Is Telehealth Safe for Cannabis Scripts in Australia?

What is Medicinal Cannabis?

Medicinal cannabis refers to a variety of cannabis-derived products. It is available in different strengths and forms. The Therapeutic Goods Administration (TGA) regulates the use of these types of products. However, most of the currently available medicinal cannabis products remain unapproved medicines. This means they are not listed on the Australian Register of Therapeutic Goods and lack TGA oversight for safety, quality, or efficacy [1].

While they can be used to treat certain medical conditions, including chronic pain, epilepsy and the side effects of chemotherapy, they are not the first line of approach.

Where Telehealth Comes In

Telehealth has changed the way many Australians use healthcare, including access to doctors remotely prescribing medicinal cannabis via eScripts. While this convenience can help bridge gaps in access, there is some concern among experts about the lack of in-person assessments [1].

Some telehealth providers have also fallen foul of advertising restrictions. Due to their unapproved status, telehealth providers are also not allowed to advertise medicinal cannabis products directly to patients.

Best Practice for Prescribing Medicinal Cannabis

The approval process for medicinal cannabis requires a comprehensive clinical assessment by a licensed medical practitioner. This includes the patient’s medical history, mental health, potential drug interactions, and evaluation of the necessary dose. For example, doctors should start the patient on the lowest possible dose if medicinal cannabis is indicated as the best approach. However, Queensland Health guidelines clearly state that medicinal cannabis should only be prescribed after conventional treatments have been shown to be ineffective [2].

Furthermore, the TGA advised prescribing medicinal cannabis on a one-month trial basis. This should also include clear treatment goals and ongoing monitoring and support [2] – not always available in the context of telehealth, where contact is often patient-initiated.

Finally, the doctor and patient should have a clear exit strategy in place, as withdrawal can have many unwanted side effects. This is particularly important in younger patients.

While vaporising is common, smoking is discouraged due to the inherent health risks. Topically applied products, on the other hand, are less effective than other forms of administration [2].

Lack of Regulation

There’s a lack of standardisation and oversight of the available medicinal cannabis products due to them not being listed by the TGA, which means dosing can vary widely. This means you cannot always be sure how much of the active ingredient THC you will actually be exposed to. Essentially, there’s a regulatory gap which allows unscrupulous providers to operate [1].

Inappropriate Prescribing

Experts warn of "single-issue" clinics that may prioritise profit over patient safety. This could be access to a monthly subscription of a high-strength cannabis product after a short 15-minute phone call with a new doctor [1].

Also, THC-containing products should not be taken by pregnant patients or those with mental health conditions or cardiovascular instability [2]. There is a heightened risk of these contraindications being missed during a short telehealth consult or by a junior doctor or less experienced nurse practitioner (NP). If you are looking for mental health support, visit MediCompare’s Mental Health Telehealth Provider page to compare options.

Some patients also seem to follow a script to gain access to medicinal cannabis, without seeking genuine advice from the telehealth doctor. In other instances, some telehealth providers use nurse practitioners for a quick assessment before a prescribing doctor issues the requested script, also not following best practice.

While medicinal cannabis may also be appropriate in some (supervised) settings, such as end-of-life care, prescribing it for younger patients has the added consideration of the potential length of staying medicated and the impact side effects or an unsuccessful exit strategy may have.

Pharmacokinetic Risks

Medicinal cannabis products can have adverse effects with some other medications, as well as certain health conditions. This may also be missed without a thorough assessment.

Oral and vaporised products have unpredictable absorption rates that may vary individually, further complicating dosing [2].

Summary

While telehealth has brought convenience and greater access to healthcare, medicinal cannabis is best used under the guidance and close supervision of a prescribing doctor. This should be part of a thorough evaluation of the patient’s options, individual needs, and risks. Health guidelines advise starting on the lowest possible dose and on a one-month trial basis to lower risks. Vaporised or topical products should only be used where other products are contraindicated.

If you are looking to use a telehealth provider to evaluate your need for medicinal cannabis, choose a high-quality provider, such as Hola Health or Prime Medic, offering ongoing support and access to GPs for telehealth where possible. You can check out a list of MediCompare’s vetted providers or even search for bulk billing services.

Check with your doctor which products and strengths are available and how to ensure you receive the most accurate dose of the active ingredient.

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