(Adapted from https://www.medsafe.govt.nz/profs/RIss/unapp.asp)
A patient comes to a medical practitioner’s surgery saying that medicinal cannabis has been helpful in the past for their symptoms. The practitioner knows that medicinal cannabis is not approved and that it has recently been scheduled a prescription medicine. They have no knowledge of the safety or efficacy of medicinal cannabis. The practitioner is obliged to use the means available to them to obtain unbiased information on the efficacy and safety of medicinal cannabis in the treatment of symptoms described by the patient, and be assured that it may benefit and not harm the patient. They are then able to decide whether he wishes on scientific grounds to assist the patient to obtain medicinal cannabis. They should discuss with the patient the information obtained, as well as the nature of the patient’s symptoms, and other medical and non-medical treatment options.
If, after a full and frank discussion, the decision of both the medical practitioner and the patient is to use medicinal cannabis the practitioner has three further steps to take before obtaining supplies. They should decide whether medicinal cannabis should be regarded as experimental, necessitating signed consent. If it is considered experimental, they should agree with the patient on a suitable procedure for monitoring for safety and efficacy. Finally, they should advise the patient that it is a requirement under the Medicines Act for the information about the supply, including the patient's name, to be forwarded to Medsafe and be stored in a database.
The practitioner then contacts a company providing medicinal cannabis and requests medicinal cannabis for their patient. If the medicinal cannabis is procured from company, the company must report the supply to the Director-General.
Since individuals may react differently when first exposed to medicinal cannabis, it is suggested that each patient is titrated to the most appropriate dose over a period of days or weeks.
Currently, there is one cannabis-based product that is registered as a prescription medicine and classified as a Schedule 2, Part 1 (Class B1) controlled drug product under the Misuse of Drugs Act 1975. It is an oromucosal (mouth) spray administering a metered, actuated dose containing the cannabis extracts delta-9-tetrahydrocannabinol (THC) (2.7 mg/spray) and cannabidiol (CBD) (2.5 mg/spray). It is only indicated for use as an add-on treatment for symptom improvement in patients with moderate to severe spasticity due to Multiple Sclerosis, cannabis is an unapproved medicine.
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