Background: Medicinal Cannabis became available for prescription in Australia in February 2016. In 2019 the RACGP updated its position statement to emphasise the need for further high-quality research as current evidence is limited and inconclusive. It also documented that after current evidence-based treatment options had failed a specialist-general practitioner should be able to prescribe appropriate medicinal cannabis products according to legislative frameworks.
Method: The review examined medicinal cannabis prescriptions from August 2018 to August 2020 for a single general practitioner based at two Melbourne general practice locations. Data was collected from practitioner TGA Special Access Scheme-B (SAS-B) records and Authorised Prescriber (AP) records.
Results: Over this three-year period 102 patients received prescriptions for medicinal cannabis. 50% of prescriptions were for inflammatory chronic pain, 16% neuropathic chronic pain and 9% cancer-related chronic pain. Other indications included: anxiety (15%), insomnia (3%), multiple sclerosis (3%), Parkinsons (3%) and autism (1%). 50% of prescriptions were for cannabidiol-dominant oils, 48% were for balanced cannabidiol and tetrahydro-cannabinoid oils and 2% were for dried flower product. 43% of patients over the three-year period continued with treatment for greater than 6 months. Barriers to longer term treatment included cost (23%), no clinical benefit (12%), lost to follow up (12%), doctor costs (4%), driving (3%), interrupted cannabis supply (2%).
Discussion: The majority of cannabis prescriptions were for chronic pain. Less than 50% of patients continued with prescribed medicinal cannabis long-term. Cost was the main barrier for treatment continuation. 27% of long-term treated patients were able to be deprescribed from other medications.
Implications for practice: This is the first audit of medicinal cannabis prescribing outcomes in Australian General Practice. Medicinal Cannabis is a relatively new treatment option in Australian. Due to the variety of indications for prescription in chronic complex illness general practitioners are well placed to include medicinal cannabis in their therapeutic armamentarium. However, the long-term benefits and outcomes require further monitoring and assessment.