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General practitioners (GPs) and specialists can apply to prescribe medicinal cannabis. There are four different ways to get a prescription for CBD oil or medical cannabis products. Learn how to get a cbd oil prescription in Canada. Cannabidiol prescription in clinical practice: an audit on the first 400 patients in New Zealand Cannabidiol (CBD) is the non-euphoriant component of cannabis. In 2017, the New Zealand Misuse of

Prescribing medicinal cannabis

Any registered medical practitioner in Queensland can prescribe medicinal cannabis for any patient with any condition, if they believe it is clinically appropriate and have obtained the required Commonwealth approval.

Medicinal cannabis products are classified as either Schedule 3, Schedule 4 or Schedule 8 controlled substances, most products are not listed on the Australian Register of Therapeutic Goods (ARTG). In circumstances where patients need access to therapeutic goods that are not included in the ARTG, a Therapeutic Goods Administration (TGA) approval is required in order for the medicine to be prescribed.

The Commonwealth Department of Health manages and enables access to:

In Queensland, the Medicines and Poisons (Medicines) Regulation 2021 describes the requirements for prescribing and dispensing S4 and S8 medicines.

Queensland doctors can prescribe Schedule 4 – cannabidiol (CBD) and Schedule 8 – tetrahydrocannabinol (THC) or tetrahydrocannabinol: cannabidiol (THC:CBD) products without a Queensland approval.

Guidance and regulations

  • Guidance’s for the use of medicinal cannabis in Australia are a suite of national guidance documents that cover a range of medical conditions, symptoms, and products to be used. The individual documents can be viewed on the TGA’s website.
  • The Medicines and Poisons (Medicines) Regulation 2021 outlines specific requirements for dealing with regulated substances, including medicinal cannabis, review the Regulation for more information.
  • The Medicines and Poisons Act 2019 provides for the development of departmental standards which outline the minimum requirements for safe and effective management of regulated substances, including medicinal cannabis, review the standards for more information.

Clinical evidence

When making an application to the TGA, you will need to reference clinical evidence that supports using the specific type of medicinal cannabis product proposed (e.g. THC, CBD, or THC and CBD in combination) for your patient’s medical condition or symptoms.

More research is being done on the uses of medicinal cannabis. The scientific evidence base is limited but suggests that medicinal cannabis may be suitable for:

You may apply for other conditions; however, you will need to supply clinical evidence with your application for this to be considered. There is no evidence that medicinal cannabis is an effective treatment for cancer.

Clinicians should not:

  • consider medicinal cannabis as an alternative treatment for cancer.
  • defer their standard treatment in favour of using medicinal cannabis.

NSW Cannabis Medicines Advisory Service – (for NSW health practitioners only). However, the Service is also available if:

  • You are a medical practitioner in a state or territory outside of NSW but are treating a patient residing in NSW, or
  • You are a NSW medical practitioner treating a patient in cross-border areas of NSW.

Commonwealth Department of Health

The Commonwealth Department of Health regulates medicinal cannabis products through the Therapeutic Goods Administration (TGA) and the Office of Drug Control (ODC).

Generally, medicines imported into, supplied in, and exported from Australia must be entered in the Australian Register of Therapeutic Goods (ARTG), which is administered by the TGA. However, there are mechanisms available for access to medicines that are not registered on the ARTG.

As most medicinal cannabis products are currently unregistered medicines, access to these products is through the Commonwealth Special Access or Authorised Prescriber Schemes or through a Clinical Trial.

Your legal obligations

The prescriber must:

  • adhere to all conditions as detailed in any TGA import licence or permit, if they are the importing party
  • comply with any conditions imposed on a TGA approval relating to the medicinal cannabis product(s) being used, including obtaining informed consent in writing from the patient (or the person with the legal authority to consent to the treatment on behalf of the patient) in relation to the proposed use of the specified medicine
  • comply with the Departmental standard – monitored medicines when prescribing S8 medicinal cannabis products for dispensing or giving a treatment dose
  • comply with the requirement to check QScript prior to prescribing or giving a treatment dose of a monitored medicine, including S8 medicinal cannabis
  • report any adverse events, adverse reactions, serious adverse reactions and unexpected reactions to the TGA.

Find a product

Doctors can apply to prescribe both plant-based products and synthetic products when used for a therapeutic purpose, including:

  • tinctures: plant material infused in oil or alcohol
  • vapour: dried plant material or concentrated cannabis extract is heated in a vaporiser
  • capsules or sprays: generally, oil-based capsules taken orally
  • pharmaceutical products such as nabiximols.

Smoking in general is harmful, smoking of cannabis products is not supported.

Products currently used in Australia:

    provide a list of manufacturers and suppliers for imported and locally produced medicinal cannabis products currently in use in Australia.
  • Nabiximols (Sativex), is listed as an approved medicines on the Australian Register of Therapeutic Goods.
    • Sativex is a Schedule 8 medicine and is a plant-derived product. In Queensland medical practitioners can prescribe Sativex without requiring an approval from the state or the TGA.

    How to make an application

    Doctors seeking approval to prescribe medicinal cannabis products that are not registered on the ARTG to a Queensland patient will do so via the TGA’s Online System.

    Doctors who have already registered can login to the TGA’s Online System

    There is no requirement for a Queensland approval to prescribe S8 or S4 medicinal cannabis.

    How to get a CBD oil prescription or medical cannabis prescription

    There are four ways to get a prescription for CBD oil or other medical cannabis products:

    1. From your doctor or specialist
    2. From a cannabis nursing service
    3. From a cannabis clinic (“canna clinic”)
    4. From a cannabis telemedicine service

    Here’s what you can expect from each of these approaches.

    Your doctor or specialist

    Very few doctors and specialists are readily prescribing cannabis, for a variety of reasons. Many will simply refer you to a cannabis clinic, or even suggest you go buy it from a retail store.

    If your doctor is knowledgeable and willing, count yourself lucky. That said, they are unlikely to have time to educate you on all of the ins-and-outs of medical cannabis, or help you decide which licensed producer to register with. Nor are they likely to have staff at their clinic who can help.

    Some doctors may have a single licensed producer that they have a relationship with. They will forward your prescription to that producer, who will then call you to help you choose a product. It’s convenient for the doctor, but it doesn’t leave the patient with any choice of producer. This is unfortunate because no single producer can meet the diversity of needs that patients have.

    [By the way, Wayfare works with quite a few doctors who are prescribing cannabis but count on us to provide educational support to their patients. We can even help prepare documents you can take to your doctor.]

    Cannabis nursing service

    You can think of this service as a mobile clinic. The nurse will come to your home, provide education, take a medical history and connect with a doctor or Nurse Practitioner to obtain the authorization. She will also help you select an appropriate product and develop a detailed treatment plan and dosing schedule. She will then help register you with a licensed producer so you can order products by phone or on-line, and will follow up with you semi-weekly while you work toward your goal.

    The cost for this service is usually fully-covered by insurance as a home nursing expense.

    Wayfare falls into this category, although we do often work with patients’ own doctors, and there are some cannabis clinics who refer to us to provide extra support for patients. We are now also providing a telehealth option as well.

    Cannabis clinics

    Over the past few years a number of specialized cannabis clinics have opened up. These are typically staffed by doctors who work there on a part-time basis. These doctors may come from specialties including psychiatry, surgery, and anesthesiology. This means that some patients may see a heart surgeon for their arthritis! But really, bless these doctors for making time to learn about cannabis and help people.

    The educational portion of your visit, where you select a licensed producer and product, is quite often handled by a lay person who may have the title of “cannabis educator”, “canna counsellor”, or “patient educator”. These people rarely have medical training, although they may be knowledgable about particular strains, the pricing programs of the various producers, and how to use a vaporizer.

    Cannabis telemedicine services

    You can get on a video conference with a doctor or Nurse Practitioner, who will assess you and provide an authorization for medical cannabis. Some of these services are stand-alone whereas others are provided by cannabis clinics as described above.

    The educational component of the service may again be handled by a lay person, sometimes via a separate video call or by telephone through a call centre.

    Cannabidiol prescription in clinical practice: an audit on the first 400 patients in New Zealand

    Cannabidiol (CBD) is the non-euphoriant component of cannabis. In 2017, the New Zealand Misuse of Drugs Regulations (1977) were amended, allowing doctors to prescribe CBD. Therapeutic benefit and tolerability of CBD remains unclear.

    To review the changes in self-reported quality of life measurements, drug tolerability, and dose-dependent relationships in patients prescribed CBD oil for various conditions at a single institution.

    Design & setting

    An audit including all patients (n = 400) presenting to Cannabis Care, New Zealand, between 7 December 2017 and 7 December 2018 seeking CBD prescriptions

    Method

    Indications for CBD use were recorded at baseline. Outcomes included EuroQol quality of life measures at baseline and after 3 weeks of use, patient-reported satisfaction, incidence of side effects, and patient-titrated dosage levels of CBD.

    Results

    Conclusion

    There may be analgesic and anxiolytic benefits of CBD in patients with non-cancer chronic pain and mental health conditions such as anxiety. CBD is well tolerated, making it safe to trial for non-cancer chronic pain, mental health, neurological, and cancer symptoms.

    How this fits in

    CBD prescription in primary care was legalised in New Zealand in 2017. Previous preclinical trials have shown CBD to have anxiolytic and anti-inflammatory properties but there remains a paucity of studies investigating its therapeutic potential. In this quantitative observational study of the first 400 patients prescribed CBD in New Zealand, CBD was well tolerated amongst patients with a wide range of conditions and symptoms. Quality-of-life benefit was experienced to a greater degree in patients living with non-cancer chronic pain and anxiety-related mental-health conditions, and to a lesser degree in patients with cancer or neurological symptoms.

    Introduction

    With the amendment of the New Zealand Misuse of Drugs Regulations 1977 in 2017, CBD has become a legal prescription medicine. The amendment recognises the right of New Zealand doctors to prescribe CBD products that contain no more of 2% of 9-Δ-tetrahydrocannabinol (9-Δ-THC) in the product. 1

    CBD and 9-Δ-THC are cannabinoids, active compounds found within the Cannabis genus of plants. 2 While 9-Δ-THC is the main psychoactive component responsible for euphoria and the ‘high’ associated with marijuana, CBD is the non-euphoriant component. 2 , 3

    CBD is currently FDA-approved for the treatment of Dravet and Lennox-Gastaut syndrome, two childhood seizure disorders. 4 Randomised controlled trials (RCTs) have shown that, when CBD is added to existing anti-epileptic medication in patients with these syndromes, seizure frequency decreases. 5 , 6

    However, CBD shows potential therapeutic use beyond this. Pre-clinical studies demonstrate that CBD has potential anti-inflammatory effects via inhibition of immune cell migration, which may be useful in chronic inflammatory conditions. 7

    Moreover, preclinical studies have demonstrated anxiolytic effects of CBD. 3 , 8 – 10 Crippa et al found that in patients with generalised anxiety disorder given 400 mg of oral CBD, there was decreased cerebral blood flow to anxiety processing areas of the brain and a decrease in patient-reported anxiety when compared to placebo. 8 CBD in one double-blinded placebo-controlled RCT decreased symptoms of social anxiety disorder patients and fear of public speaking. 10 CBD may also reduce psychotic symptoms of schizophrenia. 11

    CBD appears to be safe for patients, with a recent phase I dosage trial showing purified CBD oil is well tolerated up to doses of 6000 mg. 12 However, due to a paucity of clinical studies, prescribing guidelines are lacking.

    The aim of this study was to conduct a clinical audit on the patient population referred to Cannabis Care (a primary care clinic in Auckland, New Zealand) for CBD oil. The authors explored the indications for prescribing CBD oil, patient quality of life, patient satisfaction, and self-titrated dosage levels.

    Method

    The STROBE statement for reporting observational studies was followed. 13

    Patients

    Patients included in this audit were those who were prescribed CBD from 7 December 2017 to 7 December 2018. Patients included in this audit either were referred by their primary care provider or self-referred to the service. Patients were prescribed CBD oil (Tilray CBD100, Tilray, Nanaimo, BC, Canada) containing 100 mg CBD/mL in 25 mL bottles administered orally via a dropper. Bottles costed approximately USD300 each, which was self-funded as CBD is not on the New Zealand government-subsidised pharmaceutical schedule (PHARMAC).

    Outcomes

    Patient sex, age, and details of medical condition were recorded at first consultation. Each participant was grouped into one of four broad clinical groups based on their presenting medical symptoms: non-cancer chronic pain symptoms, neurological symptoms, mental health-related symptoms, or cancer symptoms. When a patient presented with symptoms fitting multiple categories, the clinician assigned the patient to the category fitting their primary presenting complaint.

    Patients completed an EQ-5D-5L questionnaire at baseline before taking CBD, and again after at least 3 weeks of using the medicine as part of routine clinical assessment. The EQ-5D-5L is a two-part tool consisting of the EQ-5D-5L descriptive system and the EQ Visual Analogue scale (EQ-VAS). 14 The descriptive system measures five domains (mobility, self-care, usual activities, pain or discomfort, anxiety or depression) each with five levels of severity: no problems, slight problems, moderate problems, severe problems, and extreme problems. The EQ-VAS is a 20 cm vertical printed scale from 0 to 100 whereby the upper endpoint of the scale corresponds the ‘best health you can imagine’ and the lower corresponds to the ‘worst health you can imagine’. The patient rated their current overall health on this visual scale to yield a corresponding numerical score.

    Patients also rated their satisfaction with their CBD use at follow-up. They rated their experience as ‘no benefit, good, very good, or excellent’ and reported any side effects. In addition, variations in patient dosage and the duration and frequency of CBD oil intake were recorded where possible.

    Statistical methods

    The EQ-5D-5L data was measured on ordinal scales and hence considered as non-parametric data. The EQ-VAS scores were recorded on a continuous scale and treated as a parametric variable. Non-parametric data was presented as median (interquartile range [IQR]) and analysed for differences using the Wilcoxon rank sum test. Change in patient EQ-VAS scores was presented as mean (standard deviation [SD]) and analysed using one-way analysis of variance (ANOVA) to assess any differences between indication categories. Binary logistic regression was used to analyse potential dose-dependent responses, dose of CBD, and patient-reported benefit.

    Categorical data such as the indications for CBD, patient satisfaction with CBD use, and side effects of use were presented as frequencies. A P value of ≤0.05 was taken as statistically significant. SPSS software (version 23.0) was used for statistical analysis.

    Results

    A total of 400 patients presented to Cannabis Care from 7 December 2017 to 7 December 2018. Three patients did not receive a prescription based on a clinician decision that they would not benefit. Patients receiving CBD prescription consisted of 214 females (53.9%) and 183 males (46.1%), for a total of 397 individuals. The mean age of patients was 51.48 years (SD 19.1). Of those prescribed CBD, 61 patients (15.4%) fit more than one category of indication and were assigned to a group based on their primary condition.

    Patient indication for CBD prescription is shown in Table 1 . The non-cancer pain symptoms group included patients with fibromyalgia, osteoarthritis, rheumatoid arthritis, neuropathic pain, chronic non-specific pain, pain due to ulcerative colitis, and migraines. Cancer-related symptoms included pain, nausea, poor appetite, emotional distress, and adverse effects of radiotherapy and/or chemotherapy treatment. Mental health symptoms included anxiety disorders, depressive disorders, post-traumatic stress disorder, and insomnia. Neurological symptoms included Parkinson’s disease, multiple sclerosis, epilepsy, autism spectrum disorder with challenging behaviour, amyotrophic lateral sclerosis, multiple system atrophy, various neuropathies, and tremors.

    Table 1.

    Characteristic Frequency, n Proportion, %
    Mean age, years (±SD) 51.48 (±19.1)
    Sex Male 183 46.1
    Female 214 53.9
    Indication for CBD prescription Non-cancer pain symptoms 181 45.6
    Mental health symptoms 64 16.1
    Neurological symptoms 60 15.1
    Cancer symptoms 92 23.2

    Of the 397 patients initially prescribed the CBD oil, 253 (63.7%) were followed up either through a second appointment with the clinician or by phone. In total, 250 patients (63.0%) reported their satisfaction with CBD use, with three patients (0.8%) refusing to comment. Within these 250 patients, a subset of 110 patients (27.7%) completed before and after EQ-5D-5L questionnaires; 144 patients (36.3%) did not complete follow-up assessment, with 82 patients (20.7%) lost to follow-up and 62 patients (15.6%) choosing not to take the CBD. Reasons for patients not taking the CBD included death, financial barriers preventing purchase of the oil, severe illness, participation in a clinical trial, or consumption of alternative illicit cannabis products.

    Median follow up duration for patients who completed their CBD prescription was 36 days (IQR 28–65).

    Outcomes of CBD treatment

    Results from Wilcoxon rank sum tests for EQ-5D-5L domains found that patients experiencing non-cancer pain symptoms had a significant improvement of self-reported mobility scores (P = 0.02), ability to complete their usual activities (P = 0.007), self-reported pain (P<0.001), and self-reported anxiety or depression (P = 0.017). Patients with mental-health related symptoms experienced improvements to their ability to carry out their usual activities (P = 0.002), pain (P = 0.039), and anxiety or depression (P = 0.02). Patients with neurological symptoms experienced no statistically significant differences in any of the five domains. Patients with cancer symptoms experienced improvements in pain (P = 0.047). Complete results of EQ-5D-5L questionnaires are shown in Table 2 .

    Table 2.

    Indication for CBD prescription Domain of
    EQ-5D-5L
    Baseline EQ-5D-5L scores, median (IQR) Follow-up EQ-5D-5L scores, median (IQR) P value
    Non-cancer pain symptoms (n = 53) Mobility 2.0 (1.0 to 3.0) 2.0 (1.0 to 3.0) 0.022
    Self-care 1.0 (1.0 to 2.0) 1.0 (1.0 to 2.0) 0.046
    Usual activities 3.0 (2.0 to 4.0) 2.0 (1.0 to 3.0) 0.007
    Pain/discomfort 3.5 (3.0 to 4.0) 3.0 (2.0 to 3.0)
    Anxiety/depression 2.0 (1.0 to 3.0) 2.0 (1.0 to 2.0) 0.017
    Mental health symptoms (n = 21) Mobility 1.0 (1.0 to 1.0) 1.0 (1.0 to 1.0) 0.577
    Self-care 1.0 (1.0 to 1.75) 1.0 (1.0 to 1.0) 0.096
    Usual activities 3.0 (2.0 to 3.0) 1.0 (1.0 to 2.0) 0.002
    Pain/discomfort 2.0 (1.0 to 3.0) 1.0 (1.0 to 2.0) 0.039
    Anxiety/depression 4.0 (3.0 to 4.0) 2.0 (1.5 to 3.0) 0.002
    Neurological symptoms (n = 11) Mobility 1.0 (1.0 to 3.0) 1.5 (1.0 to 2.0) 0.317
    Self-care 1.0 (1.0 to 3.0) 1.5 (1.0 to 2.0) 0.317
    Usual activities 3.0 (1.75 to 4.0) 2.5 (1.75 to 3.25) 0.194
    Pain/discomfort 3.0 (1.5 to 3.5) 3.0 (1.5 to 3.0) 0.18
    Anxiety/depression 3.0 (2.0 to 3.0) 1.5 (1.0 to 3.0) 0.194
    Cancer symptoms (n = 24) Mobility 1.0 (1.0 to 2.0) 1.0 (1.0 to 2.0) 0.56
    Self-care 1.0 (1.0 to 2.0) 1.0 (1.0 to 1.0) 1
    Usual activities 2.0 (1.0 to 2.75) 2.0 (1.0 to 3.0) 1
    Pain/discomfort 3.0 (2.0 to 3.0) 2.0 (1.0 to 2.5) 0.047
    Anxiety/depression 2.0 (1.0 to 3.0) 1.0 (1.0 to 2.0) 0.11

    Score of 1 = no problems, 2 = slight problems, 3= moderate problems, 4 = severe problems, 5 = extreme problems. P values are calculated from Wilcoxon rank sum tests. ‘Before’ scores taken at first consultation. ‘After’ scores taken after at least 3 weeks of cannabidiol intake.

    CBD = cannabidiol. IQR = interquartile range.

    Patient-reported satisfaction of CBD treatment found that 175 patients (70.0% of the 250 patients for whom there was available data, or 44.1% of the 397 patients prescribed the CBD), reported some level of satisfaction with CBD use (good, very good, or excellent). Seventy-five patients (30.0% of 250 patients, or 19.0% of 397 patients) reported no benefit from CBD use. There was no statistically significant relationship found between patient age or sex and patient-reported satisfaction.

    Side effects

    Adverse effects such as sedation and vivid dreams were experienced by 25 out of 253 patients (9.9%). A worsening of a pre-existing condition was reported by 2 of 253 (0.8%) patients upon follow-up. Thirty-eight of followed-up patients (15.0%) reported positive side effects of CBD use, such as improved sleep or improved appetite. Side effects experienced by follow-up patients are summarised in Table 3 .

    Table 3.

    Side effect Frequency, n (%)
    Positive effects
    Improved sleep 31 (12.3)
    Improved appetite 7 (2.8)
    Adverse effects
    Sedation 5 (2.0)
    Vivid dreams 5 (2.0)
    Emotional disturbances eg, irritable, depressed, anxious 5 (2.0)
    Disorientation 3 (1.2)
    Sleeplessness 1 (0.4)
    Nausea 1 (0.4)
    Constipation 1 (0.4)
    Diarrhoea 1 (0.4)
    Headaches 1 (0.4)
    Oral mucosa irritation 1 (0.4)
    Hallucinations 1 (0.4)

    Dosage

    Amongst those who completed the course of CBD, the dose per day ranged from 40mg/day to 300mg/day. However, dosage information was incomplete, existing for only 110 patients out of the 253 followed-up patients (43.5%). The clinician recommended dosing to at least 100 mg/day. Overall dosage between patients varied widely and was reported inconsistently by patients. Binary logistic regression analysis was conducted for the existing values and there was no significant association between dosage and patient-reported benefit from CBD (P = 0.145).

    Discussion

    Summary

    CBD treatment improved self-reported quality of life measures for patients in the non-cancer pain and mental health-related symptom groups. There was no statistically significant improvement in those with cancer or neurological symptoms. Of those prescribed CBD, 44.1% (or 70.0% of the follow-up group) reported good to excellent benefit for relatively intractable conditions; 19.0% of those prescribed CBD (or 30.0% of the follow-up group) reported no benefit. CBD is well tolerated in most patients and may be of benefit to patients with various intractable chronic conditions.

    Strengths and limitations

    The strength of this study is that it assesses effects of CBD on a large range of chronic medical conditions in a clinical context. Only three patients were excluded (due to extreme severity of their conditions).

    There are several limitations to this present audit. There was a large loss to follow-up due to patients not attending follow-up and cost barriers. Hence, the results reported may not be fully representative of the entire patient population. Moreover, patients had to pay USD300 for 2500 mg of the CBD oil, USD150 for an initial consultation, and USD75 for follow-up. Most patients had refractory chronic pain and conditions resistant to conventional treatment uncommon in the wider population, increasing risk of selection bias. These patients are unlikely to be representative of a wider, more generalised cohort of patients. It is difficult to elucidate the effect of selection bias on these findings. The high cost barriers may augment the placebo effect of treatment, 15 resulting in an overestimation of treatment effects. However, due to many patients having resistant symptoms, CBD may conversely prove more efficacious in patients with less severe symptoms.

    The follow-up period was variable, resulting in interviews with some patients who had stopped taking CBD for a period of months. This may have confounded the patient’s recollection of the effects of CBD, likely causing an underestimation of the effect. Some follow-up was completed by the clinician instead of a non-clinical author. This increased the risk of expectation bias by the clinician, likely overestimating the effect. Considering these limitations, results should be interpreted with the appropriate caution.

    Comparison with existing literature

    Numerous preclinical trials 9 , 10 and neuro-imaging studies 8 have demonstrated the anxiolytic effects of CBD. A recently published case-series in psychiatric patients found a benefit of CBD for anxiety and sleep, 16 which is in agreement with the above findings.

    On a pharmacological level, preclinical trials suggest CBD’s analgesic action is due to its effect on certain receptors: TRPV1 and a3 GlyRs, involved in nociceptive transmission. However, human studies are still inconclusive. 17 – 19 The apparent benefit of CBD on pain reported by patients in this audit remains difficult to interpret. Current guidelines for the prescription of medicinal cannabis, including both 9-Δ-THC and CBD, recommend it as a third-line treatment for neuropathic pain, palliative and end-of-life pain, chemotherapy-induced nausea and vomiting, and spasticity due to multiple sclerosis or spinal cord injury . 20 However, RCTs investigating the use of CBD alone for the treatment of pain are lacking.

    The ineffectiveness of the CBD oil for 75 of the 250 patients with available data (30.0%) may be due to lack of patient compliance and inadequate dosing. The expense of the pure CBD 100 mg/mL may have influenced patient attitudes towards this matter. Previous studies investigating CBD’s anxiolytic effect have shown a U-shaped dose curve with highest efficacy at 300 mg as a single-dose. 21 This audit did not find a statistically significant dose-response, likely due to missing data and the aforementioned factors regarding financial cost.

    CBD’s ineffectiveness in improving self-reported health in patients in the cancer and neurological groups may be due to the high heterogeneity of the clinical presentations within these groups. Additionally, patients within these groups had more severe disease progression compared to the mental health and non-cancer pain symptom groups, which may have limited efficacy.

    Overall, CBD treatment was well tolerated with mild adverse effects, most commonly related to sedation. This is consistent with the findings of a phase I clinical trial showing the main side effects of CBD were related to the gastrointestinal and central nervous system. 12 Patient-reported sleep benefits are likely related to these sedative effects. While cannabis (containing both 9-Δ-THC and CBD) has been indicated for use as an appetite stimulant in HIV-affected patients with cachexia, 22 , 23 it remains unclear if CBD alone has significant appetite stimulating effects beyond placebo. Long-term side effects were not analysed in this current audit and future study is still needed to clarify chronic effects of CBD administration. 24

    Implications for research and practice

    Some urgency on this topic exists due to the increasing worldwide legalisation of cannabis and its related products. A focus should be placed on confirming the anxiolytic effects of CBD in clinical conditions. Future studies should investigate the effectiveness of full spectrum CBD oil with the retention of terpenes, the essential oils found in cannabis plants. Terpenes may enhance the effects of pure CBD because of a synergistic effect known as the entourage effect.

    Overall, this audit demonstrated the potential benefit of CBD in treating anxiety and pain. The present study shows that it improves quality of life for a diverse range of patients. CBD in this population has been shown to be safe and well tolerated. However, despite potential biases of patients influenced by the high treatment cost, pure CBD is not effective for all. Benefit was more pronounced in patients who had conditions with less severe disease progression (such as mental health or non-cancer chronic pain conditions). Due to lack of a control group, high drop-out rate, and an extreme patient population, these study results should be interpreted with caution. Future studies should investigate effects of long-term CBD use, which could not be analysed in this present audit.

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