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Doctors in the dark about medicinal cannabis: Research


Evelyn Lewin


7/05/2019 3:19:13 PM

In light of new research, an expert shares what GPs need to know about medicinal cannabis.

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An expert declares there is ‘large’ demand by GPs for more information on medicinal cannabis.

Health professionals support the use of medicinal cannabis, but generally feel they lack knowledge on the topic, a new Australian-led review of studies found.
 
Published in PLOS ONE, the review included 26 studies, 18 of which focused on medical practitioner’s perspectives.
 
In six of the studies, the majority of participants supported the clinical usefulness of medicinal cannabis, while in a further five, they believed it to be a viable therapeutic option. Only one study reported doctors’ lack of confidence in the use of cannabis as a treatment option.
 
Despite this support, the review found health professionals lacked self-perceived knowledge on all aspects relating to medicinal cannabis.
 
Dr Vicki Kotsirilos told newsGP she isn’t surprised by these findings.
 
The GP and integrative medicine practitioner became Australia’s first authorised GP prescriber of medicinal cannabis in May last year, and says GPs currently have ‘a large demand’ for knowledge about the use of medicinal cannabis.
 
That demand is so significant, she is approached ‘all the time’ by GPs who contact her to request information on prescribing it.
 
Dr Kotsirilos says the lack of knowledge about the clinical usage of medicinal cannabis stems from a lack of formalised education and upskilling on the topic.

‘We need regular top-ups of education because the science actually changes every day and there’s new studies that come out all the time,’ she said.
 
‘Because it is a plant medicine, it’s not part of our curriculum, so all the learning is self-taught.’
 
She says the main medical conditions for which medicinal cannabis is prescribed in Australia are:

  • chronic non-cancer pain
  • epilepsy
  • multiple sclerosis
  • palliative care including cancer pain management
  • cancer-related nausea and vomiting.
If GPs wish to prescribe medicinal cannabis, Dr Kotsirilos says the first step is becoming familiar with the available products.
 
‘It’s not easy,’ she warns.
 
‘It’s not like a normal prescription. It’s not on our MIMS software. They’re unapproved products.’

Dr-Vicki-Kotsirilos-article.jpg Dr Vicki Kotsirilos became Australia’s first authorised GP prescriber of medicinal cannabis in May last year.

To learn about which products are best suited for certain conditions, Dr Kotsirilos advises doing a course on medicinal cannabis and reading widely around the topic, learning about the pharmacology of medicinal cannabis, the differences between tetrahydrocannabinol (THC) and cannabidioil (CBD), and concentrations of different products.
 
When selecting a specific product, Dr Kotsirilos says there are many factors to consider.
 
‘You need to know the evidence behind the use of that product, because the Therapeutic Goods Administration (TGA) do ask for the clinical justification,’ she said.
 
‘The TGA ask that the use of medicinal cannabis is your last resort treatment, so you should have exhausted all other treatment options.’
 
The RACGP’s updated position statement, ‘Medicinal use of cannabis products’, concurs and does not recommend medicinal cannabis broadly, instead stating current evidence on its usage is ‘limited and inconclusive:
 
Medicinal cannabis products should only be considered when all first-line, conventional, evidence-based treatment options have been exhausted, and after detailed discussions of the potential benefits and harms of medicinal cannabis products with the patient.
 
Dr Kotsirilos points out financial concerns should also be taken into account, as medicinal cannabis is an out-of-pocket expense that can cost $350 a month.
 
‘[That] is very expensive for a patient with a chronic disease,’ she said.
 
Selecting the right product can be laborious, she cautions, but necessary as, unlike prescriptions for other treatments, there is no generic option available.
 
Once a GP has educated themselves on the risks, benefits and usage of medicinal cannabis, the next step is to apply to prescribe through the TGA. To prescribe medicinal cannabis, practitioners need to register online, create a password, receive an email confirmation, then save the link to the desktop.
 
‘Every time a patient comes in you go onto that online system and there’s a TGA application form that you fill in,’ Dr Kotsirilos explains.
 
Filling in those forms can be time-consuming, she says, noting it generally can take up to 30 minutes to complete per patient prescription.
 
While Dr Kotsirilos says prescribing medicinal cannabis has become a lot easier over the past year, she believes there is a long way to go in terms of rectifying the gap between doctors’ willingness to support the use of medicinal cannabis and their knowledge on the topic, along with the practicalities of prescribing.
 
‘I believe the authorities need to help make prescribing medicinal cannabis a lot easier,’ she said.
 
For more information on medicinal cannabis, refer to the RACGP position statements 'Medicinal use of cannabis productsand ' The regulatory framework for medicinal use of cannabis products.
 
The ‘Medicinal use of cannabis products’ statement now includes an appendix, Prescribing medicinal cannabis products checklist.



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Muhammad pervez   8/05/2019 9:48:45 AM

CPD program on medicinal cannabis use should be available in check / RACGP website....


Celia   8/05/2019 12:15:29 PM

Chronic Pain Australia are running a practitioner information session in Melbourne which is an introduction to medical cannabis for healthcare professionals. Details at: https://www.eventbrite.com.au/e/melbourne-medicinal-cannabis-healthcare-professionals-information-session-tickets-59938388333


Dr Kylie O'Brien PhD   8/05/2019 1:34:45 PM

Great article and you have highlighted an important need- education of medical practitioners. The need for healthcare practitioner education about medicinal cannabis is something being addressed by not-for-profit organisation Global Health Initiative. Research indicates that mental health conditions are common reasons why people use cannabis. Global Health Initiative is running a conference and masterclass on mental health and medicinal cannabis in Melbourne on 20/21 July 2019. The conference covers foundation knowledge about medicinal cannabis, plus its evidence base in mental health. The masterclass provides doctors with the knowledge to apply to prescribe via the TGA's medicinal cannabis prescribing schemes. RACGP CPD points pending. See http://www.globalhealthinitiative.life/healthcare-practitioner-training-and-education/ for details.


Michael   8/05/2019 3:39:24 PM

Muhammad, have you seen the free RACGP accredited online courses for Medicinal Cannabis? See https://mymedic.org.au/


Loren paul wiener   10/05/2019 11:54:47 AM

I was reminded by a GP in the USA recently when laughing that Aussie GPs don't understand Cannabis in Australia. He said "Apparently, GPs there in Australia have heard of something called PANADOL (paracetamol) - It works on the HECS (human endocannabinoid system) as does something called Cannabis" If they don't understand Cannabis or the CB1 system then they should not be suggesting Panadol and perhaps should give up medicine. Once it was made legal it was amazing how fast the lack of knowledge went away in The USA and Canada also. It looks like GPs have the same condtion in Australoia :-) (selective ignorance).


Dr. No   11/05/2019 6:56:47 AM

There is a big difference between “medical marijuana” and cannabinoid-based pharmaceuticals, this article fails to make the distinction.
More importantly, the RACGP ought to be embarrassed to support, endorse or even allow “integrative GPs”. Integrating actual medicine with fanciful, evidence-free nonsense does not turn the nonsense into actual medicine; it sullies medicine and makes us no better that the money-grubbing vultures prescribing turmeric and vitamin c infusions for made-up conditions. In fact, Drs like this are worse than the naturopaths and chiroquacktors because they should know better.


Associate Professor Vicki Kotsirilos   14/05/2019 12:21:52 PM

Dear Dr No, thank you for your comments. We understand your concerns about some doctors style of practice working in areas of Complementary Medicine. However most GPs who practice evidence based Integrative Medicine (IM) strive to do this is in the most ethical way. We see ourselves first as GPs, keeping up to date with the research in the area of IM with the aim to help & advice our patients on the best available modalities that are safe and more evidence based. 70% of our patients are using IM. The term IM was adopted by the RACGP to help GPs identify those therapies that are more evidence based and safe to advice patients: https://www.racgp.org.au/education/education-providers/curriculum/contextual-units/processes/im16-integrative-medicine
We agree more research is required. We welcome you to join the IM Specific Interests Network to receive our regular newsletters that keep GPs up to date with the latest evidence. Kindly, Vicki


Sonia Sorbello   16/05/2019 8:47:01 PM

Hi, I’m an approved patient and have ptsd, chronic pain. I was first approved for the product Jasper. It was crap. I took up to 3.6ml anymore than that I got a headache. $270 for 20 days
Now I’ve been approved for cannabis flower it is $23 a gram plus $50 freight. We are buying from the Netherlands ffs. The government needs to pass laws quick so the flower is available to patients for no more than $10 a gram. We have no shortage of land and even approved farms but they are only approved for oil. Oils may work for some. And definitely add a layer of pain help but not measurable.
For me on my current dosage of 2.5grams per day (vaping) that is currently $50 bucks basically per day plus freight.
I completely broke down when I was told that 5 grams plus freight is $179
This product has only 6% thc and 9% cbd

Costs were $225 for initial consult then $250 for application to tga and $120 for approval then $80 a fortnight for consults.

Vote greens and let get this legal


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