The Medical Board of Australia is working on new guidance for cannabis prescribers, as the AMA calls for more regulation.
Following the revelation that some prescribers are writing thousands of medicinal cannabis scripts per year, the AMA has backed proposed changes that would allow the TGA to share information with AHPRA and state governments.
High rates of medicinal cannabis prescribing have been the topic of mainstream media reporting this week, with AHPRA confirming that it had identified eight practitioners who appear to have written more than 10,000 cannabis scripts each within a six-month timespan.
According to the regulator, a single nurse practitioner issued up to 31,000 scripts for medicinal cannabis over the same timeframe.
Medical Board of Australia chair Dr Susan O’Dwyer told The Medical Republic that the board had been working on new guidance in relation to medicinal cannabis, which it hoped to issue shortly.
“If you’re a practitioner and you’re working for a medicinal cannabis provider via telehealth, and all you’re providing is one single kind of medicinal cannabis, and that’s all you’re offering … that would seem to be a conflict of interest in the first instance,” she said.
“[It] would also not seem to be consistent with good medical practice, because it is rare that one kind of drug suits everybody who rings up asking for it.”
According to Dr O’Dwyer, a key sign that a practitioner is potentially not practising in a way that is consistent with the code of good medical practice is if the model they are working in does not allow them to engage with a patient face-to-face.
“You still do need to take a proper patient history with telehealth as much as possible … if you can do face-to-face, it would be preferred,” she said.
“It’s better that way, so that you get some interaction with the patient.
“You obviously can’t do a patient examination, and I think you need to hold it available to yourself that some consults are not suitable for telehealth consultations, and you need to be able to end that consultation by telehealth if you aren’t able to come to a conclusive thought process or a conclusive diagnosis and treatment plan.”
Telehealth has proven difficult to regulate.
Most online-only clinics, including many in the medicinal cannabis space, operate entirely outside of the MBS and PBS systems, which puts them out of scope of Medicare-related regulatory mechanisms like the Professional Services Review.
The medical board does not have the power to regulate specific business models; it is legal, for instance, for a telehealth company to pay prescribers per script written.
“The best thing we can do is educate our practitioners and provide them with solid guidance about what good medical practice looks like and help them make informed decisions about … where they choose to work and what they choose to choose to engage in,” Dr O’Dwyer said.
“And that’s the best thing we can do for them.
“There are obviously other regulators in the scheme, such as the TGA, which regulates prescribers as well … I think it is beholden on us as a regulator to engage with our other regulators to see how we can all engage in this space.”
As it happens, the TGA is currently running a targeted consultation on the institution of legal provisions to be able to share information relating to therapeutic goods accessed via the unapproved therapeutic goods framework – e.g. medicinal cannabis – with other regulators.
This would include both AHPRA and state and territory governments.
In its submission, the AMA said it had been “appalled” by the behaviour of some vertically integrated direct-to-consumer telehealth entities and would support significant TGA-led reforms.
“The AMA is supportive of a robust regulatory scheme with medicines regulated by the TGA and practitioner behaviour regulated by Ahpra and the relevant national board,” the submission said.
Related
“The proposed instrument would likely enhance patient safety and prescribing practices by identifying and addressing questionable behaviours, ensuring better oversight, and supporting informed regulatory actions.
“However, while this collaboration could contribute to higher quality practices, the accountability it seeks to impose must be proportional to clinical risk and respectful of practitioner’s clinical judgement.”
The AMA stressed that it would not support the TGA taking a role in regulating health professional behaviour but said it would be “reasonable” to expect that a practitioner providing patients with unapproved medicines would be subject to additional scrutiny.
In addition to information-sharing laws, the AMA said it would support the complete ban on products with a THC content greater than 98% while a review of medicinal cannabis products was underway.
