Medical cannabis use in the Australian community following introduction of legal access: The 2018-2019 Online Cross-Sectional Cannabis as Medicine Survey (CAMS-18)

Abstract

Background : In 2016 the Australian federal government passed legislation enabling a range of cannabis-based products to be prescribed to patients by registered healthcare professionals. An online survey conducted immediately prior to these legislative changes found that the vast majority of respondents at the time were illicitly sourcing cannabis plant matter, smoking was the preferred route of administration, and mental health, chronic pain, and sleep conditions were the most frequently cited reasons for medical cannabis use. This manuscript reports the results of a follow-up survey conducted in 2018-2019, the Cannabis As Medicine Survey (CAMS-18). The goal of this second questionnaire was to examine patterns of use and consumer perspectives regarding medical cannabis use in Australia, two years after the introduction of legal access pathways. Methods : Anonymous online cross-sectional survey with convenience sample, recruited mainly through online media between September 2018 and March 2019. Participants were adults (18 years or over) residing in Australia who reported using a cannabis product for self-identified therapeutic reasons during the preceding 12 months. The survey measured consumer characteristics; indications and patterns of medical cannabis use; routes and frequency of administration; perceived benefits and harms; experiences and preferred models of access to medical cannabis. Results : Data were available for 1388 respondents. The main categories of condition being treated with medical cannabis were pain (36.4%), mental health (32.8%), sleep (9.2%), neurological (5.2%) and cancer (3.8%). Respondents reported using medical cannabis on 15.8 (11.2) days in the past 28, by inhaled (71.4%) or oral (26.5%) routes and spending AUD$82.27 ($101.27) per week. There were high levels of self-reported effectiveness, but also high rates of side effects. There was uncertainty regarding the composition of illicit cannabinoid products and concerns regarding their possible contamination. Few respondents (2.7%) had accessed legally prescribed medical cannabis, with the main perceived barriers being cost, dis-interest from the medical profession, and stigma regarding cannabis use. Conclusions : Chronic pain, mental health and sleep remain the main clinical conditions for which consumers report using medical cannabis. Despite two years of legal availability, most consumers in Australia reported accessing illicit cannabis products, with uncertainty regarding the quality or composition of cannabis products.

Prescribing medicinal cannabis

“…36 The reasons for this may include the high cost of unregistered cannabisbased products compared to illicit cannabis (which is often home-grown), the inability to find a doctor who will assist in making an application to the TGA, lack of knowledge of official access pathways, and a reticence to discuss cannabis use with a doctor. 34,35 Illicit cannabis products are likely to be suboptimal as therapeutics. They probably contain a great deal of THC and little CBD 37 and may also contain contaminants such as pesticides and heavy metals.…”

“…Despite the exponential rise in approvals under the SAS-B scheme, surveys suggest that many Australians continue to self-medicate with illicit cannabis. 34 , 35 Indeed, the National Drug Strategy Household Survey recently reported that 600,000 Australians use cannabis for medicinal purposes, but only 3.9% obtain it via legal pathways. 36 The reasons for this may include the high cost of unregistered cannabis-based products compared to illicit cannabis (which is often home-grown), the inability to find a doctor who will assist in making an application to the TGA, lack of knowledge of official access pathways, and a reticence to discuss cannabis use with a doctor.…”

“…36 The reasons for this may include the high cost of unregistered cannabis-based products compared to illicit cannabis (which is often home-grown), the inability to find a doctor who will assist in making an application to the TGA, lack of knowledge of official access pathways, and a reticence to discuss cannabis use with a doctor. 34 , 35 …”

Lack of evidence for the effectiveness or safety of over-the-counter cannabidiol products

“…88 An Australian survey of 1388 medicinal cannabis users listed a similar range of indications, including pain (62%), sleep (49%), mental health (45%), gastrointestinal disorders (13%), neurological disorders (11%) and cancer (8%). 89 However, the evidence base for most of these putative indications is limited, with the exception of anxiety. A recent systematic review identified six randomized pre-clinical studies in this area.…”

Framing the use of cannabis as a medicine in New Zealand: Regulatory, Clinician and Patient contexts

“…This survey was then repeated in 2018 (CAMS-18, n=1388). 98 The majority of participants in the CAMS-16 survey, who predominantly used illicit cannabis for medicinal symptoms indicated that they believed that cannabis should be legal for all uses (88.8%). 97 A further 11.0% indicated it should be legal for medical purposes only, with approximately 90% indicating they 'strongly agreed or agreed' that medicinal cannabis should be part of routine health care in Australia.…”