Wed Mar 25

Medicinal cannabis has gone mainstream. But Australia’s struggling to cope

Written by Christine Mary Hallinan, Senior Research Fellow, Department of General Practice and Primary Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne

Medicinal cannabis has become a routine part of health care in Australia far more quickly than many expected.

What began in 2016 as a tightly controlled pathway for patients with complex conditions that had not responded to other treatments has grown into a large, mainstream prescribing market. Today, medicinal cannabis is increasingly delivered through telehealth and online platforms.

But our health system was not designed for this demand, nor for the shift in prescribing practices. So many of the safeguards in place for other medicines don’t exist for medicinal cannabis.

Now, Australia’s medicines regulator is deciding how best to update medicinal cannabis prescribing and regulation to make it safer.

Its yet-to-be released review is focusing on “unapproved” medicinal cannabis products, ones that are legal but that it hasn’t assessed to make sure are safe, of good quality and actually work.

The rise and rise of medicinal cannabis

Prescribing of medicinal cannabis rose sharply from 2019. By the end of 2025, publicly available Therapeutic Goods Administration (TGA) data I analysed shows close to one million approvals for medicinal cannabis in Australia.

However, the systems needed to monitor safety, effectiveness and longer-term outcomes have lagged behind this rapid growth.

Doctors told us as far back as 2018 (in research published in 2021) of their concerns about medicinal cannabis prescribing. They described how the rollout had occurred before the system was fully prepared.

At the time, they raised the potential for fragmented care (patients seeking health care from multiple professionals, not all aware of what the others were prescribing), limited guidance for prescribers, and the absence of routine mechanisms to monitor benefit and harm.

These concerns have persisted as the market has grown, and changed.

From oils to flower, and telehealth

Over time, publicly available TGA data I analysed shows a shift in the type of medicinal cannabis prescribed.

Herbal products – such as dried flowers you smoke and inhale – are increasingly prescribed at higher rates than oral oils containing cannabis extract. This shift from oils to herbal products matters.

Inhaled cannabis is absorbed rapidly through the lungs, with effects felt within minutes, making it one of the fastest ways cannabis acts in the body. But oils are absorbed more slowly through the gut, have delayed onset, and can take hours to reach peak effect.

But this shift towards inhaled cannabis (with its rapid onset) challenges the conventional way medicines are prescribed. This would be to start off with a low dose, then monitor the effects (known as the “start low and go slow” approach).

Medicinal cannabis has gone mainstream. But Australia’s struggling to cope

CC BY-NC Medicinal cannabis prescriptions have skyrocketed in Australia, mostly for legal but unapproved products we don’t even know work or are safe. In this series, experts tease out what’s fuelling the rise of medicinal cannabis, the fallout, and what needs to happen next. Approvals for THC (tetrahydrocannabinol) dominant products are also rising, according to publicly available TGA data I’ve analysed. THC is psychoactive and can cause side effects such as impaired cognition, anxiety and, in some people, psychosis. When medicines, including the less-psychoactive cannabidiol (CBD) products, are prescribed by someone other than a person’s usual doctor, it is often unclear who is responsible for monitoring any harm. There’s also been a rise in product-specific telehealth consultations for prescribing medicinal cannabis. With these, there’s often limited contact with a patient’s regular doctor. This matters because many patients prescribed cannabis are also taking antidepressants, sedatives, opioids or other medicines with overlapping side-effects. Products containing THC can cause sedation, dizziness and cognitive impairment. Both THC and CBD can interact with other drugs, altering blood levels and increasing the risk of harm. So we end up with a system in which prescribing often occurs in one place, while monitoring occurs elsewhere, or nowhere in particular. Limited evidence, social media filling the gap Many others have written about the limited, robust evidence for whether medicinal cannabis works for a range of conditions, including for anxiety, pain and sleep. Based on the evidence to date, it’s unlikely to reduce your anxiety, pain or help you sleep. Reviews show a similar lack of evidence for mental health conditions more broadly and for substance use disorders. These are among the many reasons Australians are prescribed medicinal cannabis. This means health professionals are often prescribing medicinal cannabis in the absence of clear benchmarks for benefit, harm or how long treatment should last. So patients are increasingly turning to social media, online forums and internet searches to share experiences, compare products, discuss dosing strategies, and interpret side-effects. While shared experience can be valuable, it is a poor replacement for medical oversight, particularly for patients using multiple medicines or inhaled cannabis products where dose, timing and drug interactions matter. What needs to happen next? The federal government has announced reforms requiring medicines prescribed online or via telehealth to be visible in My Health Record, alongside any clinical context. This means patients and doctors will have a more complete picture of someone’s medicines, including medicinal cannabis. That’s especially the case if they are prescribed in different settings. But visibility alone is not enough to prevent the safety issues I’ve highlighted. We need to examine how medicinal cannabis is promoted and prescribed, how it is used in mental health care and by young people, how safety risks are managed, and whether current regulatory arrangements remain fit for purpose. We need to move towards nationwide oversight and monitoring of medicinal cannabis prescribing. This could include analysing secure, de-identified data from electronic medical records, linked across care settings, to provide the real-world evidence needed to support safer prescribing, detect emerging harms, and inform policy. If we had that, we could answer: who is using medicinal cannabis, and for which conditions? which health professional starts the treatment, and how? what benefits are patients experiencing? what adverse effects, interactions and longer-term harms may be occurring? Medicinal cannabis is now part of routine health care, and it should be monitored with the same level of accountability expected of any other widely used medicine.

Authors: Christine Mary Hallinan, Senior Research Fellow, Department of General Practice and Primary Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne

Medicinal cannabis has gone mainstream. But Australia’s struggling to cope

The rise and rise of medicinal cannabis

From oils to flower, and telehealth

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