AHPRA targets medicinal cannabis prescribing

Practitioners who prescribe medicinal cannabis have been put on notice by the regulator in response to growing concerns over patient safety and over-servicing.
 
On Wednesday, the Australian Health Practitioner Regulation Agency (AHPRA) clarified its expectations of prescribers in firm new guidance, emphasising that prescribers be as careful and diligent when prescribing medicinal cannabis as they are with other drugs of dependence.
 
It also flagged concerns over patients presenting to emergency departments with medicinal cannabis induced psychosis as well as ‘evidence of over-servicing and ethical grey areas around single-purpose dispensaries’.
 
Medical Board of Australia Chair Dr Susan O’Dwyer said ‘patient demand is no indicator of clinical need’.
 
‘We don’t prescribe opioids to every patient who asks for them, and medicinal cannabis is no different,’ she said.
 
The crackdown comes as an analysis of prescribing data has already raised several red flags, including eight practitioners who issued more than 10,000 scripts in a six-month window and one practitioner who appears to have issued more than 17,000 scripts.
 
In its advice to prescribers, AHPRA’s ‘poor practice’ examples also included consultations lasting just a few seconds, prescribing without a legitimate indication, failing to fully assess a patient’s mental health, and having a conflict of interest.
 
The AHPRA guidelines state that safe prescribing of medicinal cannabis includes assessing patients thoroughly, formulating and implementing a management plan, and facilitating coordination and continuity of care.
 
It also says practitioners must maintain medical records, recommend treatments only where there is an identified therapeutic need, ensure medicinal cannabis is never a first line treatment, and develop an exit strategy from the beginning.  
 
‘With a few exceptions, such as the treatment of certain childhood epilepsies, muscle spasms and pain symptoms associated with multiple sclerosis, some neuropathic pain and chemotherapy-induced nausea and vomiting in cancer, there is little evidence to support the use of medicinal cannabis,’ the guidance states.
 
‘Medical and nurse practitioners should only prescribe it when there is an evidence-supported clinical indication and when other treatments have not worked.’
 
RACGP president Dr Michael Wright welcomes the regulator’s guidance.
 
‘We share AHPRA’s concerns when profits are being prioritised over patient safety by some bad operators in the industry,’ he told newsGP.
 
‘What AHPRA, the Medical Board, and the Nursing Board are trying to make crystal clear is that if you’re prescribing these medications, your obligations to meet the code of conduct and your duty of care is the same as any other medications.
 
‘There’s the added complexity because the number of these medications are S8 listed, so they’re restricted drugs and drugs of dependence, so prescribers have to be particularly careful about using those sorts of medications, as much as you would for other S8s like opiates.’
 
AHPRA CEO Justin Untersteiner also warns prescribers of the inherent conflict of interest for practitioners 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 said. 
 
‘This raises the very real concern that some practitioners may be putting profits over patient welfare.’
 
The health practitioner watchdog is working with other regulators, including the Therapeutic Goods Administration (TGA), to understand prescribing patterns.
 
‘We will investigate practitioners with high rates of prescribing any scheduled medicine, including medicinal cannabis, even if we have not received a complaint,’ said Mr Untersteiner.
 
According to the ABC, AHPRA has taken action against 57 medical practitioners, pharmacists and nurses over medicinal cannabis prescribing practices and is currently investigating a further 60.
 
Legislation changed to allow medicinal cannabis prescription in 2016, and with the boom in telehealth, the number of scripts issued has skyrocketed. This includes hundreds of thousands of scripts annually for high-strength category 5 tetrahydrocannabinol (THC).
 
Associate Professor Vicki Kotsirilos, one of the first GPs to become an authorised prescriber, is particularly concerned about TGA data showing high-dose THC medicinal cannabis is being highly prescribed.
 
While the TGA is unable to provide figures on the number of patients accessing medicinal cannabis, it is able to indicate approvals to individual patients – after approval, the supply of cannabis is a matter for the prescriber and patient, the TGA explains.
 
Figures show in 2025, there have been almost 60,000 approved applications so far for category 5 THC.
 
‘When you look at the TGA figures, what it demonstrates for this year alone is that the majority of scripts are for category 5 medicinal cannabis products, which contain over 98% THC,’ Associate Professor Kotsirilos told newsGP.
 
‘Now that is concerning, because out of CBD and THC products, it is a THC product that could potentially cause more harm.’
 
TGA data also shows most prescriptions are for chronic pain, anxiety and sleep disorder, with the highest approvals in patients aged 19–44 years and in dried herb form.
 
‘It is extremely concerning. We know from the recreational use of cannabis that it can trigger anxiety, paranoia and psychotic reactions, so it is most concerning that the majority of prescribers are now prescribing THC category 5 products,’ Associate Professor Kotsirilos said.
 
She now believes the Government should take a step further and prohibit sponsors from direct prescribing.
 
‘This business model is a direct conflict of interest, and it should be prohibited,’ Associate Professor Kotsirilos said.
 
‘GPs are in a very good position to look after patients for medicinal cannabis. A GP knows the patient, they are also aware of risk factors, for example, mental health issues and family mental health issues that might put the patient at greater risk.
 
‘However, as per the AHPRA guidelines, we need to do it properly.’
 
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AHPRA cannabis medicinal cannabis telehealth TGA Therapeutic Goods Administration Vicki Kotsirilos