Long-term experiences of patients prescribed medicinal cannabis in Australia: a qualitative interview study

There is limited, but emerging, evidence supporting the use of medicinal cannabis (MC) to manage pain, anxiety, spasticity, insomnia and depression. Although Australian legislation changed in 2016 to provide access to unapproved MC products, clinical guidance on prescribing MC is limited because it is still mostly an unapproved therapy accessed under strict conditions. Since legislation changed, little is known about the long-term lived experience of patients being prescribed unapproved MC products in Australia. We aimed to explore, and obtain an in depth understanding of, the long-term experiences of patients prescribed MC.

Using an interpretive qualitative approach, participants were recruited from the Quality-of-Life Evaluation Study, a nationwide longitudinal study of patients with any chronic health condition prescribed orally administered MC oil over 1 year. Semi-structured interviews explored experiences of accessing and using MC during and since completing the Quality-of-Life Evaluation Study. Thematic analysis identified themes and subthemes from the data.

Fifteen participants aged 33-78 years (nine female) who had completed the Quality-of-Life Evaluation Study and renewed MC oil prescriptions within the previous 6 months to manage chronic pain, insomnia, muscle spasticity, anxiety or depression were interviewed. Analysis identified four overarching themes: 'This isn't living'; 'I was looking for a solution'; 'It wasn't to get high'; and 'Everything's much better', and eight subthemes covering concerns, barriers, patient autonomy and benefits. Participants commonly used MC to reduce or replace conventional medications taken for their conditions, and viewed MC as a low-risk 'natural' alternative. Barriers to accessing MC included difficulties obtaining prescriptions and the cost of MC products. Participants reported symptom improvements that flowed on to benefit relationships, productivity and mental health over the long term. Although initially concerned about side-effects, participants self-managed these effectively, with perceived benefits outweighing side-effects. Participants described roadside drug testing as an ongoing concern.

This group of patients prescribed orally administered MC oil in Australia reported many benefits of MC, but faced ongoing barriers to MC access. Improved awareness and education, simplified prescribing processes, and less prohibitive driving laws could lead to wider acceptance of MC as a therapeutic option and improved patient-centred care.