Australian Doctor and Medico-Legal Consultant Reveals Cannabis Prescribing Challenges
A Conversation with Dr. Navin Naidoo
Read time: 7-8 mins
Cannabis induced psychosis, Medical Cannabis during Pregnancy, Teen Use & other controversies.
In this candid interview, Dr Navin Naidoo shares his experiences navigating some of the most challenging aspects of medicinal cannabis prescribing. Drawing on his unique background as both a litigator and medical practitioner, Dr Naidoo discusses the complex ethical and legal considerations around treating vulnerable patient populations, from pregnant women to adolescents with severe behavioural issues.
This discussion provides rarely discussed insights into the practical realities facing cannabis prescribers in Australia, the regulatory hurdles they encounter, and the approaches being employed to ensure patient safety whilst maintaining therapeutic access.
Adam Miller
So happy to have you on the Insiders Extract Navin. Let’s jump in at a high level, to understand how you got into medical cannabis prescribing. And when?
Navin Naidoo
I qualified in 1994, and I've been working in Australia for the last 17 years. I normally do emergency medicine and GP work. So, I was not very inclined to get involved in cannabis prescribing initially. The laws changed in 2016-17, I only got involved in 2021, reluctantly. I initially was concerned about prescribing cannabis because of the stigma and the socioeconomic area I was practising in and all that kind of stuff.
I was given a proposal based on CBD-only products and asked by a persistent MSL whether I had any particular patient who had run out of conventional medicine options. And there was a patient with severe dementia. She was on a combination of two anti-psychotics and a strong benzodiazepine just to keep her stable. She's a woman in her 80s, the medication was needed to keep her safe because she would just run off and even with the strong sedative psychotropics that she was on, it was still difficult to manage her.
In August of 2021, while walking with her husband, she just took off, ran off, tripped, face planted and ended up with multiple facial fractures and a head injury - the full works. This patient came to mind; she was on a lot of very sedating medication and CBD seemed to be a reasonable option for her. We started on an exceedingly small dose of CBD, just 10 milligrams. By the second day, it was clear she didn't need to have her usual mid-morning antipsychotic. So, it was a dramatic difference immediately, from a minute dose.
I was able to reduce her antipsychotics as well as other medications. She started functioning a significantly better! She was awake a lot more, able to interact with her husband and other people around her in a more substantial way than she had been able over the previous year or more.
That was the patient who was the turning point. So, after that response, I jumped very much into it and started doing training to upskill myself beyond prescribing just CBD.
It was the end of 2021, when together with my wife Sandra, an ex-registered nurse, we set up our clinic M-Powered Medical Monitoring. This is a face-to-face service. That's the basis of the service; it is not a principal telehealth service. All our new patients come in for a face-to-face consultation where I do a half-hour consultation, with a full comprehensive history and a lot of education regarding the pharmacology of cannabinoids and terpenes. After this they have a further half an hour, or more face-to-face education provided by Sandra the practice manager.
Patients may move over to being more of a telehealth kind of patient. However, we actually enjoy seeing our patients and interacting with them.
It's a controversial space that's still very polarising within the medical fraternity. However, I have seen results with cannabinoids that conventional Western medicine could not achieve. It's an interesting field. It's polarising, you’ll still find many firmly anti-cannabis physicians; on the other hand, there are plenty of doctors who have seen what medicinal cannabis can do from a therapeutic perspective.
There are still a lot of issues regarding the medicinal cannabis industry. A lot of people who are prescribers come up against a lot of very difficult issues. The main problematic issues are things like cannabis misuse disorder, people with a history of psychosis, women who may become pregnant during treatment and minors - young people currently using cannabis flower and wanting to transition to a legally prescribed route.
Those are all sorts of issues at the moment.
Adam Isaac Miller
How do you manage those four issues then? Considering that you have worked with over a thousand patients, how do you manage the issues around mental health and psychosis, cannabis misuse, pregnancy, and teen use?
Navin Naidoo
Let's start with the first one. With any patient, I believe the most important thing is a robust consent document. It's not just a robust consent document, but your initial consultation is exceptionally important. That initial consultation is an obligation on the doctor to take a comprehensive and thorough history that's supposed to uncover any of these controversial histories, particularly around mental health, and cannabis misuse.
However, the physician is very dependent on the patient being honest. There are certain ways that doctors are able to look for information, which is really important within the medicinal cannabis arena. Access to things like Q Script in Queensland and Safe Script in NSW and Victoria are government-run departments where doctors prescribing any high-scheduled substance are obliged to go check before prescribing that. Those avenues into the patient's previous history that would basically guide you as to whether this is gonna be a controversial patient or an issue or not.
I'm admitted as an advocate in South Africa. I did my bar training and started litigating in 2004 when I was in South Africa and finished the pupillage and the bar exam. I’ve got a legal background; in Australia I'm a fellow of the Australian College of Legal Medicine. I also hold a Juris Doctor degree from Australia and work as an emergency medicine consultant, as well as a conventional GP. So, I've got access to the full spectrum of patients, some patients who suffer with these chronic conditions on a long-term basis, chronic pain, insomnia, anxiety, PTSD, and I also see patients in the acute setting.
I also provide a lot of medico-legal advising and consulting services to doctors. Using all those various elements, what we've done with M-Powered is to try to build up a very robust body of standard operating procedures that we use to deal with any of these challenges.
I’ll give you a practical example. Initially when we started the clinic, challenging situations would arise, and we'd adapt our protocols accordingly. Let's use the pregnant woman scenario. When we got our first patient who actually became pregnant while we were treating her, we immediately updated our consent model. Now, we stipulate upfront that if patients become pregnant, we're obligated to cease prescribing immediately due to the medico-legal implications.
This creates a difficult and controversial situation because many of these patients, when denied legally prescribed cannabis, simply turn to the black market. There's already been fentanyl-laced cannabis identified in Australia and elsewhere. In my experience, particularly in Queensland, the same dealers selling illicit cannabis are often pushing methamphetamine and other contraband. So, patients using the illicit market are exposed to far more than just illegal cannabis, which isn't good for anyone, society, or patient.
We had one patient who stated categorically she'd turn to illicit cannabis if we stopped her prescription, it was the only way she could manage. Across her history, she’d tried numerous medications for her mental health (she had history of trauma with severe episodes of suicidality and self-harm) and had never been successfully stabilised on antidepressants before her medical cannabis prescribed regimen.
This was particularly challenging because she had commenced her treatment prior to the pregnancy and cutting her off would push her towards illicit drug dealers. So, I took several protective steps: I obtained a declaration from the patient for her file, stating that if taken off prescribed cannabis, she'd only be able to manage through illegal cannabis. I also arranged for her to see her referring GP and to secure written support from that GP, documenting her long traumatic mental health history, sleep issues, previous treatment failures, and how she'd actually settled and was functioning far better than she had in years.
These are all risky approaches for any practitioner, but I felt there was a duty of care to continue her medication given how well it was working. However, from a medico-legal perspective, you don't have much to defend yourself with if a case like that gets referred to AHPRA. I tried to document everything thoroughly to establish a reasonable position for why I continued prescribing.
Eventually, as the pregnancy progressed, we did stop prescribing to her. I haven't seen her since.
Adam Isaac MillerIt's an interesting issue. We know there's clinical evidence that shows that cannabis use, particularly around THC during pregnancies, has some serious considerations around negative outcomes. There are other clinical insights that challenges that position. As this case points to, there are other considerations; you have a patient on a stable regime of cannabis medicine who becomes pregnant. What about the net effect of the stress that will occur when the patient's not using their medicine? What are the effects of high cortisol on pregnancy? Let alone the safety issues with adulterated illicit cannabis.
It's a tricky one. Does it come down to individual patient risk assessment?
Navin Naidoo
Absolutely, it all comes down to risk assessment. I tried to protect myself in that circumstance by having her formally declare that if I didn't continue prescribing, she would use illicit cannabis. In that context, my prescribing can be considered harm reduction prescribing, which would give me a possible defensible position against AHPRA. Again, not something I would advise without a great appreciation of the risks involved.
It's not a strong defence; I wouldn't advertise it or tempt an AHPRA investigation. However, drawing on my background as a litigator, I took the two protective measures I could implement at the time. But we've since adjusted our consent document to clearly state that if a patient is diagnosed as pregnant, we will cease prescribing completely.
Adam Miller
Let’s talk about psychosis.
Navin Naidoo
The College of Psychiatry stipulates cannabis is a strict contraindication to treat somebody with a history of psychosis or any severe mental health issue. I believe that's not entirely accurate; it's not a strict contraindication. What happens if a doctor has a patient who's currently using illicit cannabis with a history of psychosis? To say that that person can never be prescribed legal cannabis, is inaccurate in my opinion.
I know this because I've got patients like this. I've done applications to the TGA where I've disclosed that this patient has a history of psychosis. This is what they are using. This is what I'm treating them with. And I've received permission from the TGA to carry on with those patients, even with a history of psychosis. Obviously, this does would not apply to recent or acute psychosis, and there would need to be other safeguards in place (ongoing GP or mental health follow-up for depot anti-antipsychotic, face to face appointments, regular GP visits, etc).
The problem is that the polarised medical fraternity is not looking at it like that. They're looking at what the psychiatric college is saying that there is a strict contraindication. So, they're not allowing room for doctors to apply their minds. They're going in and taking an overly rigid stance.
In the last two to three years, I've done a bit of consulting and advising for doctors that have ended up finding themselves in front of an AHPRA investigation. In this regard, the main issue has been a history of psychosis, or even the history of bipolar affective disorder, depression and mania.
Here’s the thing- it’s not an absolute contraindication. Patients may have had a psychosis 10-20 years ago from any number of causes and now are mentally stable and using illicit cannabis to manage medical symptoms. For psychiatrists to claim there's no flexibility around this position is fundamentally flawed. The entire methadone program and opiate diversion programs are clear evidence that harm reduction prescribing has an established place in modern medicine.
Adam Isaac Miller
I appreciate that. There is surely room for harm reduction when people are clearly using it illicitly. Additionally, when you become more specific and examine individual and combination cannabinoids, you begin to see a clearer picture of treatment options.
Navin Naidoo
It's a bit of a direct challenge to everybody for doctors or clinicians to make comments about cannabis who don't or haven't actually read the pharmacology or any of the clinical trials that demonstrate efficacy.
To a degree, I empathise, I've gone from staying out of the cannabis arena to jumping into the cannabis arena, now I say to anybody, if you haven't read the literature, then check yourself.
Adam Isaac Miller
That makes sense. Especially if you haven't prescribed and seen firsthand the implications of treatment.
Navin Naidoo
So, I've done a complete turnaround from being on the fringe to now jumping straight into it. Clinicians that are involved in this are managing complex patients. I'm not talking about the guys that are dishing out prescriptions by the truckload. The guys that are doing four grams a day prescriptions to 200 patients in a day are probably not practising safely.
Part of the problem is that everyone is inclined to report cannabis doctors to AHPRA, local psychiatrists, other practitioners, especially if they're uneducated about cannabis or if there's any history of psychosis. Many doctors are being automatically referred even without adverse outcomes, simply because patients have had a history of psychosis, even if there isn't any odd or negative outcome. This is not good for patients or the medical fraternity, and could in circumstances be considered vexatious, especially if the reporting doctor is uneducated in the science and pharmacology of cannabis.
Adam Isaac Miller
I can see there's an absolute difference between the over-prescribing or neglectful prescribing of five five-minute doctors; we’ve heard about recently in the news and the approach that you're taking.
Navin Naidoo
The best evidence that can defend you in an AHPRA investigation is your medical notes. The quality of your entire file: your consent documents, patient education materials, everything. Your statement and your documentation either hangs you or sets you free.
Part of the problem is everyone's inclined to report cannabis doctors to AHPRA, local psychiatrists, other practitioners, especially if they're uneducated about cannabis or if there's any history of psychosis. Many doctors are being automatically referred even without adverse outcomes, simply because patients have psychotic histories, even if there isn't any odd or negative outcome. This is not entirely accurate.
Many AHPRA investigators and panel doctors judging these cases have had no formal education in medicinal cannabis. They're operating from academic observer positions using the psychiatric colleges' rigid stance that there is no evidence that cannabis works, and that there are absolute contraindications for certain patients.
Any patient with a mental health history who ends up in emergency with symptom exacerbation results in psychiatric registrars referring cannabis prescribers to AHPRA, based on the Psychiatric Colleges' statements: that there's no evidence medicinal cannabis works, and that there are absolute contraindications for severe mental health histories. Any clinician can challenge both statements.
I had a patient well-controlled on cannabis for two years who then went on a methamphetamine bender, developed full-blown psychosis, and was hospitalised. The final diagnosis? Cannabis-induced psychosis—with no mention of methamphetamine whatsoever.
Adam Miller
That creates an incomplete picture. It's deceptive.
Navin
It's obvious deception. As a litigator, that's malfeasance - deliberate deception. Someone stable on cannabinoids for two years uses methamphetamine, has a psychotic breakdown within three days, and psychiatrists don't include that in the diagnosis? This is what cannabis prescribers across the country are facing.
Any patient with mental health history who ends up in emergency with symptom exacerbation results in psychiatric registrars referring cannabis prescribers to AHPRA, based on the Psychiatric College's statements: that there's no evidence medicinal cannabis works, and that there are contraindications for severe mental health histories. Both statements can be challenged by any clinician.
Regarding pregnant patients, from a medico-legal perspective, a child could potentially sue the prescribing doctor up to 24 years later, as their limitation period only starts when they turn 18.
It's something nobody really considers unless you are a lawyer; there are a lot of these potential problems within the prescribing of cannabis that are quite different from normal practice.
Adam Isaac Miller
It sounds like a minefield.
Navin Naidoo
It is, but this is where that consent document is so important. A lot of patients who get caught driving with the presence of THC, often the story is nobody told them. If you've got it included in your consent document and the patient is signed off on it, they can't deny that. That's where the best defences that you can have as a medicinal cannabis prescriber are having a rock-solid consent document and educating your patients on the safe and responsible use of medicinal cannabis.
Adam Isaac Miller
We've covered some controversial stuff here: pregnancy, we've covered mental health, medico-legal concerns and then our last item was teen use. How do you approach that?
Navin Naidoo
When we first started, I accepted a 17-year-old patient for THC prescribing as harm reduction. He was using over two grams of illicit cannabis daily I put him on a regulated regime of one gram per day plus CBD oil. This was before the current regulatory drama, and we haven't accepted minors since.
We've had referrals for 16-year-olds, even a 14-year-old. I'm comfortable starting teenagers on CBD-only, but to prescribe THC and avoid AHPRA issues, you need TGA approval, which requires psychiatric backing for minors.
The challenge is, where do you draw the line? We get cases where there's extreme household violence. For example, 13-year-old “Johnny” weighing 100 kilos, stabbing his sister with scissors, threatening his mother, smoking five grams of illicit cannabis daily. How do you manage that? Over the past year and a half, we've had GPs desperately seeking assistance because conventional mental health approaches aren't working, risk levels are escalating, and these kids are already using cannabis.
I've submitted TGA applications for permission, most don't even get replies, just processed notifications. The best pathway requires psychiatric support, GP referral, and ongoing monitoring. The position overseas seems to have changed in some places, there's a lot more leeway for doctors to prescribe to pregnant women as well as children, including THC. But each case is assessed as special circumstances.
For paediatric referrals, we haven't had a single successful TGA application for harm reduction prescribing. We're primarily an adult clinic. When we get paediatric referrals, we explain the process upfront, so families don't waste resources. We provide details of psychiatrists involved in paediatric medicinal cannabis oversight and advise getting GP referrals to them first. If we receive positive psychiatric backing, we'll take them on and submit formal TGA applications.
Adam Miller
That's a very comprehensive approach. It creates administrative overhead, but you're covering your tracks, ensuring patient care standards, and keeping the TGA informed. Your legal background clearly shows. This conversation has provided rich insights, thanks for joining me! We'd love to host you for another interview.
Navin Naidoo
Thanks Adam.
Dr Naidoo's insights highlight the complex intersection of medical ethics, legal responsibility, and patient advocacy in Australia's evolving medicinal cannabis landscape. His experience demonstrates that whilst regulatory frameworks continue to develop, practitioners must navigate challenging grey areas with careful documentation, robust consent processes, and a clear understanding of both therapeutic benefits and medico-legal risks.
This interview was conducted as part of our ongoing efforts to examine the real-world challenges in medicinal cannabis practice. For more insights from leading practitioners, visit our archives.
Navin Naidoo is a multifaceted professional blending expertise in medicine, law, and entrepreneurship. A graduate of the University of the Witwatersrand with an MBBCh in 1994, he has practised as a General Practitioner and Emergency Medicine Consultant since then, currently serving as a Staff Specialist at Bundaberg Hospital and a GP at Quality Family Care Clinic in Queensland, Australia, where he relocated in 2008. In 2004, he earned an LLB and was admitted as an Advocate of the High Court of South Africa, specialising in medico-legal advising, litigation support, medical mediation, and the legislative framework for medicinal cannabis in Australia. As an entrepreneur, Navin co-founded the M-Powered Medical Monitoring Clinic in 2021, managing nearly a thousand patients with cannabis-based treatments.
Disclaimer: This information is shared with a global readership for educational purposes only and does not constitute medical or business advice. All patient-related information has been de-identified OR fictional to protect privacy. Nothing in this article is intended to promote the use or supply of medical cannabis to members of the public.
