MIPS receives requests for advice and membership changes from doctors who are considering prescribing medicinal cannabis infrequently. While the prescribing is not mainstream, we observe it is now more commonplace.
To date, MIPS has not received a notification or claim concerning any act, error or omission in the treatment of a patient prescribed medicinal cannabis however, we strongly recommend that practitioners understand their obligations to their state/territory’s drugs and poisons authority and the Therapeutic Goods Administration (TGA) before considering prescribing medicinal cannabis.
Caution to MIPS members
Where consultation is exclusively via telehealth for the prescription of medicinal cannabis, MIPS recommends practitioners exercise a high degree of caution. Any issues that lead to complaints are less defensible if telehealth was used inappropriately (eg for speed and convenience alone).
Before taking a role where you will be expected to see patients who are likely candidates for medicinal cannabis it is advisable to assess the practice's processes and consider if the practice is unfairly passing the liability to you.
Where practitioners are GPs (see patients on the referral of a GP), are appropriately screened, consented and monitored, and your practice is in accordance with AHPRA, your college and TGA requirements, MIPS will be able to extend cover. You must follow all the prescribed Government guidelines for use of Medicinal cannabis including:
- Meeting TGA requirements for prescribing
- maintaining/obtaining an appropriate licence, if required, with relevant state drugs and poisons authority
Additionally, MIPS highlights that you ought to ensure you meet Medicare requirements if you are eligible to bill through Medicare.
TGA Approved Provider
The TGA have approved one medicinal cannabis product: Nabiximols (Sativex®). This can be used for “treatment for symptom improvement in patients with moderate to severe spasticity due to multiple sclerosis (MS) who have not responded adequately to other anti-spasticity medication and who demonstrate clinically significant improvement in spasticity related symptoms during an initial trial of therapy”. Practitioners must be authorised to prescribe Schedule 8 drugs in their jurisdiction in order to prescribe Nabiximols.
Any other medicinal cannabis products (ie unapproved products) can only be prescribed with special permission obtained from the TGA through any of the following:
Practitioners can apply for this where patients genuinely require an unapproved product. If successful, practitioners are granted authority to become an 'Authorised Prescriber' of a specific medicinal cannabis to specific patients (or type of patients).
Practitioners can apply where there are exceptional clinical circumstances. There are multiple pathways defined by the TGA.
MIPS also provides indemnity for members involved in clinical trials. Cover is subject to approval but provided at no additional cost. Members can apply to MIPS through the Clinical Trial and Research Project Notification form
The TGA provide further guidance about prescribing medicinal cannabis, specifically for the:
- treatment of multiple sclerosis
- treatment of palliative care patients
- treatment of epilepsy in paediatric and young adult patients
- prevention or management of nausea and vomiting
- treatment of chronic non-cancer pain
While the guidelines do not prohibit the prescription of medicinal cannabis for other conditions, both MIPS and the TGA have an expectation that the treating doctors use their judgement. The TGA advise that:
As with all therapies medical practitioners must exercise their professional judgment in determining if this [medicinal cannabis] is an appropriate product for an individual patient. In general terms, the less critical the clinical need for the proposed product, the higher the degree of evidence needed to support the use of that product. At this time, we suggest that the use of medicinal cannabis may be considered only when registered medicines have been tried and proven unsuccessful in managing the patient's symptoms or medical condition.
Check list for practitioners considering prescribing medicinal cannabis:
- Obtain a (or check your) permit with your state/territory’s drugs and poisons authority for Schedule 8 drugs
- Prescribe only Nabiximols (Sativex®) for treating spasticity due to multiple sclerosis (MS)
- Seek TGA approval to prescribe any unapproved forms of medicinal cannabis (currently anything other than Nabiximols) under either the Special Access Scheme or the Authorised Prescriber Scheme
- Contact MIPS to request consideration for confirmation of your indemnity cover specific to how you intend to practice