The Pharmacy Board of Australia has put pharmacists on notice around medicinal cannabis supply, saying ‘safe practice must apply’.
Concerns have been raised by the National Boards and the Australian Health Practitioners Regulation Agency (Ahpra) that financial incentives may, in some cases, be placed ahead of patient safety.
In response to this, the Pharmacy Board has published guidance reminding pharmacists that prescribed medicinal cannabis, a Schedule 8 medicine, must be supplied with the same diligence as any other drug of dependence.
The Pharmacy Board aims to support pharmacists to practise safely and meet their professional responsibilities, which include practising in accordance with the code of conduct.
‘A reminder to all pharmacists of their obligations’
“Most pharmacists are diligent and do the right thing when it comes to dispensing medicines,” says Pharmacy Board of Australia Chair, Dr Cameron Phillips.
“With the exponential increase in the number of scripts being written for medicinal cannabis, the Board thought it was timely to remind all pharmacists of their obligations when supplying such products.
“Patient safety is paramount when supplying prescribed medicines which is no different when supplying medicinal cannabis.”
Most medicinal cannabis products unapproved by TGA
Most medicinal cannabis products prescribed in Australia remain unapproved by the Therapeutic Goods Administration (TGA) and have not been assessed for safety, quality, performance or effectiveness.
Many contain THC (delta 9-tetrahydrocannabinol), a Schedule 8 substance with recognised risks of misuse and dependence.
Safe and appropriate supply
Safe and appropriate supply of prescribed medicinal cannabis includes:
- Determining the prescriber’s intentions as to the prescribed medicinal cannabis.
- Reviewing the patient’s medication history and other relevant information.
- Counselling the patient.
- Exercising independent judgement to ensure the medicinal cannabis is safe and appropriate for the patient.
- Contacting the prescriber to discuss any concerns, seek clarification and if required, confirm any changes to therapy.
Dr Phillips says pharmacists have also been warned that supplying medicinal cannabis products without in-person interaction or direct communication with the patient, may give rise to additional challenges which must be addressed appropriately in the interest of patient safety.
Examples of poor practice
Cases of poor practice in supplying medicinal cannabis include:
- Supplying excessive quantities of prescribed medicinal cannabis.
- Dispensing medicinal cannabis on repeat authorisations without the patient requesting an additional supply.
- No counselling or inadequate counselling given to the patient on safe and effective use of the medicinal cannabis.
- No engagement with patients while dispensing medicinal cannabis.
- Supplying multiple prescribed medicinal cannabis products for a single patient at the same time, so they can ‘try which one suits them’.
- Not checking the relevant Real Time Prescription Monitoring system and therefore not being aware of other prescribed and dispensed medications.
- Brand substitution of medicinal cannabis products that is not compliant with legislation.
- Storage of medicinal cannabis that is not compliant with legislation.
- Not appropriately managing a conflict of interest.
Guidance on supply of prescribed medicinal cannabis
Ahpra and the National Boards are working with other regulators like the TGA and state and territory authorities to understand prescribing and dispensing patterns and stay ahead of emerging trends.
The guidance on supply of prescribed medicinal cannabis is published on the Ahpra website.
It builds on existing regulatory guidance about safe care, including the Board’s code of conduct and the Ahpra guidance on virtual care.
Ahpra and the National Boards have also published guidance on the prescribing of medicinal cannabis on the Ahpra website.
Report unsafe practice
Patients and practitioners are encouraged to report unsafe practice.
Call the Notifications Hotline on 1300 361 041 to report bad practice and help protect others.
For more information, visit pharmacyboard.gov.au/Codes-Guidelines.aspx.
