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Doctor Information
Pack
CONFIDENTIAL – CDA CLINICSTM
Prescribing Doctors
Thank you for consider ing our products.
Please enter your contact detai ls on
CDAClinics.com.au for pr ice l ists and any
requirements.
Please consider becoming a CDA Associate
Doctor for work you are already preforming.
Please enter your contact detai ls on
CDAClinics.com.au
Prescr ibing medicinal cannabis
(MC) now?
Would you l ike to learn
how to prescr ibe
MC?
Do you have any pat ients to refer for medicinal
cannabis Rx?
Real ly, no pat ients? You are unique
That is a step on the r ight side of history. Please enter your contact detai ls via
CDAClinics.com.au for educat ional advice
Please send your pat ient to CDAClinics.com.au to f ind a local CDA doctor or use our telehealth
option. Please refer with a standard medical referral
YES
YES
YES
NO
NO
NO
REDISCOVERY
PROHIBITION
ANCIENT USE
Cannabis history
Sir William Brooke
O’Shaughnessy (1809 –
1889) introduced the
therapeutic use of
Cannabis to Western
Medicine after
scientifically validating its
effectiveness
From Ancient China to Ancient Greece, Cannabis
was safely used for medicine for 5000 years
At the end of Alcohol
Prohibition Mr Harry
Anslinger was facing
unemployment, but with
the backing of corporate
ties, he formed the
Federal Bureau of
Narcotics, whom focused
on prohibiting Cannabis
and spreading
propaganda about
Cannabis being a
“demon drug”
In 1964 Prof Raphael
Mechoulam first isolates
THC
The American Medical
Association of Doctors
lobbied hard to prevent
the prohibition of
Cannabis as medicine,
but facing imprisonment
abandoned the cause
In 2003 the USA
Department of Health
patented Cannabinoids as
Neuroprotectants (Brain
Protecting)
Australia became the first
whole continent to re-
legalize Medicinal
Cannabis in 2016
Prior to prohibition
Cannabis was the most
prescribed drug by
American Doctors
In 1996 California became
the first US state to re-
legalize Medicinal
Cannabis
Uruguay became the first
country in the world to re-
legalize recreational
cannabis in 2013. Canada
then legalized recreational
cannabis in 2018
LEGALISATION
CB1
receptors
Cannabinoid Type
1 (CB1) receptors
are found in the
brain and on nerve
cel ls
Act ivated CB1
receptors
downregulated the
upstream neuron
to protect the
downstream
neurons
The Endocannabinioid System
Every human has an Endocannabinoid System in their bodies
that restores homeostasis by promoting sleep, appetite, stress
reduction, modulation of pain and inflammation.
Cannabinoid compounds in Cannabis interact with the
Endocannabinoid System to produce effects
Cannabinoid Type
2 (CB2) receptors
are found in
immune system,
brain, and through
the body
Activated CB2
receptors act ivated
inf lammatory
modulat ion and
var ious other
ef fects
CB2
receptors
Other receptors are involved in the Endocannabinoid System
such as GPR18, GPR 55, GPR119, TRPV1, 5HT-3, Gly-R, PPAR
alpha and PPAR gamma
Ingesting vs Inhaling
Inhaled cannabis effects last 2 to 4 hours, which is beneficial for patients wanting to have quick on-set and quick off .
Ingested CannabisOnset in 30-90 minutes.Peak onset in 2-4 hours.Lasts 8-24 hours
Inhaled CannabisOnset within 90 seconds.Peak onset 15-30 minutesLasts 2-4 hours
Time
Onset
Ingested cannabis can have effects that last up to 24 hours, but generally effects dissipate after 12 hours meaning twice daily dosing is common.
Inhaled cannabis should be with a vapouriser set to above 185 degrees Celsius, but below where smoke or combustion occurs. After inhalation of a dose a patient should wait 10 minutes to see effects before repeat dosing.
Ingested cannabis will take up to 90 minutes to take effect, and therefore repeat dosing should only occur after this time to avoid side effects.
THC vs CBD
CBD (Cannabidiol) does not bind to CB1 receptors so is not psychoactive
at all. CBD works by inhibiting the degradation of natural endogenous
endocannabinoids, meaning the levels of endocannabinoid the body
makes are increase; making the natural endocannabinoid signalling more
effective.
THC (Tetrahydrocannabinol) binds to CB1 receptors in the brain, causing
downregulation of neuronal signals. In this way THC is considered
psychoactive, and may have effects on reducing pain, spasms, nausea,
vomiting, and improving sleep and appetite.
Cannabinoids are
metabolised by
CYP450 enzymes in
the liver and
throughout the body
Other drugs that are
also P450
metabolised should
be monitored and
adjusted
CYP450 enzyme
Metobolisation
THC CBD
The LD50 (median lethal dose) of THC is estimated at
>800mg/kg, and CBD at >1000mg/kg
THC does not cause
schizophrenia but it can
unmask it; thus
contraindicated in those
patients. Note: CBD is a
treatment consideration for
schizophrenia.
The National Academies of Sciences, Engineering and
Medicine (2017) report that cannabis has a lower risk of
dependence than coffee, alcohol, nicotine, and morphine.
Safety
There have been no recorded human deaths directly
attributable to acute cannabinoid toxicity ever
Beneficial Effects
• Analgesic• Anti-inflammatory• Anti-epileptic• Neuroprotective• Immuno-modulation• Anxiolytic• Anti-psychotic
Side Effects
CBD Effects
• Dry mouth• Fatique• Changes in
appetite• P450 inhibition• Diarrhoea
CBD
Beneficial Effects
• Anti-spasmotic• Analgesic• Anti-epileptic, in
some cases• Neuroprotective• Antiemetic• Anxiolytic, in some
cases• Decreases sleep
Apnea index and Insomnia
Side Effects
THC Effects
• Short term memory impairment
• Changes in appetite
• Nausea• Short term memory
impairment• Dizziness /
Hypotension• Anxiety / Paranoia /
Temporary Toxic Psychotic Symptoms
THC
Product Selection
CBD mitigates potential THC anxiety effects
Binds to CB1 receptors on
neurons
THC THC : CBD CBD
Increases natural Endocannabinoid
effectiveness
Neuroactive, sedating, driving
exclusion
Entourage effect of CBD with THC
Effects on CB2 receptors
1mg initiation2.5mg initiation
(total)2.5mg initiation
Max 120mg/dayMax / day
120mg : 1200mgMax 1200mg/day
Indication Consideration
Medical Marijuana Matrix
The doses above are oral
doses; Vaporised doses are
approx. half
CBD
THC
50mg
5mg
5mg 25mg
JUICERS
ANXIETY
PARKINSONS
EPILEPSY
BACK PAIN
SPASMS
SEVERE PAIN
INSOMNIA
PTSD
THC has an sedating and
neurotropic effects from 5mg
orally single dose
Always start with a low <2.5mg
dose and titrate up to the
patients symptom control
Treat the patient, not the
guideline
Eligibility
Chronic condition
lasting 3 months or
more, unless justifiable.
Medical drugs tried
but failed to resolve
indication
Medical drugs tried
with side effects
List other failed treatments e.g. Surgery,
Injections, Therapies
Clinical reviews to
stabilise, e.g. Week
1, Week 2, then
Monthly
INTENDED
MONITORING
Baseline ELFTs, and
1 month, or
stabilised dose
INDICATION
CLINICAL
JUSTIFICATION
Monitor P450 metabolised medication levels
Symptom
treatment
TGA
APPLICATION
What conditions can medicinal cannabis be
prescribed for?
“FAST TRACK” CONDITIONS• chronic pain• palliative care• epilepsy• chemotherapy induced
nausea• multiple sclerosis
ANY CHRONIC CONDITION THAT…
• has lasted 3 months or longer
• and has not responded to conventional medical treatment, or has side effects
MEDI CINA L CA NNA BI S
PRESCR I PT I ON A PPL ICATI ON
TGA SA S B & S TA TE
A PPRO VA LS
Cannabis oil is a simple and easy to administer form. You can use the
dropper cap or the provided measuring syringe to get an accurate
dosage. Patients are advised that sublingual is the best
administration. The carrier oil can be Hemp Seed Oil, Olive Oil,
Fractionated Coconut Oil (MCT) or Grapeseed Oil.
Product Forms
Cannabis f lower comes mil led and needs to be heated
and inhaled. The patent is advised to vaporise the f lower
to decarboxylate the cannabis at the correct
temperature. Inhal ing i t in this way increases the onset,
and it wears off sooner. This makes inhal ing useful for
people who need fast-act ing treatment for ai lments such
as spast ic ity.
Cannabis products come in a
variety of forms. Selection of the
product depends on the patient
condition, ease of use, dosage,
Oi l Capsu les
Typical ly preferred by people who suffer f rom respiratory
problems, young chi ldren and those who want to protect
their health, Cannabis Oil Capsules are safer and more
discreet than other forms of cannabis products. Pi l ls also
provide a exact and steady dosage and they don’t smell l ike
f lower or oi l can.
Product Forms
Crystal
Crystals are highly ref ined and the pures t fo rm of CBD. Unl ike other extracts,
crystals are at least 98% pure, meaning that no other substances are present in
your product. Crystal comes in a salt - l ike form in a smal l container and unl ike
other product forms, doesn’t need to be stored in any way.
Cor rect dos ing
Crystal are easier to dose with since they are a pure form of the cannabinoid. I f
you need to take 1 mg of CBD a day, you simply need to measure out 1 mg of
crystal , rather than having to f igure out how to ensure that you’re gett ing the
correct dosage.
Versat i l i t y
You can take i t in many dif ferent forms depending on your tastes and
preference.
A highly convenient way to take crystals is to mix with an e- l iquid for a vape pen.
There are tons of dif ferent kinds of e- l iquids avai lable, many of them containing
no nicot ine, only f lavour. You can mix up to 200 mg of crystals into 10 mg of the
e- l iquid. You wi l l need to slowly heat the mixture to al low the CBD crystals to
ful ly absorb into the l iquid. I t can then be vaped l ike any other l iquid.
You can also mix i t with many dif ferent types of oi ls. . The standard potency of
most oi l is about 10%, so you wi l l want to mix about a gram of crystals in with 10
ml of whatever oi l you are using. You wi l l need to warm the oi l enough to al low
the crystals to dissolve into the oi l . The best oi ls to use are Hemp Seed Oil or
Olive Oil .
Crystal can also be compounded into a topical cream or mixed into baking.
Fi rst t ime prescr ipt ions
For first time prescriptions (Rx) you will need to load the product into
your computers system or write it by hand on a prescription pad.
Handwritten Rx: Written in short hand and words
Computer generated: Hand written under computer text l ike an
Opiate Rx
Important!
Attach to the Rx the TGA Approval and State Approval if
applicable
Write starting / current dose and maximum titration
Write Rx as a S8 requires in your state
Important Checks
Repeats
Repeats are not allowed, however pharmacists are allowed to partially
dispense a Rx. Therefore, prescribing the max monthly amount means
a patient can collect 1 bottle/item at a time.
Pharmacists
Pharmacists will need to get in touch with our wholesaler to order the
product that you have prescribed. Pharmacists are able to make an
order on our website: CDAClinics.com.au/pharmacists
How to write a medicinal cannabis prescription.
Check DOB on RxCheck SAS # on Rx
ORAL DOSING GUIDECONDITION THC:CBD RECOMENDED DOSE
Anxiety CBD2.5mg BD, titration double dose Q3days up to
300mg BD maxChemo-induced
NauseaTHC>>CBD 2.5mg titrated up to 20mg QID reg or PRN
Chronic Pain1+:1, a cohort of
patients respond to CBD alone
2.5mg PRN titration up to max 20mg per hour and max 120mg per day
Endometriosis THC<CBD 2.5mg titrated up to 25mg QID reg or PRN
EpilepsyCBD, in resistant
cases add a little THC after CBD titration
2.5mg/kg BD, increase Q1 week by 2.5mg/kg QID to max dose of 1000mg/day
Fibromyalgia THC<CBD 2.5mg titration up to 25mg QID reg or PRNInflammatory
DiseaseCBD (some evidence for CBDA and THCA)
2.5mg titration up to 25mg QID reg or PRN
Insomnia / Sleep Disorder
THC>CBD 2.5mg Nocte, titration to max 50mg
Migraine 1:1 2.5mg titration up to 25mg BD reg or PRNMS Insomnia / Sleep Quality
1:1 2.5mg Nocte, titration to max 50mg
MS PainTHC > CBD, some respond to either
2.5mg PRN titration up to max 120mg per day
Dystonia / Spasticity
1:1 2.5mg PRN titration up to max 120mg per day
Neuropathic Pain1+:1, a cohort of
patients respond to CBD alone
2.5mg PRN titration up to max 20mg per hour and max 120mg per day
Paediatric EpilepsyCBD, in resistant
cases add a little THC after CBD titration
1mg/kg BD, increased Q1week by 1mg/kg BD to max dose of the lower of 20mg/kg/day or
1000mg/day (some studies go to 50mg/kg/day)
Palliative Care Regular Dosing
1:10 moving to 20:4 if required
2.5mg BD titrated up to 120mg per day
Palliative Care PRN Dosing
1:10 moving to 20:4 if required
2.5mg PRN titration up to max 20mg per hour and max 120mg per day
PTSD1+:1, a cohort of
patients respond to CBD alone
2.5mg PRN titration up to max 20mg per hour and max 120mg per day
Schizophrenia CBD25mg BD, titration to max 1200mg per day
(consider QID dosing)
Sleep Apnoea THC 2.5mg Nocte, titration to max 50mg
Doses above are oral. PRN = As required, BD = Twice per day, TID = Three per day, QID = 4 times per day, Nocte = Each
night, Titrate = Gradually adjust, Q2 = every 2 days.Example prescription wording: Oil 2.5 mg BD, max 10mg /day.
Prescription wording Wikipedia
VAPE DOSING GUIDECONDITION THC:CBD RECOMMENDED DOSE
Anxiety CBD1mg QID, titration double dose Q3days up to 50mg QID
max
Chemotherapy-Induced Nausea
THC>>CBD 1mg titrated up to 20mg QID reg or PRN
Chronic Pain1+:1, a cohort of
patients respond to CBD alone
1mg PRN titration up to max 20mg per hour and max 100mg per day
Dystonia / Spasticity 1:1 1mg PRN titration up to max 100mg per day
Endometriosis THC<CBD 1mg titrated up to 25mg QID reg or PRN
EpilepsyCBD, in resistant
cases add a little THC after CBD titration
1mg/kg BD, increase Q1week by 1mg/kg QID to max dose of 500mg/day
Fibromyalgia THC<CBD 1mg titration up to 25mg QID reg or PRN
Inflammatory DiseaseCBD (some evidence for
CBDA and THCA)1mg titration up to 25mg QID reg or PRN
Insomnia / Sleep Disorder
THC>CBD 1mg Nocte, titration to max 50mg
Migraine 1:1 1mg titration up to 25mg QID reg or PRN
MS Insomnia / Sleep Quality
1:1 1mg Nocte, titration to max 50mg
MS PainTHC > CBD, some respond to either
1mg PRN titration up to max 100mg per day
Neuropathic Pain1+:1, a cohort of
patients respond to CBD alone
1mg PRN titration up to max 20mg per hour and max 100mg per day
Paediatric EpilepsyCBD, in resistant
cases add a little THC after CBD titration
0.5mg/kg QID, increased Q1week by 0.5mg/kg BD to max dose of the lower of 10mg/kg/day or 500mg/day
(some studies go to higher dose)
Palliative Care Regular Dosing
1:10 moving to 20:4 if required
1mg QID titrated up to 100mg per day
Palliative Care PRN Dosing
1:10 moving to 20:4 if required
1mg PRN titration up to max 20mg per hour and max 100mg per day
PTSD1+:1, a cohort of
patients respond to CBD alone
1mg PRN titration up to max 20mg per hour and max 100mg per day
Schizophrenia CBD 5mg QID, titration to max 1000mg per day
Sleep Apnoea THC 1mg Nocte, titration to max 50mg
Doses above are for inhaled vaporizer. Product type (e.g. crystal) may require starting at 10 mg. For vapourised product focus on PRN
titration to symptom effect, e.g. 0.1g dried flower or 1mg Q10mins PRN for symptom control titration to max 2g/day. After an inhaled dose of vaporizer wait 10 mins to see if symptoms are
controlled; a repeat dose or larger dose can then be tried every 10 mins. PRN = As required, BD = Twice per day, TID = Three per day, QID = 4 times per day, Nocte = Each
night, Titrate = Gradually adjust, Q2 = every 2 days, Q10 mins = every 10 mins.Example prescription wording: (1) Flower 0.1g Q10mins PRN, max 2g/day; (2) Vape Solution 1
mg Q10 mins PRN, max 10mg /day. Prescription wording Wikipedia
CONSULTATION
COSTSCLINIC
MEDICARE
REBATE
Clinic Only
TELE
HEALTH
Application
consultation$199 $71 $199
Prescription
Collection- - -
Review / Repeat
Prescription$65 $37 $59
Approval renewal $170 $71 $99
These prices are only a guide. Each practitioner and clinic sets
their own prices dues to local overhead costs. CDA Prescriber
support allows for streamlined consultation and application.
Medicare rebates are only available with a physical clinic visit and
not available with TeleHealth or online consultations.
Patients located in a remote area without access to a prescribing
doctor may qualify for a TeleHealth Medicare rebate.
Consultation Costs
TGA SAS Portal
Clone patient
applications
Download
documentationsas.fga.gov.au
New
applications
Expiring
approval l ist
Searches e.g.
patient initials
TGA SAS Portal 2
Autogenerated prescriber info
TGA SAS Portal 3
Search “CDA”Select Medicine
Select Notify State
Select NOT SAS A
TGA SAS Portal 4
Initial to Maximum Dose
Write CDA Product Name
Supplier –Burleigh Heads
Cannabis
Indication
Clinical
justif ication
Intended
monitoring
TGA SAS Portal 5
Patient Details
Patient Class
Prescriber option State Information
Requirements
Prescriber
infomation
Patient
information
TGA SAS Portal 6
Prescription Pathway
Application consultation
Prescription collection
Review week 1
Review week 2
Monthly reviews and
prescriptions
APPEAL OR REASSESS
Declined
CLONE REAPPLICATION
TGA / STATE ASSESSMENT
Patient provides
doctor with Referral Letter
and Medical Information
Further Info Required
References
REFERENCE SOURCE
Access to medicinal cannabis products – The Therapeutic Goods
Administration
https://www.tga.gov.au/access-medicinal-cannabis-products-1
Guidance for the use of medicinal cannabis for the prevention or
management of nausea and vomiting in Australia – The Therapeutic Goods
Administration
https://www.tga.gov.au/publication/guidance-use-medicinal-cannabis-
prevention-or-management-nausea-and-vomiting-australia
Guidance for the use of medicinal cannabis in Australia: Overview – The
Therapeutic Goods Administration
https://www.tga.gov.au/publication/guidance-use-medicinal-cannabis-
australia-overview
Guidance for the use of medicinal cannabis in the treatment of chronic
non-cancer pain in Australia – The Therapeutic Goods Administration
https://www.tga.gov.au/publication/guidance-use-medicinal-cannabis-
treatment-chronic-non-cancer-pain-australia
Guidance for the use of medicinal cannabis in the treatment of epilepsy in
pediatr ic and young adult patients in Australia – The Therapeutic Goods
Administration
https://www.tga.gov.au/publication/guidance-use-medicinal-cannabis-
treatment-epilepsy-paediatr ic-and-young-adult-patients-australia
Guidance for the use of medicinal cannabis in the treatment of multiple
sclerosis in Australia – The Therapeutic Goods Administration
https://www.tga.gov.au/publication/guidance-use-medicinal-cannabis-
treatment-multiple-sclerosis-australia
Guidance for the use of medicinal cannabis in the treatment of pall iat ive
care patients in Australia – The Therapeutic Goods Administration
https://www.tga.gov.au/publication/guidance-use-medicinal-cannabis-
treatment-pall iat ive-care-patients-australia
Medicinal Cannabis - The Office Of Drug Control
https://www.odc.gov.au/medicinal-cannabis
The Health Effects of Cannabis and Cannabinoids - The National
Academies of Sciences, Engineering and Medicine
https://www.nap.edu/catalog/24625/the-health-effects-of-cannabis-and-cannabinoids-the-current-state
Update of Cannabis and its medical use - World Health Organization
https://www.who.int/medicines/access/controlledsubstances/6_2_cannabis_up
date.pdf
CDA Help Phone +61 468 459 540
info@cdacl in ics .com.au
Contacts
BHC Help Phone +61 478 943 237
orders@bur le ighheadscannabis .com
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