Prescribing medicinal cannabis: be aware of the medico-legal risks

Medicinal cannabis use as a therapeutic agent has rapidly evolved over the last decade in Australia, despite it not having been approved as first-line therapy for any indication. It is only TGA approved for two very specific and rare indications, and only covered by the PBS for one of these.*

Recent media attention and member calls to Avant’s Medico-legal Advisory Service have highlighted several areas of concern regarding both the clinical and medico-legal risk of prescribing these drugs.

In July 2025, Ahpra and the National Boards released an official guidance on medical cannabis prescribing. At the same time Ahpra warned doctors and nurse practitioners that they will be monitoring real-time prescribing patterns to identify prescribers who are writing excessive numbers of scripts, even in instances where there has been no official complaint.

Evidence base is limited and inconclusive

The published evidence to support the effectiveness of medicinal cannabis is weak for most indications. 

Several specialist medical colleges advise it should not be used in the more common circumstances for which it is currently being prescribed, including chronic pain, anxiety and sleep disturbances. Further quality research is required to validate the anecdotal evidence that supports prescribing for these conditions. 

According to the ANZCA Faculty of Pain, the scientific evidence for the efficacy of cannabinoids in the management of people with chronic non-cancer pain remains insufficient to justify endorsement of their clinical use. The RANZCP has informed their psychiatrist members that medicinal cannabis should only be prescribed in rare circumstances, after other treatments have been tried without benefit, and with outcomes recorded.

 Prescribing that is not clinically indicated is of particular concern where medicinal cannabis is being used to ‘treat’ a single issue, without a holistic approach to patient care, particularly in complex cases.

Regulator complaints increasing

Increased prescribing in recent years has led to an increased number of complaints received by Ahpra concerning medicinal cannabis prescriptions. This is reflected in the number of requests by members seeking support from Avant following an Ahpra notification relating to their prescribing decisions. While most complaints alleged inappropriate prescribing or inadequate clinical assessment, in some cases an appropriate refusal to prescribe has triggered a complaint from the patient.

The regulator has also indicated it is concerned about the safety and appropriateness of emerging models of care related to prescribing medicinal cannabis. As at July 2025, action has been taken against 57 medical practitioners, pharmacists and nurses who have not met their requirements. A further 60 cases are under active investigation.

Investigations by Ahpra have required the prescribing doctor to provide comprehensive details on: 

• their experience and training in prescribing medicinal cannabis
• how they assess patients
• their criteria for establishing a patient’s eligibility for receiving a prescription
• the information they provide to patients, including risks, benefits, side effects, precautions and contraindications (such as past psychosis, serious cardiac disease and opioid substitution treatment programs)
• how they communicate with other treating practitioners
• the follow up their patient receives.

Medicinal cannabis prescribing has also recently been scrutinized in coronial investigations. A coronial enquiry into a suicide led to the NSW Coroner questioning the appropriateness of cannabis prescribing to a patient who had known mental health issues. Another patient, who was hospitalised due to acute deterioration of their mental health, also resulted in a claim brought by the family against their doctor. In both cases, the patient had been prescribed cannabis through a telehealth clinic.

Restrictions on telehealth models

Recent mainstream media news reports have highlighted the rapid increase in the number of cannabis telehealth clinics, where both doctors and nurse practitioners are writing prescriptions for high-strength medicinal cannabis products, often after only a brief phone or online consultation with the patient. 

It should be noted that asynchronous telehealth, or “tick box” medicine, where requests for medication are submitted by text, email, live-chat or online, is discouraged by the Medical Board. Additionally, delivery of care through a telehealth service, where there is not an initial in-person, phone, or video consultation, may not be covered under Avant’s Practitioner Indemnity Insurance Policy. 

The joint guidance recently issued by Ahpra and the Board reminds practitioners of their duty of care when providing prescriptions of any kind, whether it be in-person or via telehealth. For prescribers, good care was noted to include:

• Assessing patients thoroughly, including a social, mental health and substance use history, and conducting an appropriate physical examination. This cannot be achieved in a short online consultation.
• Formulating and implementing a suitable management plan, that includes arranging investigations and providing information, a diagnosis, treatment and advice.
• Facilitating coordination and continuity of care. 
• Maintaining adequate medical records and avoiding the use of pre-filled medical record templates. 
• Providing treatment options based on the best available information and only recommending treatments when there is an identified therapeutic need and/or a clinically recognised treatment, and a reasonable expectation of clinical efficacy and benefit for the patient.

Practitioners are encouraged to read the guidance in full, which includes specific examples of poor practice released by Ahpra.

From November 2025, the Department of Health and Aged Care will tighten the rules around telehealth, so that nurse practitioners have the same requirement as GPs to demonstrate an 'established clinical relationship’ with the patient.

Advertising medicinal cannabis is prohibited

Ahpra has strict guidelines around advertising a health service and can impose significant penalties if these are breached.

The TGA guidance for businesses involved with medicinal cannabis clarifies that advertising medicinal cannabis to the public is prohibited in all forms of media. This includes any statement, pictorial representation or design that promotes the use or supply of medicinal cannabis.

Likelihood of fragmentation of care

When a patient does not reveal to their healthcare provider that they are taking medicinal cannabis the potential for harm increases. Doctors have reported finding out their patients had been prescribed cannabis through a clinic and not being informed or made aware of this for some time. 

As medicinal cannabis products are unregistered Schedule 8 medicines* they should be recorded on SafeScript or equivalent Real Time Prescription Monitoring (RTPM) systems. These RTPM systems must be reviewed every time medical cannabis is prescribed in the states and territories where this is mandatory (everywhere except WA, ACT and NSW). Even if you are not prescribing medicinal cannabis or another drug of dependence, checking the RTPM can let you know if a patient is accessing these through another clinic or online service.

In summary

Like any other medication, medicinal cannabis should only be prescribed when it is clinically indicated and necessary for the patient. A doctor’s duty to exercise reasonable care extends to prescribing, with a thorough clinical evaluation and discussion of the risks and benefits required before making the decision it is appropriate to prescribe. 

As medicinal cannabis continues to evolve as a therapeutic option, practitioners who do not display requisite caution are exposing themselves to the potential of a complaint if their patient suffers harm as a result. Additionally, if telehealth services are provided, they may need to have conducted an initial in-person, phone, or video consultation to have cover under their medical indemnity policy.

*TGA approval has been granted for treatment of certain symptoms of Dravet syndrome (PBS-listed) and multiple sclerosis (not PBS-listed)

Useful resources

Ahpra guidance: Medicinal cannabis prescribing: Meeting your professional responsibilities 

TGA resource: Guidance for the use of medicinal cannabis in Australia: Patient information 

Avant resources: Prescribing safely: what you need to know  

Avant article: Advertising your practice 

More information

For medico-legal advice, please contact us here, or call 1800 128 268, 24/7 in emergencies.