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 etiquette 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 I have prescriptions for multiple forms of cannabis (oil vs flower)?
- What information other than the medicine details are on a script?
- What does a pharmacy need to dispense medicinal cannabis?
- Who should choose the pharmacy that dispenses my medicine?
- Should I be given a copy of my prescription?
- Will I get a medical cannabis (medical marijuana/weed) card in Australia?
- What is the legal proof that I’m a medicinal cannabis patient in Australia?
- If I have my prescription, can I switch pharmacies?
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. There are some intricacies to the prescribing and limited cases where multiple doctors may be necessary.
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 script(s). This is no longer true.
Originally, the state health departments were very engaged in the medical cannabis approval process. 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 do 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 required dose may change.
If you need to find a prescriber, you can use our find a prescribers or clinic feature.
Can I 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.
A good example would be a chronic pain patient.
A patient may need 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 impairment. 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 our team to really precisely dose medications for our 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.
What information other than the medicine details are on a script?
A prescription contains many details which are important for the pharmacist to have so that they can dispense your medication and help you with dosing and titration. Depending on whether you have a regular or open script, your prescription may have the product brand and name or just a range of active ingredients. Aside from the product, the script should have the following information.
- A dose form (ie oil vs flower)
- A quantity per dispense (the number of products you may have dispensed at one time).
- A repeat interval, how often the pharmacy may dispense your repeats.
- A maximum quantity (limit) per month.
The information that affects patients the most is the quantity, repeat interval and limit. Each prescriber may write this information differently. Some prescriptions are written with multiple quantity per dispense and a 30 day repeat interval while others are written with a single quantity per dispense and a 1 or 7 day repeat interval. It all depends on your doctor.
Asking your prescribing practitioner how your prescriptions will be written at the time of your appointment will help you understand how to manage your medication. It will also reduce communication challenges with your pharmacist as the pharmacy is not allowed to go over these limits without written permission from your prescriber.
What does a pharmacy need to dispense medicinal cannabis?
To dispense medicinal cannabis a pharmacy needs a prescription and the prescriber’s TGA authorisation.
Prescriptions can be either paper or digital (eScripts). With a paper prescription, the pharmacy needs the original copy of the prescription or after a dispense happens, the original copy of the repeat prescription. eScripts make things a lot easier for patients because, in theory, a patient always has the most up to date copy of that prescription.
eScripts can be sent to patients via text or email. Once a dispense happens, the pharmacy software invalidates the original eScript “Token” and creates a new “repeat eScript token”. Pharmacies tend to keep these repeat tokens, however, patients may request the repeat token be sent to them via text or email. Patients may then take that repeat token to the same or a different pharmacy.
There are two types of prescriber authorisations:
- Special Access Scheme B (SAS B) letters
- Authorised Prescriber (AP) letters
If a patient doesn’t have access to the authorisation letter then the pharmacy should be willing to reach out to the clinic/prescriber to get that document for the patient.
Who should choose the pharmacy that dispenses my medicine?
The decision of which pharmacy dispenses your medication should be a decision made by the patient in conjunction with the clinic/prescriber. If a clinic tells you where your script is being sent and you have no choice, you may want to think about whether the clinic is doing what’s best for you as a patient.
All pharmacies may dispense medicinal cannabis, however, most do not due to the storage and reporting requirements.
It’s also important to know that many pharmacies, including some of the better known dispensaries, are marking up medicinal cannabis medication. When getting your script, ask your doctor the cost (RRP) of the medication or use a free tool like Catalyst to get medicine prices and then compare that with the price you’re paying at the pharmacy. In some cases patents have reported paying over $200 more than RRP per month for their medication.
In terms of how patients are given their scripts/dispensed medication, there are multiple models. We’ve listed the models being used by most clinics/prescribers from best (most patient freedom) to worst (being locked into a pharmacy/network) below:
- Patient receives their eScript directly via text or email (authorisations are sent to the patient, pharmacy or 3rd party service)
- Patient is given the choice to have their scripts sent to themselves as the patient or a pharmacy of their choosing (authorisations are sent to the patient, pharmacy or 3rd party service)
- Patients are given the choice of a large number of pharmacies and may choose one of them but also may choose their own if requested (authorisations are sent to the patient, pharmacy or 3rd party service)
- Patients are locked into the clinic/prescriber’s pharmacy network and are charged to use a pharmacy that’s not in the network (authorisations are sent to the patient or pharmacy)
- Patients are locked into the clinic/prescriber’s pharmacy (single pharmacy) and are charged to use a pharmacy that’s not in the network (authorisations are sent to the patient or pharmacy)
- Patients are locked into the clinic/prescriber’s pharmacy and are not allowed to take their scripts elsewhere.
Clinics/prescribers use these models for various different reasons. While the models that are closer to locking patients in usually have to do with financial benefits/interests, there is also an argument that having less choice means the patient will have a better experience because many pharmacies have no idea of what to do with a medicinal cannabis script.
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.
You can see which clinics have each model in our find a prescriber feature. If you have an eScript, you’re able to see a list of pharmacies, product availability, pricing and will never be locked in at Scripts by honahlee.
Should I be given a copy of my prescription?
Yes, you should be given access to your prescription and the ability to choose your pharmacy.
When you see your doctor/prescriber in their office (or in a clinic), face to face, then they may hand you a paper prescription. In many cases, however, health professionals have moved away from paper scripts to eScripts and will provide an eScript via text or email.
We would recommend always requesting an eScript because it makes accessing your medication easier.
If your clinic/prescriber refuses to give you your script then we recommend that you question whether the clinic is doing what’s best for you, the patient. Please be aware that there’s a difference between offering you options of pharmacies and refusing to give you your prescription outright or making you pay to access your prescriptions.
Will I get a medical cannabis (medical marijuana/weed) card in Australia?
While this is something that is used overseas, there is no such thing as a government issued medical weed card or medical marijuana card in Australia. Any clinic/prescriber that provides you with a card or talks about an Australian medicinal cannabis card is doing so for marketing purposes.
Please do not try to use one of these cards as a form of proof of prescription with the police or any government official.
What is the legal proof that I’m a medicinal cannabis patient in Australia?
The only forms of proof that you are a medicinal cannabis patient are:
- The TGA SAS B authorisation letter (which is less and less frequently used as most health professionals are now Authorised Prescribers)
- Your prescription (paper or eScript) and
- The original medicine packaging that should have a pharmacy label with your prescriber’s name, pharmacy name, your name and the product name. The information on the product packaging is proof that you are a 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.
If I have my prescription, can I switch pharmacies?
With an eScript, yes. With a paper script sometimes, but there is a process.
With a paper script, once you choose a pharmacy and have that product dispensed, if you have additional repeats on your script, in most cases you have to stay with that pharmacy. There are some pharmacies that are willing to transfer the original paper scripts but it’s a frustrating process for everyone. In NSW, pharmacies are required to keep the original paper script and are not allowed to transfer scripts.
With eScripts, patients may request their eScript repeat tokens to be sent to them via text or email. Once you have the repeat token, you may order your medication from another pharmacy. If your pharmacy is unwilling to release your prescription, you can always ask your new pharmacy to activate your Active Script List (ASL) and they will be able to pull all of your prescriptions down onto their system.
Please remember that for a pharmacy to be able to dispense your medication they need a script and prescriber authorisation.