Medical cannabis (also known as CBD oil) is not a first line treatment but the Royal Australian College of GPs guidelines recognise it as a valid therapy for consideration once all first line, conventional options have been tried. So, for medical condition of more than 3 months duration, where conventional medications have not proven effective or the side effects have outweighed the benefits, then it may be worth having a detailed discussion about the potential benefits and downside of medicinal cannabis with one of our doctors.
At the Wholistic Medical Centre, Dr Nick Bassal, Dr Amy Gajjar, Dr Marie Paek an Dr Suzi Wigge are all registered with the Therapeutic Goods Authority – Special Access Scheme (TGA SAS) to prescribe Cannabis.
Cannabis or CBD oil can only be prescribed by a Doctor through an individual application on your behalf to the Therapeutic Goods Authority – Special Access Scheme TGA SAS.
The Wholistic Medical Centre Difference
At the Wholistic Medical Centre, unlike some other clinics who prescribe cannabis, we will consult with you from a holistic perspective.
Cannabis is not just another drug, herb or magic bullet, we view it as an adjunct to holistic health care. So, where appropriate we can also discuss nutritional medicine, exercise, sleep and psychological support. It may also be useful to incorporate Chinese herbs relevant to your condition to improve outcomes. The above adjuncts will potentially have the effect of improving health outcomes, reducing the dose of cannabis you need and hence reduce the monthly cost and any potential side effects.
The Consultation Processes
For the initial appointment (which can be in person or via video) you will need to have relevant information such as medical history, letters from your GP or specialists. If Cannabis is indicated, the Wholistic Medical Centre doctor will make a formal online application to the TGA on your behalf. Note that your name is not revealed. We only need your initials and DOB.
You will be notified once we receive the approval from the TGA. You will be asked to make an appointment to discuss the specific medication and starting dose and things to look for. Your doctor will write a prescription and send/give that to you, along with the approval documentation. We will also endeavour to find a specific pharmacy near you that will provide you with the medication. Follow up appointments are advised initially fortnightly to establish the correct dose and then monthly for the first 6 months to monitor progress and thereafter every 3-6 months as advised to obtain repeat scripts.
If you would like to discuss further, please make an appointment.
Call 02 9211 3811 or make an online booking via our website.
Forms of Medical Cannabis
The oil (CBD oil) is the most commonly used method for administering medical cannabis. The whole plant extract is mixed with a food grade oil (e.g. olive, canola). A dropper is used to place the oil under the tongue, it is absorbed within a minute.
Taste is generally not an issue. Capsules containing the oil are also available.
There are other methods like using a vaporiser or inhalation and creams/patches, but these are not currently approved in Australia.
More on the History of Cannabis use in Medicine – click here
Absorption of Cannabis
When taken as an oil (most common form of medical cannabis) under the tongue, and not swallowed, Cannabis is absorbed directly into the blood stream and has medium bioavailability. The effects can be felt in 30min to 90min and last about 4-8 hrs.
When CBD cannabis is ingested, (as in added to food) i.e. goes through the digestive tract, has lower bioavailability and is slower to act 30min to 2 hours and lasts 3-6 hours.
By contrast smoking ‘community acquired’ cannabis (not recommended) provides high bioavailability and acts within a few minutes with a duration of 3 to 4 hours. The dose delivered by smoking is highly variable depending on the strain, potency of the plant, how it has been grown and dried. Generally smoking can deliver a dose of about 250mg to 1000mg of THC this of course hinges on initial quantity and how many people are sharing.
Can I drive?
In the doses that CBD and THC are medically prescribed driving is not likely to be impaired. The issue here are the driving laws regarding Drug Testing. Unlike alcohol, which allows certain permissible amounts, it is an offence in Australia to have any detectable amount of THC while driving. Even if your driving ability is not impaired. So, until Mobile Drug Testing legislation allows for minimal levels of medicinal THC (similar to alcohol), it is not advisable for you to drive when taking medication containing THC. Please discuss your individual circumstances with our doctors.
More on the Chemistry of Cannabis – click here
Which medical conditions are Medical Cannabis useful for?
- Chronic non cancer pain (CNCP)
- Chemotherapy induced nausea and vomiting (CINV)
- Cancer pain
- Multiple Sclerosis
- Inflammatory bowel disease
- Chronic insomnia
- Parkinson’s disease
- Alzheimer’s disease
- Sleep disturbance associated with Obstructive sleep apnoea (OSA)
Who cannot use Cannabis?
CBD oil is generally contraindicated in:
- Unstable cardiopulmonary disease
- Cardiovascular risk factors
- Pregnancy and breast feeding.
- Active mood disorder, a history of psychotic disorder, schizophrenia.
- Hypersensitivity to cannabis products
Caution required in:
- Patients < 25 years old. Cannabis can be used with careful monitoring in children/young adults with certain conditions like epilepsy (e.g. Dravet syndrome- drug resistant epilepsy) or autism.
- Kidney/liver impairment
- History of substance abuse
- Previous or family history of mental illness e.g. schizophrenia.
- Patients with risk of fall e.g. frail elderly patients.
Drug interactions – caution if taking these medications
- Blood thinning agents e.g. warfarin.
- Drugs/herbs that are also metabolised by CP450.
- Sedatives and analgesics- alcohol, benzodiazepines, anti-depressants, anti-epileptics
What are the side effects of Cannabis (CBD)?
The most common side effects are dry mouth, dizziness, disorientation, confusion, drowsiness, fatigue and anxiety.
Less commonly, people may also experience increased heart rate, impaired reaction times, fatigue, nausea, diarrhoea, vomiting and depression.
These effects are dose related and completely reversable.
That’s why we use the principle of “start low and go slow”. Each patient is started at a low dose, with any dose changes done gradually and closely monitored, especially in the initial phase. Once on a stable dose, the follow up visits can be less frequent. The aim is to be on a dose that provides maximum benefit with minimal side effects. Each patient will be different.
Costs of Medical Cannabis
The fees below apply to Medical Cannabis consultations with Dr Nicholas Bassal
Initial consultation- $228 for a 40 min consultation. The gap fee (your out-of-pocket amount) is $116.50. This is for the initial in person consultation. (it includes the time taken for Dr Bassal to complete the TGA SAS application on your behalf). Follow up consultations are shorter, the fee is $142.70 with a gap fee $66.95 . Follow up consults are needed to arrive at the right dose and formulation. Usually weekly for the first few weeks then as needed.
The gap fee is different if the first consultation is on video or phone. Medicare does not cover the fee if there has not been an initial in-person consultation.
So, in those cases you do not receive a rebate from Medicare.
In the unlikely event that your application is declined, unfortunately the initial consultation fee is not refundable
The cost of the medical Cannabis depends on the exact product recommended (CBD:THC ratio, supply company and pharmacy). The cost can vary between $95-$225 per script. Each script could last 3 to 10 weeks depending on your final effective dose.
Note- Currently cannabis products are not on the PBS (Pharmaceutical Benefits Scheme). So, there is no government subsidy. So, all the costs of the cannabis products as supplied by the pharmacy are privately paid for.
Additional Services that may complement Medical Cannabis
If you wish to gain from mindfulness-based psychotherapy, in addition to the cannabis, to assist in your holistic treatment, then a follow up consultation will be required with Dr Nicholas Bassal.
As Cannabis has been used in Traditional Chinese Medicine (TCM) for millennia, usually in conjunction with other herbs, TCM practitioners already know which Chinese herbs to use to boost the benefit of cannabis. Each case however needs to be individualised according to their TCM presentation. If that is of interest to you, then make a consultation with Tanya Newton our highly experienced TCM herbal practitioner.
Medicinal Cannabis prescribers with fees based on their usual standard hourly rates
Dr Amy Gajjar. is a prescriber of medical cannabis. Dr Amy Gajjar’s fees are based on her usual standard rate of $495/$430 per hour for initial consultations (with/without online questionnaire), or $250 for a 30minute initial consultation. Please see her practitioner profile for more fee details.
Dr Marie Paek is a prescriber of medicinal cannabis. Eligibility and suitability for medical cannabis will be conducted in the context of an integrative medical assessment. Dr Marie Paek’s fees are based on her usual standard rate of $350 per hour. Please see her practitioner profile for more fee details.
Dr Suzi Wigge is a prescriber of medicinal cannabis. Eligibility and suitability for medical cannabis will be conducted in the context of an integrative medical assessment. Dr Suzi Wigge’s fees are based on her usual standard rate of $395 per hour. The duration of your initial medical cannabis consultation for an existing patient would require 30 to 45 minutes with an item 36 ($75.05) as your rebate. Please see her practitioner profile for more fee details.
If you want to find out if CBD cannabis might help you
Please call 02 9211 3811 for an appointment.