The Who, What, How & Why of Medical Cannabis in NSW

Since first becoming legal in 2016, more than 390,000 prescriptions have been filled for medical marijuana in Sydney, NSW and all over Australia.

After legalisation, NSW became one of the only states to make cannabis research a priority, with the creation of the government-funded Centre for Medicinal Cannabis Research and Innovation.

Yet there remain a lot of misconceptions about who can be prescribed medical cannabis, how the system works, what it actually means to use marijuana to treat your chronic condition and if weed is legal in NSW. If you’re a resident in Sydney, or anywhere in NSW and curious about what rules apply for access to medical cannabis, you’ll find everything you need to know here.‍

Who Can Be Prescribed Medical Cannabis in Sydney & NSW?

Thanks to Hollywood, people usually associate medical marijuana with one thing: cancer. And people certainly do use medical cannabis to help alleviate the pain and nausea associated with cancer treatment.

But in Australia medical cannabis can be prescribed for more than 130 chronic conditions, from anxiety to PTSD, pain, insomnia, epilepsy, multiple sclerosis, autism, fibromyalgia, ADHD and many more. If the condition has persisted for more than three months and has proven resistant to conventional treatment methods, it can be considered for cannabis care.

This requirement that your condition be “treatment resistant” is the biggest difference between medical cannabis and other prescription medications. As an alternative treatment, cannabis typically can’t be the first treatment offered to patients. This doesn’t mean that you need to have exhausted all other treatment options. Rather you simply need to have already tried other treatments – whether pharmaceutical or non-pharmaceutical – and to have found that these treatments failed to improve your condition or produced unpleasant side-effects.‍

How Do Medical Cannabis Prescriptions Work?

Like all other prescription medicines, the only way to get access to medicinal marijuana in NSW is being prescribed it by a doctor. However, medical cannabis prescriptions work slightly differently to, say, the antibiotics prescription you might be given to treat a bacterial infection.

Prescription medicines are regulated by a government body called the Therapeutic Goods Administration (TGA). Essentially, the TGA assesses the available evidence for a given medicine and then determines if they should be considered registered or unregistered.‍

Is Cannabis a Registered Medicine?

Registered medicines tend to be those that make more significant claims about serious health conditions (i.e. antibiotics are an effective treatment for bacterial infections). By and large, these are medicines where safety and efficacy have been proven over years, if not decades of use and study. The TGA then registers these medicines for very specific purposes.

As it stands, the TGA only recognises two medical cannabinoids in NSW:

• CBD oil for the treatment of seizures associated with the Lennox-Gastaut and Dravet forms of epilepsy.
• A combination of THC and CBD oil for the treatment of multiple sclerosis.
  

What Does It Mean That Cannabis is an Unregistered Medicine?

The TGA also gives doctors a pathway to prescribe “unregistered” medicines – medicines that are still undergoing testing for safety and efficacy, but whose potential benefit (and potential for harm) is greater than, for instance, the cough syrup you might buy at the chemist.

This doesn’t necessarily mean that cannabis is an ineffective medicine, simply that research into medical cannabis remains in its infancy. The kinds of research projects that the TGA recognises are expensive and take years to execute. Thanks to decades of demonisation, scientists are only now getting the resources required to assess marijuana to the same standards as other prescription drugs.

As it stands, doctors are allowed to prescribe unregistered medicines under two schemes:

• Authorised Prescriber: Authorised Prescribers are doctors that have been given pre-approval by the TGA to prescribe cannabis for certain patients.
• Special Access Scheme: the SAS allows doctors to prescribe medicines for any condition. These prescriptions are approved by the TGA on a case-by-case basis.

The vast majority of cannabis prescriptions in Australia are completed through the SAS. If you’re curious as to who’s being prescribed medical cannabis and what conditions it’s being prescribed for, the TGA makes the prescribing data publicly available.‍

What Types of Cannabis Can Be Prescribed?

Cannabis can be prescribed in a wide variety of forms, cultivars and THC concentrations. For doctors, there are three major things to consider when deciding what type of medical cannabis they might prescribe to an eligible patient:

1. The ratio between THC and CBD
2. The cannabis cultivar
3. The form of administration
   

Prescribing CBD, THC and Other Medicinal Cannabinoids

Most of the research being done into medical cannabis focuses on two compounds: cannabidiol (CBD) and tetrahydrocannabinol (THC). There are other potentially important compounds in cannabis, including cannabinoids like CBN, THCA, CBG and a whole family of terpenes and flavonoids, but their role in medical cannabis treatment is only now being explored.

THC is the psychoactive component of marijuana, the chemical compound that makes you feel “affected”. By contrast, CBD has no psychoactive properties but is still the subject of keen medical interest, especially for its role in treating some forms of epilepsy.

While treatment for certain illnesses relies on THC’s psychoactive properties, patients may not be able or want to feel those effects. (For instance, it’s illegal to drive in NSW with any amount of THC in your system.) There are also conditions for which only CBD is thought to have a therapeutic effect. For this reason, medical cannabis products are often offered as pure CBD – more than 98% – pure THC or a variable mix between the two.

Before writing a prescription, your doctor will ask you about your lifestyle and history with cannabis to assess what kind of THC-CBD ratio will work best for you.

What’s the Difference Between Sativa and Indica?

While THC is the dominant psychoactive compound in marijuana, different strains of the cannabis plant produce vastly different physical and cognitive effects.

For many years, cannabis marketers and consumers have adhered to a system that divides cannabis into three categories: indica, sativa, and hybrid. Indica is said to relax and facilitate sleep, sativa reportedly induces energetic highs and hybrids vary between the two. There’s no evidence that these strains are different on a genetic level, however the categorisation persists.

When you’re prescribed a cannabis product, it will usually be made from a specific strain, with a name like Blue Dream, Green OG Kush or Pineapple Express. These cultivars are typically indica-sativa hybrids that have been shaped by growers to have elevated amounts of THC, along with certain psychoactive properties from both the indica and sativa plants.

Your doctor will consider your symptoms, medical history and any previous experience with cannabis before deciding what type of cultivar might benefit you.

How Can I Consume Medical Cannabis in NSW?

Your doctor will also talk to you about your preferred method of administration. Cannabis can be prescribed in many forms – including lozenges, capsules and ointments – but by far the most commonly prescribed are flowers and oils. (Despite their popularity overseas, cannabis edibles are not a readily available prescription option in Australia.)

When we talk about cannabis flowers, we’re talking about the dried plants you probably picture when you think about marijuana. Flowers are ground up using a grinder and then added to a vaporiser, which makes it easy for the patient to control their dosage. It’s important to note that under TGA guidelines, cannabis flower can only be vaporised. Smoking cannabis is not an approved method of ingestion due to issues with regulating dosage and the adverse health effects of smoke inhalation.

A more recent innovation, oils are highly concentrated extracts of CBD and THC (along with various terpenes, flavonoids and cannabinoids) that allow for the delivery of tailored cannabis medicines. This is particularly the case with CBD oils, which can offer therapeutic benefits without the psychoactive effects of the cannabis flower. Oils also allow for very precise dosing and can be consumed in a wide variety of ways, from drops under the tongue (sublingual) to vape cartridges, capsules, ointments and more. ‍

How Much Does Medical Marijuana in NSW Cost?

The cost of medical cannabis varies depending on the form and dosage prescribed by your doctor. However, as most medical cannabis prescriptions aren’t covered by the Pharmaceutical Benefits Scheme (which generally only applies to drugs that have been fully approved by the TGA), you’ll have to pay your medication costs out-of-pocket.

The average cost for patients is around $250-$300 per month. This is in addition to the cost of your consultation with the prescribing doctor, which is usually between $80-$150.‍

What's the Difference Between a Cannabis Clinic and a GP?

One of the biggest barriers for people who might be eligible to access medical marijuana in NSW is access itself. It’s estimated that only 5% of Australian doctors are currently prescribing medical cannabis and it can be difficult and uncomfortable for patients to have open conversations about cannabis care with their GP.

Dedicated cannabis clinics offer confidential consultations with doctors who understand the potential benefits and risks of medical cannabis. They’ll ask you questions about your condition and treatment history and – if they assess that you might benefit from a prescription – they’ll help you navigate towards a formula and type of cannabis product that best suits your symptoms and level of comfort.

If you are eligible for a medical cannabis prescription, you can typically purchase your medicine and have it delivered to your door, packaged in a discreet box. All medical cannabis products must pass exhaustive checks with the TGA before being offered to patients, so you can be confident that what you’re buying is exactly what you’re getting. And if the treatment isn’t what you expected, you can set up a follow-up appointment with a cannabis clinician to discuss what is and isn’t working.