The Woolcock Institute of Medical Research

We’re at the dawn of a new era in the use of medicinal cannabis in Australia. Recent regulation changes have allowed people to get low-dose medicinal cannabis products directly from their pharmacist.

In a recent project conducted by researchers at the Lambert Initiative (University of Sydney), pharmacists were surveyed to see what impact the changes are having. Professor Bandana Saini, one of the pharmacist researchers involved in the study, reported that the study found that public interest in medicinal cannabis is growing strongly: over half of pharmacists surveyed said that medicinal cannabis enquiries had risen over the three months before the survey.

What do pharmacists think about the change? And how are they handling the growth in medicinal cannabis enquiries from their customers? We asked Bandana what the research found.

First of all, can you clarify what medicinal cannabis is?

There's quite a landscape of products that can be labelled ‘medicinal cannabis’. 

A medicinal cannabis preparation can contain many different chemicals, but the two main ingredients are tetrahydrocannabinol (THC) and cannabidiol (CBD).

THC is more psychoactive, and can alter a user’s perception, mood or behaviour leading to what is known as a ‘high’. CBD is not considered to be psychoactive in the same way as THC; that is, it does not produce a ‘high’ or euphoric effect.

In medicinal cannabis products, both chemicals can be used, and different products can have different percentages of one or the other. Synthetic versions of cannabinoids are used in some products as well.

Medicinal cannabis products can also take many different forms. They’re found as traditional oral medicines, but you can also get them as oils, sprays and so on.

So there's a bewildering array of products that can fit the description of medicinal cannabis.

Our research focussed on low-dose medicinal cannabis products that can be supplied by a pharmacist, especially certain low-dose CBD products that pharmacists could provide without a prescription.

Hear Bandana talking about why she did this research and more findings from the survey

Why are pharmacists getting so many requests about medicinal cannabis now?

Part of the reason is that there was recently a change to regulations about low-dose medicinal cannabis.

Drug supply in Australia is categorised into different schedules: these schedules identify the access, storage and other rules for supply. 

In 2020, low-dose medicinal cannabis products were included in schedule three (S3), which means they can now be obtained through a pharmacy, without a prescription.

S3 drugs are not kept out in public counter space in a pharmacy. They are kept behind the counter in the dispensary and have to be provided by the pharmacist, which means the pharmacist can check that the patient is getting the right medication. Salbutamol, which is used in asthma reliever inhalers, is an example of another S3 drug.

In theory, the move to S3 has certainly made low-dose medicinal cannabis products more accessible. I say in theory because there actually aren’t any products available in Australia yet.

Why are people taking these products?

We asked our pharmacists this question, and the results are really interesting.

Most pharmacists had at some point dispensed medicinal cannabis prescriptions, with more than a third dispensing multiple prescriptions over the two month period before the survey.

The highest proportion of prescriptions were for different types of pain. The second most common reason was anxiety, and insomnia came in third. Other applications included epilepsy, spasticity, and depression.

What did your research find?

The most striking finding from our research is that almost all pharmacists said they would like more training about low-dose medicinal cannabis products.

The majority of pharmacists were supportive of providing these products through their pharmacies, but only a minority – just over a third – felt confident answering cannabis-related enquiries from their customers. 

The clear implication is that we need to provide training and support to pharmacists to help them respond to the growing demand from their customers for advice about these products.

There were a lot of other very interesting findings. We asked pharmacists what barriers they saw to supplying medicinal cannabis. They said that there's a lot of stigma in the community associated with medicinal cannabis. I think this needs to be addressed by providing more education on the medication’s benefits, the evidence about why some people might benefit from using medicinal cannabis or a low-dose CBD product.

Are you planning further research about this?

I’d like to do further sleep health research to see who pharmacists are supplying low-dose CBD products to, when they become available — what kind of patients with what kind of sleep disorder – and how sleep health is managed in the context of the provision of low-dose CBD products.

I also have an interest in education. As an academic I teach pharmacy students, so I’m very interested in developing new evidence-based training for students on low-dose medicinal cannabis and CBD products.

I've been working with one of my colleagues from the Woolcock, Associate Professor Chris Gordon, to trial a teaching module about insomnia. We get a clear message from pharmacy professionals that they need more training on sleep health: not just about the range of products, but about the concept of sleep health and why certain medications might be affecting sleep and how to use them safely and effectively.

And I think we could extend this training to other healthcare professionals, such as nursing students, who have also told us they need more training on all aspects of sleep health.

We’ll be able to use our research on low-dose medicinal cannabis to inform our training. It’s an important addition to our goal of improving sleep health here in Australia and internationally.

The survey was conducted by Ms Zeeta Bawa, a doctoral candidate from the Lambert Initiative.

Find out more

• A cross-sectional survey exploring the knowledge, experiences and attitudes of Australian pharmacists toward medicinal cannabis, International Journal of Clinical Pharmacy
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