“PATIENT demand is not an indication to prescribe medicinal cannabis,” said the Australian Health Practitioner Regulation Agency (Ahpra) in new guidelines for medicinal cannabis prescribing issued today.

The guidelines were released in response to “evidence of poor practice in prescribing medicinal cannabis that is leading to significant patient harm”.

Medicinal cannabis can be prescribed by medical and nurse practitioners, but Ahpra has noted that their respective professional boards are concerned that “profits are being prioritised over patient safety in some medicinal cannabis prescribing practices”.

The agency pointed to emerging business models that use aggressive and sometimes misleading advertising targeting vulnerable people.

“Some of these practices only offer the prescription and supply of a single product or class of drug and use online questionnaires that coach patients to say ‘the right thing’ to justify prescribing,” Ahpra noted.

“While these models may work well for access, there is an inherent conflict of interest for medical and nurse practitioners working in an organisation that prescribes and dispenses a single medication.”

The agency highlighted specific instances of poor practice (PD 23 May), including practitioners who have each issued more than 10,000 prescriptions for medicinal cannabis products in six months; consultations of only a few seconds that make proper patient assessment impossible; and prescribing without a legitimate indication – or simply because “the patient requested it”.

Issues surrounding prescribing to under-18s, not taking comorbidities into account, prescribing excessive quantities, and prescribing for self and friends were also raised.

The new guidelines require medical and nurse practitioners to have the necessary knowledge, skill and training to provide safe clinical care, and outline what “good patient care” entails.

Ahpra reminded practitioners that it should only be prescribed when there is an evidence-supported clinical indication and when other treatments have not worked.

By the same token, it pointed out there is little evidence to support the use of medicinal cannabis generally, with a few limited exceptions, and the TGA has approved only two products.

The new guidelines are HERE. KB

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