NSW Cannabis Medicines Advisory Service | Applying for authority to prescribe and supply cannabis products | Writing a prescription | Dispensing | Manufacture | Import | Wholesale supply | Contact details for further information
Streamlining processes for applications to prescribe cannabis medicines
On 2 March 2018, the NSW and Commonwealth governments announced a change in the prescribing process in NSW to improve individual patient access to unregistered cannabis medicines by introducing a single application process.
NSW Health relies on a single clinical assessment by the Therapeutic Goods Administration (TGA) under the Special Access Scheme and confines its review to checking the credentials of the prescribing doctor and the patient history, as with any other Schedule 8 drug authority.
TGA online system for unregistered cannabis medicines
On 30 July 2018, the Commonwealth government announced a new single application online system for authority to prescribe unregistered cannabis medicines under the Special Access Scheme. This online system is available on the TGA’s website.
Medical practitioners can continue to use the existing Special Access Scheme application forms if they wish. These forms are also available on the TGA's website.
Registered cannabis medicines
NSW Health has also introduced streamlined processes for registered cannabis medicines. At present the only cannabis product registered as a medicine and marketed in Australia is nabiximols oromucosal spray (Sativex®).
Information on how to apply for a NSW authority to prescribe a cannabis medicine for a patient is provided further below.
The NSW Cannabis Medicines Advisory Service
The NSW Cannabis Medicines Advisory Service is available to assist doctors in NSW with the streamlined application process. Doctors can contact the Service by email HNELHD-CMAS@hnehealth.nsw.gov.au or telephone (02) 4923 6200.
The Service can also provide doctors with up-to-date information about managing the symptoms their patient is experiencing, and any clinical trials using cannabis medicines that might be relevant.
A TGA review of the current clinical evidence for cannabis products in paediatric and adult epilepsies, multiple sclerosis, nausea and vomiting resulting from chemotherapy and HIV/AIDS therapy, pain, and palliative care is available on the TGA website.
Applying for authority to prescribe and supply cannabis products
Generally it is illegal to supply any medicine product which is not registered with the Therapeutic Goods Administration (TGA). Certain unregistered cannabis products can be prescribed and supplied if the prescriber and products meet certain requirements.
Note that not all of these requirements apply to cannabidiol – see details further below.
To apply to prescribe under the Special Access Scheme, use the forms published on the TGA's website.
The form Application for Authority to Prescribe and Supply a Cannabis Product for Human Therapeutic Use is to be used to apply for NSW authorisation to:
- prescribe a registered cannabis medicine
- prescribe under the Authorised Prescriber Scheme
- prescribe for a clinical trial
When considering applications, NSW Health records are checked to determine if the prescriber’s authorities for prescribing scheduled medicines have been withdrawn by the Secretary under the Poisons and Therapeutic Goods legislation. Consideration will be given to any conditions placed on the prescriber’s registration as a medical practitioner (as may be published on the Australian Health Practitioner Regulation Agency’s Register of Practitioners).
Prescribers with a history of diversion of controlled substances or poor practice in managing patient/s’ diversion of such substances are unlikely to be granted an authority.
Where the patient is aged under 16 years, the prescriber may also need to meet other legal obligations, e.g. authorisation under s175 of the Children and Young Persons (Care and Protection) Act.
Medical Practitioners may contact Pharmaceutical Services on (02) 9391 9944 or email email@example.com for more information on NSW authorities to prescribe medicines.
Requirements on the prescriber
To prescribe and supply a Schedule 8 cannabis product, the prescriber must:
- be a registered medical practitioner who may lawfully prescribe scheduled medicines in NSW; and
- hold an authority issued by the Secretary, NSW Health, to prescribe that particular product for a particular patient (or a particular group of patients in case of an approved clinical trial); and
- hold an approval issued by the Secretary, Commonwealth Department of Health to import and/or supply that particular product under the Commonwealth’s:
- Special Access Scheme Category A or B (for a particular patient), or
- “Authorised Prescriber” scheme (for a particular group of patients), or
- Clinical Trial schemes (for a particular group of patients)
The prescriber or pharmacist who will supply the product must either:
- obtain a licence and a permit to import the unregistered product, issued under the Customs (Prohibited Imports) Regulation by the Commonwealth Office of Drug Control (ODC); or
- obtain the product from an importer holding both a licence from NSW Ministry of Health to supply the product by wholesale, and a licence and a permit to import the product issued by the ODC; or
- obtain the product from a manufacturer licensed by the TGA, the ODC and the NSW Ministry of Health (or the equivalent authority in its home Australian State or Territory) to manufacture the product.
The TGA publishes a flowchart that summarises the requirements for an Australian registered medical practitioner to access cannabis products.
Requirements on the product
The product applied for must have been lawfully manufactured or imported, i.e. under a Commonwealth licence or an approval. The application must include full details of the product including its form, composition, and administration. Some cannabis-based products have been formally assessed for quality, safety and efficacy by a medicines regulator in Australia or another country, including:
- Nabiximols (Sativex®) for managing spasticity associated with multiple sclerosis
- Dronabinol for anorexia in AIDS patients and chemotherapy-induced nausea and vomiting
- Nabilone for chemotherapy-induced nausea and vomiting.
Applications to prescribe are not limited to such products; however the product applied for must be legally produced and manufactured to appropriate quality standards.
The Commonwealth can license cultivation, production, manufacture and supply of cannabis and its products for therapeutic use. A NSW based manufacturer must also hold a licence issued by NSW Health to manufacture each cannabis product and supply it by wholesale.
The cannabis product must be derived naturally from the Cannabis plant, not synthetic substances (with the exception of the synthetic products dronabinol and nabilone which have been assessed by a foreign medicines regulator).
Products that might be accessed from unregulated sources, including oils, tinctures and plant material, are of unknown safety and efficacy and may include harmful substances and contaminants. These will not be authorised.
A cannabidiol preparation (when containing no more than 2% of other naturally-derived cannabinoids as impurities in the cannabidiol component) for therapeutic use is a Schedule 4 medicine (though there is no approved product) so no NSW Health authority is required. The other requirements for unregistered cannabis products apply, e.g. Commonwealth licences to import/manufacture and TGA approval (under SAS Category B, Authorised Prescriber or Clinical Trial schemes) are still required.
Writing a prescription
The medical practitioner must specify on the prescription for a Schedule 8 cannabis product:
- the name and description of the cannabis product (manufactured or imported under Commonwealth and NSW licences) which the medical practitioner has been authorised to prescribe,
- the NSW Health authority number issued to the medical practitioner.
- if prescribed in an approved Clinical Trial, its name and/or the Trial ID (ACTRNxx xxx xxx xxx xxx),
- (in the case of an unregistered medicine) the name of the pharmacy where the prescription will be dispensed, and
- all of the other requirements for the form of an Schedule 8 prescription, such as adequate directions for use, handwritten quantity in words and figures and repeat intervals (see Guide to Poisons and Therapeutic Goods Legislation for Medical, Nurse and Midwife Practitioners and Dentists for details).
The medical practitioner must make a prescribing record as for any Schedule 8 prescription.
A pharmacist can dispense a prescription for a Schedule 8 cannabis product (other than Schedule 4 cannabidiol) only if the prescriber is authorised by NSW Health to prescribe it and (except for nabiximols, dronabinol and nabilone) only at the pharmacy specified in the authority and written on the prescription by the prescriber.
The prescription cannot be legally dispensed unless it bears the NSW authority number and other details described above written by the prescriber.
A pharmacist can dispense only on receipt of a hard copy written prescription. (Emergency supply provisions do not apply.) Hospital pharmacies may supply for inpatients on a copy of a medication chart order.
The other usual requirements as for Schedule 8 prescriptions apply, e.g. the pharmacist must verify the prescriber, must report any apparently forged or fraudulently altered prescriptions, and must retain the dispensed prescription, separately from other prescriptions.
Cannabis products supplied to a patient (by a pharmacy or medical practitioner) must be labelled with a dispensing label with the usual details for any dispensed medicine including name of the product, prescription number, patient name, directions for use, date of supply, name and address of supplier.
A pharmacy (or medical practitioner) cannot hold stocks of a cannabis product in anticipation of an authority being issued to the medical practitioner to prescribe the product for supply from that pharmacy.
It should be noted that a pharmacy (or medical practitioner) cannot hold stock of any unregistered medicine unless it has been specially permitted by the Commonwealth as a substitute for a registered medicine.
All supplies and receipts of Schedule 8 cannabis products (whether dispensed on prescription or supplied directly by a medical practitioner) must be recorded in a drug register. If used in a clinical trial, a record of the NSW authority number must be made in the clinical trial records.
For further information see the Guide to Poisons and Therapeutic Goods Legislation for Pharmacists.
Any loss or theft of cannabis products must be reported to the Secretary, NSW Health, on the Notification of Loss or Theft of Accountable Drugs (S8 and S4D substances) form as for Schedule 8 drugs. Unwanted cannabis products may not be destroyed except by a person authorised to destroy Schedule 8 drugs.
Cultivation, production and manufacture of cannabis and its products require licences under the Commonwealth Narcotic Drugs Act and Therapeutic Goods Act. Detailed information on Commonwealth licences can be found on the TGA website. Manufacture of each cannabis product also requires a licence under the NSW Poisons and Therapeutic Goods Act. A NSW licence must be obtained first, using the Application for a Licence to Manufacture and Supply by Wholesale, Drugs of Addiction.
The TGA is responsible for the regulation of the quality aspects of medicinal cannabis products. The TGA's Therapeutic Goods Order No. 93 - Standard for Medicinal Cannabis (TGO 93) provides controls aiming to ensure acceptable quality of cannabis products and ingredients used in their manufacture.
An overseas supplier could supply a cannabis product directly to a medical practitioner, person responsible for a clinical trial or a pharmacist, provided that the supply is for the treatment of patients of the NSW- and Commonwealth-authorised medical practitioner and the Commonwealth has issued an import licence and permit. Alternatively the overseas supplier could supply to an Australian importer holding a Commonwealth licence and permit to obtain the product, and a licence from NSW (or its home Australian State or Territory) to supply the product by wholesale. Approval by the relevant authority of the national government of the exporting country must also be obtained before shipment can occur.
For further information on importing visit The Office of Drug Control. Application forms are provided on their website.
Possession for supply by wholesale (i.e. supply for the purpose of re-supply to a third party) of any cannabis product for therapeutic use (either imported under a licence and permit from the Commonwealth Office of Drug Control (ODC) or manufactured in Australia under TGA, ODC and State manufacturing licences) requires a licence under the NSW Poisons and Therapeutic Goods Act to supply cannabis product/s as drug/s of addiction (Schedule 8) (or restricted substance/s (Schedule 4) in the case of cannabidiol) by wholesale.
The NSW licence must be held before applying to the Commonwealth for an import licence. The type of licence required will depend upon whether the cannabis product is included in Schedule 8 or Schedule 4 (as in the case of some cannabidiol products) of the NSW Poisons List.
The licence application must be submitted with a full company extract obtained from the Australian Securities and Investment Commission, statutory declaration forms, fitness and probity check forms, and National Criminal Record Check certificates.
Upon acceptance of the application, a Drugs and Poisons Control Procedure template will be provided for completion, to describe the proposed handling of the cannabis product in compliance with the Australian Code of Good Wholesaling Practice for Medicines in Schedules 2,3,4 and 8 (the Code) and the Poisons and Therapeutic Goods legislation. The Code requires that a Security Risk Assessment of the business premises be prepared by a licensed security service provider, and for a Risk Management Plan to be developed.
Standard requirements for handling Schedule 8 drugs include storage in a strongroom or safe with restricted access, maintenance of a drug register, tamper-evident packaging of products, procedures for signed orders by authorised persons, consignment and receipt procedures, and packaging of orders.
An inspection of any proposed premises by NSW Health is undertaken prior to a licence being issued. On receipt of all satisfactorily completed documents and the proposed premises are found to be suitable, NSW Health will generally issue a licence within 20 business days. Licences are subject to conditions.
Companies with existing wholesale licences for other Schedule 8 drugs need to apply to NSW Health for approval of revised procedures and amendment of their licence in order to supply cannabis product/s and/or refrigerated storage of Schedule 8 product/s.
Holders of a wholesale licence can hold the products until they are authorised for supply under the Therapeutic Goods Administration Special Access Scheme (Category B) or Authorised Prescriber Scheme.
A licensed importer or licensed wholesaler in NSW cannot supply to another intermediate wholesaler, but must supply directly to the authorised medical practitioner or pharmacy. The importer/wholesaler must first obtain, and retain, a copy of the prescriber’s NSW authority to prescribe the product to the patient/s, and retain a copy of the Commonwealth licence and permit for import and/or supply of an unregistered medicine.
It is not possible for the premises of a pharmacy (or medical practitioner’s place of practice) to also be the licensed premises of a wholesale Schedule 8/ Schedule 4 medicine supplier. Separate premises, capable of complying with the provisions of the Australian Code of Good Wholesaling Practice for Medicines in Schedules 2, 3, 4 and 8 are required. Transportation by carriers is treated as for other Schedule 8 medicines.
Cannabis products must be stored separately and securely, as is required of Schedule 8 drugs. Some products may require refrigeration and information on storage details is available.
Patients who believe a cannabis product may be helpful to their condition should consult their General Practitioner for advice. For further information patients may contact the Centre for Medicinal Cannabis Research and Innovation.
A patient or his/her carer may receive, possess and administer a cannabis product which has been legally imported/manufactured and prescribed for him/her.
Cannabis products supplied in or from NSW (other than when dispensed to a patient) must be packaged and labelled as Schedule 8 drugs (unless a Schedule 4 cannabidiol product), unless otherwise exempted by the Secretary, NSW Health.
It is illegal to label a product suggesting it is a cannabis product if it is not.
Contact details for further information
For general enquiries, contact:
Centre for Medicinal Cannabis Research and Innovation
GPO Box 5477
Sydney NSW 2001
For medical practitioner and other health practitioner enquiries about using a cannabis medicine to treat a patient, contact:
NSW Cannabis Medicines Advisory Service
Phone: (02) 4923 6200
For medical practitioner enquiries about authorisations to prescribe, contact:
Chief Pharmacist Unit, Ministry of Health
Phone: (02) 9391 9944
For enquiries about NSW licences to manufacture and/or supply cannabis products by wholesale, contact:
For enquiries relating to the importation, cultivation, production and manufacture of cannabis products, contact:
The Office of Drug Control
Phone: (02) 6232 8433 for general enquiries regarding the cultivation of medicinal cannabis
Phone: (02) 6232 8648 for enquiries relating to completing a medicinal cannabis manufacturing or import licence/permit application
Phone: (02) 6232 8740 for all other enquiries
For enquiries relating to products not approved for use in Australia, contact:
Therapeutic Goods Administration (TGA)
Phone: (02) 6232 8106 for enquiries about clinical trials
Phone: (02) 6232 8644 for enquiries about the Special Access Scheme
Phone: (02) 6232 8101 for enquiries about the Authorised Prescriber scheme