Health watchdog cracks down on medicinal cannabis prescriptions

New guidelines for medicinal cannabis prescription have been revealed, targeting poor practice that affects patients. See what it means.

Australia’s medical watchdog has announced a crackdown on practitioners prescribing medicinal cannabis, revealing poor prescribing practices were leading to significant patient harm.

The Australian Health Practitioner Regulation Agency and the National Boards today announced the nation’s first official guidelines for surging medicinal cannabis prescriptions, stemming from concerns that profits were being prioritised over patients.

Why is AHPRA cracking down on medicinal cannabis prescriptions?

The decision by regulators to clarify expectations of practitioners was driven by evidence of over-servicing and reports of a number of patients presenting to emergency departments with medicinal cannabis induced psychosis.

According to the regulator eight practitioners had issued more than 10,000 prescriptions for medicinal cannabis products over a six-month period, with one believed to have issued more than 17,000 scripts.

The Australian Health Practitioner Regulation Agency and the National Boards today announced the nation’s first official guidelines for surging medicinal cannabis prescriptions. Picture: Supplied

AHPRA also flagged that some consultations would only last between a few seconds and a few minutes, which it said makes a “proper assessment impossible”.

Other cases of poor prescribing practice observed by the AHPRA included doctors failing to assess a patient’s mental health, prescribing for people under the age of 18, providing multiple scripts for a single person so they can “try which one suits them” and prescribing excessive quantities.

AHPRA has taken action against 57 medical practitioners, pharmacists and nurses over medicinal cannabis prescribing practices so far since December 31 last year.

Who is the target of the new guidelines?

Vertically integrated, one-stop shop telehealth companies that have seen unprecedented growth in recent times have caught the eye of regulators, with some accused of putting profits ahead of patient welfare.

The APHRA said “ethical grey areas” around single-purpose dispensaries were a significant driver for the formulation of the guidelines themselves.

The body’s CEO Justin Untersteiner said the move warned practitioners of conflicts of interests that arose from working in an organisation that only prescribes and dispenses a single medicine.

The regulator has flagged practitioners will be investigated if they have high rates of prescribing any scheduled medicine. Picture: Peter Mathew

“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.”

The regulator has flagged practitioners will be investigated if they have high rates of prescribing any scheduled medicine, including medicinal cannabis, regardless of whether a complaint has been made.

What do the guidelines recommend for practitioners prescribing medicinal cannabis?

The regulators have essentially shut the door on short online consultations, mandating that patient assessment must be thorough taking into account medical history including social, mental health and substance abuse history.

The guidelines also say outside of a few exceptions there is little evidence to support the use of medicinal cannabis, and that patient demand is not an indication to prescribe the drug.

‘We don’t prescribe opioids to every patient who asks for them, and medicinal cannabis is no different. Patient demand is no indicator of clinical need,’ Medical Board of Australia Chair Dr Susan O’Dwyer said.

The AHPRA-issued guidance also made specific reference to telehealth consultations, suggesting prescribers may have to make arrangements for the patient to be seen-in-person if necessary.

The regulators have essentially shut the door on short online consultations, mandating that patient assessment must be thorough. Picture: Chris Kidd

“Safe prescribing of medicinal cannabis includes assessing patients thoroughly, formulating and implementing a management plan, facilitating co-ordination 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,” the AHPRA said.

With only two medicinal cannabis products having been approved by the TGA, prescribers must also get informed consent from patients when prescribing products that have not been approved or assessed for safety, efficacy or quality by the TGA.

How is medicinal cannabis prescribed?

After parliament passed legislation that legalised medicinal cannabis in 2016, doctors have been able to prescribe the drug even though a large majority of products remain unapproved.

Doctors are able to prescribe drugs that remain unapproved by the TGA through the Special Access Scheme (SAS) or the Authorised Prescriber (AP) pathways.

The rise of telehealth companies that operate by prescribing one sort of medicine, has seen prescriptions for drugs like medicinal cannabis skyrocket.

“Business models have emerged that appear to use aggressive and sometimes misleading advertising that targets vulnerable people,” the AHPRA said.

“Some of these practices only offer the prescription and supply of a single product or class of drug and use online questionnaires that coach patients to say ‘the right thing’ to justify prescribing.

“While these models may work well for access, there is an inherent conflict of interest for medical and nurse practitioners working in an organisation that prescribes and dispenses a single medication.”

Originally published as Health watchdog cracks down on medicinal cannabis prescriptions