The Australian Health Practitioner Regulation Agency (Ahpra) has issued new guidance to improve the safe prescribing of medicinal cannabis amid growing concerns that poor practice is leading to significant patient harm.
The national health-practitioner regulator raised the alarm due to red flags in current prescribing data revealing that some practitioners are not safely prescribing medicinal cannabis, including eight practitioners who issued more than 10,000 scripts in a six-month window, and one practitioner who issued more than 17,000 scripts.
Other cases of poor practice include consultations lasting between a few seconds and a few minutes, making proper assessment impossible, overprescribing, and inadequate assessment of a patient’s mental health and/or history of substance use disorders – leading to serious adverse outcomes like psychotic episodes requiring inpatient admission.
The guidance aims to address the regulator’s concern that profits are being prioritised over patient safety, reminding practitioners to be careful and diligent when prescribing, particularly for patients at most risk of harm.
“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,” said Medical Board of Australia Chair, Dr Susan O’Dwyer.
According to Ahpra, safe prescribing of medicinal cannabis includes assessing patients thoroughly, formulating and implementing a management plan, facilitating coordination 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.
Adjunct Professor Veronica Casey, Chair of the Nursing and Midwifery Board of Australia, urged nurse practitioners who prescribe medicinal cannabis to combine the guidance with their professional practice framework when conducting assessments.
Ahpra CEO Justin Untersteiner said practitioners are also being warned of the inherent conflict of interest when working in an organisation that only prescribes and dispenses a single medicine.
“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 claimed.
“This raises the very real concern that some practitioners may be putting profits over patient welfare.”
Read the guidance on safe medicinal cannabis prescribing here
