Australian Regulators Crack Down on ‘Poor Practice’ in Medicinal Cannabis Prescribing
New guidance from Ahpra and National Boards aims to curb patient harm linked to over-servicing and conflicts of interest in the rapidly expanding medicinal cannabis sector.
Australian health regulators are intensifying scrutiny of medicinal cannabis prescribing practices following a surge in reports of patient harm, including cases of psychosis. The Australian Health Practitioner Regulation Agency (Ahpra) has issued a formal notice to practitioners, accompanied by new guidance, to ensure they meet their obligations when prescribing the increasingly popular treatment.
The move comes as evidence mounts of concerning trends, including over-servicing and ethical dilemmas surrounding clinics that dispense only a single type of medicinal cannabis product. Regulators are now clarifying expectations for practitioners operating within this evolving industry.
Addressing Rising Concerns Over Patient Safety
The newly released guidance emphasizes that medicinal cannabis should be treated with the same level of care and diligence as any other drug with dependence potential. A core aim is to protect vulnerable patients and address concerns that commercial interests are overshadowing patient wellbeing.
“We don’t prescribe opioids to every patient who asks for them, and medicinal cannabis is no different,” stated Dr. Susan O’Dwyer, Chair of the Medical Board of Australia. “Patient demand is no indicator of clinical need.” Nurse practitioners are also being reminded to integrate the new guidance with their existing professional frameworks during patient assessments.
According to Adjunct Professor Veronica Casey AM, Chair of the Nursing and Midwifery Board of Australia, “Nurses and other registered practitioners must provide holistic care in all areas of their practice. They must take their professional responsibilities with them no matter where they work.”
Key Elements of Safe Prescribing
Ahpra has outlined several key principles for the safe prescribing of medicinal cannabis, including:
- Thorough patient assessment
- Development and implementation of a comprehensive management plan
- Facilitating coordinated and continuous care
- Maintaining detailed medical records
- Recommending treatment only when a clear therapeutic need is identified
- Ensuring medicinal cannabis is not a first-line treatment option
- Establishing a clear exit strategy from the outset of treatment.
Conflict of Interest and Questionable Business Models
Regulators are particularly concerned about the potential for conflicts of interest when practitioners work for organizations that exclusively prescribe and dispense a single medicinal cannabis product. A senior official stated that some emerging business models utilize online questionnaires designed to elicit responses that justify prescribing, raising serious ethical questions.
“This raises the very real concern that some practitioners may be putting profits over patient welfare,” the official added.
Data currently under review by Ahpra and the National Boards reveals alarming prescribing patterns. Authorities are collaborating with the Therapeutic Goods Administration (TGA) and state and territory agencies to monitor trends and identify potential issues. Specifically, one practitioner has reportedly issued over 17,000 prescriptions, while eight others have issued more than 10,000 prescriptions within a six-month period.
“We will investigate practitioners with high rates of prescribing any scheduled medicine, including medicinal cannabis, even if we have not received a complaint,” confirmed Ahpra CEO Justin Untersteiner.
Examples of Poor Practice Identified
Ahpra has detailed a range of concerning practices observed in medicinal cannabis prescribing, including:
- Extremely brief consultations – lasting only seconds or minutes – precluding proper assessment.
- Issuance of over 10,000 medicinal cannabis prescriptions by individual practitioners within six months.
- Failure to adequately assess a patient’s history of substance use or mental health issues, leading to adverse outcomes like psychosis requiring hospitalization.
- Lack of patient identity verification, including prescriptions for individuals under the age of 18.
- Prescribing based solely on patient request, without a legitimate medical indication.
- Prescribing excessive quantities of medicinal cannabis per prescription.
- Issuing multiple prescriptions to allow patients to “try different products.”
- Failure to check real-time prescription monitoring systems (RTPM), leading to potential drug interactions.
- Lack of coordination with other healthcare providers, particularly when a patient’s history suggests they are unsuitable for medicinal cannabis treatment.
- Prescribing for family members or self-prescribing.
- Conflicts of interest stemming from prescribing only products supplied by the practitioner’s affiliated company.
The guidance on medicinal cannabis prescribing is available on the Ahpra website. This guidance supplements existing regulatory standards for safe care, including each board’s code of conduct and guidelines on telehealth and virtual care.
