Doctors Warn of Psychosis Spike Linked to Medicinal Cannabis Prescriptions
Doctors warn of significant increase in people hospitalised with psychosis after being prescribed medicinal cannabis.
Medicinal cannabis is causing harm to some patients, with doctors warning of a significant increase of people ending up in hospital with psychosis after being prescribed the drug.
Their concerns come amid a proliferation of "single-issue" cannabis clinics setting up in Australia, some of them willing to prescribe via telehealth consultations with few checks.
Brett Emmerson, Queensland chair of the Royal Australian and New Zealand's College of Psychiatrists, says the college wants stronger regulations of medicinal cannabis products and prescribing practices.
"We're seeing a lot of people getting medicinal cannabis who end up with their first psychotic episode, or we're seeing it dispensed to people who have psychotic conditions, and these people are relapsing," Professor Emmerson says.
"Part of the issue … are these single-issue clinics which, if you ring up, it doesn't matter what you say you want.
"They'll provide it for you even though there is probably no indication that it will work, and the prescribers never contact the person's treating doctor.
"You find out two or three months down the track that one of your patients has been on medicinal cannabis — not prescribed by you but by some other prescriber — usually a doctor who hasn't had the professional courtesy of contacting you and letting you know."
A lot of prescriptions happening over the internet
Professor Emmerson says Queensland's Metro North Health — Australia's largest public health service, based in north Brisbane and the surrounding region — is seeing increased presentations of psychosis due to medicinal cannabis.
"The Metro North early psychosis service reports 10 per cent of their new presentations — so these are kids aged 16 to 21 — are people who've ended up on medicinal cannabis and are becoming psychotic," the Brisbane-based psychiatrist says.
"A lot of other mental health services are reporting several admissions a week of people who have been placed on medicinal cannabis who shouldn't be on it.
"Medicinal cannabis is causing harm. The medication is unregulated, and it's being used widely for a whole range of conditions for which there is no evidence."
Newcastle-based general physician and clinical pharmacologist Jennifer Martin says apart from triggering psychosis in some patients, hospital emergency departments are also seeing people presenting with a condition called cannabis hyperemesis syndrome after taking medical cannabis.
"That's when you vomit a lot when the potency is too high," Professor Martin, who is also the President of the Royal Australasian College of Physicians, says.
"Some of these products have a lot of very psychoactive product in them.
"These are big problems for our hospital system, because those people sit in the emergency department [and] they potentially take up a bed for a long period of time."
Professor Martin, of the University of Newcastle, says a lot of medicinal cannabis prescriptions are being done on the internet, via "a web interaction or telehealth".
"It's actually very difficult to get access to the doctor that actually signed the script for a patient," she says.
What is medical cannabis prescribed for?
Medicinal cannabis was legalised in Australia in 2016.
Some products are based on the compound cannabidiol, or CBD, but others also contain tetrahydrocannabinol, or THC, the psychoactive ingredient in cannabis.
Professor Emmerson says the two most common reasons medicinal cannabis is prescribed is for anxiety and insomnia.
"There's no evidence that medicinal cannabis is helpful or treats those conditions," he says.
"Treatment for anxiety, and often insomnia, is cognitive behavioural therapy from a good psychologist.
"Getting people hooked on a drug of dependence when there are other non-drug treatments available, and haven't been accessed, is wrong.
"The medicinal cannabis industry is marketing and making claims that cannabis can cure a whole range of different medical conditions and there's just no evidence for it."
Professor Emmerson likened medicinal cannabis companies to alcohol and tobacco retailers who "want people to end up on their product for their profit".
But he stressed he’s not calling for medicinal cannabis to be removed from the market altogether, given its legitimate uses in treating conditions such as severe childhood epilepsy and vomiting associated with cancer drugs.
Calls to regulate, not remove
In a clinical memorandum released in March, the RANZCP called for regulatory changes surrounding medicinal cannabis products and prescribing practices.
"There is insufficient evidence to support medicinal cannabis as a treatment for anxiety and other mental disorders," the memorandum says.
"As there are no restrictions on the medical conditions for which a prescriber can apply to use unapproved medicinal cannabis products, given the high rates of prescribing for anxiety, in particular, RANZCP is concerned that patients are not receiving evidence-based treatment.
"Refinements to legislation and treatment frameworks for medicinal cannabis should be considered in line with available evidence and harm minimisation strategies."
Professor Emmerson would like to see medicinal cannabis made a regulated medication like other drugs of dependence in Australia.
He also believes Australia's medicines regulator, the Therapeutic Goods Administration (TGA), should ban products containing THC, except for those used to treat nausea and vomiting associated with cancer drugs and spasticity in multiple sclerosis.
In February, the Australian Health Practitioner Regulation Agency (AHPRA) convened a forum of health regulators to share information and discuss how they could best work together to protect the public in relation to the prescribing and dispensing of medicinal cannabis.
"The use of unregistered medicinal cannabis products has spiralled in recent years, from around 18,000 Australian patients using products in 2019 to more than one million patients using medicinal cannabis up to January 2024," a communique from the forum says.
"The number of prescribers accessing the authorised prescriber and the special access scheme has also risen sharply to more than 5,700 medical and nurse practitioners using these schemes to prescribe and dispense medicinal cannabis products."
Only two medicinal cannabis products have been evaluated for safety, quality, and efficacy by the TGA — Epidyolex for severe childhood epilepsy and Sativex for spasticity in multiple sclerosis.
Data supplied by the TGA shows the total number of different medicinal cannabis products supplied in Australia increased from 504 in 2022 to 690 in 2023.
The TGA was unable to provide the ABC with information regarding the number of times medicinal cannabis has been dispensed in Australia.
"Data cannot be extracted from PBS (Pharmaceutical Benefit Scheme) information as they are purchased on private prescription," a spokesperson says.
"The TGA is not aware of a single source that can provide complete and accurate dispensing data on medicinal cannabis products."
