Medicinal cannabis for chemotherapy-induced nausea and vomiting: prescribing with limited evidence

Although medicinal cannabis can now be prescribed for CINV, high quality clinical trial evidence is required to determine its efficacy and safety

Access to medicinal cannabis in Australia is a rapidly evolving and controversial field that is relevant to clinicians across a range of medical disciplines. There is widespread community interest in allowing access to medicinal cannabis for a variety of unapproved indications, despite a lack of high level evidence of efficacy.1 Legal and regulatory constraints make this access challenging; however, state and federal governments have now passed legislation enabling prescription by medical practitioners of medicinal cannabis in defined circumstances.2 In recognition of the lack of high level evidence supporting the use of medicinal cannabis for indications including but not limited to cancer pain, refractory paediatric epilepsy and palliative care, combined with the lack of formalised teaching in medical training programs, the Australian Government Therapeutics Goods Administration, in conjunction with state and territory governments, has commissioned a systematic review into the efficacy of medicinal cannabis, and has developed guidance documents for indications in which the evidence base is strongest to assist clinicians in appropriate prescribing of cannabis-based products.3 Despite these initiatives, willingness by medical practitioners to prescribe remains a significant barrier, with only 34 registered prescribers as of 31 July 2018.4