Medicinal cannabis prescribing guidance documents: An evidence-based, best-practice framework based on the New South Wales experience

Abstract

Introduction: In 2018, the Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE), a National Health and Medical Research Council (NHMRC) Centre of Research Excellence was funded to develop a suite of state-wide medicinal cannabis prescribing guidance documents. At this time, regulatory changes in Australia were enabling broader access to medicinal cannabis in a medical model. The initiative funded through the New South Wales (NSW) Government’s Clinical Cannabis Medicines Program enabled the development of practical resources to support NSW medical practitioners in prescribing medicinal cannabis to patients for conditions where cannabinoids are perceived to have some benefit. Aim: To provide interim guidance to support medical practitioners in the prescription of medicinal cannabis where they are perceived to have potential benefit. Methods: A team of clinical pharmacologists, pharmacists and clinicians collaborated in the development of the first tranche of prescribing guidance documents. The suite of six medicinal cannabis prescribing guidance documents covered the most common indications for which prescriptions for medicinal cannabis were being sought by NSW patients: dementia; anorexia and cachexia; nausea; chemotherapy-induced nausea and vomiting; spasticity; and chronic non-cancer pain. In 2019, the draft guidance documents underwent a comprehensive review and consultation process involving fifty key stakeholders before publication. Results: The ACRE medicinal cannabis prescribing guidance documents have been widely adopted, both in NSW and around the world. The prescribing guidance documents are now recommended as a health professional educational resource by the Australian national medicines regulator the Therapeutic Goods Administration and state health departments. The prescribing guidance on epilepsy from the second tranche of guidance documents has recently been published in the British Journal of Clinical Pharmacology. National medicinal cannabis prescribing pattern data and enquiries to the first-of-kind, state-government funded medicinal cannabis advisory service for medical practitioners informed the themes of the second tranche of six medicinal cannabis prescribing guidance documents being developed in 2022. Conclusions: ACRE medicinal cannabis prescribing guidance documents delivered interim guidance to Australian medical practitioners on the evidence-based and best-practice prescription of medicinal cannabis. Prescribing guidance document themes align with Australian medicinal cannabis prescribing patterns and areas where medical practitioners are seeking further information and advice. It is anticipated that the prescribing guidance documents will be updated periodically as further evidence becomes available. Acknowledgements: NSW Government through the NSW Clinical Cannabis Medicines Program supported development of the NSW Cannabis Medicines Prescribing Guidance. ACRE was established and is funded through the National Health and Medical Research Council Centres of Research Excellence scheme.