Cannabis in Oncology - Part 2

How to get medical cannabis extracts in Australia - what is the process?

There is conclusive and substantial evidence for prescribing medicinal cannabis in many conditions, and was made legal in Australia in 2016. But medicinal cannabis is not a first line therapy in Australia - this means that it can't be prescribed at the first signs of pain, for example.  It can only be prescribed if multiple medications have been trialled and the current medicines available for that condition are not effective or cause too many side effects. 

The Therapeutic Goods Administration (TGA) is the Australian government body that regulates access to medicinal cannabis and all prescription medicines.

Although legal, medicinal cannabis products are still 'unregistered medicines' and therefore do not appear on the Australian Register of Therapeutic Goods (this is a list of medications that comes up on the doctor's computer). This means that you can't just go to any doctor, ask for a script and fill it at a pharmacy as you would with conventional registered medicines. To access 'unregistered medicines' a doctor must make an application to the TGA on a patient's behalf through the 'Special Access Scheme'. Preferably this would be a specialist in the illness being treated, but a GP can manage the application, although some are more informed than others.

We can help connect you with a GP and pharmacy in your area that has experience in prescribing medicinal cannabis.

Medicinal Cannabis is approved for use in Australia in patients with the following oncology-related conditions:

• Muscle spasticity associated with MS
• Chemotherapy induced nausea and vomiting, loss of appetite and insomnia
• Chronic pain including cancer-related pain 
• Epilepsy or tumour-related seizures

There are many other conditions that medicinal cannabis may be used for, such as Generalised Anxiety, Autism, Attention Deficit Hyperactivity Disorder (ADHD), Post-traumatic stress disorder (PTSD) and Chronic Fatigue Syndrome (CFS) and also for palliative support.

FAQ's about using medicinal cannabis in cancer care

Is medical cannabis legal in Australia now?
It is legal to obtain selected cannabis products for particular medical conditions from a Medical Practitioner.

What are the conditions that it's legally prescribed for in Australia?
There are limited conditions for which medicinal cannabis products can be used for in Australia. Medicinal cannabis is not a 'first line treatment'. Medicinal cannabis products are listed for use in Generalised Anxiety, chronic pain (many types, for example neuropathic pain, arthritis, cancer pain, chronic headaches) Epilepsy, PTSD, Autism, ADHD, Tourette's Syndrome, MS spasticity, and Fibromyalgia. The list of uses is growing every day as new research is published.

How much does it cost to get medical cannabis?
The current cost of using medicinal cannabis products ranges from $200- $750 per month depending on your dosage. Unfortunately, the reality is that many of the medicinal cannabis products available for access are very expensive and are not subsidised by Australia's Pharmaceutical Benefit Scheme (PBS).
 

How many medical cannabis products are available?
There are currently 13 Australian-based manufacturers of medicinal cannabis and 19 registered importers of medicinal cannabis products in Australia so there are a lot of products available with varying levels of CBD and THC. However, there is a huge variation in product forms and ratios of THC:CBD as well as pure CBD. There is research specific to each condition and dosage form so the brand and dosage varies patient to patient.

How long does it take to get medicinal cannabis?
If all of your documentation is in order, the TGA takes about 2 days to process your application. Then it takes around 5 days from prescription to pick-up from the pharmacy.

My friend is offering to make me some CBD oil. Why should I use medicinal cannabis rather than regular backyard cannabis?
Medicinal cannabis contains a standardised dose of THC:CBD, or CBD-only. This means it's easier to determine exactly how much you are taking, and it is reliable and safe. Backyard preparations have unknown quantities of THC and CBD: every batch is different and this means that you need to start again with every batch to determine the best dose. Also, fungal or bacterial contamination and pesticide use are unknown when sourcing it yourself.

I'm scared to use medicinal cannabis. Do patients get high taking medical cannabis?
The dosage of THC required to give pain relief is much lower than the dosage required to create a 'high'. Most patients report feeling calm or relaxed at their therapeutic dose, but it is very rare to feel an altered state form medicinal cannabis. You also generally start at a very low quantity and slowly work your way up to the full recommended dose. The only time that a patient might feel a 'THC high' is if they increase the dose too quickly.

How do I know what dose to take?
The doctor will help you with this. The correct dose needs to be 'titrated': this means that you start with a low dose, and then assess after 2-3 weeks as to the effect. Because medicinal cannabis is an oil based product and takes a long time for the body to utilise, it takes a good 2 weeks to stabilise at a particular dose, and you should stay at the same dose for at least 2 weeks before assessing how much it is working. Then if necessary, you titrate up to a higher dose in a slow step-up approach. Every persons body chemistry is different and therefore we all need different doses.

What side effects will I get?
Cannabis is generally very well tolerated. Side effects at low (medicinal) doses are uncommon.
Side effects are more likely at higher doses: As the dosage increases, some patients may experience feeling hungry, dizzy or tired, drowsiness, changes in taste or a dry mouth. Higher doses are more likely to cause side effects such as memory and concentration problems, feeling abnormal or drunk, lack of energy or feeling weak, depressive or gastrointestinal symptoms.

What are some tips when starting to use medicinal cannabis?

• Start at a very low dose and slowly increase to the optimal level. The doctor will help determine the correct dose for you, which is individually titrated (determined by sex, age, weight, medical condition, severity of symptoms).
• Patients should use a diary to record any symptoms and side effects.
• Have regular appointments with your prescribing GP/specialist to monitor your results.

Can I use medical cannabis with other medications?
There are a number of interactions between medicinal cannabis and medications such as warfarin, psychoactive medications, pain medications and some heart medications. Speak to your health practitioner.

What about alcohol? Can I drink alcohol at the same time as using medicinal cannabis?
It is not recommended. Using medicinal cannabis and alcohol together may increase their effects (such as loss of balance or slowed reaction time).

Can I drive while taking medicinal cannabis?
No. You must not drive or operate machinery while using medicinal cannabis.

Is medicinal cannabis safe for everyone? It's from a plant, so it should be right?
Absolutely not. Medicinal cannabis should not be used in patients with a history of mental health conditions such as schizophrenia, psychosis or other significant psychiatric disorder (except when prescribed under the care of a Psychiatrist of course). There's not enough evidence to say that medicinal cannabis is safe during pregnancy or breastfeeding. And some people are actually allergic to cannabis.

Can I use medical cannabis at the same time as 'backyard' cannabis?
It's not a good idea. It's too hard to be sure of dosage, and the side effects are much more likely.

What about if I'm going in to hospital? Can I take my medicinal cannabis with me?
Yes. Once you have a prescription, you take it with you like any other medicine it is on your file and all of your medical team should be informed about its use.

Would you like more information about medicinal cannabis in Australia?

If you are a patient of MIOG, our lead clinician Tanya Wells is happy to chat with your GP or Medical Oncologist regarding the situations in which medicinal cannabis might be appropriate.

Alternatively you can book a consultation to discuss medicinal cannabis further: call us on +61 3 9571 7498 or email info@miog.com.au to arrange an online or in-clinic consultation. We have a large network of Integrative GP's and Specialists, and pharmacies who are experienced in prescribing medicinal cannabis.