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Talking to your doctor

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How to discuss Medical Cannabis with your Doctor

Understanding the current situation, and understanding some of the issues relevant for your GP, can make it much easier to discuss medical cannabis and its place in your treatment. The first thing to understand is that medical cannabis is a relatively new treatment treatment option in Australia. That often means that a doctor is neither positive nor negative about prescribing it- it simply means that many practitioners lack experience. The application process imposes additional challenges that are not an issue for established treatments and for some doctors the hassle just seems too great. CannaPacific recognises this and aims to make prescribing safer, easier and more efficient for GPs with our online portal and education resources. 

Doctors in Australia carry a great deal of responsibility and everyone – including patients, the government and the media, are very quick to condemn any doctor who causes harm, even if that harm wasn’t the result of negligence. Obviously doctors need to be careful and prescribe safely, but sometimes reactions simply can’t be predicted or things don’t work out as planned despite everyone doing the right thing. Basically if plumbers had the same weight of risk as GPs no one would ever fix your toilet.

The next thing to remember is that in Australia, there is a very strict process for medications being made available to the public. They need to pass stringent tests and go through a rigorous process of clinical trials. This hasn’t happened with medical cannabis and it’s pointless pretending that it has. In 2016 medical cannabis was legalised by the Federal Government based on the fact that it is a relatively safe medication that many patients and clinicians around the globe have assessed as beneficial and as such have demanded access to it, there is a limited body of evidence to support this, you can find the Therapeutic Goods Administation medicinal cannabis guidance documents here https://www.tga.gov.au/medicinal-cannabis-guidance-documents. The combination of the lack of clinical trials and the legalisation by the Federal Government means you can legally access medicinal cannabis but there is a more extensive process to move through and this makes some doctors nervous. CannaPacific is focussed on improving the high-level evidence base for medical cannabis and regularising the application process as much as possible within the current government constraints.

Is it a good idea to do some research and take it to your next GP appointment?

It’s great to be informed, however Dr Google can often mis-inform with articles and opinion discussions. You can do your own research to understand what form of medical cannabis patients with your condition have benefitted from and there are clinical studies available online that patients are able to print and share with their medical practitioner – but ultimately the clinical decision is the responsibility of your doctor. Some GPs might be open to discussing them, and some less so. That’s why accessing medical cannabis from a GP you know, and have a good relationship with, is the best solution. Remember that just because an article is on the internet, doesn’t mean that it is actually a quality, peer-reviewed study that can help a practitioner understand more about medical cannabis as a treatment option for your condition. A lot of what is written on the web is opinion dressed up as evidence and for your GP, who has to take medico legal responsibility for the scripts they are writing, that is not good enough.

Remember that GPs are busy and it would be helpful to book a long appointment for the discussion.

Be honest and talk about your experiences

When discussing your condition, it is important to discuss with your doctor how you feel, and the effects of the medications you have tried in the past. It’s important to be honest and advise your practitioner if you’ve already tried cannabis (whether legal or street) and what the effects were. There is absolutely no benefit in concealing the use of street cannabis and it is really helpful for your doctor to understand how much you have used and in what ways it helped.

Street cannabis and medical cannabis are very different and we have some added information (see extra attachment). The differences are particularly in relation to quality, potency, cannabinoid concentration and the significant potential for harmful additives in street cannabis.

Work Together with your Doctor

Doctors have strict legal obligations to comply with regulations in relation to medical cannabis and the prescribing guidelines. Being patient with your doctor if they still have questions or need more evidence to feel comfortable prescribing is important and is the best way to move forward. There is still a lot to learn about the potential benefits of medical cannabis and how to prescribe it effectively and with confidence. Research in this space is very active.

“While there are additional legal requirements that must be met before medicinal cannabis products can be imported and supplied through these schemes, they do provide a pathway for access to these medicines to appropriate patients.” https://www.tga.gov.au/access-medicinal-cannabis-products-1

Both doctors and patients are actively exploring the science behind medical cannabis for a variety of conditions and how it compares to established medications. One of the important potential benefits of medical cannabis is the growing evidence that it can help reduce the use of other substances such as opioid medications, benzodiazepines and alcohol, that patients often use when their symptoms are not well controlled. If you are using any of these things to manage your symptoms, discussing the role that medical cannabis use may have in reducing that use, can help your doctor understand the benefits that a trial of medical cannabis may have for you personally.

Think Through Your Choice

When considering any new treatment, you should consider the possible impact on your life as a whole. Will there be any side effects that could interfere with a regular activity that is important to you such as operating heavy machinery or driving? Remember that medical cannabis that contains THC can affect your ability to focus and concentrate and that the law states that you must not drive if you have used any substance containing THC. Having properly prescribed THC does not change this legal situation.

Another important consideration is the cost. There is currently no PBS subsidy available for medical cannabis so its cost will be worn entirely by the patient. In Australia we have all grown up with the PBS (pharmaceutical benefits scheme) so this can be quite a shock. Most patients find however, that the cost, whilst significant, is worth assessing because of the potential symptom control benefits. The cost of medical cannabis in Australia varies and depends on a number of considerations such as a patient’s condition and the product being prescribed.

Your doctor needs to know about these practical matters, as well as your specific condition and symptoms, and also about your family history and the other medications you are using, so they can choose the right treatment for you and develop a treatment plan that works for your individual circumstances.

What if my doctor is interested in prescribing medical cannabis but doesn’t know where to start?

This is quite a common situation. Many doctors are willing to consider prescribing medical cannabis for certain patients with certain conditions, and are actually quite interested in the growing evidence base, but they simply don’t know where to begin. Often they believe that it is all harder and more complex than it actually is.

Cannapacific is committed to helping educate GPs and have developed a lot of resources, including an online prescribing portal, to assist. Importantly the GP stays in control of all steps in the process. We can also provide doctors with product and price lists and provide education sessions if requested. Sometimes just directing the doctor to our website is enough and we are happy to talk to them if they contact us.

What if my doctor isn’t interested in prescribing medical cannabis?

Some practitioners still lack experience and knowledge, or may simply not be comfortable treating patients with medical cannabis. Your doctor may have certain beliefs or convictions that mean they are not prepared to apply for or prescribe medical cannabis for you. CannaPacific encourages you to maintain your relationship with your doctor even if they won’t prescribe medical cannabis themselves because there are several other avenues available to you.

The first is to ask if your doctor could consider writing you a referral to another doctor who they know is willing to consider medical cannabis. There are a growing number of practitioners in Australia who are open to prescribing medical cannabis as a second line treatment to eligible patients, and being referred to a colleague of your GPs is a great solution. If that isn’t an option there are stand-alone medical cannabis clinics that your doctor can refer you to.



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