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68 MEDICINAL CANNABIS The case for marijuana as medicine Medicinal cannabis has been the subject of heated debate for years and with its use on the rise, this month we explore its role within healthcare and what pharmacists need to know. By Margaret Mielczarek. While medicinal cannabis is controversial and its use within healthcare hotly debated, there is a lot more to the product than meets the eye. Speak with the experts and you soon discover there might just be a place for medicinal cannabis – tetrahydrocannabinol (THC) and cannabidiol (CBD) – within mainstream Australian healthcare. The topic that has interested both healthcare professionals and consumers alike for years – those with chronic conditions desperate to try something that ‘might just work’ for them yet experiencing significant barriers in accessing the so-called complementary drug, which includes both CBD and/or THC. In Australia, “almost all medicinal cannabis is scheduled under the Special Access Scheme and thus can only be prescribed by a registered medical practitioner”, the Therapeutic Goods Administration (TGA) states. “With the exception of one product (Nabiximols), medicinal cannabis products are not registered medicines in Australia, so they must be accessed through special pathways available for unapproved medicines ... such access can only be arranged through an Australian-registered medical practitioner with appropriate qualifications and/or expertise for the medical condition requiring treatment,” the TGA continues. “This doctor can notify/apply on the patient’s behalf for approval to import and supply these products through the Special Access Scheme (SAS Category A or B). Alternatively, the doctor can apply to us \\\\\\\\\\\\\\\[the TGA\\\\\\\\\\\\\\\] to become an authorised prescriber (AP).”1 In addition, some states and territories may have their own qualification criteria. While currently THC (Schedule 8) and CBD (Schedule 4) both remain drugs that can only be prescribed through the SAS or an AP, access to low-dose CBD is being reviewed. In November last year, as reported on the TGA website, an inquiry into barriers to patient access to medicinal cannabis in Australia was referred to the Senate Community Affairs References Committee for inquiry and report by March 2020.2 According to the TGA, in January 2020 the Department of Health made a submission to this inquiry, which included that the TGA was currently undertaking a safety review of CBD at lower doses, noting there were only limited published studies.3 The Department also noted within the submission that “depending on the outcome of the review, the scheduling status of low dose CBD products would be considered”,4 meaning that CBD would go from a Schedule 4 (prescription only) to a Schedule 3 (pharmacist only) substance. This makes community pharmacy and pharmacists important players within the medicinal cannabis space. “It’s critical that pharmacists have the facts ... a lot of the time people go to a pharmacist first \\\\\\\\\\\\\\\[so\\\\\\\\\\\\\\\] pharmacists need to play a key role \\\\\\\\\\\\\\\[in this space\\\\\\\\\\\\\\\],” said Pharmacy Guild Queensland Branch Vice-President Kos Sclavos AM, a passionate supporter of medicinal cannabis use in healthcare. “The knowledge base of CBD and THC – how they work and what they’re for – is not covered” within medical education/training streams, he adds, insisting that this is something all pharmacists, and other health professionals, need to be upskilled in. “At the moment a lot of people rely on illicit \\\\\\\\\\\\\\\[cannabis\\\\\\\\\\\\\\\] – they can’t get a prescriber,” Mr Sclavos said. “\\\\\\\\\\\\\\\[My\\\\\\\\\\\\\\\] driver is to make sure that medicinal cannabis RETAIL PHARMACY • AUG 2020