Australians are being prescribed medical cannabis in droves

medicinal cannabis in Australia

Prescription of medical cannabis in Australia: an analysis of trends over the first five years

In 2016, the Australian government passed legislation to make it legal to use cannabis for medicinal purposes. Over time, requests for prescriptions have increased and since January 2020, they represent more than 85% of prescriptions written.

Since then, prescriptions for cannabis, including varieties containing THC, have skyrocketed, with new research showing that doctors have prescribed it for more than 140 different conditions.

The study, conducted by the University of Sydney's Lambert Initiative for Cannabinoid Therapeutics, found that nearly a quarter of a million prescriptions had been approved over the past six years in Australia, with anxiety being one of the main causes of "flower prescriptions". Other common conditions include pain (61%) and sleep disturbances (5,7%).

“There seems to be an increase in approvals over time for conditions falling under mental health. But those aren't the only conditions we've seen growth for,” says Sara Macphail, research assistant at the Lambert Initiative for Cannabinoid Therapies.

“So far, only a limited number of high-quality clinical studies have been performed on cannabis for mental health disorders. Of these few studies, most used CBD products. So with THC products, we just don't know how effective it would be – more studies need to be done to draw conclusions one way or the other. »

So how do medicinal cannabis prescriptions work?

According to Macphail, the Office of Drug Control classifies drugs in a "schedule" based on potential risks and harms. CBD falls under schedule 4 (prescription only drug) and THC under schedule 8 (controlled drug), which means they are regulated separately.

“When a physician asks to prescribe medicinal cannabis, they must provide the TGA with a clinical rationale explaining why cannabis is considered a treatment option. This will include details of the condition being treated, and other treatments previously tried,” she says. “In some states, prescribing Schedule 8 products requires TGA approval and additional approval from a state health authority. »

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Who has access to these prescriptions?

While before 2020 people aged 45-52 had the highest incidence of cannabis prescriptions, after 2020 people aged 20-31 were the predominant group. The study also found that flower-based cannabis (containing THC) was prescribed for anxiety, and particularly among men aged 31 or younger.

“We cannot say for certain why there has been an increase in approvals for this subgroup of patients, we can only speculate. There may be a greater incidence of young men with these conditions, but we haven't specifically looked at that,” Macphail says.

“It should be noted that our analysis also revealed an increase in requests for products containing THC in all sectors,” she adds.

Researchers are currently unable to say whether this rise is related to the pandemic, but research shows that more than 85% of total prescriptions to date have been given since January 2020. Additionally, there was a bias of state, with Queensland responsible for more than half of all prescriptions written nationally.

Why do GPs prescribe so many drugs?

According to Macphail, there is a need to strengthen education and training. “[It is] definitely a barrier to patient access to medicinal cannabis, and the 2020 Senate inquiry proposed that the medical degree curriculum be updated,” she says.

“There just isn't a whole lot of information available to medical practitioners about accessing and prescribing these products either. It is often up to the practitioner to do their own research. The Therapeutic Goods Administration provides a few guidance documents for the conditions it believes have the best evidence, which were published in 2017: chronic noncancer pain, epilepsy, palliative care, chemotherapy-induced nausea and vomiting, and spasticity in multiple sclerosis. »

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Although she points out that this is just speculation at this point, the rapid escalation of prescriptions in 2020 could come down to:

  • Policy changes: allowing for greater ease of access, particularly in Queensland and New South Wales.
  • Acceptance: of the therapeutic potential of medicinal cannabis.
  • The combination of these two elements could lead doctors to consider cannabis as a therapeutic option when other solutions have failed.

The study's lead author, Dr Elizabeth Cairns, said: "There is a clear and unmet need for effective drug treatments in a variety of conditions that could be helped by medicinal cannabis. For example, it could be interesting to conduct high-quality clinical trials on the use of flower-based products to treat anxiety, and this is certainly something that the Lambert Initiative and its collaborators could consider in the future. 'coming. »

Of course, the bottom line is that there is not enough scientific knowledge and evidence.

 The cannabis plant is extremely complex and clinical studies are difficult and expensive, which is why, although we hear it often, studies are absolutely necessary. The lack of clinical evidence should not be confused with a lack of efficacy, it is simply that the studies have not yet been done,” explains Mr. Macqphail.

“We are helping to fill some of these gaps through the research we conduct as part of the Lambert Initiative and the unbiased communication of our results. At the end of the day, what we care about is what's best for the patient, so if something isn't working, we want to know that too. This study is the tip of the iceberg and highlights the next areas where we can focus our attention. »

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