Medicinal cannabis policy
Guidelines for providing medicinal cannabis to injured workers.
Background
What is medicinal cannabis used for?
Medicinal cannabis is sometimes referred to as medical cannabis or medical marijuana.
Currently, most medicinal cannabis products are unapproved therapeutic goods, which means they have not been assessed by the Therapeutic Goods Administration (TGA) for safety, quality or effectiveness. However, where clinically appropriate, there are pathways for doctors to access medicinal cannabis products for their patients.
Where medicinal cannabis has been approved by the TGA, (for the treatment for a rare genetic disorder which causes drug-resistant epilepsy in adolescence as well as in multiple sclerosis) these are prescribed for conditions that we are unlikely to see in injured workers.
Who can prescribe medicinal cannabis?
As most medicinal cannabis products are not approved, before prescribing a medical practitioner can gain approval from the TGA either through the TGA's Special Access Scheme (SAS) or becoming an authorised prescriber (AP). The medical practitioner can then apply to the TGA on behalf of the patient and must also meet certain requirements, obtain permits and comply with state laws.
What is the evidence for its use?
There is a lack of robust evidence at this point in time to support the use of medicinal cannabis to treat chronic non cancer pain (CNCP). CNCP is defined as pain that persists for longer than 3 months or beyond the expected healing time and is not related to cancer.
There is also inconsistent evidence supporting its use in treating sleep disorders, migraines, opioid dependence, inflammatory bowel disease and a variety of mental health conditions such as mood disorders and post-traumatic stress disorder.
Additionally, injured workers may be at risk of harm or adverse side effects from using medicinal cannabis.
When considering requests for funding any pharmaceutical item, this policy must also be read with the following policies:
Guidelines
The following guidelines will be used to assess requests to treat chronic non cancer pain (CNCP).
Requests that are made for exceptional circumstances for conditions other than CNCP will be assessed under the Non-established, New or Emerging Treatments and Services (NeNETS) policy.
Will WorkSafe pay for medicinal cannabis?
WorkSafe does not support the use of medicinal cannabis to treat CNCP. This is due to the lack of demonstrated evidence and unreliable information to base clinical decision making. This is backed by international and national expert organisations such as Australian Faculty of Pain Medicine, International Association for the Study of Pain, and the Therapeutic Goods Administration. Additionally, extensive evidence reviews conducted by the Institute for Safety, Compensation and Recovery Research (ISCRR) in 2020 and 2021, and Monash University in 2022*, further demonstrated the lack of current available evidence to support the use of medicinal cannabis to treat CNCP. WorkSafe will undertake a regular review of any new and emerging evidence and update this policy as required.
WorkSafe recognises that there may be the rare exception where medicinal cannabis is an appropriate treatment for a period of time, when all other reasonable treatments and services have been exhausted, and may consider paying the reasonable costs of the treatment.
A request for funding of medicinal cannabis for CNCP must be accompanied by the following to be considered:
- Evidence from a treating pain specialist that the injured worker has trialled all other reasonable established treatments and services with limited efficacy, or are inappropriate for the individual specific reasons (such as contraindication or significant side effects).
- Evidence from a treating pain specialist that is supportive of the use of medicinal cannabis for the easing symptoms of CNCP for the injured worker.
- A treatment plan from the requesting medical practitioner or pain specialist including baseline standardised outcome measures to assess the efficacy and side effects, and evidence that the injured worker has been advised about potential risks and adverse effects including the potential for workplace impairment.
- If the injured worker is using an oral morphine equivalent > 100mg/day or has a history of dependency, evidence is provided by an addiction specialist including that the risk of an adverse event or dependence has been assessed and is deemed acceptable.
- Evidence of support from the injured worker's general practitioner.
- Evidence that the injured worker has completed a face to face assessment with the requesting medical practitioner.
When will WorkSafe respond to a request?
Once all required information is received, notification of an outcome will be made within 28 days.
For what period of time will WorkSafe pay for medicinal cannabis?
After an initial trial period (usually 3 months), WorkSafe will review the standardised outcome measures and treatment plan provided by the pain or addiction specialist in line with the Clinical Framework for the Delivery of Health Services. WorkSafe will then assess if medicinal cannabis is the appropriate treatment to support a worker's recovery and this process will be repeated every 12 months.
* Nielsen S, Tsering D, Waddell A, Grundy E, Lennox A, Bragge P, Delafosse V, & Kellner P. Medicinal Cannabis Evidence and Practice Review. Monash Sustainable Development Institute Evidence Review Service, BehaviourWorks Australia, Monash University, August 2022.