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Doctors in the dark about medicinal cannabis: Research
In light of new research, an expert shares what GPs need to know about medicinal cannabis.
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 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 products'
and ' 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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