Medicinal Cannabis Prescribing in Australia: An Analysis of Trends Over the First Five Years

A regulatory framework allowing legal access to medicinal cannabis (MC) products has operated in Australia since November 2016. MC prescribing by healthcare practitioners (HCPs) is primarily conducted through the Special Access Scheme - Category B (SAS-B) pathway, through which prescribers apply to the Therapeutic Goods Administration (TGA–the federal regulator) for approval to prescribe a category of product to an individual patient suffering from a specific indication. The dataset collected by the TGA provides a unique opportunity to examine MC prescribing trends over time in the Australian population. Here we analysed this TGA SAS-B dataset since inception with respect to age, gender, product type (e.g., oil, flower, etc.), CBD content, indication treated, and prescriber location. Results are presented descriptively as well as being analysed using non-linear regression models. Relationship between variables were explored via correspondence analyses. Indications were classified with reference to the International Statistical Classification of Diseases and Related Health Problems (10th Revision). As of 31 August 2021, a total of 159,665 SAS-B approvals had been issued for MC products, 82.4% of were since January 2020. Leading indications for approvals were for pain, anxiety, and sleep disorders. Oil products were the most popular product type, while CBD-dominant products (≥98% CBD) accounted for 25.1% of total approvals. Approvals for flower products increased markedly during 2020–2021, as did approvals involving younger age groups (18–31 years old), male patients, and non-CBD dominant products. A disproportionate number of SAS-B MC applications (around 50%) came from HCPs in the state of Queensland. Associations between patient gender and age and/or indication with product type were found. For example, approvals for oil products were commonly associated with approvals for pain. While, overall prescribing increased dramatically over the last 2 years of analysis, stabilization of approval numbers is evident for some indications, such as pain. Current prescribing practices do not always reflect provided TGA guidance documents for MC prescribing. While acknowledging some limitations around the SAS-B dataset, it provides a unique and valuable resource with which to better understand current prescribing practices and utilisation of MC products within Australia.

Medicinal cannabis in the treatment of chronic pain

BACKGROUND

Chronic pain is a major health issue, adversely affecting millions of Australians and costing billions of dollars annually. Current pharmaceutical treatments may be limiting, and in some cases ineffective, while carrying substantial liabilities. Medicinal cannabis is an increasingly popular, albeit controversial, alternative.

OBJECTIVE

The aim of this article is to briefly review the scientific evidence related to medicinal cannabis for the treatment of chronic pain and update physicians on relevant issues and optimal prescribing practices.

DISCUSSION

To date, >130,000 medicinal cannabis approvals have been issued in Australia, mostly by general practitioners, with approximately 65% of these to treat chronic non-cancer pain. Available products deliver Δ9-tetrahydrocannabinol (THC) and/or cannabidiol (CBD). Despite robust supportive data from animal models, current clinical trial evidence for THC and CBD efficacy in chronic pain is incomplete. In their prescribing decisions, doctors must balance patient demand and curiosity with caution regarding potential risks and limited efficacy.

Integrative Medicine in General Practice in Australia: A Mixed-Methods Study Exploring Education Pathways and Training Needs

Background

Globally, a substantial proportion of general practitioners (GPs) incorporate integrative medicine (IM) into their clinical practice.

Objective

This study aimed to map the IM education and training pathways and needs of a cohort of Australian GPs who are members of the Royal Australian College of General Practitioners’ IM Specific Interest Network, which is a group of GPs with interest in IM.

Methods

We conducted a mixed-methods study comprising of an online, cross-sectional survey supplemented with in-depth semi-structured interviews. Data from the survey and interviews were initially analysed separately and then combined.

Results

Eighty-three (83) of 505 eligible GPs/GPs in training (16.4%) participated in the survey, and 15 GPs were interviewed. Results from the two datasets either converged or were complementary. Almost half (47%) of survey respondents had undertaken formal undergraduate or postgraduate IM education, a short course (63%), informal education (71%) or self-education (54%), in at least one of 20 IM modalities listed. Interviewees affirmed there was no single education pathway in IM. Survey respondents who identified as practicing IM were significantly more likely to have IM education, positive attitudes towards IM, particularly natural products, and higher self-rated IM knowledge and competencies. However, knowledge gaps were identified in professional skills domains of population health and context, and organisational and legal dimensions of applied IM practice. Interviewees also highlighted a range of professional and systemic barriers to the practice of IM, education, and training. There was broad support for recognition of IM as a sub-specialty through formalised post-graduate training and accreditation. Most survey respondents (62%) expressed interest in post-fellowship recognition of GPs with advanced skills in IM.

Conclusion

Our findings demonstrate that it is important to define best practice in IM for GPs in Australia and provide a standardised pathway towards recognition of advanced skills in IM.

Complementary medicine in general practice - a national survey of GP attitudes and knowledge

BACKGROUND

Integrative medicine is a holistic approach to patient care that utilises both conventional and complementary therapy. This article compares the demographics of Australian general practitioners who do, and those who do not, practise integrative medicine, and their perceptions and knowledge about complementary medicines.

METHODS

A postal survey sent to a random sample of 4032 Australian GPs.

RESULTS

Data from 1178 GPs was analysed. While GPs who practise integrative medicine were more knowledgeable about complementary medicine and more aware of potential adverse reactions, there were significant knowledge gaps for both groups.

DISCUSSION

Many GPs incorporate complementary medicines into their practice, whether or not they identify with the 'integrative medicine' label. General practitioners need to be well informed about the evidence base for, and potential risks of, complementary medicines to ensure effective decision making. Use of available resources and inclusion of complementary medicine in education programs may assist this.

GPs' attitudes toward complementary medicine

The National Center for Complementary and Alternative Medicine (NCCAM) define complementary and alternative medicine as a group of 'diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine', as defined by our medical peers. Since the 1990 s the term 'integrative medicine' has gained increasing popularity and acceptance by doctors aligned with the importance of evidence based medicine and the demonstration of increasing nonorthodox therapies having a scientific basis. The RACGP-AIMA (The Royal Australian College of General Practitioners-Australasian Integrative Medicine Association) position paper on complementary medicine (CM) defines integrative medicine as 'the blending of conventional and natural/complementary medicines and/or therapies with the aim of using the most appropriate of either or both modalities to care for the patient as a whole'.

Complementary and alternative medicine. Part 2--evidence and implications for GPs

This second article in a 2 part series exploring the issues around the use of complementary and alternative medicine (CAM) in the Australian general practice context gives an overview of the available evidence for the benefits and risks of CAM, and how to access that evidence. It also outlines an approach to addressing the ethical considerations for general practitioners using CAM or discussing CAM with their patients.

Complementary and alternative medicine. Part 1--what does it all mean?

This is the first of a two part series exploring issues around the use of complementary and alternative medicine in the Australian general practice context. Part 1 discusses the definitions of "complementary and alternative medicine" and their use in the community. Part 2 will give an overview of the available evidence for the benefits and risks of complementary and alternative medicine and an approach to accessing that evidence.

Characteristics of Victorian general practitioners who practise complementary therapies

BACKGROUND

To compare the characteristics of Victorian general practitioners who practise and do not practise complementary therapies.

METHOD

A self administered postal survey sent to 800 Victorian GPs.

RESULTS

The response rate was 64%. There were no statistically significant differences between complementary therapy practitioners and nonpractitioners in the number of patients seen per week, urban versus rural location, solo versus group practice or Fellowship of the Royal Australian College of General Practitioners. In some complementary therapies, practising GPs tended to be male, full time and older.

DISCUSSION

Victorian GPs who practise complementary therapies are on the whole not from the fringes of the medical community. The reasons why GPs include complementary therapies in their practice cannot be answered by this study.

Complementary therapies: have they become accepted in general practice?

OBJECTIVES

To describe Victorian general practitioners' attitudes towards and use of a range of complementary therapies.

DESIGN

A self-administered postal survey sent to a random sample of 800 general practitioners (GPs) in Victoria in July 1997.

PARTICIPANTS

488 GPs (response rate, 64%).

MAIN OUTCOME MEASURES

GPs' knowledge; opinions about harmfulness and effectiveness; appropriateness for GPs to practise; perceived patient demand; need for undergraduate education; referral rates to complementary practitioners; and training in and practice of each therapy.

RESULTS

Acupuncture, hypnosis and meditation are well accepted by the surveyed GPs, as over 80% have referred patients patients to practitioners of these therapies and nearly half have considered using them. General practitioners have trained in various therapies--meditation (34%), acupuncture (23%), vitamin and mineral therapy (23%), hypnosis (20%), herbal medicine (12%), chiropractic (8%), naturopathy (6%), homoeopathy (5%), spiritual healing (5%), osteopathy (4%), aroma-therapy (4%), and reflexology (2%). A quarter to a third were interested in training in chiropractic, herbal medicine, naturopathy and vitamin and mineral therapy. General practitioners appear to underestimate their patients' use of complementary therapies.

CONCLUSIONS

There is evidence in Australia of widespread acceptance of acupuncture, meditation, hypnosis and chiropractic by GPs and lesser acceptance of the other therapies. These findings generate an urgent need for evidence of these therapies' effectiveness.

Stress and Health Implications

The aim of this paper is to review the current literature of the effects of stress on health, including other factors, such as lifestyle and loneliness. It also aims to explore methods of dealing with stress. Stress plays a large role in, and is the basis of many medical conditions, and appears to be the common cause of relapse towards unhealthy behavior patterns. Chronic stress may manifest as: a number of physical and psychosocial symptom presentations; unhealthy behaviour patterns; immune system dysfunction; and some medical conditions. A number of techniques can be used to help alleviate stress, for example, meditation. Apart from stress, other factors known to precipitate or aggravate illnesses include: social isolation (loneliness); a lack of love, meaning and purpose in life; a lack of joy, humour and laughter; a lack of expression of emotions; and negative attitudes and belief system. Studies demonstrate that the mind has a direct influence on the physical body. There is good evidence that optimism, hope and a sense of control can improve the quality of a person's life and their health.