Patients ask 60 per cent of GPs about medicinal cannabis

There are calls for more general practitioners to become educated about medicinal cannabis and authorised to prescribe it, after a survey of 640 Australian GPs found almost two thirds have had patients ask about the drug.

More than half the doctors said they supported the drug being available by prescription for use in cancer pain, palliative care and epilepsy, with their preferred ‘access model’ involving GPs prescribing independently of specialists.

The survey was conducted by researchers from The Lambert Initiative for Cannabinoid Therapeutics at the University of Sydney late last year and the results have been published in the British Medical Journal Open today.

The survey found 61.5 per cent of GPs reported one or more patient had asked about medicinal cannabis in the three months before the questionnaire.

“This is a very live issue for GPs,” Professor Iain McGregor from The Lambert Initiative told ABC News.

“58 per cent of the GPs we surveyed were in favour of the prescription of medicinal cannabis, so that’s a clear majority of the GPs.”

However the survey found most of the doctors felt their knowledge of the drug was inadequate and they were not comfortable discussing it with patients.

Fewer than one in 10 knew how to navigate the bureaucracy involved with prescribing medicinal cannabis.

Currently GPs wishing to prescribe it must either become an authorised prescriber for a class of patients, or apply for access per patient through the Therapeutic Goods Administration’s (TGA) Special Access Scheme B (SAS-B).

They also require approval from their state’s health or poisons body and the support of a specialist.

Process ‘should be straightforward, streamlined’

Professor McGregor said the process is onerous, complicated and time-consuming.

“It’s really putting GPs in quite an uncomfortable position because no one has stepped up to train GPs about this issue properly,” he said.

“The TGA has information on their website but I think some GPs look at that website, look at the application process, and just say ‘I’m far too busy to deal with that’.”

Dr Bastian Seidel from the Royal Australian College of GPs said the college was working with state and federal governments to develop a national framework that would allow GPs who want to prescribe medicinal cannabis to be able to do so.

“Medicinal cannabis prescribing is a basket case here in Australia and it’s completely inappropriate — it should be much more straightforward, it should be streamlined as well,” Dr Seidel said.

“If your GP feels it’s appropriate for you to have medicinal cannabis and if it’s appropriate for medicinal cannabis to be prescribed for your medical condition, then of course the GP should be authorised to prescribe that.

“I think it’s a no-brainer.”

However he added that the drug should only be considered as a last resort.

“I believe we need to be open-minded, we need to think of the opportunity medicinal cannabis offers, but we also need to be aware of the risk and benefits.

“We need to be very careful here because I recall very much that 20 years ago opioids were heavily promoted for the treatment of chronic pain and now we know they’re actually doing more harm than good — we don’t want to fall into the same trap when it comes to medicinal cannabis.”

First GP to be approved says ‘it’s not a magic bullet’

Last month Dr Vicki Kotsirilos became the first Australian GP authorised to prescribe medicinal cannabis after a rigorous application process before an ethics committee.

She now has TGA authorisation to prescribe medicinal cannabis for patients with chronic and severe cancer pain or neuropathic pain, without the need for federal bureaucrats to approve each prescription.

The Melbourne GP still needs the consent of a patient’s specialist and approval from the state health department, but bypassing the TGA means the process takes hours, not days.

“So it’s usually when a patient has tried everything and nothing else has helped them then I can now use medicinal cannabis as an option for treatment,” Dr Kotsirilos told ABC News.

“These patients’ quality of life has improved, they sleep better, they feel better, their moods improve, they have more energy because they sleep better, and they can think more clearly because they suffer less pain.”

Dr Kotsirilos believes more GPs should learn about the drug and consider applying to become authorised prescribers.

“GPs need more training and education on at least learning what is the potential evidence, what is the science or lack of science, and what are the risks, benefits and side effects of using medicinal cannabis,” she said.

“However one thing patients must realise is it’s not the magic bullet — it is an alternative pain treatment, however it is not the magic bullet because it doesn’t treat everybody and there can be some side effects from it.”

Medicinal cannabis is not on the Pharmaceutical Benefits Scheme so patients need to pay full price for products they are prescribed.

The TGA’s latest figures show that 193 patients had been treated by authorised prescribers, of which there are 33, and 673 patients had been given access under the SAS.

There are many clinical trials underway but the number of participants is unknown.