Prescribed drug causes psychosis hospitalisations: Are you at risk?
- Replies 37
The promise of medicinal cannabis as a treatment for various ailments has been a beacon of hope for many Australians since its legalisation in 2016.
However, recent reports from the medical community are sounding the alarm on a disturbing trend: a significant rise in hospitalisations due to psychosis linked to prescribed medicinal cannabis.
This has raised serious concerns about the safety and regulation of these products, particularly as the number of 'single-issue' cannabis clinics and telehealth prescriptions surge across the country.
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has observed an alarming pattern of patients experiencing their first psychotic episodes or relapses in existing psychotic conditions after being prescribed medicinal cannabis.
Professor Brett Emmerson, the Queensland chair of the RANZCP, has called for stronger regulations on products and prescribing practices.
‘We're seeing a lot of people getting medicinal cannabis who end up with their first psychotic episode, or we're seeing it dispensed to people who have psychotic conditions, and these people are relapsing,’ he said.
‘Part of the issue … are these single-issue clinics which, if you ring up, it doesn't matter what you say you want.’
‘They'll provide it for you even though there is probably no indication that it will work, and the prescribers never contact the person's treating doctor.’
‘You find out two or three months down the track that one of your patients has been on medicinal cannabis — not prescribed by you but by some other prescriber — usually a doctor who hasn't had the professional courtesy of contacting you and letting you know.’
Metro North Health, Australia's most significant public health service, has reported that some of their new early psychosis cases were linked to medicinal cannabis use.
‘The Metro North, early psychosis service, reports 10 per cent of their new presentations — so these are kids aged 16 to 21 — are people who've ended up on medicinal cannabis and are becoming psychotic,’ Professor Emmerson continued.
‘A lot of other mental health services are reporting several admissions a week of people who have been placed on medicinal cannabis who shouldn't be on it.’
‘Medicinal cannabis is causing harm. The medication is unregulated and being used widely for a whole range of conditions for which there is no evidence.’
Professor Jennifer Martin, a clinical pharmacologist and general physician, has highlighted another concerning condition emerging from medicinal cannabis use: cannabis hyperemesis syndrome.
This condition, characterised by severe and persistent vomiting, is placing additional strain on emergency departments and hospital resources.
‘Some of these products have a lot of very psychoactive products in them.’ she stated.
‘These are big problems for our hospital system because those people sit in the emergency department [and] they potentially take up a bed for a long period of time.’
Professor Martin explained that many medicinal cannabis prescriptions are now being issued online through web interactions or telehealth services.
‘It's actually very difficult to get access to the doctor that actually signed the script for a patient,’ she added.
The prescribing of medicinal cannabis, which can contain varying levels of cannabidiol (CBD) and tetrahydrocannabinol (THC), the psychoactive component, has been particularly prevalent for conditions such as anxiety and insomnia.
However, Professor Emmerson stressed that there is no evidence to support the effectiveness of medicinal cannabis for these conditions.
‘There's no evidence that medicinal cannabis is helpful or treats those conditions,’ he clarified.
‘Treatment for anxiety, and often insomnia, is cognitive behavioural therapy from a good psychologist.’
‘Getting people hooked on a drug of dependence when there are other non-drug treatments available and haven't been accessed is wrong. ‘
‘The medicinal cannabis industry is marketing and making claims that cannabis can cure a whole range of different medical conditions, and there's just no evidence for it.’
The medicinal cannabis industry's aggressive marketing tactics have been likened to those of alcohol and tobacco companies, with a focus on profit over patient well-being.
While there are legitimate uses for medicinal cannabis, such as treating severe childhood epilepsy and managing nausea and vomiting associated with cancer treatments, the current state of prescribing practices is causing harm to patients.
The RANZCP has issued a clinical memorandum calling for regulatory changes to ensure patients receive evidence-based treatments and minimise harm.
‘There is insufficient evidence to support medicinal cannabis as a treatment for anxiety and other mental disorders,’ the memorandum read.
‘As there are no restrictions on the medical conditions for which a prescriber can apply to use unapproved medicinal cannabis products, given the high rates of prescribing for anxiety, in particular, RANZCP is concerned that patients are not receiving evidence-based treatment.’
‘Refinements to legislation and treatment frameworks for medicinal cannabis should be considered in line with available evidence and harm minimisation strategies.’
Professor Emmerson advocated for making medicinal cannabis a regulated medication, similar to other drugs of dependence, and for the Therapeutic Goods Administration (TGA) to ban THC-containing products except for specific approved uses.
The Australian Health Practitioner Regulation Agency (AHPRA) has also recognised the need for a collaborative approach among health regulators to protect the public regarding medicinal cannabis prescribing and dispensing.
‘The use of unregistered medicinal cannabis products has spiralled in recent years, from around 18,000 Australian patients using products in 2019 to more than one million patients using medicinal cannabis up to January 2024,’ they announced.
‘The number of prescribers accessing the authorised prescriber and the special access scheme has also risen sharply to more than 5,700 medical and nurse practitioners using these schemes to prescribe and dispense medicinal cannabis products.’
With over one million patients using medicinal cannabis products and a sharp increase in authorised prescribers, the urgency for regulatory refinement is apparent.
The TGA has only evaluated two medicinal cannabis products for safety, quality, and efficacy: Epidyolex for severe childhood epilepsy and Sativex for spasticity in multiple sclerosis.
TGA data shows that the variety of medicinal cannabis products available in Australia increased from 504 in 2022 to 690 in 2023.
However, the TGA was unable to provide the ABC with the number of times medicinal cannabis has been dispensed in Australia.
‘Data cannot be extracted from PBS (Pharmaceutical Benefits Scheme) information as they are purchased on private prescription,’ a spokesperson said.
‘The TGA is not aware of a single source that can provide complete and accurate dispensing data on medicinal cannabis products.’
Have you or someone you know been affected by these issues? How do you feel about the current state of regulation and prescribing practices? We’d love to hear your insights in the comments below.
However, recent reports from the medical community are sounding the alarm on a disturbing trend: a significant rise in hospitalisations due to psychosis linked to prescribed medicinal cannabis.
This has raised serious concerns about the safety and regulation of these products, particularly as the number of 'single-issue' cannabis clinics and telehealth prescriptions surge across the country.
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has observed an alarming pattern of patients experiencing their first psychotic episodes or relapses in existing psychotic conditions after being prescribed medicinal cannabis.
Professor Brett Emmerson, the Queensland chair of the RANZCP, has called for stronger regulations on products and prescribing practices.
‘We're seeing a lot of people getting medicinal cannabis who end up with their first psychotic episode, or we're seeing it dispensed to people who have psychotic conditions, and these people are relapsing,’ he said.
Doctors reported a significant rise in hospitalisations for psychosis after medicinal cannabis prescriptions in Australia. Credit: Shutterstock
‘Part of the issue … are these single-issue clinics which, if you ring up, it doesn't matter what you say you want.’
‘They'll provide it for you even though there is probably no indication that it will work, and the prescribers never contact the person's treating doctor.’
‘You find out two or three months down the track that one of your patients has been on medicinal cannabis — not prescribed by you but by some other prescriber — usually a doctor who hasn't had the professional courtesy of contacting you and letting you know.’
Metro North Health, Australia's most significant public health service, has reported that some of their new early psychosis cases were linked to medicinal cannabis use.
‘The Metro North, early psychosis service, reports 10 per cent of their new presentations — so these are kids aged 16 to 21 — are people who've ended up on medicinal cannabis and are becoming psychotic,’ Professor Emmerson continued.
‘A lot of other mental health services are reporting several admissions a week of people who have been placed on medicinal cannabis who shouldn't be on it.’
‘Medicinal cannabis is causing harm. The medication is unregulated and being used widely for a whole range of conditions for which there is no evidence.’
Professor Jennifer Martin, a clinical pharmacologist and general physician, has highlighted another concerning condition emerging from medicinal cannabis use: cannabis hyperemesis syndrome.
This condition, characterised by severe and persistent vomiting, is placing additional strain on emergency departments and hospital resources.
‘Some of these products have a lot of very psychoactive products in them.’ she stated.
‘These are big problems for our hospital system because those people sit in the emergency department [and] they potentially take up a bed for a long period of time.’
Professor Martin explained that many medicinal cannabis prescriptions are now being issued online through web interactions or telehealth services.
‘It's actually very difficult to get access to the doctor that actually signed the script for a patient,’ she added.
The prescribing of medicinal cannabis, which can contain varying levels of cannabidiol (CBD) and tetrahydrocannabinol (THC), the psychoactive component, has been particularly prevalent for conditions such as anxiety and insomnia.
Concerns rose over 'single-issue' cannabis clinics and telehealth prescriptions with minimal checks. Credit: Shutterstock
However, Professor Emmerson stressed that there is no evidence to support the effectiveness of medicinal cannabis for these conditions.
‘There's no evidence that medicinal cannabis is helpful or treats those conditions,’ he clarified.
‘Treatment for anxiety, and often insomnia, is cognitive behavioural therapy from a good psychologist.’
‘Getting people hooked on a drug of dependence when there are other non-drug treatments available and haven't been accessed is wrong. ‘
‘The medicinal cannabis industry is marketing and making claims that cannabis can cure a whole range of different medical conditions, and there's just no evidence for it.’
The medicinal cannabis industry's aggressive marketing tactics have been likened to those of alcohol and tobacco companies, with a focus on profit over patient well-being.
While there are legitimate uses for medicinal cannabis, such as treating severe childhood epilepsy and managing nausea and vomiting associated with cancer treatments, the current state of prescribing practices is causing harm to patients.
The RANZCP has issued a clinical memorandum calling for regulatory changes to ensure patients receive evidence-based treatments and minimise harm.
‘There is insufficient evidence to support medicinal cannabis as a treatment for anxiety and other mental disorders,’ the memorandum read.
‘As there are no restrictions on the medical conditions for which a prescriber can apply to use unapproved medicinal cannabis products, given the high rates of prescribing for anxiety, in particular, RANZCP is concerned that patients are not receiving evidence-based treatment.’
‘Refinements to legislation and treatment frameworks for medicinal cannabis should be considered in line with available evidence and harm minimisation strategies.’
Professor Emmerson advocated for making medicinal cannabis a regulated medication, similar to other drugs of dependence, and for the Therapeutic Goods Administration (TGA) to ban THC-containing products except for specific approved uses.
The Australian Health Practitioner Regulation Agency (AHPRA) has also recognised the need for a collaborative approach among health regulators to protect the public regarding medicinal cannabis prescribing and dispensing.
‘The use of unregistered medicinal cannabis products has spiralled in recent years, from around 18,000 Australian patients using products in 2019 to more than one million patients using medicinal cannabis up to January 2024,’ they announced.
‘The number of prescribers accessing the authorised prescriber and the special access scheme has also risen sharply to more than 5,700 medical and nurse practitioners using these schemes to prescribe and dispense medicinal cannabis products.’
With over one million patients using medicinal cannabis products and a sharp increase in authorised prescribers, the urgency for regulatory refinement is apparent.
The TGA has only evaluated two medicinal cannabis products for safety, quality, and efficacy: Epidyolex for severe childhood epilepsy and Sativex for spasticity in multiple sclerosis.
TGA data shows that the variety of medicinal cannabis products available in Australia increased from 504 in 2022 to 690 in 2023.
However, the TGA was unable to provide the ABC with the number of times medicinal cannabis has been dispensed in Australia.
‘Data cannot be extracted from PBS (Pharmaceutical Benefits Scheme) information as they are purchased on private prescription,’ a spokesperson said.
‘The TGA is not aware of a single source that can provide complete and accurate dispensing data on medicinal cannabis products.’
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