Published: 8 June 2022
It is strongly recommended that the linked article is read before considering the questions.
As of 1 April, 2020, regulatory changes came into effect to make medicinal cannabis more accessible to patients in primary care in
New Zealand. Registered medical practitioners (i.e. doctors) can now prescribe
medicinal cannabis via two main pathways:
- Products that have consent for distribution (approved or provisionally approved) under the Medicines Act 1981, e.g. Sativex
- Products that are not approved, but that are verified by the Medicinal Cannabis Agency as meeting minimum quality standard
For an up to date list of available medicinal cannabis products, see:
https://www.health.govt.nz
If a medicinal cannabis product does not fit the criteria of being a cannabidiol (CBD) product then it is considered to be a controlled drug. A CBD product is a type of
medicinal cannabis product where (1) CBD is present and constitutes at least 98% of total cannabinoid content, (2) the tetrahydrocannabinol [THC] and other specified
substance content do not exceed 2% of the total THC, CBD and other specified substance content, and (3) no other controlled drugs or psychoactive substances present.
For further information, see
Section 2A of the Misuse of Drugs Act 1975.
While medicinal cannabis products require a doctor’s prescription, community pharmacists may be approached by people interested in its possible benefits for treating their
particular condition or symptom(s), and have questions about how to access it. Despite numerous anecdotal reports from people claiming that medicinal cannabis products are
effective, the available pool of peer-reviewed clinical trials in humans is limited, and the quality of evidence is not considered to be strong. Therefore, medicinal
cannabis products cannot currently be considered a first-line option for any indication. However, trialling a medicinal cannabis product may be suitable in some cases
if (1) patients experience ongoing symptoms despite optimal dosing of available evidence-based treatments, or (2) conventional treatments are contraindicated or not
tolerated. Potential indications for which medicinal cannabis could be considered include chronic neuropathic or malignant pain, chemotherapy-related nausea and
vomiting, refractory spasticity associated with multiple sclerosis and seizures due to epilepsy.
When presented with a prescription for a medicinal cannabis product, pharmacists should ensure all appropriate legal and regulatory criteria are fulfilled before
placing an order to procure it. There are a range of factors to consider at this stage, including whether the product is a controlled drug (e.g. Sativex or other
non-CBD products) and therefore subject to the
corresponding restrictions,
or whether it is an unapproved medicine, meaning it should be dispensed by a pharmacy under Section 29 of the Medicines Act 1981.
If a person has a valid prescription for product that is Medsafe approved or verified as meeting the minimum quality standard, pharmacists can procure
the named product from a wholesaler or manufacturer, and dispense it in accordance with any relevant controlled drug or unapproved medicine requirements.
There are pathways for doctors to prescribe medicinal cannabis products that are neither Medsafe approved nor verified by the Medicinal Cannabis Agency as
meeting the minimum quality standard – such products need to be imported directly either by the prescribing doctor in an amount required for a named patient,
or by a registered pharmacist on their behalf. In this instance, if the product selected is a controlled drug, Ministerial approval is also required,
as well as a licence to import controlled drugs issued by Medsafe for each consignment.
Questions for discussion:
- How would you rate your understanding of the new regulatory framework relating to medicinal cannabis? Has reading this article improved your understanding of this process?
- Have you (or a colleague) ever procured and dispensed a medicinal cannabis product, and if so, how easy or difficult was the process?
- The efficacy and safety of medicinal cannabis has been investigated in clinical trials across a range of indications, however, there are ongoing discussions among healthcare professionals regarding the quality of evidence. How confident are you in discussing the evidence about medicinal cannabis with customers in the pharmacy? Can you share your experience of any such discussions?
- Under the current regulatory framework, long-term use of a medicinal cannabis product is likely to incur a substantial ongoing expense given that all products are unfunded, and advertising restrictions mean that pricing is not readily available to the public or health practitioners. What is the policy in your pharmacy regarding the price of medicinal cannabis products? Are you aware of customers 'pharmacy-shopping' to get a better price?
- What, if any, strategies do you have in place to identify potential misuse of medicinal cannabis products? Are there particular situations that might make you more cautious when dispensing?
