The use of medical cannabis is accelerating all around the world as cannabis-based medicines become increasingly accessible. Many countries have now passed legislation allowing the medicinal use of cannabis for at least a small number of conditions – including Australia.
Australian lawmakers legalised medical cannabis and introduced a legal framework in 2016. Current guidelines recommend the prescription of cannabis medicines for a number of conditions, including chronic pain, palliative care, chemotherapy, and epilepsy; however, in reality, doctors may prescribe for any clinical inclination for which they can justify, with evidence, to the regulatory body.
Patient access to medical cannabis in Australia is generally easier than in a lot of other countries around the world – including the UK. Any medical practitioner (without special credentialing) is able to prescribe cannabis-based medicines using compassionate access regulatory pathways. This means that GPs as well as specialists can prescribed medical cannabis. Cannabis medicines can also be dispensed at any community pharmacy and delivered by courier directly to the patient. For comparison, medical cannabis prescriptions issued in the UK must only be started by a specialist clinician.
As of August 2022, there are over 200 unregistered cannabis-based medicines – with various cannabinoid profiles and routes of administration – available in Australia. However, national surveys from 2016 and 2018 indicated that most consumers that used cannabis for medicinal purposes continued to acquire their products from illicit sources. This may be beginning to change, though, as regulatory data shows an increase in the prescription of medical cannabis since 2019. The 2020 cannabis as a medicine survey aimed to examine consumer experiences of prescribed and illicit medical cannabis use in Australia.
The Cannabis as a Medicine (CAMS) Survey
Australia’s cannabis as a medicine survey is a cross-sectional anonymous online survey. The 2020 edition of the survey was administered between September 2020 and January 2021 via social media, professional and consumer forums, and medical practices. Eligible participants were aged 18 years or over; used a cannabis product for medicinal purposes in the last year; and were residents in Australia. The CAMS-20 survey used many of the same questions as the previous surveys, but added a number of extra questions to better understand differences between prescribed and medicinal cannabis use.
A recent analysis of Australian regulatory data suggests the most common reasons for medical cannabis prescription were indications of pain, anxiety or sleep disorders, and that the majority of prescriptions involve THC-based medications rather than CBD-only products. The 2019 National Drug Household Survey found that 11.7% of Australians had used cannabis in the last year – 23.1% of whom used cannabis for medicinal reasons. Only 3.9% of respondents, however, reported obtaining their cannabis products through prescription.
Since then, Australian Therapeutics Good Administration regulatory data reported a significant uptake in medical cannabis prescriptions (57,710 in 2020 vs. 25,160 in 2019). Researchers aimed to determine whether the recent uptake in prescribed medical cannabis had changed the profile of people using medical cannabis in the community, the range of conditions, patterns of use, and consumer experiences of accessing medical cannabis.
Results of the 2020 Survey
Of the 2152 respondents who commenced the survey, a total of 1600 were included for review following adjustment for exclusion criteria (incomplete data; no consent given; no medical indication given; duplicate entries).
The majority of participants (n = 999; 62.4%) reported sourcing illicit only medical cannabis products in the previous 12 months. Over a third (n = 601; 37.5%) accessed prescribed medical cannabis – of whom 388 (24.3%) reported using both prescribed and illicit products for medical reasons. Only 13.3% of respondents reported using only prescribed products.
Demographic data showed that prescription only respondents tended to be older than illicit only, and prescribed and illicit product respondents, were more likely to be female, and were less likely to be employed. Pain and mental health conditions were the most commonly reported reasons for medical cannabis use. Respondents who sourced prescribed cannabis (prescribed only and prescribed and illicit product) were more likely to use cannabis for pain while illicit only users were more likely to use cannabis for sleep conditions.
Illicit Cannabis Use for Medicinal Purposes
While a high percentage of respondents reported using illicit cannabis products medicinally, of those who reported both prescribed and illicit use (n = 388), over a third (n = 153; 39.4%) reported that they had not recently consumed illicit cannabis products and did not plan to resume illicit use. In comparison, only 34.5% (134) of prescribed and illicit product consumers had used illicit supplies in the last two weeks and planned to continue using illicit products on a regular basis; over a quarter (26%) of this group reported using illicit products only occasionally and indicated that they would use as required.
The main reason given for continuing the use of illicit cannabis products were: cost of prescribed medical cannabis (79.3%), to ensure an adequate supply (51.1%), to improve effectiveness (48.9%), and the cost of medical consultation fees (38%).
Participants who reported illicit cannabis use were more likely to report being uncertain about the cannabinoid profile of their cannabis products (34% vs. 3% or prescription users), more likely to smoke than use other administration methods (44%) while prescription only respondents favoured oral administration (72%). Illicit users (illicit only, and prescription and illicit) were also more likely to report improvements in their condition and less likely to agree that accessing medical cannabis in Australia is “straightforward/easy” (87%) – although most prescription users (66%) also disagreed with this statement.
Conclusions
The results of the CAMS-20 indicated that the uptake of prescribed medical cannabis has increased significantly since the legalisation of medical cannabis in 2016. Furthermore, the current regulatory framework appears to have attracted patients with little to no history of cannabis use, as well as those with prior experience of illicit use. Nevertheless, the responses from current illicit and prescription medical cannabis users show that many patients continue to find the regulatory framework difficult to navigate, and the cost of prescribed products a major barrier.
The findings of the CAMS-20 suggest that further refinements to the Australian framework could further improve patient access and help to facilitate the transition from illicit to prescribed cannabis products.
