09 Nov 2020 Medicinal Cannabis And Treatment Access.
What is medicinal cannabis?
Medicinal cannabis (also called medical cannabis or medical marijuana) is the cannabis plant and its component cannabinoids (such as THC and CBD) used for therapeutic purposes to alleviate symptoms.
In Australia, medicinal cannabis is a pharmaceutical product prescribed by a medical practitioner and taken to treat the symptoms of a medical condition or the side effects of certain treatments. These products are highly regulated to ensure patient safety and consistency of product formulation.
What is the difference between street cannabis and medicinal cannabis?
Street cannabis and medicinal cannabis are very different, particularly in relation to quality control, potency, known cannabinoid concentration and the potential for harmful additives in street cannabis.
Medicinal cannabis in Australia is highly regulated to ensure patient safety, consistency of product formulation and the absence of potentially dangerous contaminants such as pesticides and moulds.
What is the difference between THC and CBD?
The cannabis plant contains up to 545 chemical compounds including 114 different cannabinoids, many of which have been clinically demonstrated to interact with the endocannabinoid system in the human body. To date, the most researched cannabinoids have been Δ 9-tetrahydrocannabinol (THC) and cannabidiol (CBD).
THC is a cannabinoid in the cannabis plant that is frequently associated with the treatment of chronic pain, inflammation, spasticity, and nausea. It also has intoxicating effects. These are also typically the most abundant cannabinoids in the cannabis plant.
CBD is a non-intoxicating cannabinoid typically prescribed for seizures, pain, anxiety and inflammation. CBD is non-addictive and less potent than THC with very low toxicity.
THC and CBD may work synergistically, while CBD is understood to antagonise the adverse side effects associated with THC, so when used in combination, patients are less likely to feel euphoria or ‘high’.
How do I take medicinal cannabis?
Medicinal cannabis is available in various delivery forms, as well as a range of strengths and varieties. In Australia your Doctor can prescribe you medicinal cannabis in oil form, tablets/pills, sublingual spray or flower for vaping. The dose and strength of the medicinal cannabis will depend on your condition and the recommendation from your prescribing Doctor.
How much does medicinal cannabis cost?
The cost of medicinal cannabis in Australia can vary greatly and depends on a number of considerations such as a patient’s condition and the product being prescribed.
A helpful guide to the average costs of medicinal cannabis products can be found in an independent report conducted by Freshleaf Analytics ‘Australian Medicinal Cannabis Market Patient, Product and Pricing Analysis – Q1 2020’. The report advised that the average patient taking prescribed medicinal cannabis is spending less than $10 per day.
Please note, this cost does not take into consideration the HIF rebate which eligible patients can receive.
What rebate does HIF provide for medicinal cannabis products
Rebates for medicinal cannabis are available under the Pharmacy Drugs benefit on five of our Extras covers.
The maximum rebate is $80 per script. Where Little Green Pharma products are prescribed, the maximum rebate is $105 per script until June 2022.
Annual limits apply to these rebates.
What does medicinal cannabis fall under on my Extras cover?
Medicinal cannabis products falls under Pharmacy Drugs on all HIF Extras policies, except Vital Options.
Is medicinal cannabis currently unapproved by the Australian Register of Therapeutic Goods ARTG?
Yes, all but one product is currently unapproved. However, Doctors are still able to prescribe medicinal cannabis to patients by applying for approval from the Therapeutic Goods Administration (TGA).
How can a doctor prescribe medicinal cannabis if it’s unapproved by he Australian Register of Therapeutic Goods ARTG?
Despite medicinal cannabis not being currently listed on the ARTG, there are several ways that doctors can still access medicinal cannabis for their patients even though it is an unapproved product in Australia.
The three access pathways are:
If you’re interested in trialling medicinal cannabis for your condition, we encourage you to speak with your Doctor about your options.
What conditions is medicinal cannabis being prescribed for?
As of 31 December 2019, over 130 conditions had been approved for medicinal cannabis use in Australia, with over 60% of approvals having been granted by the TGA for the treatment of chronic pain1. Other common conditions that have been approved for it’s use include: cancer pain, neuropathic pain, fibromyalgia, seizure management/epilepsy, psychological conditions such as; anxiety, anorexia, insomnia, post-traumatic stress disorder, multiple sclerosis and movement disorders. Research is also being undertaken internationally and locally to understand other conditions that it can be used to treat.
1 The Senate, Community Affairs References Committee ‘Current barriers to patient access to medicinal cannabis in Australia’. (https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/024403/toc_pdf/CurrentbarrierstopatientaccesstomedicinalcannabisinAustralia.pdf;fileType=application%2Fpdf)
How do I discuss medicinal cannabis with my doctor?
Medicinal cannabis is a relatively new treatment option in Australia.
Before you meet with your practitioner there are some steps you can take to learn more about this new treatment choice and share this information with your doctor:
1) Do some research and take it to your next appointment
There are clinical studies available online that patients are able to print and share with their medical practitioner. Peer-reviewed studies can help a practitioner understand more about medicinal cannabis as a treatment option for your condition and help support your doctor’s understanding of your decision for wanting to consider medicinal cannabis.
You can find research relating to various conditions by visiting GreenChoices.
2) Be honest and talk about your experience
When discussing your condition, it is important to discuss with your doctor how you feel and the effects of the medications you have tried. It’s important to be honest and advise your practitioner if you’ve already tried cannabis and what the effects were.
3) Have patience and work together
Doctors have a legal obligation to comply with regulations in relation to medicinal cannabis and the prescribing guidelines, however education around these guidelines is still new in Australia. Showing patience towards your doctor if they still have questions or need more information to feel comfortable prescribing, is important.
There is still much to learn about the potential benefits of medicinal cannabis, how to prescribe it accurately and the pathways to access this medication. Both doctors and patients are exploring the science behind this treatment for various conditions and how it compares to established medications. Together, you’re more likely to find the best medical outcome for you.
4) Share your point of view
When considering any new treatment, you should consider the possible impact on your overall life e.g. will any side effects interfere with a regular activity that’s important to you e.g. operating heavy machinery? Driving? Employment drug testing? Can you afford this treatment?
What is the cost of medicinal cannabis?
The cost of medicinal cannabis in Australia is varied and depends on a number of considerations such as a patient’s condition and the product being prescribed.
Your doctor needs to know about these practical matters so they can choose the right treatment for you and develop a treatment plan that works for your circumstances.
There is currently no PBS subsidy available for medicinal cannabis so this cost will be worn entirely by the patient.
How to find a Doctor?
Patients considering medicinal cannabis treatment should first discuss this option with their treating GP or specialist medical practitioner before talking to a new doctor.
If you would like to access a list of doctors that are open to discussing medicinal cannabis please visit: https://www.greenchoices.com.au/patients/find-a-doctor
What do I need to take to my doctor?
If you are visiting a new doctor, you will need to discuss with them the following information so they can consider your suitability for medicinal cannabis as a treatment option:
· Previous medicinal history (around the condition you would like to discuss medicinal cannabis as a treatment)
· Previous medications taken (for this same condition)
· List of your current medications
· Summary of prior medical history and diagnosis (eg high blood pressure, asthma etc)
When is it advised not to use medicinal cannabis?
As with all medical treatments, medicinal cannabis isn’t for everyone. In Australia medicinal cannabis is not a first-line treatment for any condition. This means that doctors only use medicinal cannabis for people who have tried other medicines without success.
History of Psychotic Illness
Medicinal cannabis is not safe for people who have a personal or family history of certain mental health conditions, such as:
· Psychotic illnesses e.g. schizophrenia
If You Are Pregnant or Breastfeeding
Women who are pregnant or are planning to become pregnant should not use medicinal cannabis. Tests in animals have shown that cannabis can harm the developing baby.
In addition, cannabis can pass into a woman’s breast milk at high concentrations; this can harm the breast-fed infant. Women who are breastfeeding should avoid medicinal cannabis.
Driving and Operating Machinery
People who use medicinal cannabis, especially with THC present can experience dizziness, fatigue and concentration problems as side effects. This makes it difficult to carry out skilled tasks and can impair judgement. People who need to drive or operate dangerous machinery should not take medicinal cannabis with THC.
A small number of people are hypersensitive to cannabis or other ingredients in medicinal cannabis products. These people should avoid using medicinal cannabis as it can cause a severe allergic reaction.
Will I feel ‘high’ when taking medicinal cannabis?
The cannabinoid in cannabis which is well-known as being responsible for numerous psychoactive properties is THC (tetrahydrocannabinol).
Not all medicinal cannabis products have THC or enough of this cannabinoid to make a patient feel ‘high’. There are alternative options for patients that don’t want an intoxicating ‘high’ effect so talk to your medical practitioner about using strains which are low in THC.
CBD (cannabidiol) is a second cannabinoid present in significant concentrations in the cannabis plant that will not make patients feel ‘high’. CBD is non-psychoactive and some evidence suggests that CBD can counteract the intoxicating effects of THC when used in combination.
Can I drive whilst taking medicinal cannabis?
Patients will be advised by their doctor not to drive while using a product that contains THC. This is because THC, a psychoactive cannabinoid of the cannabis plant, can affect cognitive and motor skills necessary for safe driving such as attention, judgement, memory, vision and coordination.
Roadside drug testing in Australia tests for Tetrahydrocannabinol (THC) in saliva. Currently, in all states and territories it is an offence to drive (a) with the presence of THC in oral fluid, blood or urine; or (b) under the influence of THC.