The land of legal medical cannabis has many windy roads and detours. It’s often tricky to know what you can or can’t do, who to talk to and the process and ettiquette to follow when it comes to doctors, clinics, pharmacies and your medication.
In this article, you’ll learn about the different parts of the access process, and answers to some of the most frequently asked patient questions. You’ll read about the number of doctors that can prescribe at any given time, and you’ll learn about the number of prescriptions and how to get a copy of your script. Finally, you’ll hear about the process of choosing a pharmacy and why it’s a good idea to talk about the choice of pharmacy with your doctor before getting your script. Here’s the article index so you can navigate to your preferred topic:
- How many doctors can prescribe cannabis to a single patient?
- What are some scenarios where a patient would have multiple doctors?
- Can you have prescriptions for multiple forms of cannabis (oil vs flower)?
- How do I get a copy of my prescription?
- Is there a legal document (or card) that can prove I’m a cannabis patient?
- How does a doctor choose the pharmacy for dispensation?
- Once I have my prescription, can I choose a new pharmacy?
How many doctors can prescribe cannabis to a single patient?
A medical cannabis patient can have more than one prescribing doctor. However, it’s always recommended you keep your treatment with one doctor if possible. It’s also recommended that you start with your GP. Any GP can prescribe medical cannabis in Australia (with the exception of Tassie where you need a specialist). There are some intricacies to the prescribing and limited cases where multiple doctors may be necessary.
It’s critical that your whole care team is up to date on your portfolio of medications and treatments so that they can provide the best care to you and get you the best possible outcomes.
NOTE: Your doctor may have informed you that, in order for a second doctor to prescribe you medical cannabis, the original doctor had to cancel your original script. This is no longer true. Originally, the state health departments were very engaged in the medical cannabis approval process (in Tasmania, this is still the case).
The health departments would flag schedule 8 (products containing less than 98% CBD) prescriptions with the TGA. When this was happening, your original doctor had to rescind their original TGA approval before a new doctor could get approval.
What are some scenarios where a patient would have multiple doctors?
There are not many situations where a patient needs to have more than one doctor prescribing cannabis. As mentioned, having one doctor prescribing cannabis allows for better dosing and management of not only the medical condition(s) but also outcomes.
Two examples of where we often see patients with multiple doctors are in interstate prescribing and when patients are using specialists.
All doctors who have telehealth may prescribe interstate. Many patients go to cannabis clinics to get their prescriptions. Because clinics are often the ones prescribing interstate, patients may try multiple clinics or use a local doctor for a CBD only product and an interstate doctor for a different type of product. While this is not recommended, it does happen.
When an individual is being treated for multiple types of conditions, we often see multiple doctors prescribing cannabis. For example, if a patient is seeing a psychiatrist for a mental health condition and a pain specialist for a back issue. The psychiatrist may only be comfortable prescribing a CBD product and the pain specialist may want to prescribe something with THC for pain management.
The important thing to remember is that it’s critical that each doctor know what medications you’re taking, cannabis-based or otherwise. They also need to be able to collaborate on not only your general care but also your titration and dosing.
Remember that many researchers and doctors believe that consuming the whole plant or a whole plant extract has stronger medicinal effects and benefits than the individual parts (called the Entourage Effect) and therefore when combining the two, your require dose may change.
Can you have prescriptions for multiple forms of cannabis (oil vs flower)?
Yes. If your prescribing physician sees the clinical benefit of multiple products, then a patient may be prescribed multiple products. Here’s example of when a patient might have multiple products.
A good example would be a chronic pain patient.
The patient may have to be alert during the day. They may be prescribed a CBD Oil for daytime and a THC oil at night to help with sleep or because they don’t have to worry about impairments. Then, they may also have a THC flower to help with breakthrough pain.
Or, maybe they’re just using THC or flower on weekends when impairment doesn’t have to be taken into consideration. This kind of strategy actually allows a medical team to really precisely dose medications for patients and to find the treatment plan that works best for them and their lifestyle.
By starting with multiple products that have a single cannabinoid it makes it easier to understand which product, if any, is helping the patient or causing side effects. Once doctors and patients understand their treatment it’s easier to move to a mixed or balanced product, depending on their needs.
How do I get a copy of my prescription?
There are a number of different situations based on the way the patient engages with a doctor (ie clinic vs GP vs telehealth etc).
If you’re seeing your doctor in their office (or in clinic) then the doctor may just hand you the original copy of the script. That script can then be taken to any pharmacy that’s willing to dispense medical cannabis. The pharmacy then takes the script and keeps it on file.
You’re not allowed to take or duplicate your prescription once it’s been dispensed because of the scheduling of the medication.
If you have a telehealth appointment, then the doctor will likely send your script to a pharmacy. The pharmacy can either be a pharmacy that the doctor knows will dispense medical cannabis or a pharmacy that you choose. Again, you’re not allowed to have a copy of the script once dispensed.
Your medication has all of the important information on the bottle. This will include your name, dose, your doctors name and batch information of the particular medication. Keeping your medication in the original packaging shows that you are in fact a medical patient.
Is there a legal document (or card) that can prove I’m a cannabis patient?
Many patients ask for copies of their script and some ask for a medical cannabis card. In Australia there is no such thing as a medical cannabis card. The way to prove that you are a medical cannabis patient is to ask for your Therapeutic Goods Administration (TGA) approval letter.
Your approval letter will show that the TGA has given written permission for your doctor to prescribe you medical cannabis and therefore that you are in fact a medical patient.
Many clinics offer a medical letter. A medical letter can contains details from your doctor about what you’ve been prescribed, what your dosage is, what your condition is, and can be kept on your person in case you have any issues where you need to prove you are a patient.
How does a doctor choose the pharmacy for dispensation?
It’s not just the doctor who can choose the pharmacy from which your medication is dispensed. You can have a say in the process.
If you’re seeing your normal doctor or GP they may use your local pharmacy so that you can go and pick up your medication. Some doctors and clinics have preferred pharmacies in your state that they may suggest. Quite often cannabis clinics will have pharmacies that they work with regularly and carry their medications or be able to obtain them faster.
Most of these pharmacies are able to deliver to your home. Another benefit of these preferred pharmacies is that they may have standardised pricing for medical cannabis. Finally, pharmacists who are trained in medical cannabis can offer lots of support to new patients.
Pharmacies often mark up your cannabis medication. When getting your script, it’s important to ask your doctor what the cost of the medication is and then compare that with the price you’re paying at the pharmacy. In some cases there are differences of up to $60.
It’s important to note that not all pharmacies are willing or able to dispense medical cannabis. A pharmacy does not have to be ‘authorised’ to dispense, but they do need to have specific systems and processes set up. They have to be able to store schedule 8 products on site. There is also a lot of admin involved in the medical cannabis process when compared to other medications. Because of this, sometimes pharmacies won’t want to dispense cannabis.
If your preference is to get your medicine dispensed from your local pharmacy, it’s best to check if they can before getting your prescription.
Once I have my prescription, can I choose to switch pharmacies?
Yes, but there is a process. Once you choose a pharmacy and have that product dispensed, if you have additional repeats on your script, you have to stay with that pharmacy. Because of this, it’s important that you choose your pharmacy up front so that you don’t need to go through extra steps to change.
If you decide to switch pharmacies once the original script has been filled, your doctor will need to write a completely new script and send that to the new pharmacy. To clarify, it’s not that you’ll need to get a completely new approval from the TGA, it’s just the doctor writing a new script and sending that to a new pharmacy.
Effectively, your doctor is cancelling the old script and writing you a new one.