The Pharmacy Board of Australia has warned that part of safe and appropriate supply of medicinal cannabis includes determining the prescriber’s intentions.
Pharmacists have been cautioned that they must exercise their independent judgement in ensuring that medicinal cannabis is “safe and appropriate” for patients before filling a script, as AHPRA continues to crack down on the sector.
A new set of guidelines issued by the regulator on Tuesday outlines the professional expectations of pharmacists supplying medicinal cannabis.
Similarly to the guidance for medical practitioners released in August, the new statement on pharmacist responsibilities noted concerns that profits were being prioritised over patient safety at some medicinal cannabis clinics.
“Business models have emerged that appear to use aggressive and sometimes misleading advertising that targets vulnerable people,” it said.
“Some of these practices only offer the prescription and supply of a single product or class of drug and use online questionnaires that coach patients to say ‘the right thing’ to justify prescribing.
“While these models may work well for access, there is an inherent conflict of interest for pharmacists working in an organisation in which a single medication is prescribed and dispensed.”
Like the guidance for doctors, it also included “a word of caution” that AHPRA may investigate a practitioner even in the absence of a complaint.
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The guidance advised that “safe and appropriate” supply of prescription medicinal cannabis included “determining the prescriber’s intentions as to the patient’s medicinal cannabis”, “exercising independent judgement to ensure the medicinal cannabis is safe and appropriate for the patient” and “counselling the patient, or the patient’s agent, sufficiently to allow a proper understanding of all the information required by the patient to use the medicinal cannabis safely and effectively”.
“With a few exceptions, such as the treatment of certain childhood epilepsies, muscle spasms and pain symptoms associated with multiple sclerosis, some neuropathic pain and chemotherapy-induced nausea and vomiting in cancer, there is little evidence to support the use of medicinal cannabis,” the Pharmacy Board of Australia said.
“If the pharmacist decides not to supply the prescribed medicinal cannabis, the patient and the prescriber should be informed about the reasons for the decision and any alternative options that may meet the patient’s needs.
“Appropriate documentation should be kept about the action taken and the reasons.”
Other inclusions in the guidance were to review medication history, comply with state or territory laws around real-time prescription monitoring and contacting the prescriber with any queries.
In respect to good patient care and the pharmacist code of conduct, the board also urged pharmacists not to make a decision to supply a medicine that was influenced by financial gain.
Conflicts of interest, it reiterated, are inherent in clinics that both prescribe and dispense a specific medication.
“A declaration of a conflict on a website is not sufficient, and you must be prepared to explain how a declared conflict is not impacting patient care,” the board said.
“Not appropriately managing a conflict of interest” was included as a specific example of poor practice.
