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DVA brings in dosage cap for medicinal cannabis
‘Increasing evidence of harm’ has led to new limits on THC products, with prescribers also needing specialist registration.
Changes to the DVA medicinal cannabis framework have come into effect immediately for veterans who have not previously had prescriptions.
Dosage caps and stricter prescriber requirements have been introduced by the Department of Veterans’ Affairs (DVA) for funding medicinal cannabis prescriptions.
Only medical practitioners who have a specialist registration with the Australian Health Practitioner Regulation Agency (AHPRA) can prescribe following changes to the DVA’s Medicinal Cannabis Framework this month.
The DVA has also introduced a daily dosage cap and concentration limit for products containing tetrahydrocannabinol (THC) due to ‘increasing evidence of harm … with insufficient evidence of benefit’ linked to the high-strength products.
The update means an initial consultation needs to take place in-person.
RACGP Rural Chair and veteran Associate Professor Michael Clements welcomes the move to restrict prescribing to specialists, saying it ‘recognises the skillset of our GPs’.
‘We also recognise the importance that they’ve placed on a face-to-face appointment,’ he told newsGP.
‘This supports our call for there to be some counterbalancing of the convenience aspect of telehealth with the safety aspects.
‘Nothing beats that face-to-face relationship with a patient.’
While Associate Professor Clements describes the changes as ‘good clinical care’ that are ‘very much supported by GPs’, he sought to allay concerns that medicinal cannabis prescription will be cut off altogether.
‘This does not actually restrict veterans who do need access to these medications in a therapeutically appropriate dose,’ he said.
‘When they’ve got an appropriate relationship with a treating practitioner, we can still prescribe for our veterans when we need to.
‘The framework the DVA has established here for prescribing cannabis sets a good standard for considering how it should be prescribed for the rest of the population as well.’
The DVA will only fund products with cannabidiol and THC as the labelled active ingredients and will limit dried herb medicinal cannabis products to those with a THC concentration of 25% or less.
The new restrictions will take effect immediately for veterans who have not previously had prescriptions, with a six-month grandfathering arrangement for those with an existing prescription until 1 September.
The DVA stresses that funding medicinal cannabis will still be considered on a case-by-case basis for previously supported conditions and circumstances, including:
- chronic pain
- chemotherapy induced nausea and vomiting
- palliative care
- anorexia and wasting from chronic illness
- spasticity from neurological conditions
- refractory paediatric epilepsy.
The DVA first began funding medicinal cannabis for veterans under the Repatriation Pharmaceutical Benefits Scheme in 2018.
Under the framework, prescribers also need to ensure a mental health assessment has taken place, that patients have no current substance use disorder, and that there is ‘active monitoring’ for signs of cannabis use disorder.
Last year, AHPRA published
new guidelines for all medicinal cannabis prescribers, raising concerns over emergency department presentations linked to medicinal cannabis-induced psychosis and ‘evidence of over-servicing and ethical grey areas around single-purpose dispensaries’.
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