Life changer - The first 7 years of prescribing medical cannabis. Part 2
Article Written by Dr Stephen Gipps
Read time: 5-6 mins
Lessons Harvested: Key learnings for novices to medical cannabis prescribing
For any GP new to exploring this topic, I first want to foster confidence that adding medical cannabis is generally very safe and relatively low risk. Utilising the “start low and go slow” titration method is incredibly reassuring for any would-be new prescriber.
It empowers the patient to graduate the dose carefully observing for desired effects and any negative effects . This enables a simple dose reversal adjustment to settle at the optimal dose, or the very rare discontinuation if necessary. Generally speaking, most patients simply titrate up slowly and come back to you having experienced some benefit.
There are some precautions, of course. Certainly, GPs are familiar with aquainting themselves with pharmacuetical cautions and contraindications, there being a veritable plethora of routine TGA-approved medications being prescribed with more significant side effect potentials than medical cannabis.
To clarify, for those who are concerned that these patients are all becoming impaired or stoned in the way that the media represent, or recreational youth may be portrayed, this is simply not true.
In as much as someone having a glass of wine with dinner is not necessarily drunk, the same is true with cannabis. The practice of titrating within a relatively large therapeutic window, plus the fact that CBD tempers the psychotropic effects of THC, renders a therapeutic dose often only mildly “intoxicating”. And to the degree that the patient is psycho effected, it is a misnomer to call it intoxication.
The enhancement of feelings of wellbeing, potentially uplifted mood, a balming bodily relief or the soothing relaxation that facilitates easy sleep-onset, is hardly well defined as “toxic”.
It’s unfortunate that too many patients, despite being increasingly aware of the general availability of medical cannabis, find their GP oblivious to the value of cannabis and unable to assist.
The bottom line is that many patients present to their GP whereby cannabis is either not even considered an option or remains too mysterious or stigmatised - or, for those that are better informed, the task of addressing the TGA SAS B pathway is just too much of an administrative hurdle in an otherwise busy schedule.
It’s not as if there is a specific Medicare item number for dealing with these added bureaucratic requirements! However, the online portal process becomes really quite familiar and less burdensome after a few applications. In the context of a GP practice, a standard consult time dedicated to the SAS B application would be very reasonable. Upon application approval and prescription, a follow-up consultation to discuss the dosing details, etc. is also appropriate.
Further, if one persists a little and becomes an Authorised Prescriber the process becomes quite streamlined and really not a significant burden.
A novel medicine that deserves a personalised approach
The “demand” for medical cannabis in the general community is large! Many people have genuinely failed other pharmacological-based treatments and do qualify for medical cannabis but are yet to access it. There are too many patients persevering with undesirable and intolerable side effects from current allopathic medications. This has led to people seeking cannabis - either via a doctor or illegal “green-market” suppliers.
It’s not surprising to see online-based telehealth and shopfront medical cannabis businesses popping up to meet the vast need. Fair enough, but some of the operators are essentially medical cannabis product-supplying companies and appear to be motivated more by profits from the medical cannabis products they sell. They may engage ethical doctors and comply with regulations, yet their business model is not a customary medical consultation service as one would expect from a medical specialist, for example.
The patients are, however, gaining access that they may otherwise not have gotten. Communication back to the GP from these services may vary significantly in quality and a GP without specific medical cannabis education may have difficulty comprehending and integrating this new therapeutic mode into the patient’s overall management plan.
Clearly, it would be preferable if more GPs could undertake to manage their own patients by including medical cannabis as part of their equipping.
For any GPs reading this, please consider the journey of prescribing medical cannabis can be immensely satisfying from a professional standpoint. There's a unique reward in witnessing the grateful expressions of patients who find relief through this treatment modality.
I encourage you to embark on this not-too-difficult learning curve, which will empower you with additional tools to address complex patient needs.
Upskilling: Adding Medical Cannabis to your Tool Kit
Several quality teaching courses with associated CPE are available in Australia. Needless to say, there is also a plethora of information and teaching available on YouTube and various local and international websites - though seeking out quality sources and critical analysis of clinical data is still crucial in this environment.
Most worthy of a big shout-out are the many representatives of the many cannabis distribution companies, such as client liaisons and scientific education facilitators.
These people are very helpful in guiding you through all that is needed to know regarding prescribing in Australia. From understanding products, indications, and the process of SAS approvals, they are often a wellspring of knowledge for newcomers navigating the landscape.
Once you’ve done a few scripts, familiarity makes the process easier. After a time, you may wish to streamline processes further by becoming an Authorised Prescriber. Again, industry representatives can be helpful here, including guiding you through the ethics committee qualification via NIIM (National Institute of Integrative Medicine) and the TGA SAS portal application for Authority under the 5 categories and product forms.
This categorisation system, introduced in 2021, is a significant improvement over the previous method. Before, we needed separate authorities for each individual product by brand name and form, resulting in an extensive list of authorisations.
The current system, with separate authorities required for each of its product forms in each of the 5 THC percentage-based categories is more manageable and practical. This makes becoming an Authorised Prescriber a more appealing option for practitioners than prior.
Whilst today’s 5 categories with all the forms of products are an improvement, I should still add that I think they could be further simplified (to be discussed in a future article; stay tuned).
In conclusion, it remains that medical cannabis is still highly under-utilised by the medical community at large, even via the pathways provided. As a consequence, too many patients are still not receiving the life-changing care available.
Having read about my experience, a venture into a now matured and well-supported medical cannabis prescribing environment awaits your move.
I eagerly await the life-changing reports.
Dr. Stephen Gipps is a seasoned medical practitioner with over four decades of diverse experience since 1984. His expertise spans general practice, natural and alternative medicine, occupational medicine, musculoskeletal injury and degeneration, and pain management. Dr. Gipps holds a Bachelor of Medicine and Bachelor of Surgery (MBBS) from UNSW and completed additional medical training in the USA, achieving high percentiles in USMLE exams. Currently serving as the Managing Director and CEO of CannAgeWell.com, he has a particular interest in medical cannabis, offering advisory services to emerging companies in this field. Dr. Gipps' broad experience includes roles as a medical advisor for various health-related companies and a stint as a licensee for Exclusiv Brigitte Kitchens.
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.
