Medicinal Cannabis for Chronic Pain: An Introduction
By Isabella Gosling
Something we are often asked about within our QENDO community is the use of medicinal cannabis. Is it legal? How do I go about getting my doctor to prescribe it for me? Is it included on the PBS? Can I drive while using medicinal cannabis? This piece discusses the legality around medicinal cannabis within Australia, as well as highlighting the process and information you may need to know when considering medicinal cannabis in your toolkit for managing your chronic condition. Please keep in mind, as always this is intended for educational purposes, and it does not replace the advice and care of your medical team.
As the body of research around the use of medicinal cannabis for chronic pelvic pain sufferers is still limited, acquiring medicinal cannabis for treatment of the associated symptoms of conditions such as endometriosis, adenomyosis or fibromyalgia can be confusing for patients and consumers. Through work from advocacy and community groups, as well as media and medicinal cannabis programs from other countries, the Commonwealth and State / Territory Governments have implemented legislative and policy change to allow for the cultivation, manufacture, prescribing and dispensing of medicinal cannabis products for patients within Australia.
The Single Convention on Narcotic Drugs 1961 and other international conventions requires all medicinal cannabis prescribed within Australia to be accounted for. These controls are put in place to ensure products are not being used illegally (Queensland Government, 2020). In Australia, most medicinal cannabis products are not registered medicines, meaning they can only be accessed via special pathways. Due to this consumers are unable to apply for access, and must do so through a registered medical practitioner (Therapeutic Goods Administration, 2020).
Prior to prescribing these products, your approved GP or specialist should complete a comprehensive clinical assessment, which will allow them to identify any risks which need to be addressed prior to applying for access to medicinal cannabis, such as; presenting symptoms and diagnosis, past medical history, a medication review, mental health history, family health and mental health history, social history, any ‘at risk’ behaviours and physical investigations, where appropriate (Therapeutic Goods Administration, 2017).
Doctor’s can apply on their patient’s behalf for approval to access medicinal cannabis products either through a clinical trial, through the Special Access Scheme or the Authorised Prescriber Scheme.
There are still a number of barriers to accessing medicinal cannabis, such as your GP being open to prescribing it. They may have their own preconceived ideas about the use of cannabis, or the differences between legal medicinal cannabis products and those from the black market. Should you not feel comfortable discussing accessing medicinal cannabis with your current GP, there are clinics which can facilitate the responsible access to medicinal cannabis products and treatments for patients across Australia, making it easier to navigate this process. Usually all you will require from your current GP is a health statement or summary for your chronic condition, as well as a current list of medications you’re taking (Tetra Health, 2020). You can also prepare any pathology reports, scans, surgical notes or photos which you may have copies of, however these are generally not needed.
The approval times from the TGA have recently been reduced, and can take just 48 hours. After this, your GP or clinic doctor will work with you to determine which products may work best for you, write a prescription and forward it onto the pharmacy. You will then work with your doctor to evaluate what is working and if the dose or products need adjusting. It’s important to note that this process can take anywhere from six to eight weeks. At time of writing, medicinal cannabis products are not covered under the PBS in Australia, and can be quite expensive. In some circumstances, your clinic appointment may have a medicare rebate, and some health funds may cover some costs associated, however it’s best to check with your individual health fund (Cannabis Doctors Australia, 2020).
It’s important to note that your doctor may ask for you to sign an informed consent form around driving whilst taking medicinal cannabis products. This should be read properly and adhered to. It’s also worthwhile discussing with your workplace about their drug policy, especially if they conduct drug testing. Open communication can go a long way, and most workplaces are particularly understanding when you discuss the nature of your condition and how you’re able to best manage it. You can learn more about talking about endometriosis with your workplace and some of the relevant workplace laws and protections here.
If you’d like to do some further reading on medicinal cannabis in Australia, there’s some links below to journal articles and resources which may be of assistance to you. We have also recently done a webinar around Navigating Medicinal Cannabis in Australia, to watch this you can become a member (for free) here, and access our video library here.
References
Cannabis Doctors Australia. (2020). Frequently Asked Questions https://cannabisdoctorsaustralia.com.au/faqs/
Queensland Government. (2020). Medicinal Cannabis Products
https://www.qld.gov.au/health/conditions/all/medicinal-cannabis/access
Queensland Government. (2020). Medicinal Cannabis Legislation and Compliance https://www.health.qld.gov.au/public-health/topics/medicinal-cannabis/regulation/legislation
Queensland Government. (2020). Role of Commonwealth and State Governments. https://www.health.qld.gov.au/public-health/topics/medicinal-cannabis/regulation/commonwealth
Queensland Government. (2020). Medicinal Cannabis Treatment. https://www.qld.gov.au/health/conditions/all/medicinal-cannabis/treatment
Tetra Health. (2020). Beginners Guide to CBD. https://www.tetrahealth.com.au/beginners-guide-to-cbd/
Therapeutic Goods Administration. (2017). Guidance for the use of Medicinal Cannabis in Australia Overview. https://www.tga.gov.au/sites/default/files/guidance-use-medicinal-cannabis-australia-overview.pdf
Further Reading
Arkell. T.R., Kevin, R.C., Stuart, J., Lintzeris, N., Haber, P.S., Ramaekers, J.G., & McGregor, I.S. (2019). Detection of Δ9 THC in oral fluid following vaporized cannabis with varied cannabidiol (CBD) content: An evaluation of two point-of-collection testing devices, Drug Testing and Analysis, 11(10), 1486-1497. https://doi.org/10.1002/dta.2687
Arkell, T.R., Lintzeris, N., Kevin, R.C., Ramaekers, J.G., Vandrey, R., Irwin, C., Haber, P.S., & McGregor, I.S. (2019). Cannabidiol (CBD) content in vaporized cannabis does not prevent tetrahydrocannabinol (THC)-induced impairment of driving and cognition, Psychopharmacology, 236, 2713-2724. https://doi.org/10.1007/s00213-019-05246-8
Cannabis Doctors Australia. (2020). Frequently Asked Questions https://cannabisdoctorsaustralia.com.au/faqs/
Casey, S.L., Atwal, N., & Vaughan, C.W. (2017). Cannabis constituent synergy in a mouse neuropathic pain model, Pain, 158(12), 2452-2460. https://doi.org/10.1097/j.pain.0000000000001051
High on Hemp. (2020). Everything you Should Know about Buying CBD in Australia https://www.highonhemp.com.au/2020/05/everything-you-should-know-about-buying-cbd-in-australia/
Ketchell, M. (2019). 1 in 10 Women with Endometriosis Report using Cannabis to Help Ease their Pain https://theconversation.com/1-in-10-women-with-endometriosis-report-using-cannabis-to-ease-their-pain-126516
Tetra Health. (2020). Beginners Guide to CBD. https://www.tetrahealth.com.au/beginners-guide-to-cbd/
The University of Sydney. (2020). Lambert Initiative for Cannabinoid Therapeutics
https://www.sydney.edu.au/lambert/
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