Medicinal cannabis products are legal, high quality medicines that can be prescribed for people by their doctor. Medicinal cannabis is derived from cannabis plants and can be used to treat the symptoms of certain medical conditions, and the side effects of some treatments.
There are different medicinal cannabis products available to treat different conditions.
The active ingredients in medicinal cannabis are called ‘cannabinoids’. There are between 80 and 100 cannabinoids in medicinal cannabis, and researchers are still investigating how they all work.
At the moment, most medicinal cannabis products contain the cannabinoids cannabidiol (CBD) and tetrahydrocannabinol (THC).
What medicinal cannabis products are available?
Medicinal cannabis products vary, depending on the symptoms or condition they are designed to treat. The way that you take them can vary too. Your doctor will need to assess your needs, and make a decision about whether there is an appropriate medicinal cannabis product for you.
The majority of products are available through import, but more locally available products are expected to become available as the Australian medicinal cannabis industry becomes more established.
What can medicinal cannabis be used for?
While cannabis, or marijuana, has been around for a long time, there is still not much formal evidence for doctors to rely on if they are thinking about prescribing a medicinal cannabis product to a patient.
There is some evidence that certain medicinal cannabis products may be useful in treating the following conditions:
The Commonwealth Government has released documents
which summarise the evidence so far that medicinal cannabis may be useful in treating some conditions.
A doctor or specialist can apply to the government for approval to prescribe medicinal cannabis for any medical condition. However, the doctor may have to provide evidence that shows that medicinal cannabis may be effective for the particular condition being treated. The Office of Medicinal Cannabis has information and resources
to help support medical professionals prescribing medicinal cannabis.
How can I access medicinal cannabis in Victoria?
You can only access legal medicinal cannabis products via your treating doctor or specialist, and only if they believe medicinal cannabis will help treat your condition.
The first step is to discuss medicinal cannabis with your doctor. If they agree medicinal cannabis is appropriate, they will need to decide which medicinal cannabis product to prescribe to you, and get any necessary government approvals.
Once your doctor has received the required approvals, they may issue a prescription to you. You may then take this prescription to any pharmacy to have your medicinal cannabis product dispensed (see Figure 1). More information on accessing medicinal cannabis can be found on the Department of Health and Human Services website
Figure 1: How to access medicinal cannabis in Victoria
How much does medicinal cannabis cost?
In Australia, most medicines prescribed by your doctor are subsidised by the Commonwealth Government under the Pharmaceutical Benefits Scheme (PBS). There are currently no medicinal cannabis products subsidised by the PBS. The cost of medicinal cannabis varies depending on the type of product and the dose recommended by your doctor. As these products are not subsidised by the PBS, you must fund the cost yourself.
The Victorian Government has a ‘compassionate access scheme’ that funds medicinal cannabis products for a limited number of children with severe intractable epilepsy. If you are a parent or carer of a child who may be eligible for this scheme, speak to your child’s paediatric neurologist to find out more.
Can I drive while taking medicinal cannabis?
Driving is not advised while taking medicinal cannabis. THC, one of the common active ingredients in medicinal cannabis, causes impairment in drivers. Unlike alcohol, it is not known what dose of THC will cause impairment in most people.
Even if you believe you are not impaired, it is illegal to drive in Victoria with any THC in your system. Consuming alcohol while taking medicinal cannabis also results in more severe impairment, and carries greater penalties for driving offences.
While CBD on its own is not known to cause impairment, it may occur if the CBD interacts with other medications.
Patients using medicinal cannabis products should seek their doctor’s advice before driving or operating machinery.
Can I bring medicinal cannabis to Australia?
If you are travelling to Australia, you are able to carry up to a 3 months’ supply of medicinal cannabis for yourself or a passenger in your care, provided you have the relevant prescription from a medical practitioner. To learn more, please visit the Office of Drug Control
If you have a physician’s recommendation to use cannabis, you can:
- Buy cannabis products with more THC
- Buy more cannabis at a time, if needed for your medical condition
- Possess more cannabis
- Grow more plants at home, if needed for your medical condition
- Get a medical marijuana ID card
Even with a physician’s recommendation, you must follow laws about where you can use cannabis.
Eligible medical conditions
Your primary care physician can recommend cannabis to help you manage any of these medical conditions:
- Acquired immune deficiency syndrome (AIDS)
- Cachexia (wasting syndrome)
- Chronic pain
- Severe nausea
- Persistent muscle spasms (for example, spasms caused by multiple sclerosis)
- Seizures (for example, epileptic seizures)
Your physician can also recommend cannabis to help with chronic or persistent medical symptoms that either:
- Substantially limit your ability to conduct major life activities
- May cause serious harm to your safety, physical health or mental health
Medical marijuana ID cards
You can get a medical marijuana ID card with a physician’s recommendation. Medical marijuana ID cards are voluntary. If you have one, your cannabis purchases are exempt from sales and use tax.
Medical marijuana ID cards are valid for up to one year. Both patients and their primary caregiver can get a card.
How to get a medical marijuana ID card
- Fill out the application
Download and complete the medical marijuana ID card application form.
- Gather your supporting documents
When you apply, you’ll need a copy of your medical recommendation, proof of identity (driver’s license or other government-issued ID), proof of residency that shows your name and current address (like a rent or mortgage agreement, utility bill, or California motor vehicle registration)
- Make an appointment with your county health department
You must submit your application in person. Contact the health department for the county you live in for an appointment.
- Go to your appointment
You’ll pay an application fee and have your photo taken for your ID card. Application fees vary by county, but they are not more than $100. If you’re applying as a primary caregiver, the patient will need to come to your appointment with you. If you receive healthcare through Medi-Cal, your application fee is reduced by 50%. If you receive healthcare through a medically-indigent service program, your application fee is waived.
- Wait for approval
It can take up to 35 days for the county health department to issue your medical marijuana ID card.
What to do if your application is denied
You can file an appeal with the California Department of Public Health if your county health department denies your application. There is no fee to appeal.
Who is a primary caregiver
Primary caregivers are responsible for a patient’s everyday needs, such as:
CBD oil and physician liability
Cannabidiol oil (CBD), a cannabinoid derived from cannabis that doesn’t create the “high” associated with marijuana since it lacks the cannabinoid THC, is gaining interest among health practitioners for its long list of potential benefits.
CBD oil for pain is one of the most widely discussed medical uses for the oil, although the list is much longer and includes seizure reduction, cancer treatment, anxiety relief and more cosmetic purposes such as acne reduction, among others.
There are three main issues with CBD oil for physicians who might prescribe it, however. First, cannabis and CBD oil remain illegal under federal law since it is classified as a schedule 1 drug under the Controlled Substances Act. More than 23 states have decriminalized its use for medical purposes, but this still comes in conflict with federal law and the Drug Enforcement Agency. Going near CBD oil in a healthcare setting is tricky.
Second, its status as an illegal substance makes it hard to test and run clinical trials that definitively prove its medical efficacy. This creates a vicious circle where marijuana and CBD are not fully legal because there is no data on its safety and efficacy, and its medical use in not proven because there is not enough testing due to being illegal.
Then there’s the liability of prescribing CBD oil and any product related to cannabis. Does the regulatory environment and the risk of malpractice outweigh the benefits for patients? This article will focus on this third challenge related to CBD oil for medical use.
Currently, prescribing CBD oil still is relatively unexplored territory for physicians in terms of legal liability. But medical boards want clarity.
In 2016, the Federation of State Medical Boards (FSMB) surveyed member boards regarding the issues related to cannabis and medical regulation. The survey found that the issues most important to board about CBD and marijuana included guidance on handling recreational use by physicians (31.4%), guidance on handling marijuana products for medical use by physicians (47.1%), and model guidelines for recommending marijuana products for medical purposes to patients (49.0%).
The trouble is that CBD oil, despite its potential medical benefits, lacks the certainty of an FDA-approved drug. The legal framework for that just isn’t there yet, which puts physicians in a bind.
To reduce the risk of liability, however, the FSMB has developed some guidelines for the recommendation of cannabis and cannabinoids such as CBD oil in medical settings as part of its Workgroup on Marijuana and Medical Regulation.
Guidelines for Minimizing Liability Around CBD Oil Recommendation
The FSMB workgroup recommends several conditions for safeguarding the ethical recommendation of cannabis-based products such as CBD oil for medical use.
1. Establish a Preexisting Medical Relationship with the Patient
To avoid questions of inappropriate prescription of CBD oil for medical conditions, the FSMB recommends that physicians first make sure they have a documented, existing medical relationship with the patient before recommending products such as CBD oil.
Consistent with prevailing ethical standards, physicians also should not recommend, attest or authorize CBD oil for themselves or family members.
2. Documented Patient Evaluation
A second key to reducing liability around recommending CBD oil for medical use suggested by the workgroup is taking extra pains to document that an in-person medical evaluation and collection of relevant medical history is performed before considering if CBD oil is appropriate for the patient.
While less applicable to CBD oil because it lacks the high of THC that is present in medical marijuana prescriptions, physicians should nonetheless also ensure the patient does not have a history of substance abuse. This ensures that physicians are covering their bases even if THC is not present in CBD oil.
3. Advise and Decide Together with the Patient
Physicians should discuss the risks and benefits of CBD oil with the patient before making a recommendation because CBD oil is clinically unproven and lacks the standardization present with many other potential treatments, according the FSMB workgroup.
This is key for minimizing the potential for liability because then the choice is not made by the doctor alone, shifting responsibility. It also is important because due to the current legalities of cannabis-related treatments, physicians cannot actually prescribe CBD oil—they can only recommend it as a possible treatment.
4. Include a Treatment Agreement
Physicians that recommend CBD oil should also document alternative options available to the patient in the form of a treatment agreement.
- Review of other measures attempted to ease the suffering caused by the terminal or debilitating medical condition that do not involve the recommendation of CBD oil.
- Advice about other options for managing the terminal or debilitating medical condition.
- Determination that the patient with a terminal or debilitating medical condition may benefit from the recommendation of CBD oil.
- Advice about the potential risks of the medical use of CBD oil, including the variability of quality and concentration of CBD oil.
- Additional diagnostic evaluations or other planned treatments.
- A specific duration for the CBD oil authorization for a period.
- A specific ongoing treatment plan as medically appropriate.
5. Avoid Any Other Relationship with Cannabis-based Products
Finally, one of the most important ways that physicians can reduce the potential liability from recommending CBD oil is by having a clear and impartial relationship to CBD oil and marijuana in general.
That means that doctors should not have a professional office at or near a marijuana dispensary or cultivation center, or receive compensation from or hold a financial interest in a CBD-related business.
By clearly demonstrating that the recommendation of CBD oil is for medical purposes and not based on personal considerations, physicians will help cut the liability associated with CBD recommendation.
That noted, there is no clear-cut way to completely reduce liability when recommending CBD oil to a patient any more than there is a way to completely eliminate the chances of malpractice when advising patients. Some potential for liability is inherent.
As the use of CBD oil and marijuana for medical purposes increased, and further standards and regulations develop, recommending it should become less legally fraught. Until then, reducing the potential risk of liability is the best that physicians can do in the case of CBD oil.
This article is for information only, and does not constitute legal advice.