that use the cannabis plant or chemicals contained within it to treat medical conditions, and are only available via prescription. There are over 100 cannabinoids in the cannabis plant. The two main cannabinoids that have been studied for potential therapeutic effects are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). As a result, medicinal cannabis products available in Australia tend to contain mostly THC, mostly CBD or a combination of both in their formulations. Some products also contain other chemical components from the cannabis plant including additional cannabinoids, terpenes and flavonoids.

Different cannabinoids or combinations of cannabinoids can have different therapeutic effects, as well as different side effects. Before deciding which medicinal cannabis product to prescribe, available clinical evidence should be reviewed to determine the product composition most likely to produce positive outcomes for the patient.

In addition to cannabinoid content, medicinal cannabis products vary in formulation (oils, tinctures, plant material, topical gels, etc.) and routes of administration (inhalation, ingestion, etc.). Smoking medicinal cannabis should not be supported as it is difficult to estimate dosage, and due to the well-documented evidence that smoking in general is harmful.

Medicinal cannabis does not include the recreational or self-described medical use of cannabis without a prescription, both of which remain illegal in Victoria.

Scheduling

THC is classified as a Schedule 8 drug under the Australian Poisons Standard. Because most medicinal cannabis products contain varying amounts of THC, they are then classified as Schedule 8 products, and are controlled drugs in Victoria.