Medicinal cannabis is causing harm to some patients, and doctors are warning of a significant increase in hospitalizations for psychosis after being prescribed the drug.

These concerns arise amid the proliferation of cannabis-focused clinics in Australia, some of which are willing to prescribe through telehealth consultations with few checks.

Brett Emmerson, president of the Queensland branch of the Royal Australian and New Zealand College of Psychiatrists, calls for stricter regulations on medicinal cannabis products and prescribing practices.

«We are seeing many people receive medicinal cannabis and experience their first psychotic episode, or it is being given to those with psychotic disorders, causing relapses,» Emmerson says.

«Part of the problem is these single-issue clinics that, if you call them, don’t care about what you say you need.»
«They will provide it even if there’s probably no indication that it will work, and the doctors who prescribe it never contact the patient’s primary doctor.»

«Two or three months later, you find out one of your patients has used medicinal cannabis, not prescribed by you, but by another doctor who didn’t have the professional courtesy to inform you,» he continues.

Emmerson indicates that Queensland’s Metro North Health is seeing a rise in psychosis cases linked to medicinal cannabis.
«The early psychosis service reports that 10 percent of their new patients, aged 16 to 21, have used medicinal cannabis and are becoming psychotic,» Emmerson states.

«Many other mental health services report several admissions per week of people who have been prescribed medicinal cannabis when they shouldn’t have.»

«Medicinal cannabis is causing harm. The drug is not regulated and is widely used for a range of conditions without evidence,» he emphasizes.
Jennifer Martin, a general practitioner and clinical pharmacologist, also warns about cases of cannabis hyperemesis syndrome in hospitals.
«That’s when you vomit a lot due to the high potency of the cannabis,» explains Martin.

«Some of these products contain highly psychoactive substances, causing significant issues for our hospital system,» she adds.
Martin also highlights that many medicinal cannabis prescriptions are made online, making it difficult to access the prescribing doctor.
Medicinal cannabis was legalized in Australia in 2016, with products based on cannabidiol (CBD) and others containing tetrahydrocannabinol (THC), the psychoactive ingredient in cannabis.

Emmerson states that the most common reasons for prescribing medicinal cannabis are anxiety and insomnia, despite the lack of evidence for its effectiveness.

«The treatment for anxiety and often insomnia is cognitive-behavioral therapy by a good psychologist, not a drug that can cause dependence,» he asserts.

«The medicinal cannabis industry promotes its product as a cure for various medical conditions without evidence,» he adds.
Emmerson compares medicinal cannabis companies to alcohol and tobacco retailers seeking profits at the expense of people’s health.

However, he does not advocate for the complete removal of medicinal cannabis from the market, recognizing its legitimate uses for conditions like severe childhood epilepsy and chemotherapy-induced vomiting.

In March, the RANZCP called for regulatory changes for medicinal cannabis products and prescribing practices, highlighting the lack of evidence for treating anxiety and other mental disorders.
«Improvements in legislation and treatment frameworks should be based on available evidence and harm minimization strategies,» the memorandum states.

Emmerson suggests regulating medicinal cannabis like other addictive drugs in Australia and banning THC-containing products except for treating chemotherapy-induced nausea and multiple sclerosis spasticity.
In February, the Australian Health Practitioner Regulation Agency (AHPRA) held a forum to discuss how to better protect the public regarding medicinal cannabis prescription and dispensing.

«The use of unregistered medicinal cannabis products has surged, from around 18,000 Australian patients in 2019 to over a million by January 2024,» the forum notes.
The number of prescribers has also increased, with more than 5,700 doctors and nurses using schemes to prescribe and dispense medicinal cannabis products.

The Therapeutic Goods Administration (TGA) has only evaluated the safety and efficacy of two medicinal cannabis products: Epidyolex for severe childhood epilepsy and Sativex for multiple sclerosis spasticity.
The TGA reports that the number of different medicinal cannabis products supplied in Australia rose from 504 in 2022 to 690 in 2023.
The TGA could not provide information on the number of times medicinal cannabis has been dispensed in Australia.

«It’s not possible to extract data from the PBS (Pharmaceutical Benefits Scheme) information because the medications are privately purchased,» a spokesperson states.
«The TGA does not know of a single source that can provide complete and accurate data on the dispensing of medicinal cannabis products,» the spokesperson concludes.