When chronic pain from repeated injuries forced legendary basketballer Lauren Jackson into retirement, her journey to recovery became a complex challenge. But Lauren defied the odds, returning to the court to play in the Australian squad for the FIBA Women's Basketball World Cup in 2022. This case study explores the challenges faced by female athletes in high-impact sports, including the prevalence of bone stress and joint injuries, the impact of hormonal factors, and the complexities of chronic pain management. It also addresses how medical cannabis was incorporated in Lauren's treatments. Healthcare practitioners will gain insights into: The pathophysiology of common injuries in female athletes, including bone stress and joint injuries Potential benefits and limitations of medical cannabis in managing chronic pain and aiding recovery Considerations for incorporating medical cannabis into treatment plans alongside conventional therapies. Strategies for discussing medical cannabis with patients while prioritiding safety and minimising risks Explore the evidence and evaluate how medical cannabis might fit within a broader approach to managing chronic conditions and sports-related injuries. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of common conditions and impact-based sporting injuries for female athletes and identify common management strategies Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of chronic sporting injuries and recovery from surgery Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of endometriosis Explain how medical cannabis treatment may integrate into and influence prescribed opioid treatment outcomes and effects Identify suitable candidates for medical cannabis treatment Devise treatment plans that consider patient safety and minimise risk Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in the management of chronic conditions, impact-based sporting injuries and recovery from surgery Disclaimer: Lauren has a financial interest in a medicinal cannabis company. Lauren is not receiving any financial remuneration from SAGED for her involvement in this case study.

Frances’ journey with fibromyalgia: Medical cannabis for chronic pain associated with fibromylagia Published: September 2025 Disclaimer: This is an anonymised patient case study, written with patient consent. The decision-making in this case study was undertaken by a doctor. The information in this document does not constitute medical advice or treatment recommendations. The use of cannabis based medications is the responsibility of a qualified medical professional who may initiate treatment after reviewing a patient's medical history. Most medical cannabis products are unapproved medicines and are regulated by the Therapeutic Goods Administration (TGA) Special Access Scheme (SAS), for which individual responses may vary. Meet Frances Frances* (pseudonym) is a 32-year-old woman living with fibromyalgia – one of an estimated 3–5% of Australians affected by this chronic condition, which is characterised by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties.1,2 Frances is seeking treatment for persistent pain, poor sleep and daily fatigue related to fibromyalgia. Despite trialling a range of conventional medications, she has experienced only limited relief. Her ongoing pain and exhaustion significantly affects her ability to work, exercise, and maintain daily life. Fibromyalgia presents with a variety of symptoms, including widespread pain, sleep disturbance, fatigue, headaches, mood disorders and irritable bowel syndrome (IBS) and is more common in women than in men.1,2,3 These symptoms often overlap with other conditions such as anxiety, depression, and chronic fatigue syndrome.1,3 Many people living with fibromyalgia describe conventional medical treatments as only partly effective, with burdensome side effects.2,3 Current management usually combines lifestyle and self-management strategies with medications such as antidepressants (e.g. duloxetine), anticonvulsants (e.g. pregabalin) and analgesics.2,3 However, many patients, like Frances, continue to struggle with persistent pain and impaired quality of life despite best-practice care. Frances’s consultation with her doctor Ongoing pain and fatigue, alongside variable responses to standard pharmacological treatments, led Frances and her healthcare team to consider other strategies. Use of medical cannabis is increasingly reported by patients with chronic pain conditions, with some users citing improved pain intensity, sleep, and overall wellbeing.4 These trends highlight the potential role of cannabis-based therapies as adjuncts in managing chronic pain conditions such as fibromyalgia.4 This case study explores how Frances’s medical team carefully assessed her presentation, medical history, risk factors, and possible drug interactions before initiating medical cannabis as part of her management plan. Frances’s doctor collected the following information: Patient information and presentation Presenting condition: Fibromyalgia Age: 32 years Symptoms Widespread musculoskeletal pain – particularly dull back ache Baseline back ache flares to sharp pain during physical exertion Insomnia with frequent night waking leading to daytime fatigue Anxiety – rapid heartbeat, clammy hands Pain assessment Position: Diffuse – neck, shoulders, hips but mainly lower back Type: Chronic with flare-ups after exertion or stress Severity Good days: 4–5/10 Bad days: 7–8/10 Triggers: Exertion, stress, lack of sleep, cold weather Personal and family medical history Medical history Fibromyalgia – diagnosed 2 years ago Generalised anxiety disorder Family history Grandfather – myocardial infarction Allergies: None known Current and past medications and treatments Current medications Amitriptyline – for nerve pain Tramadol Multivitamin Past treatments Sertraline for anxiety (ceased 3 years ago) Morphine and fentanyl during recent hospital admission Buprenorphine patches (ceased 1 year ago) Non-pharmacological treatments Stretches and regular exercises using cross trainer at home Sleeps supported with full body pillows Meditation and breathing exercises Specialist and other healthcare involvement Rheumatologist Ongoing GP management – last seen 6 weeks ago Psychologist Lifestyle factors Smoking: Never Alcohol: Nil Driving: THC liability verbalised Workplace drug testing: N/A Exercise: Stretches and regular exercises using cross trainer at home Support network: Lives with partner and child, parents are supportive Previous use of cannabis Black market cannabis flower intermittently since age 15 years – ceased 1 year prior, nil side effects noted Preferred treatment form: oils Frances' risk assessment & treatment plan Risk assessment Anxiety Given Frances’ history of generalised anxiety disorder, her doctor noted the importance of monitoring mood closely. While CBD may reduce anxiety, THC can in some cases exacerbate it.5 Regular reviews to monitor mood and anxiety symptoms A “start low, go slow” dosing approach6 Driving Inform Frances of the Therapeutic Goods Administration (TGA) guidance that patients must not drive while being treated with medical cannabis that contains THC, noting that measurable concentrations of THC can remain detectable in saliva for many hours after administration.7 Drug interactions CBD may inhibit CYP2C19, CYP2D6 and CYP3A4, which metabolise tramadol and amitriptyline.8 Careful titration and monitoring for side effects such as drowsiness were advised Treatment plan After reviewing Frances’s presentation and history, her doctor developed a personalised treatment plan for fibromyalgia symptom relief. Treatment goals Reduce baseline pain (particularly back pain) Manage pain flares Reduce anxiety Reduce insomnia Initial products prescribed Full spectrum balanced oil (THC 10 mg/mL, CBD 10 mg/mL) Start 0.1 mL twice daily Increase by 0.1 mL every to two days until symptom control is reached Maximum daily dose 3.0 mL Full spectrum indica-dominant oil (THC 20 mg/mL, CBD 1 mg/mL) Start 0.1 mL nocte After two days increase by 0.1 mL Increase by 0.2 mL every 2 days until symptom control is reached Maximum daily dose 1 mL Risk management plan Symptom diary – to record pain scores, doses, sleep quality, and side effects Pre-treatment Depression Anxiety Stress Scales (DASS) assessment – repeated at follow-ups Close monitoring for sedation, dizziness, or gastrointestinal upset Follow-up plan 4- and 8-week reviews, with monitoring of pain, sleep, mood, and functional status Treatment outcomes At 8 weeks: Frances was using 0.3 mL balanced oil in the mornings (already the maximum dose) and reported limited benefit, indicating that this formula was not strong enough to address her symptoms The full spectrum indica-dominant oil has assisted with sleep - Frances is currently using 0.2 mL at night Actions Replace the 10:10 balanced oil with a 25:25 balanced oil (THC 25 mg/mL, CBD 25 mg/mL) Continue with the indica dominant oil nocte Keep up the symptom diary What the research says Exploring the science in Frances’ case, what is the relationship between medical cannabis, the endocannabinoid system, and fibromyalgia? The endocannabinoid system (ECS) – comprising CB1 and CB2 receptors, endocannabinoids, and enzymes – plays a key role in modulating pain, sleep, mood, and immune responses.9 Research suggests that fibromyalgia may be linked to a concept called endocannabinoid deficiency, which may lead to heightened pain sensitivity, poor sleep, and mood disturbances.10,11 CB1 receptors in the brain and spinal cord regulate pain perception, sleep, and mood9 CB2 receptors in immune cells modulate inflammation and pain signalling9 It has been proposed that cannabinoids such as CBD and THC may help restore ECS balance and reduce fibromyalgia symptoms, preferably using a gentle approach with standardised whole-cannabis extracts.10 Clinical evidence for medical cannabis remains limited but is growing: Small randomised controlled trials and a large observational study report that medical cannabis can reduce symptom severity and improve quality of life in patients with fibromyalgia.11 A randomised clinical trial with nabilone, a synthetic cannabinoid, has shown improvements in sleep in patients with fibromyalgia compared to the standard amitriptyline therapy.12 Key Takeaways Fibromyalgia is a complex, multifactorial condition that imposes a substantial burden on quality of life and conventional treatments often provide incomplete relief.1,2 Emerging evidence suggests a role for the endocannabinoid system in fibromyalgia pathophysiology.10 While clinical trials remain limited, cannabinoids, particularly CBD and low-dose THC, may help reduce pain, improve sleep, and enhance wellbeing in select patients.4,10 Frances’s case illustrates how a careful, individualised, and evidence-informed approach – including risk assessment, slow titration and structured follow-up – can support safe and effective access to medical cannabis. Disclaimer: Medical cannabis products may be associated with adverse events. For more information please contact medinfo@saged.com.au. Medical cannabis products are not suitable for use during pregnancy or breastfeeding, for anyone with a history with psychotic disorders, or for those with unstable cardiovascular disease. Treatment for patients under 18 years is recommended under the guidance of a paediatrician. Patients should not drive or operate machinery while being treated with some forms of medical cannabis.

Gina’s Story: Endometriosis, the Endocannabinoid System, and Emerging Approaches to Care Published: August 2025 Disclaimer: This is an anonymised patient case study, written with patient consent. The decision-making in this case study was undertaken by a doctor. The information in this document does not constitute medical advice or treatment recommendations. The use of cannabis based medications is the responsibility of a qualified medical professional who may initiate treatment after reviewing a patient's medical history. Most medical cannabis products are unapproved medicines and are regulated by the Therapeutic Goods Administration (TGA) Special Access Scheme (SAS), for which individual responses may vary. Meet Gina (pseudonym), a 38-year-old woman living with endometriosis—one of an estimated 10% of Australian women affected by this chronic condition, which involves the growth of endometrial-like tissue outside the uterus.1 Gina is seeking treatment for ongoing gastrointestinal and pain-related symptoms associated with endometriosis. Despite trialling a range of conventional medications, she’s experienced limited relief—particularly for her chronic pain, which significantly affects her ability to work and maintain daily functioning. Endometriosis is a condition that can cause a wide range of chronic pelvic pain symptoms, including dysmenorrhea (painful periods), dyspareunia (pain during intercourse), fatigue, dyschezia (pain during bowel movements), and dysuria (pain during urination).1 It may also co-occur with other conditions such as irritable bowel syndrome, rheumatoid arthritis, psoriasis, anxiety, depression, and chronic fatigue syndrome.1 Despite the substantial burden of endometriosis, many patients consider conventional medical treatments to be suboptimal—often citing limited efficacy and unwanted side effects.1 Current management typically involves a combination of medical and/or surgical interventions, including hormonal therapies, non-opioid and opioid analgesics, and neuropathic pain agents.1 While surgery can be effective, it carries high costs, long wait times, and high recurrence rates—often leading to the need for repeat procedures.1,2 Gina’s consultation with her doctor Limited access to surgery and variable responses to pharmacological treatments, have led patients with endometriosis to self-management strategies.1 Cannabis use—both prescribed and non-prescribed—is increasingly reported, with some individuals noting improvements in symptom severity.1 These trends highlight a need for more research into cannabis-based therapies as potential adjuncts in endometriosis care.1 This case study explores how Gina’s medical team carefully assessed her clinical presentation, medical history, potential psychological and cardiovascular risk factors, and possible drug interactions before initiating medical cannabis to support her pain management and overall wellbeing. Gina’s doctor collected the following information: Patient information and presentation Personal and family medical history Current and past medications and treatments Specialist and other healthcare involvement Lifestyle factors Discover Gina’s patient profile below. Presenting condition Female, aged 38 years Presenting condition – endometriosis Symptoms Excruciating dysmenorrhoea since menarche Vomiting, diarrhoea and nausea Low appetite and weight loss Headaches Pain assessment Position – lower abdomen Quality – severe, accompanied by sweating, crying or doubling over in pain Type – intermittent sharp pains and general abdominal tenderness Radiates – to arms or legs Severity Good days – 6–8/10 Bad days – 10/10 Timing – menstruation and ovulation Triggers – stress Personal and family medical history Medical history Endometriosis (stage 4) – diagnosed in 2019 Pericarditis post coronavirus – diagnosed 2022* Generalised anxiety disorder and depression – diagnosed 18 years prior Vitamin D deficiency Allergies Latex Medical history (family) Maternal aunt – endometriosis *This may be a risk factor for medical cannabis.3 Current and past medications and treatments Current medications Drospirenone – 4 mg/day Past medications Tapentadol Physiotherapy sessions – with minimal benefit Remedial massage sessions – with minimal benefit Specialist and other healthcare involvement Cardiologist review of pericarditis – referred back to GP care after diagnosis Lifestyle factors Smoking – No Social considerations Driving – drives to work 2 days per week and on occasional weekend trips THC roadside liability understood: Yes Workplace drug testing – N/A Operates heavy machinery – N/A Previous use of cannabis Use – non-prescribed cannabis daily between 2016 and 2019 Administration – flower via joint or pipe Amount – 2 g per day Effects – reduced pain, relieved bowel cramps, assisted with sleep Assessing risks After reviewing Gina’s profile, her doctor notes potential risk factors relating to her anxiety, cardiovascular health, driving and previous use of non-prescribed cannabis. Below, explore Gina’s potential risk factors and how her doctor managed them. Anxiety Given Gina’s diagnosis of generalised anxiety disorder, her doctor monitored her closely, with regular check-ins to assess mood and anxiety symptoms. As THC can cause feelings of altered mood and anxiety, it should be administered with caution in individuals with anxiety disorder.4 Her doctor ensured that Gina understands the potential mood-related side effects and equipped her with strategies to manage them effectively if they occur. Additionally, she emphasised the importance of starting on a low dose and gradually increasing the dosage as specified in the treatment plan. Cardiovascular health Before prescribing medical cannabis products, her doctor confirmed that Gina’s cardiovascular health is stable by: Reviewing previous cardiac assessments and reports from Gina’s cardiologist Obtaining approval from Gina’s cardiologist and consulting Gina’s regular GP before commencing treatment Monitoring Gina’s electrocardiogram and vital signs throughout the course of her treatment This is of particular importance as cannabis products with THC can cause tachycardia, and is not advised for patients with a history of angina or myocardial infarction.4 Driving As Gina drives to work occasionally, her doctor ensured that Gina is aware of the laws around driving. Current medical cannabis prescribing legislation does not exempt patients from THC-related drug-driving offences.4 THC can impair driving performance and increase crash risk—particularly in occasional users—with effects lasting up to eight hours after oral dosing.5 Patients using THC-containing products should avoid driving and other safety-sensitive tasks, especially during treatment initiation and shortly after each dose.5 In contrast, there is no evidence that CBD impairs driving.5 Patients taking CBD-only medicines can lawfully drive if they are not impaired.5,6 Non-prescribed use of cannabis Gina’s doctor is also concerned about her previous use of non-prescribed cannabis. Cannabis acquired on the black market is unlikely to achieve the desired results and can cause unpredictable and severe adverse reactions as it may contain hazardous ingredients and contaminants—such as microbes, heavy metals and pesticides.7,8 Devising a treatment plan After reviewing Gina’s presentation and medical history, her doctor created a treatment plan to help Gina manage her endometriosis symptoms. Developing a risk management and follow-up plan Gina’s doctor provided her with a risk management plan which included symptom tracking and monitoring of adverse effects, as well as follow-ups scheduled at 4 to 8 weeks to review progress and adjust treatment as needed. Discover Gina’s risk management and follow-up plan below Risk management plan Asked Gina to keep a symptom diary to record pain scores, doses and other symptoms Informed Gina of how to report and respond to adverse effects Conducted a pre-treatment Depression Anxiety Stress Scales (DASS) assessment and will follow up at each check-in Advised Gina to start low and go slow Reviewed Gina’s cardiovascular reports and test results, and obtained cardiologist and GP support before commencing treatment Follow-up plan Follow-ups scheduled for 4- and 8-weeks after initial treatment Review progress and adjust plan as required Monitor cardiovascular results Monitor psychiatric state via DASS results (conducted at each appointment) At 4 weeks: Gina reported that the CBD oil was moderately effective but not as effective as the inhaled product. In response, her doctor prescribed a different oil with the following profile and dosage instructions: THC 10 mg/mL : CBD 10 mg/mL Start: 0.1 mL twice a day After 2 days: increase by 0.1 mL Every 2 days thereafter: increase by 0.2 mL to full symptom control Maximum daily dose: 3.0 mL At 8 weeks: Gina shared that she found the new oil effective, and uses 1.5 mL daily. Gina and her doctor agreed to touch base again in 4 weeks. Exploring the Science in Gina’s Case What Is the Relationship Between Medical Cannabis, the Endocannabinoid System, and Endometriosis? Gina’s doctor has prescribed her with medical cannabis; understanding its proposed mechanism could provide insight into why it may have a role in Gina’s care. Studies have shown that cannabinoid receptors (CB1 and CB2) are highly expressed in ovaries with endometriosis, compared with stromal tissues surrounding the lesion.10,11 As cannabinoid receptors have been implicated in the management of chronic pain and inflammation, these findings suggest that medical cannabis may offer a targeted approach for managing endometriosis-related pain and inflammation at the lesion site.10,11 A recent literature review found that compared to conventional strategies such as analgesics and heat therapy, medical cannabis offered symptom relief for individuals with endometriosis.10 This flow diagram illustrates the potential key therapeutic targets within the endocannabinoid system that interact with cannabis compounds.10 Adapted from Cummings et al. 202410 However, there remains a lack of randomised controlled trials specifically evaluating medical cannabis efficacy for endometriosis-related pain.10 This gap in evidence highlights an important direction for future research—particularly in light of emerging findings that a dysregulated endocannabinoid system may contribute to the pathophysiology of endometriosis.10 Key Takeaways Endometriosis remains a complex condition that significantly impacts quality of life.1 While conventional treatments can help, many patients—like Gina—continue to experience debilitating symptoms despite best-practice interventions.1 Emerging evidence suggests a potential role for the endocannabinoid system in modulating inflammation, pain, and other symptoms associated with endometriosis.10,11 Though clinical research is still developing, the expression of cannabinoid receptors in endometriotic tissue, alongside promising patient-reported outcomes, highlights the potential role of medical cannabis as an adjunctive therapy in selected patients.10,11 Gina’s case illustrates how a personalised, cautious, and evidence-informed approach—grounded in thorough risk assessment and multidisciplinary collaboration—can support safe access to medical cannabis. As with any therapeutic decision, individual patient factors, clinical history, and shared decision-making remain central to guiding care. Adverse event monitoring: Medical cannabis products may be associated with adverse events. For more information please contact medinfo@saged.com.au. Medical cannabis products are not suitable for use during pregnancy or breastfeeding, for anyone with a history with psychotic disorders, or for those with unstable cardiovascular disease. Treatment for patients under 18 years is recommended under the guidance of a paediatrician. Patients should not drive or operate machinery while being treated with some forms of medicinal cannabis. Veeva job code: MONT-SGD-2025-0014Date of preparation: July 2025

Patient Conversations: Why Cultural Safety Matters in Medical Cannabis Prescribing Published: July 2025 As medical cannabis becomes an increasingly accepted therapeutic option in Australia, healthcare professionals should consider not only the clinical aspects of prescribing, but also the cultural safety of their practice. For many patients, particularly Aboriginal and Torres Strait Islander peoples and those from culturally and linguistically diverse (CALD) communities, engaging with the healthcare system can carry risks of misunderstanding, harm, and marginalisation if cultural needs are not recognised and respected.1,2 What exactly is “Cultural Safety”? Cultural safety is a patient-led concept that focuses on whether individuals feel respected, heard, and safe during healthcare encounters.3 It goes beyond merely being aware of cultural differences (i.e. "cultural awareness”) and requires healthcare professionals to reflect on their own biases, power, and privilege while actively adapting their care to meet the needs of the patient’s cultural identity and lived experience.4 Ultimately, it is the patient, not the healthcare professional, who determines whether an experience is culturally safe.3 Why is this important for medical cannabis? Medical cannabis use can be influenced by personal, cultural, legal, and social factors. Patients may have concerns regarding stigma, legality, or family and community expectations.5 For some, complementary medicines may resonate with cultural healing traditions.6 For others, medical cannabis may invoke social stigma from within their communities.6 For Aboriginal and Torres Strait Islander peoples, the impacts of colonisation, systemic racism, and intergenerational trauma can contribute to distrust of mainstream healthcare.1 For CALD communities, differing views about health, medicine, and healing may shape how medical cannabis is perceived.6 Practical considerations for culturally safe medical cannabis prescribing Stigma Acknowledge the historical criminalisation of cannabis and its disproportionate impact on some communities6,7: Be prepared to address patient concerns about legal issues, confidentiality, and fear of judgement. Recognise that concerns around stigma may be heightened among Aboriginal and Torres Strait Islander peoples and CALD patients, who may have previously experienced discrimination within healthcare and legal systems.8,9 Creating a safe, non-judgemental space is essential. This involves using inclusive and respectful language, and reassuring patients about the confidentiality of their care, and the legal and clinical appropriateness of prescribed medical cannabis.8 For Aboriginal and Torres Strait Islander patients, it is important to understand the impact of intergenerational trauma and to approach care with cultural humility and respect for their lived experiences.9 Access and equity Understand that cost, geographic barriers, and language barriers can impact access to medical cannabis.10 Share options and advocate for equitable prescribing pathways, such as the Compassionate Access Schemes offered in some states11 and through selected medical cannabis organisations. Provide translated information where available, engage with interpreters, and guide patients through application processes.8 For Aboriginal and Torres Strait Islander patients, consider the added importance of family and community in decision-making and support models: Collaborate with Aboriginal Health Workers or Aboriginal Community Controlled Health Services (ACCHSs) to provide culturally appropriate care.9 Cultural perceptions Some patients may see cannabis as an extension of traditional medicine6, while others may associate it with substance misuse or illegality6: Approach these discussions with curiosity, not assumptions. Explore patients’ beliefs about healing and medicine, and be open to integrating their cultural practices with medical care where safe and appropriate.8 For Aboriginal and Torres Strait Islander patients, acknowledge the importance of connection to Country, spiritual wellbeing, and traditional healing, and consider these when framing discussions about treatment.9 Supporting cultural safety with SPIKES When introducing sensitive treatments like medical cannabis, healthcare professionals can enhance cultural safety by using structured communication tools. One such tool, the SPIKES framework, was originally developed to aid communication of ‘bad news’ in healthcare12, and can be applied to fostering effective communication with diverse patients. Adapted from Buckman 2005 Summary Medical cannabis may offer symptom relief for some patients when clinically appropriate, but how it is introduced matters. Culturally safe practice, guided by structured, empathetic communication models such as SPIKES12, ensures that care is not only clinically sound but also respectful, empowering and patient-centred.3 Cultural safety isn’t a checkbox; it is an ongoing commitment to reflection, understanding, and partnership. Every conversation is an opportunity to make healthcare a safer, more inclusive space for all. Job code: MONT-SGD-2025-0005 | Date of preparation: July 2025

‘Unapproved’ products: Prescriber access pathways explained Published: October 2025 Accessing medical cannabis in Australia can feel complex—for both patients and healthcare practitioners.1 While demand for medical cannabis has grown steadily, it is still considered an ‘unapproved’ therapeutic good under the Therapeutic Goods Administration (TGA) for most conditions.1 This means that, in most cases, practitioners must first demonstrate that conventional, registered medicines have been tried or deemed unsuitable before turning to medical cannabis.2 Yet for many patients, especially those living with chronic pain, conventional treatments provide limited relief3—highlighting the importance of clear, workable access pathways to ‘unapproved’ products. So how does this work in practice? How do Australian practitioners access medical cannabis for their patients? Accessing medical cannabis in Australia There are two primary pathways for accessing medical cannabis in Australia, each with two sub-categories:4 Special Access Scheme Category A notification pathway Category B application pathway Authorised Prescriber Established History of Use pathway Standard pathway Each of these pathways is designed for different clinical scenarios and levels of oversight. Let’s break them down. 1: Special Access Scheme (SAS) Through the SAS, Australian-registered practitioners can apply to use an ‘unapproved’ medicine—such as medical cannabis—for an individual patient on a case-by-case basis.2 1.1: SAS-A – notification for a seriously ill patient SAS-A allows practitioners to prescribe an ‘unapproved’ medicine, such as medical cannabis, for patients who are seriously ill*.2 This is a notification pathway – which means prior approval from the TGA is not required.2 Compared with SAS-B applications, SAS-A notifications are submitted less frequently.5,6 *Seriously ill is defined as: someone who is ‘seriously ill with a condition from which death is reasonably likely to occur within a matter of months, or from which premature death is reasonably likely to occur in the absence of early treatment’.2 1.2: SAS-B – application for all other patients SAS-B allows qualified practitioners to prescribe an ‘unapproved’ medicine for patients who don’t meet the Category A definition.2 When seeking approval to prescribe an unapproved medical cannabis product under the SAS-B pathway, the practitioner must provide clinical justification.4 This justification should be succinct yet comprehensive, and include:4 A summary of the patient’s symptoms and/or diagnosis Details of prior treatments or procedures that have been trialled or considered, with reasons why therapeutic goods currently included in the Australian Register of Therapeutic Goods (ARTG) are not clinically appropriate An appraisal of the anticipated clinical benefits of the proposed treatment weighed against the potential risks The SAS does not limit applications to specific medical conditions.4 The key requirement is that the prescriber has the necessary knowledge of the patient’s condition and of the product they wish to use.4 SAS-B is an application pathway – which means an approval letter must be obtained from the TGA before the product can be supplied to the patient.2 2: Authorised Prescriber (AP) Registered practitioners can apply to the TGA to become APs of certain medical cannabis products for groups of patients they care for.7 Approval lasts up to five years, and while practitioners don’t need to notify the TGA each time they prescribe, they must provide reports every six months.7 Additional approvals are only needed if the product isn’t already on the Established History of Use list.7 2.1: AP – Established History of Use pathway The TGA’s Established History of Use lists set out which medical cannabis products and conditions have a recognised track record.4 This applies only to Category 1 (CBD ≥98%), Category 2 (CBD ≥60% and <98%), and Category 3 (CBD <60% and ≥40%) oral liquids or capsules for a select few conditions, including refractory chronic pain, anxiety, cancer pain, sleep disorders and autism spectrum disorder.8 For these, doctors can become APs without needing Human Research Ethics Committee (HREC) approval or specialist college endorsement.4 2.2: AP – Standard pathway For medical cannabis products not included on the TGA’s Established History of Use lists, doctors can apply to become APs via the Standard pathway.4 To do so, doctors must first obtain approval from an HREC or endorsement from a specialist college, before lodging their application with the TGA.4 HREC approval or specialist college endorsement includes:9 Applying in writing to an HREC or specialist college for endorsement Providing evidence to justify use of the unapproved therapeutic good Details about the doctors’ training and experience Description of the unapproved therapeutic good the doctor intends to prescribe Clinical justification for use of the unapproved therapeutic good To find an HREC, check the list of HRECs registered with the National Health and Medical Research Council.9 If an HREC is unavailable, endorsement can be sought from a specialist college.9 The specialist college must have expertise relevant to the condition being treated. The list of specialist colleges can be found here.9 The infographic below summarises medical cannabis access pathways most commonly accessed in Australia. Download this infographic here To apply for the SAS or AP pathway, visit: https://compliance.health.gov.au/sas/ Need help deciding which pathway suits your practice needs? Get step-by-step assistance with your SAS-B or AP application from a SAGED Prescriber Support Specialist. Click here for support. Use of the SAS and AP pathway Despite being labelled as complex and time-consuming,1 the TGA’s dashboard shows that the SAS and AP pathway are well utilised, highlighting ongoing patient demand. In 2024 alone, registered practitioners submitted 177,751 SAS-B applications,6 although the SAS-A pathway was less frequently used with 376 SAS-A notifications.5 Over the same period, the TGA granted 22,066 AP approvals, with 407,434 treatments initiated under these approvals between July and December 2024.10,11 Leading conditions for medical cannabis prescription According to the SAS-A and SAS-B dashboards, chronic pain is the leading condition for which medical cannabis is accessed in Australia, followed by anxiety,5,6 reflecting their significant health burden. The Australian Institute of Health and Welfare reported that in 2016, 1.6 million (1 in 5) Australians aged ≥45 years were living with chronic pain.12 Current pharmacological treatments are often limited in effectiveness, with fewer than 20% of patients achieving ≥50% pain relief.3 In light of these limitations, it is estimated that around 600,000 Australians self-medicate with medical cannabis—most commonly for chronic pain.3 The most common conditions for SAS-A notifications and SAS-B applications in 20245,6 Summary Although the regulatory framework for accessing medical cannabis is perceived as complex time-consuming,1 the SAS and AP pathways provide routes for doctors to access unapproved products for their patients.4 The SAS enables case-by-case approvals, with SAS-A reserved for seriously ill patients2 and SAS-B requiring a clinical justification for all other patients.2,4 The AP pathway allows longer-term prescribing for groups of patients, with applications made via either the Established History of Use pathway or the more rigorous Standard pathway, which requires ethics or specialist college approval.4,9 Despite perceptions of complexity,1 these mechanisms are being used extensively.5,6,10 With 1 in 5 Australians over 45 living with chronic pain—and conventional treatments often falling short—medical cannabis may offer an additional therapeutic option, particularly when conventional treatments provide limited relief.3,12

Frances’ journey with fibromyalgia: Medical cannabis for chronic pain associated with fibromylagia Published: September 2025 Disclaimer: This is an anonymised patient case study, written with patient consent. The decision-making in this case study was undertaken by a doctor. The information in this document does not constitute medical advice or treatment recommendations. The use of cannabis based medications is the responsibility of a qualified medical professional who may initiate treatment after reviewing a patient's medical history. Most medical cannabis products are unapproved medicines and are regulated by the Therapeutic Goods Administration (TGA) Special Access Scheme (SAS), for which individual responses may vary. Meet Frances Frances* (pseudonym) is a 32-year-old woman living with fibromyalgia – one of an estimated 3–5% of Australians affected by this chronic condition, which is characterised by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties.1,2 Frances is seeking treatment for persistent pain, poor sleep and daily fatigue related to fibromyalgia. Despite trialling a range of conventional medications, she has experienced only limited relief. Her ongoing pain and exhaustion significantly affects her ability to work, exercise, and maintain daily life. Fibromyalgia presents with a variety of symptoms, including widespread pain, sleep disturbance, fatigue, headaches, mood disorders and irritable bowel syndrome (IBS) and is more common in women than in men.1,2,3 These symptoms often overlap with other conditions such as anxiety, depression, and chronic fatigue syndrome.1,3 Many people living with fibromyalgia describe conventional medical treatments as only partly effective, with burdensome side effects.2,3 Current management usually combines lifestyle and self-management strategies with medications such as antidepressants (e.g. duloxetine), anticonvulsants (e.g. pregabalin) and analgesics.2,3 However, many patients, like Frances, continue to struggle with persistent pain and impaired quality of life despite best-practice care. Frances’s consultation with her doctor Ongoing pain and fatigue, alongside variable responses to standard pharmacological treatments, led Frances and her healthcare team to consider other strategies. Use of medical cannabis is increasingly reported by patients with chronic pain conditions, with some users citing improved pain intensity, sleep, and overall wellbeing.4 These trends highlight the potential role of cannabis-based therapies as adjuncts in managing chronic pain conditions such as fibromyalgia.4 This case study explores how Frances’s medical team carefully assessed her presentation, medical history, risk factors, and possible drug interactions before initiating medical cannabis as part of her management plan. Frances’s doctor collected the following information: Patient information and presentation Presenting condition: Fibromyalgia Age: 32 years Symptoms Widespread musculoskeletal pain – particularly dull back ache Baseline back ache flares to sharp pain during physical exertion Insomnia with frequent night waking leading to daytime fatigue Anxiety – rapid heartbeat, clammy hands Pain assessment Position: Diffuse – neck, shoulders, hips but mainly lower back Type: Chronic with flare-ups after exertion or stress Severity Good days: 4–5/10 Bad days: 7–8/10 Triggers: Exertion, stress, lack of sleep, cold weather Personal and family medical history Medical history Fibromyalgia – diagnosed 2 years ago Generalised anxiety disorder Family history Grandfather – myocardial infarction Allergies: None known Current and past medications and treatments Current medications Amitriptyline – for nerve pain Tramadol Multivitamin Past treatments Sertraline for anxiety (ceased 3 years ago) Morphine and fentanyl during recent hospital admission Buprenorphine patches (ceased 1 year ago) Non-pharmacological treatments Stretches and regular exercises using cross trainer at home Sleeps supported with full body pillows Meditation and breathing exercises Specialist and other healthcare involvement Rheumatologist Ongoing GP management – last seen 6 weeks ago Psychologist Lifestyle factors Smoking: Never Alcohol: Nil Driving: THC liability verbalised Workplace drug testing: N/A Exercise: Stretches and regular exercises using cross trainer at home Support network: Lives with partner and child, parents are supportive Previous use of cannabis Black market cannabis flower intermittently since age 15 years – ceased 1 year prior, nil side effects noted Preferred treatment form: oils Frances' risk assessment & treatment plan Risk assessment Anxiety Given Frances’ history of generalised anxiety disorder, her doctor noted the importance of monitoring mood closely. While CBD may reduce anxiety, THC can in some cases exacerbate it.5 Regular reviews to monitor mood and anxiety symptoms A “start low, go slow” dosing approach6 Driving Inform Frances of the Therapeutic Goods Administration (TGA) guidance that patients must not drive while being treated with medical cannabis that contains THC, noting that measurable concentrations of THC can remain detectable in saliva for many hours after administration.7 Drug interactions CBD may inhibit CYP2C19, CYP2D6 and CYP3A4, which metabolise tramadol and amitriptyline.8 Careful titration and monitoring for side effects such as drowsiness were advised Treatment plan After reviewing Frances’s presentation and history, her doctor developed a personalised treatment plan for fibromyalgia symptom relief. Treatment goals Reduce baseline pain (particularly back pain) Manage pain flares Reduce anxiety Reduce insomnia Initial products prescribed Full spectrum balanced oil (THC 10 mg/mL, CBD 10 mg/mL) Start 0.1 mL twice daily Increase by 0.1 mL every to two days until symptom control is reached Maximum daily dose 3.0 mL Full spectrum indica-dominant oil (THC 20 mg/mL, CBD 1 mg/mL) Start 0.1 mL nocte After two days increase by 0.1 mL Increase by 0.2 mL every 2 days until symptom control is reached Maximum daily dose 1 mL Risk management plan Symptom diary – to record pain scores, doses, sleep quality, and side effects Pre-treatment Depression Anxiety Stress Scales (DASS) assessment – repeated at follow-ups Close monitoring for sedation, dizziness, or gastrointestinal upset Follow-up plan 4- and 8-week reviews, with monitoring of pain, sleep, mood, and functional status Treatment outcomes At 8 weeks: Frances was using 0.3 mL balanced oil in the mornings (already the maximum dose) and reported limited benefit, indicating that this formula was not strong enough to address her symptoms The full spectrum indica-dominant oil has assisted with sleep - Frances is currently using 0.2 mL at night Actions Replace the 10:10 balanced oil with a 25:25 balanced oil (THC 25 mg/mL, CBD 25 mg/mL) Continue with the indica dominant oil nocte Keep up the symptom diary What the research says Exploring the science in Frances’ case, what is the relationship between medical cannabis, the endocannabinoid system, and fibromyalgia? The endocannabinoid system (ECS) – comprising CB1 and CB2 receptors, endocannabinoids, and enzymes – plays a key role in modulating pain, sleep, mood, and immune responses.9 Research suggests that fibromyalgia may be linked to a concept called endocannabinoid deficiency, which may lead to heightened pain sensitivity, poor sleep, and mood disturbances.10,11 CB1 receptors in the brain and spinal cord regulate pain perception, sleep, and mood9 CB2 receptors in immune cells modulate inflammation and pain signalling9 It has been proposed that cannabinoids such as CBD and THC may help restore ECS balance and reduce fibromyalgia symptoms, preferably using a gentle approach with standardised whole-cannabis extracts.10 Clinical evidence for medical cannabis remains limited but is growing: Small randomised controlled trials and a large observational study report that medical cannabis can reduce symptom severity and improve quality of life in patients with fibromyalgia.11 A randomised clinical trial with nabilone, a synthetic cannabinoid, has shown improvements in sleep in patients with fibromyalgia compared to the standard amitriptyline therapy.12 Key Takeaways Fibromyalgia is a complex, multifactorial condition that imposes a substantial burden on quality of life and conventional treatments often provide incomplete relief.1,2 Emerging evidence suggests a role for the endocannabinoid system in fibromyalgia pathophysiology.10 While clinical trials remain limited, cannabinoids, particularly CBD and low-dose THC, may help reduce pain, improve sleep, and enhance wellbeing in select patients.4,10 Frances’s case illustrates how a careful, individualised, and evidence-informed approach – including risk assessment, slow titration and structured follow-up – can support safe and effective access to medical cannabis. Disclaimer: Medical cannabis products may be associated with adverse events. For more information please contact medinfo@saged.com.au. Medical cannabis products are not suitable for use during pregnancy or breastfeeding, for anyone with a history with psychotic disorders, or for those with unstable cardiovascular disease. Treatment for patients under 18 years is recommended under the guidance of a paediatrician. Patients should not drive or operate machinery while being treated with some forms of medical cannabis.

Medical cannabis for chronic non-cancer pain: A practical guide for doctors Published: September 2025 Introduction Chronic non-cancer pain (CNCP) remains one of the most significant challenges in Australian healthcare with one in five Australians experiencing chronic pain.1,2 Historically defined as continuous or recurrent pain that persists for a period of longer than three months 2,3, CNCP is a persistent, multifactorial condition arising from diverse pathophysiological mechanisms and shaped by cultural, psychological, and individual experience.2 It is estimated that between 20 and 40% of patient presentations to general practitioners involve chronic pain, making it one of the most common conditions encountered in primary care.2 Data from the Bettering Evaluation and Care of Health (BEACH) initiative has shown that most presentations of CNCP relate to musculoskeletal conditions such as osteoarthritis and lower back pain, however one in five presentations is neurological.2 Beyond the individual burden, CNCP has a broader societal impact, contributing to disability, unemployment, and significant healthcare costs.1,3-5 Standard pharmacological approaches - including paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, antidepressants, and particularly opioids - often fail to provide adequate long-term relief. 2,5,6 Opioids remain widely prescribed, but evidence for their long-term benefit in CNCP is limited, while risks of dependence, tolerance, overdose, and death are well established.4,7 Non-drug approaches such as physiotherapy and psychological interventions play important roles but are not universally effective.8 Against this backdrop, medical cannabis (MC) has emerged as a therapy of growing interest, offering an adjunctive option for patients who have exhausted conventional treatments.3,5 Evidence for efficacy Evidence supporting medical cannabis in CNCP, whilst limited, is steadily accumulating.3,5 It is theorised that the key active cannabinoids in MC exert complementary analgesic and anti-inflammatory actions: tetrahydrocannabinol (THC) by blocking nociceptive stimuli, and cannabidiol (CBD) by exerting anti-inflammatory and calming effects.3 A 2017 meta-analysis by the Therapeutic Goods Administration (TGA) concluded that medical cannabis was more likely than placebo to produce reductions in pain intensity and to achieve clinically meaningful improvements of 30–50% in pain scores.5,9 While there remains a lack of large randomised controlled trials (RCTs) investigating MC in CNCP, real-world evidence from large cohorts has contributed to the overall body of evidence: Author & Location Study Type & Population Duration Major findings Arkell et al10Australia Real World EvidenceN = 3148 15 months After commencing MC treatment, patients reported significant improvements relative to baseline on all 8 domains of the SF-36, and these improvements were mostly sustained over time (p<0.001) Bar-Lev Schleider et al11Israel Real World EvidenceN = 9985 6 months Prior to treatment initiation: 62.0% of patients reported their pain intensity of 8–10After 6 months of MC treatment:5.0% of patients reported a pain intensity of 8–10 (p<0.001) Safakish et al12Canada ObservationalN = 751 12 months MC treatment associated with improvements in pain severity and interference (p<0.001) observed at 1 month and maintained over 12-months.Significant improvements were also observed in the SF-12 physical and mental health domains (p<0.002); headaches, fatigue, anxiety, and nausea (p<0.002).In patients who reported opioid medication use at baseline, there were significant reductions in oral morphine equivalent doses (p<0.0001) Vickery13 et alAustralia Real World EvidenceN = 3961 2 years Statistically significant improvements (p<0.001) across all outcomes were sustained for over two years, including: clinical global impression; pain interference and severity; mental health scores for depression, anxiety, stress; insomnia; health status scores for physical functions and emotional well-being However, the evidence is not uniformly positive. Some trials have failed to demonstrate the benefit of MC in CNCP. De Vries et al., in a placebo-controlled trial of THC tablets for chronic abdominal pain, found no difference in pain reduction between active treatment and placebo.14 Similarly, Campbell and colleagues, in a study of patients using illicit cannabis in conjunction with prescribed opioids, found no evidence of improved outcomes or reduced opioid use.15 Although this data was collected over a four-year period, the lack of guidance from medical practitioners on optimal use of cannabis for CNCP could have contributed to less than optimal outcomes.15 Interestingly, a number of studies reported an opioid sparing effect in subjects who took medically prescribed cannabis concomitantly with opioid therapy.3,5,12 Taken together, the evidence base suggests that while medical cannabis is not universally effective in CNCP, it could offer benefit for some patients when used as part of an integrative approach.5 Limitations of the evidence Despite promising findings, limitations remain. The majority of positive evidence comes from longer-term large observational and real-world studies, however they are highly heterogeneous in terms of formulation composition, cannabinoid ratios, and delivery methods, whilst the lack of placebo controls may lead to overestimation of MC’s benefits.3 Safety and tolerability As with any therapy, safety is a key consideration. Across clinical trials and observational studies, the most frequently reported adverse effects included fatigue, somnolence, dizziness, cognitive impairment, dry mouth, gastrointestinal upset, and increased appetite. 3 Severe adverse events are rare but do occur, including hallucinations, dysphoria, and cardiovascular complications.3 Long-term safety data remain limited, although recent large-scale studies demonstrated that over 1-2 years of MC treatment, adverse effects, while frequent, were generally mild in nature.10,13 Nevertheless, caution should be exercised in vulnerable populations (see Patient Selection below). Patient selection Deciding which patients are appropriate candidates for medical cannabis is central to safe and effective prescribing.16 MC may not be suitable for all patients with CNCP, and careful consideration of risks, benefits, and alternatives is essential. Additionally, caution is advised in patients with a personal or family history of psychosis, those with unstable cardiovascular disease, and younger adults under the age of 25, due to neurodevelopmental concerns. Pregnant and breastfeeding women should also avoid cannabinoid therapy.3,16,17 Administering medical cannabis in CNCP Beyond the general TGA "Guidance for the use of medicinal cannabis in Australia”, which recommends a ‘start low go slow’ approach to MC dose titration16, there are few guidelines for the dosing and titration of MC in CNCP. A recent consensus-based review sought to define dosing and titration protocols for oral MC in CNCP. The consensus of twenty global experts across nine countries developed three such treatment protocols based on patient factors such as susceptibility to MC, adverse effects and prior cannabis use history: Routine protocol - recommended for most patients (unless sensitive to MC or requiring rapid pain relief).17 *Refer for expert consultation if considering >40 mg/day THC (Adapted from Bhaskar et al. 2021) Conservative protocol - recommended for patients more sensitive to MC’s effects (e.g.frail, complex co-morbidities).17 *Refer for expert consultation if considering >40 mg/day THC (Adapted from Bhaskar et al. 2021) Rapid protocol - recommended for patients in severe pain, requiring palliation, or with a significant history of prior cannabis use.17 *Refer for expert consultation if considering >40 mg/day THC (Adapted from Bhaskar et al. 2021) Breakthrough pain - The authors also made provision for the use of inhaled dried flower MC (either balanced THC:CBD or THC dominant) to be considered for patients experiencing breakthrough pain.17 Integrating medical cannabis into multimodal pain care Medical cannabis should not be viewed as a standalone therapy but as one element of a multimodal pain management plan.1,5 Comprehensive care should incorporate physiotherapy, cognitive behavioural therapy, lifestyle modifications, and social support alongside pharmacological measures.1,5 Within this framework, MC may provide incremental improvements in pain relief, mood, sleep, and overall quality of life, enhancing the effectiveness of other interventions.3,5 Summary Medical cannabis represents an emerging option for the management of chronic non-cancer pain.3,5 While it is not a panacea, evidence suggests that it may provide meaningful improvements in pain, quality of life, and function for selected patients, with an acceptable safety profile.510,13 For some patients, it may reduce reliance on opioids and other medications, and may offer a safer long-term alternative.3,5,12 Prescribers should approach cannabis with the same clinical rigour as any other therapy: starting with careful patient selection, initiating treatment at low doses, monitoring closely, and discontinuing if ineffective.15 When integrated into a multimodal pain management strategy, MC has the potential to enhance outcomes and provide relief for patients whose options have been limited.5 As research expands, doctors may gain greater clarity on optimal formulations, dosing strategies, and long-term outcomes. In the meantime, thoughtful, evidence-informed prescribing may help patients achieve the desired benefit from this evolving therapeutic tool. Disclaimer: Medical cannabis products may be associated with adverse events. For more information please contact medinfo@saged.com.au. Medical cannabis products are not suitable for use during pregnancy or breastfeeding, for anyone with a history with psychotic disorders, or for those with unstable cardiovascular disease. Treatment for patients under 18 years is recommended under the guidance of a paediatrician. Patients should not drive or operate machinery while being treated with some forms of medical cannabis.

While well-known systems like the sympathetic nervous system are widely understood, doctors may be less familiar with the more recently identified endocannabinoid system (ECS).1,2 The ECS is thought to be involved in regulating pain, immunity, stress, appetite, weight, and nausea, yet it remains largely absent from traditional medical education in Australia.3 What will you learn?This module aims to equip you with the skills and confidence to integrate medical cannabis into patient care when clinically appropriate. Drawing on current evidence and theoretical case studies, the module explores the ECS, cannabinoid pharmacology, proposed therapeutic effects, and the clinical implications of both ECS function and use of medical cannabis. Through interactive scenarios and evidence summaries, you’ll explore how this knowledge may be relevant to clinical applications—ranging from the potential involvement of the ECS in patient presentations to identifying possible treatment approaches. Estimated Duration: 4 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Identify the endocannabinoid system’s components, role and functions, as currently understood Describe how endocannabinoid system function and dysfunction may contribute to symptoms such as pain, anxiety, sleep disturbance and inflammation Interpret how the mechanism of the endocannabinoid system may inform the therapeutic potential of medical cannabis Explain the pharmacological effects of THC and CBD Identify clinical features suggestive of cannabinoid tolerance or receptor desensitisation Describe the limitations and uncertainties in the current evidence relating to the endocannabinoid system References Harvard Health Publishing. The endocannabinoid system: Essential and mysterious. https://www.health.harvard.edu/blog/the-endocannabinoid-system-essential-and-mysterious-202108112569 (accessed Aug 2025). Parliament of Australia. Current barriers to patient access to medicinal cannabis in Australia. https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/024403/toc_pdf/CurrentbarrierstopatientaccesstomedicinalcannabisinAustralia.pdf (accessed Aug 2025). Hillard CJ. Circulating Endocannabinoids: From Whence Do They Come and Where are They Going? Neuropsychopharmacology. 2018;43:155–172.

Understanding Medical Cannabis Formulations: A Primer for GPs Published: August 2025 Australian general practitioners (GPs) who prescribe medical cannabis are faced with a diverse and rapidly evolving range of formulations to choose from. Beyond selecting a product with the appropriate cannabinoid profile for their patient's presentation, GPs must also consider the route of administration and formulation type, which could significantly impact onset, duration, tolerability, and patient adherence.1,2 This primer explores the key medical cannabis dosage forms currently available, their pharmacokinetic profiles, patient considerations, and practical prescribing tips to help guide formulation decisions. Overview of medical cannabis formulations The two primary active compounds in medical cannabis, Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), are available as various dosage forms.1,3 Each has distinct benefits and limitations, depending on the therapeutic goal and patient-specific factors.1 The most commonly available forms include: 1. Oral formulations: oils, pastilles, capsules Oral formulations, including oils, and softgel capsules, are the most commonly prescribed medical cannabis products in Australia.4 Oils typically come in bottles with graduated droppers, allowing for flexible dosing. Capsules and pastilles offer convenience and fixed doses.1 Pharmacokinetics: Onset: 60 -180 minutes1Peak effect: 2-4 hours5Duration: 6-8 hours1 Pros and Cons: Pros Cons Discreet and convenient to administer1 Patients with dexterity challenges may find oils difficult to administer9 Suitable for chronic conditions requiring longer-lasting relief1,5 Delayed onset may limit use for acute symptom control1 Slower onset and lower peak concentrations may potentially reduce risk of intoxication6,7,8 Low bioavailability due to first pass metabolism5 Prescribing tips: Start with a low dose, titrate slowly (e.g. “start low and go slow”).1 Oral absorption can be enhanced by administering in the presence of fats and oils thus ideally taken with food.1 2. Inhaled formulations: vaporised dried flower or inhalation oils Medical cannabis can be inhaled via a medical vaporiser device which delivers vapour containing cannabinoids and terpenes to the lungs.9 Smoking is not an approved method for medical cannabis administration in Australia.5 Use of a registered medical vaporizer device reduces exposure to potentially toxic compounds of cannabis smoke and helps to reduce variability in the cannabinoid content delivered.9 Pharmacokinetics: Onset: 5-10 minutes1Peak effect: 15-30 minutes5Duration: 2-4 hours1 Pros and Cons: Pros Cons Rapid onset may be useful for episodic or breakthrough symptoms1 Shorter duration of action than oral formulations with variable bioavailability7 Dose titration is patient-guided - patients stop when symptom relief is achieved (within daily THC limits)9 Not suitable for patients with respiratory disease (e.g. asthma, chronic obstructive pulmonary disease)2 Lack of first-pass metabolism may improve cannabinoid absorption6 May be associated with compliance issues10 Prescribing tips: Inhaled forms may be useful as an adjunct to oral formulations for conditions like chronic pain with breakthrough flares.1 Ensure patients have access to a TGA-approved vaporiser (details: TGA website).5,6 3. Oromucosal sprays These sprays are administered under the tongue or inside the cheek for mucosal absorption.10 Currently there is only one such product available in Australia (nabiximols THC 27mg: CBD 25mg oral spray), which is TGA-approved for spasticity in multiple sclerosis.12 Pharmacokinetics: Onset: 15-45 minutes1Peak effect: 1-2 hours10Duration: 6-8 hours1 Pros and Cons: Pros Cons Faster onset than oral ingestion1 May cause local irritation (dry mouth, oral ulcers) 12 Suitable for patients with swallowing difficulties 8 Can be more expensive than other forms 1 Fixed metred dosing facilitates dose titration and may be easier to administer than some oral formulations 5 TGA-approved for patients with multiple sclerosis only.12 * *Patients may be able to access via Special Access or Authorised Prescriber scheme for other conditions Prescribing tips: Consider oromucosal sprays when rapid symptom relief is needed but inhalation is contraindicated, such as in patients with respiratory disease.2,10 Six to eight sprays of nabiximols are generally required for symptomatic relief with a daily limit of 12 sprays.11 4. Topical preparations Topical formulations such as creams, ointments, or gels are suitable for localised symptoms such as dermatological conditions or arthritis pain.1 They exert their actions locally rather than systemically.1 THC is not well absorbed via the skin however CBD and the minor cannabinoid cannabinol (CBN) are much more permeable than THC.5 Pharmacokinetics: Onset: 5-120 minutes13Peak effect: variable 13Duration: variable13 Pros and Cons: Pros Cons May be useful for localised pain or inflammation 13 Limited clinical evidence to support efficacy1 Low risk of intoxication or systemic side effects13 Local side effects such as contact dermatitis13 Steady delivery of active compounds over prolonged period13 Variable absorption through the skin barrier13 Administration tips: Topical preparations should not be applied to broken skin.14 Advise patients not to rub the topical preparation into the skin vigorously.14 Factors to consider when choosing a formulation 1. Symptom profile and onset requirements Acute symptoms → inhaled or oromucosal.1 Chronic conditions → oral formulations.1 Mixed profiles → combination therapy.1 2. Patient preference and practicality Some prefer oils, capsules for discretion. Others prefer inhaled forms for feedback. Consider dexterity, cognition, access to devices. 3. Safety and contraindications Avoid inhaled in respiratory disease.2 Avoid THC in pregnancy, unstable CV disease, psychiatric history.5 Watch drug interactions with hepatic enzymes.5 4. Dosing control and titration Oral oils: flexible but delayed onset.1,10 Capsules/pastilles/sprays: consistent dosing.1,13 Inhaled: rapid but variable.1,8 Summary Clinicians prescribing medical cannabis have a considerable array of dosage forms to choose from. Understanding the factors that influence formulation selection may be central to safer more effective patient care.1,2 Choosing the most appropriate dosage form may enhance therapeutic outcomes, minimise side effects, and improve adherence.1,2 By familiarising themselves with the available formats (oral, inhaled, oromucosal, topical) and considering patient-specific needs and preferences, GPs may be better positioned to deliver personalised and evidence-informed care in this emerging therapeutic area. This article is intended for educational purposes and does not replace clinical judgment or regulatory requirements. Disclaimer: Medical cannabis products may be associated with adverse events. For more information please contact medinfo@saged.com.au. Medical cannabis products are not suitable for use during pregnancy or breastfeeding, for anyone with a history with psychotic disorders, or for those with unstable cardiovascular disease. Treatment for patients under 18 years is recommended under the guidance of a paediatrician. Patients should not drive or operate machinery while being treated with some forms of medical cannabis.

Cannabinoid Hyperemesis Syndrome: An Emerging Challenge in Patient Care Published: August 2025 Cannabinoid Hyperemesis Syndrome (CHS) is a condition increasingly observed among long-term users of cannabis.1,2 Despite cannabis being proposed for its antiemetic effects, this very same compound has been linked to CHS, a condition marked by recurring nausea, vomiting and abdominal pain, often severe enough to require emergency medical care.1,3 Increasing awareness and understanding of CHS among both patients and clinicians may play a key role in promoting safer, more effective treatment outcomes as early recognition and management of this syndrome may reduce the risk of potentially serious sequelae.1,2,4 What is Cannabinoid Hyperemesis Syndrome? Cannabinoid Hyperemesis Syndrome is a condition characterised by cyclical episodes of nausea, intractable vomiting, and abdominal pain following prolonged cannabis use.1 First described in 2004, CHS remains underdiagnosed and often mistaken for other gastrointestinal conditions such as cyclic vomiting syndrome (CVS).1,3 According to the Rome IV diagnostic criteria, CHS is defined by: Stereotypical episodic vomiting similar to CVS in onset and duration A history of prolonged cannabis use Relief of symptoms with sustained cannabis cessation.5 An additional defining feature of CHS is that patients often find relief through taking very hot showers or baths.1 Whilst the exact pathophysiology of CHS is not yet fully elucidated, it appears to be linked to the overstimulation of CB1 endocannabinoid receptors in the endocannabinoid system (ECS) by the cannabinoid tetrahyrdocannabidiol (THC), leading to changes in the body’s emetic control centres in the central nervous system and brainstem.1,2 Another proposed mechanism involves THC binding to the TRPV1 (transient receptor potential vanilloid 1) receptors, which is involved in pain and temperature perception and regulation of gut motility.1,2 Paradoxically, while low doses of cannabis exert antiemetic effects through ECS modulation and hypothalamus-pituitary-adrenal (HPA) axis suppression, chronic use of cannabis containing high-strength THC may have the opposite effect, leading to overstimulation of the ECS — one of the proposed mechanisms behind CHS.1,3,4 Cannabinoids at a Glance The two primary cannabinoids are: THC (Tetrahydrocannabinol): The psychoactive compound that binds to CB1 receptors in the central nervous system, and is believed to influence appetite, mood, pain, and nausea.2,6 CBD (Cannabidiol): A non-intoxicating cannabinoid with a weaker affinity for CB1/CB2 receptors, more commonly associated with anti-inflammatory and immunomodulatory effects.2,6 How common is CHS? The true prevalence of CHS is difficult to ascertain and likely underreported.1,2 This is partly because CHS symptoms overlap with other conditions, and in some jurisdictions, stigma and legal concerns around cannabis use lead patients to withhold disclosure of their medical cannabis use from healthcare providers.1,7 However, recent data highlight a growing concern: A study in a United States urban hospital estimated that 32.9% of chronic users of cannabis (20+ days/month) met the criteria for CHS, which extrapolates to approximately 2.75 million cases annually in the United States.7 In Australia, a six-year retrospective review undertaken at a Melbourne emergency department identified 142 CHS-related visits. The median patient age was 31 years, with nearly 69% male, highlighting its prevalence among younger adults.8 With cannabis potency and use increasing worldwide, the incidence of CHS may be expected to rise unless proactively addressed.1-3 Stages and management of CHS Patients experiencing CHS typically present to the emergency department whilst demonstrating acute gastrointestinal symptoms.7 However, according to the American Gastroenterological Association, CHS progresses through four distinct stages:2 Prodromal Phase – Early symptoms such as nausea, anxiety, and abdominal discomfort, often lasting months.2,3 Hyperemesis Phase – Acute onset of relentless vomiting, abdominal pain, dehydration, and compulsive hot bathing.2,3 Recovery Phase – Symptoms improve once cannabis use is stopped.2,3 Interepisodic Phase – Asymptomatic period between episodes; symptoms often return with cannabis reinitiation.2,3 Treatment strategies There is currently no specific pharmacological treatment for CHS. The current cornerstone of management is immediate and sustained cannabis cessation.1,9 Other strategies include: IV fluids and electrolyte correction to manage dehydration9 Hot showers or baths, which may provide temporary relief1 Antiemetics – though many are ineffective in CHS1 Capsaicin cream (a TRPV1 agonist) applied topically to the abdomen has shown some benefit in acute settings1,9 Importantly, failure to recognise and treat CHS can lead to serious complications, including electrolyte and fluid imbalance, renal failure and, in rare cases, death.1,10,11 Is CHS permanent? CHS appears reversible with cannabis cessation.1 Case studies have widely shown that symptoms resolve once cannabis use is stopped.12,13 However, due to limited long-term studies, it remains unclear whether some individuals may develop persistent or recurring symptoms even after cessation.12,13 Implications for medical cannabis use To date, CHS has been primarily associated with chronic recreational use of high-dose THC products.14 However, as medical cannabis becomes more widespread, and as higher-potency THC formulations become more accessible, it is possible that CHS may be increasingly observed among users of medical cannabis.1,2,15 Currently, there is insufficient data to draw conclusions about CHS prevalence in patients using medical cannabis. However, the following precautions are advised: Educate patients about the signs and symptoms of CHS before initiating treatment.4,15 Prescribe the lowest effective dose, especially with high-strength THC products.4,6 Consider CBD-dominant options where appropriate, as CBD has not been linked to CHS.14 Establish a thorough patient history of cannabis use, including prior and current recreational use, as past heavy use appears to increase risk.1,4,15 Summary Cannabinoid Hyperemesis Syndrome represents a growing but still under-recognised adverse consequence of long-term cannabis use.1,2 While it may seem contradictory that cannabis — which has proposed antiemetic effects — can cause intractable vomiting, this reflects the complex and dose-dependent biphasic nature of cannabinoid pharmacology.4 For healthcare professionals, particularly those prescribing medical cannabis, awareness and vigilance are essential.1,4,15 Patient education, careful product selection, and prompt cessation in response to symptoms could potentially reduce risks and improve patient outcomes.1,4,14,15 As the legal and medical landscape around cannabis continues to evolve, understanding CHS may be central to ensuring safe and responsible use of this emerging therapy. Disclaimer: Medical cannabis products may be associated with adverse events. For more information please contact medinfo@saged.com.au. Medical cannabis products are not suitable for use during pregnancy or breastfeeding, for anyone with a history with psychotic disorders, or for those with unstable cardiovascular disease. Treatment for patients under 18 years is recommended under the guidance of a paediatrician. Patients should not drive or operate machinery while being treated with some forms of medical cannabis.

A Closer Look at Medical Cannabis & Chronic Pain An evidence-based webinar exploring the role medical cannabis could play in the treatment of chronic pain. Date: Tuesday 30th September  |  Time: 7–8pm (AEST)  |  Format: Online (Zoom) Hosted by SAGED & Dr Joel Wren, GP Have you experienced challenges in managing patients with chronic pain? This webinar aims to provide you with evidence, case studies, and practical tools you can use right away. SAGED invites you to attend a free, RACGP- and ACRRM-accredited webinar, designed for Australian GPs interested in the evolving role of medical cannabis in chronic non-cancer pain (CNCP). Led by Dr Joel Wren, a GP with experience in prescribing medical cannabis, this 60-minute session will cover: Current evidence on medical cannabis in chronic non-cancer pain management Clinical insights on medical cannabis and neuropathic pain Practical case studies, dosing, and product selection Don’t miss your chance to hear from one of Australia’s leading medical cannabis practitioners on chronic pain. Designed for Australian GPs, this session aims to support safe, evidence-based prescribing in general practice. Learning Outcomes By attending this webinar, you will be able to: Identify when and why medical cannabis may be appropriate in CNCP management Understand the current evidence base supporting the use of medical cannabis in CNCP, with a focus on neuropathic pain Apply clinical insights to case examples, including product selection, dosing, and safety considerations

Gina’s Story: Endometriosis, the Endocannabinoid System, and Emerging Approaches to Care Published: August 2025 Disclaimer: This is an anonymised patient case study, written with patient consent. The decision-making in this case study was undertaken by a doctor. The information in this document does not constitute medical advice or treatment recommendations. The use of cannabis based medications is the responsibility of a qualified medical professional who may initiate treatment after reviewing a patient's medical history. Most medical cannabis products are unapproved medicines and are regulated by the Therapeutic Goods Administration (TGA) Special Access Scheme (SAS), for which individual responses may vary. Meet Gina (pseudonym), a 38-year-old woman living with endometriosis—one of an estimated 10% of Australian women affected by this chronic condition, which involves the growth of endometrial-like tissue outside the uterus.1 Gina is seeking treatment for ongoing gastrointestinal and pain-related symptoms associated with endometriosis. Despite trialling a range of conventional medications, she’s experienced limited relief—particularly for her chronic pain, which significantly affects her ability to work and maintain daily functioning. Endometriosis is a condition that can cause a wide range of chronic pelvic pain symptoms, including dysmenorrhea (painful periods), dyspareunia (pain during intercourse), fatigue, dyschezia (pain during bowel movements), and dysuria (pain during urination).1 It may also co-occur with other conditions such as irritable bowel syndrome, rheumatoid arthritis, psoriasis, anxiety, depression, and chronic fatigue syndrome.1 Despite the substantial burden of endometriosis, many patients consider conventional medical treatments to be suboptimal—often citing limited efficacy and unwanted side effects.1 Current management typically involves a combination of medical and/or surgical interventions, including hormonal therapies, non-opioid and opioid analgesics, and neuropathic pain agents.1 While surgery can be effective, it carries high costs, long wait times, and high recurrence rates—often leading to the need for repeat procedures.1,2 Gina’s consultation with her doctor Limited access to surgery and variable responses to pharmacological treatments, have led patients with endometriosis to self-management strategies.1 Cannabis use—both prescribed and non-prescribed—is increasingly reported, with some individuals noting improvements in symptom severity.1 These trends highlight a need for more research into cannabis-based therapies as potential adjuncts in endometriosis care.1 This case study explores how Gina’s medical team carefully assessed her clinical presentation, medical history, potential psychological and cardiovascular risk factors, and possible drug interactions before initiating medical cannabis to support her pain management and overall wellbeing. Gina’s doctor collected the following information: Patient information and presentation Personal and family medical history Current and past medications and treatments Specialist and other healthcare involvement Lifestyle factors Discover Gina’s patient profile below. Presenting condition Female, aged 38 years Presenting condition – endometriosis Symptoms Excruciating dysmenorrhoea since menarche Vomiting, diarrhoea and nausea Low appetite and weight loss Headaches Pain assessment Position – lower abdomen Quality – severe, accompanied by sweating, crying or doubling over in pain Type – intermittent sharp pains and general abdominal tenderness Radiates – to arms or legs Severity Good days – 6–8/10 Bad days – 10/10 Timing – menstruation and ovulation Triggers – stress Personal and family medical history Medical history Endometriosis (stage 4) – diagnosed in 2019 Pericarditis post coronavirus – diagnosed 2022* Generalised anxiety disorder and depression – diagnosed 18 years prior Vitamin D deficiency Allergies Latex Medical history (family) Maternal aunt – endometriosis *This may be a risk factor for medical cannabis.3 Current and past medications and treatments Current medications Drospirenone – 4 mg/day Past medications Tapentadol Physiotherapy sessions – with minimal benefit Remedial massage sessions – with minimal benefit Specialist and other healthcare involvement Cardiologist review of pericarditis – referred back to GP care after diagnosis Lifestyle factors Smoking – No Social considerations Driving – drives to work 2 days per week and on occasional weekend trips THC roadside liability understood: Yes Workplace drug testing – N/A Operates heavy machinery – N/A Previous use of cannabis Use – non-prescribed cannabis daily between 2016 and 2019 Administration – flower via joint or pipe Amount – 2 g per day Effects – reduced pain, relieved bowel cramps, assisted with sleep Assessing risks After reviewing Gina’s profile, her doctor notes potential risk factors relating to her anxiety, cardiovascular health, driving and previous use of non-prescribed cannabis. Below, explore Gina’s potential risk factors and how her doctor managed them. Anxiety Given Gina’s diagnosis of generalised anxiety disorder, her doctor monitored her closely, with regular check-ins to assess mood and anxiety symptoms. As THC can cause feelings of altered mood and anxiety, it should be administered with caution in individuals with anxiety disorder.4 Her doctor ensured that Gina understands the potential mood-related side effects and equipped her with strategies to manage them effectively if they occur. Additionally, she emphasised the importance of starting on a low dose and gradually increasing the dosage as specified in the treatment plan. Cardiovascular health Before prescribing medical cannabis products, her doctor confirmed that Gina’s cardiovascular health is stable by: Reviewing previous cardiac assessments and reports from Gina’s cardiologist Obtaining approval from Gina’s cardiologist and consulting Gina’s regular GP before commencing treatment Monitoring Gina’s electrocardiogram and vital signs throughout the course of her treatment This is of particular importance as cannabis products with THC can cause tachycardia, and is not advised for patients with a history of angina or myocardial infarction.4 Driving As Gina drives to work occasionally, her doctor ensured that Gina is aware of the laws around driving. Current medical cannabis prescribing legislation does not exempt patients from THC-related drug-driving offences.4 THC can impair driving performance and increase crash risk—particularly in occasional users—with effects lasting up to eight hours after oral dosing.5 Patients using THC-containing products should avoid driving and other safety-sensitive tasks, especially during treatment initiation and shortly after each dose.5 In contrast, there is no evidence that CBD impairs driving.5 Patients taking CBD-only medicines can lawfully drive if they are not impaired.5,6 Non-prescribed use of cannabis Gina’s doctor is also concerned about her previous use of non-prescribed cannabis. Cannabis acquired on the black market is unlikely to achieve the desired results and can cause unpredictable and severe adverse reactions as it may contain hazardous ingredients and contaminants—such as microbes, heavy metals and pesticides.7,8 Devising a treatment plan After reviewing Gina’s presentation and medical history, her doctor created a treatment plan to help Gina manage her endometriosis symptoms. Developing a risk management and follow-up plan Gina’s doctor provided her with a risk management plan which included symptom tracking and monitoring of adverse effects, as well as follow-ups scheduled at 4 to 8 weeks to review progress and adjust treatment as needed. Discover Gina’s risk management and follow-up plan below Risk management plan Asked Gina to keep a symptom diary to record pain scores, doses and other symptoms Informed Gina of how to report and respond to adverse effects Conducted a pre-treatment Depression Anxiety Stress Scales (DASS) assessment and will follow up at each check-in Advised Gina to start low and go slow Reviewed Gina’s cardiovascular reports and test results, and obtained cardiologist and GP support before commencing treatment Follow-up plan Follow-ups scheduled for 4- and 8-weeks after initial treatment Review progress and adjust plan as required Monitor cardiovascular results Monitor psychiatric state via DASS results (conducted at each appointment) At 4 weeks: Gina reported that the CBD oil was moderately effective but not as effective as the inhaled product. In response, her doctor prescribed a different oil with the following profile and dosage instructions: THC 10 mg/mL : CBD 10 mg/mL Start: 0.1 mL twice a day After 2 days: increase by 0.1 mL Every 2 days thereafter: increase by 0.2 mL to full symptom control Maximum daily dose: 3.0 mL At 8 weeks: Gina shared that she found the new oil effective, and uses 1.5 mL daily. Gina and her doctor agreed to touch base again in 4 weeks. Exploring the Science in Gina’s Case What Is the Relationship Between Medical Cannabis, the Endocannabinoid System, and Endometriosis? Gina’s doctor has prescribed her with medical cannabis; understanding its proposed mechanism could provide insight into why it may have a role in Gina’s care. Studies have shown that cannabinoid receptors (CB1 and CB2) are highly expressed in ovaries with endometriosis, compared with stromal tissues surrounding the lesion.10,11 As cannabinoid receptors have been implicated in the management of chronic pain and inflammation, these findings suggest that medical cannabis may offer a targeted approach for managing endometriosis-related pain and inflammation at the lesion site.10,11 A recent literature review found that compared to conventional strategies such as analgesics and heat therapy, medical cannabis offered symptom relief for individuals with endometriosis.10 This flow diagram illustrates the potential key therapeutic targets within the endocannabinoid system that interact with cannabis compounds.10 Adapted from Cummings et al. 202410 However, there remains a lack of randomised controlled trials specifically evaluating medical cannabis efficacy for endometriosis-related pain.10 This gap in evidence highlights an important direction for future research—particularly in light of emerging findings that a dysregulated endocannabinoid system may contribute to the pathophysiology of endometriosis.10 Key Takeaways Endometriosis remains a complex condition that significantly impacts quality of life.1 While conventional treatments can help, many patients—like Gina—continue to experience debilitating symptoms despite best-practice interventions.1 Emerging evidence suggests a potential role for the endocannabinoid system in modulating inflammation, pain, and other symptoms associated with endometriosis.10,11 Though clinical research is still developing, the expression of cannabinoid receptors in endometriotic tissue, alongside promising patient-reported outcomes, highlights the potential role of medical cannabis as an adjunctive therapy in selected patients.10,11 Gina’s case illustrates how a personalised, cautious, and evidence-informed approach—grounded in thorough risk assessment and multidisciplinary collaboration—can support safe access to medical cannabis. As with any therapeutic decision, individual patient factors, clinical history, and shared decision-making remain central to guiding care. Adverse event monitoring: Medical cannabis products may be associated with adverse events. For more information please contact medinfo@saged.com.au. Medical cannabis products are not suitable for use during pregnancy or breastfeeding, for anyone with a history with psychotic disorders, or for those with unstable cardiovascular disease. Treatment for patients under 18 years is recommended under the guidance of a paediatrician. Patients should not drive or operate machinery while being treated with some forms of medicinal cannabis. Veeva job code: MONT-SGD-2025-0014Date of preparation: July 2025

Patient Conversations: Why Cultural Safety Matters in Medical Cannabis Prescribing Published: July 2025 As medical cannabis becomes an increasingly accepted therapeutic option in Australia, healthcare professionals should consider not only the clinical aspects of prescribing, but also the cultural safety of their practice. For many patients, particularly Aboriginal and Torres Strait Islander peoples and those from culturally and linguistically diverse (CALD) communities, engaging with the healthcare system can carry risks of misunderstanding, harm, and marginalisation if cultural needs are not recognised and respected.1,2 What exactly is “Cultural Safety”? Cultural safety is a patient-led concept that focuses on whether individuals feel respected, heard, and safe during healthcare encounters.3 It goes beyond merely being aware of cultural differences (i.e. "cultural awareness”) and requires healthcare professionals to reflect on their own biases, power, and privilege while actively adapting their care to meet the needs of the patient’s cultural identity and lived experience.4 Ultimately, it is the patient, not the healthcare professional, who determines whether an experience is culturally safe.3 Why is this important for medical cannabis? Medical cannabis use can be influenced by personal, cultural, legal, and social factors. Patients may have concerns regarding stigma, legality, or family and community expectations.5 For some, complementary medicines may resonate with cultural healing traditions.6 For others, medical cannabis may invoke social stigma from within their communities.6 For Aboriginal and Torres Strait Islander peoples, the impacts of colonisation, systemic racism, and intergenerational trauma can contribute to distrust of mainstream healthcare.1 For CALD communities, differing views about health, medicine, and healing may shape how medical cannabis is perceived.6 Practical considerations for culturally safe medical cannabis prescribing Stigma Acknowledge the historical criminalisation of cannabis and its disproportionate impact on some communities6,7: Be prepared to address patient concerns about legal issues, confidentiality, and fear of judgement. Recognise that concerns around stigma may be heightened among Aboriginal and Torres Strait Islander peoples and CALD patients, who may have previously experienced discrimination within healthcare and legal systems.8,9 Creating a safe, non-judgemental space is essential. This involves using inclusive and respectful language, and reassuring patients about the confidentiality of their care, and the legal and clinical appropriateness of prescribed medical cannabis.8 For Aboriginal and Torres Strait Islander patients, it is important to understand the impact of intergenerational trauma and to approach care with cultural humility and respect for their lived experiences.9 Access and equity Understand that cost, geographic barriers, and language barriers can impact access to medical cannabis.10 Share options and advocate for equitable prescribing pathways, such as the Compassionate Access Schemes offered in some states11 and through selected medical cannabis organisations. Provide translated information where available, engage with interpreters, and guide patients through application processes.8 For Aboriginal and Torres Strait Islander patients, consider the added importance of family and community in decision-making and support models: Collaborate with Aboriginal Health Workers or Aboriginal Community Controlled Health Services (ACCHSs) to provide culturally appropriate care.9 Cultural perceptions Some patients may see cannabis as an extension of traditional medicine6, while others may associate it with substance misuse or illegality6: Approach these discussions with curiosity, not assumptions. Explore patients’ beliefs about healing and medicine, and be open to integrating their cultural practices with medical care where safe and appropriate.8 For Aboriginal and Torres Strait Islander patients, acknowledge the importance of connection to Country, spiritual wellbeing, and traditional healing, and consider these when framing discussions about treatment.9 Supporting cultural safety with SPIKES When introducing sensitive treatments like medical cannabis, healthcare professionals can enhance cultural safety by using structured communication tools. One such tool, the SPIKES framework, was originally developed to aid communication of ‘bad news’ in healthcare12, and can be applied to fostering effective communication with diverse patients. Adapted from Buckman 2005 Summary Medical cannabis may offer symptom relief for some patients when clinically appropriate, but how it is introduced matters. Culturally safe practice, guided by structured, empathetic communication models such as SPIKES12, ensures that care is not only clinically sound but also respectful, empowering and patient-centred.3 Cultural safety isn’t a checkbox; it is an ongoing commitment to reflection, understanding, and partnership. Every conversation is an opportunity to make healthcare a safer, more inclusive space for all. Job code: MONT-SGD-2025-0005 | Date of preparation: July 2025

Managing Respiratory Depression Risk: Exploring CB1 Receptors and Safe Co-Prescribing in Pain, Anxiety, and Palliative Care Published: July 2025 Medical cannabis has gained increasing attention as a therapeutic option for managing pain, anxiety, and symptoms in palliative care. Respiratory depression—particularly associated with opioids and some anxiolytics—remains a significant safety consideration in these settings.1,2 Unlike these medications, cannabinoids do not significantly affect brain stem respiratory centres, due to the low density of CB1 receptors in those areas.3,4 This article explores the mechanisms behind this effect and considers the implications for co-prescribing medical cannabis alongside other agents used in symptom management. Understanding CB1 receptor distribution Cannabinoids exert their effects primarily through two receptors: CB1 and CB2.3,4 CB1 receptors are abundant in brain regions involved in mood, memory, pain, and motor control, while CB2 receptors are more prominent in organs and in the immune system.3,4 However, a key finding in neuropharmacology demonstrated that CB1 receptors are only minimally present in the brain stem, the part of the brain that regulates vital functions such as breathing and heart rate.3,4 In contrast, opioid receptors are densely concentrated in the brain stem.1 When opioids bind to these receptors, they can depress the respiratory centres, reducing the drive to breathe and leading to potentially fatal respiratory depression.1 Due to the lack of significant CB1 receptors in the brain stem, cannabinoids such as tetrahydrocannabinol (THC) do not suppress respiratory function in the way opioids do.5 This fundamental difference means: Medical cannabis use is not associated with respiratory depression.5 Unlike opioids and benzodiazepines, medical cannabis does not pose the same risk of fatal overdose via respiratory failure.5 Simplified diagram demonstrating CB1 receptor distribution in the brain.Figure adapted from Kayser et al. 20196 This safety profile is supported by clinical and preclinical studies showing that medical cannabis, even when used in combination with other medications, does not increase the risk of respiratory suppression that is seen with some other central nervous system (CNS) depressants.5,7,8,9 Implications for pain management Opioid medications form the mainstay of pain management in severe and some chronic pain conditions. They carry a well recognised risk of respiratory depression, overdose and dependence.1,9 Medical cannabis offers several potential benefits in this context: Opioid-sparing effect: Medical cannabis can reduce opioid dosage requirements by providing complementary analgesic effects via different mechanisms.5,7,8,9 Reduced respiratory risk: Lower opioid doses decrease the likelihood of respiratory depression, making the overall pain management regimen safer.8 Multimodal pain relief: Medical cannabis can alleviate different types of pain (e.g. neuropathic, inflammatory) via multiple complementary mechanisms, potentially improving pain control when combined with opioids.10,11 Despite these benefits, co-prescribing medical cannabis and opioids should be undertaken with careful medical supervision and opioid dose adjustment to avoid amplification of common opioid side effects, such as sedation and constipation.11 Considerations for anxiety Anxiety disorders are commonly treated with benzodiazepines and other anxiolytic medications, which also carry risks of sedation and respiratory depression.2,12 Medical cannabis could serve as an either adjunctive or alternative treatment in some patients due to: Anxiolytic effects in certain medical cannabis strains or formulations, especially those higher in cannabidiol (CBD).13 The risk of respiratory depression from benzodiazepines, especially with higher doses.2 The potential to lower benzodiazepine dosages, reducing the risk of developing side effects and/or dependence.7 Due to inter-patient variability in response to CNS medications and medical cannabis, a personalised approach with close monitoring is advised. High-THC products (>10%) may exacerbate anxiety or cause psychoactive effects in some patients.13 CBD is thought to mitigate THC-induced anxiety, highlighting the importance of selecting products with an appropriate THC:CBD ratio, particularly in patients with a history of anxiety.13 Additionally, cannabinoids may inhibit CYP450 enzymes, potentially affecting the metabolism of concurrent medications, including anxiolytics.11 Prescribers should assess drug interactions to minimise the risk of adverse effects such as excess sedation. The role of medical cannabis in palliative care Palliative care patients commonly present with complex symptoms requiring multidrug regimens, including opioids for pain, benzodiazepines or other sedatives for anxiety and agitation, antiemetics for nausea, steroids, and other supportive therapies.14 While clinical evidence on the efficacy of medical cannabis in palliative symptom management remains inconclusive, preclinical studies and case reports suggest potential benefits in managing: Pain relief without increasing respiratory depression risk8, especially in patients with chronic pain.15 Anxiety and insomnia, which are common concerns in palliative care and are frequently reported as having a negative impact on patients’ quality of life.15 Nausea and poor appetite, thereby reducing the risk of malnutrition and cachexia.14,15 Co-prescribing medical cannabis with opioids and other CNS depressants in palliative care requires careful dosing and patient monitoring but could offer a viable adjunctive therapeutic approach in this patient group.16 Broader safety considerations for medical cannabis While medical cannabis has a low risk of respiratory depression5, potential cognitive impairment, psychoactive effects, and possible interactions with other prescribed drugs should all be taken into account when co-prescribing medical cannabis.17 More rigorous clinical trials are needed to develop standardised guidelines for medical cannabis use in combination with other medications, particularly in complex conditions such as those found in palliative care. Summary The low density of CB1 receptors in the brain stem is thought to underlie the lack of respiratory depression associated with cannabinoid use3,4, in contrast to opioids and benzodiazepines which have a strong association with respiratory sequelae.1,2 Given its distinct pharmacological profile, medical cannabis may be considered as an adjunct in pain management, anxiety treatment, and palliative care, particularly where minimising respiratory depressant effects is a clinical priority. Whilst careful co-prescribing and patient-specific considerations remain essential, medical cannabis has the potential to improve therapeutic outcomes while minimising the risk of one of the most significant side effects associated with conventional medications for these conditions. Job code: MONT-SGD-2025-0001 | Date of preparation: July 2025

Understanding Medical Cannabis Strength: A Guide for Healthcare Professionals Published: July 2025 When prescribing medical cannabis, it’s essential to understand and accurately communicate the “strength” of the product. However, the lack of standardisation in the way cannabis strength is represented can lead to confusion, complicating safe prescribing, patient education, and effective transitions between products.1 In this article, we will simplify the key concepts used to describe medical cannabis strength and highlight how these terms impact clinical practice. Methods of Describing Medical Cannabis Strength Current methods for expressing medical cannabis strength are determined by the amount of the two primary cannabinoids, CBD (cannabidiol) and THC (tetrahydrocannabinol) in a product. THC is considered the primary psychoactive component, whilst CBD is thought to modulate THC’s effects.2 The dose at which THC’s psychoactive properties become clinically apparent is generally regarded to be 5 mg.3 Medical cannabis strength can be described in different ways, each with its unique meaning: Total Cannabinoid Content (mg) This measurement describes the actual amount of THC and/or CBD per unit, such as per capsule, gummy, or spray. For example, a capsule might contain 5 mg of THC and 5 mg of CBD. Total cannabinoid content is the most clinically meaningful way to describe cannabis product strength and aligns with the dosing nomenclature used for other medications. For example, a drug may be prescribed with a specific dose in milligrams (such as 5 mg of morphine), and cannabis dosing follows this same principle. Cannabinoid Ratios (e.g. CBD:THC) This ratio describes the balance of two primary cannabinoids in a product. For example, a product with a 20:1 ratio has 20 parts CBD for every 1 part THC. The ratio can help you quickly compare products but doesn’t indicate the actual dose of THC or CBD. For instance, both a 1:1 product containing 2.5 mg of each cannabinoid and one containing 25 mg of each would have the same ratio but differ in dose. Therefore, clinical decisions must reference the exact quantities or percentages of the cannabinoids, not just the ratio. Potency (%) Potency refers to the percentage of a product’s weight that consists of THC or CBD. For instance, a product labeled as 15% THC means each gram of dried flower contains 150 mg of THC. Potency is often used to describe the strength of products like oils, tinctures, and flower, helping to compare their strength quickly. This is especially helpful when assessing products used for inhalation or topical application. Patient tolerance - a key factor affecting dosage and strength Tolerance to cannabis varies significantly from patient to patient.4 Cannabis-naïve patients (first-time users or those with limited experience) are much more sensitive to cannabinoids.4 Therefore, it’s essential to start with a low dose and gradually increase as needed.1 Conversely, experienced users may require higher doses to achieve the desired effect and may benefit from short breaks in therapy to reduce the likelihood of developing tolerance.4 Prescribers should always consider the patient's history when determining dosage.1 TGA Categorisation In Australia, the Therapeutic Goods Administration (TGA) classifies medical cannabis products based on their CBD content.5 This classification can be confusing as it reflects only the proportion of CBD in the product, not its THC or other cannabinoid content. For example, products in the "CBD dominant" category may still contain significant amounts of THC, which could have psychoactive effects. The TGA categorises products into five categories based on CBD percentage: Category 1: ≥98% CBD (Schedule 4) Category 2: ≥60% and <98% CBD (Schedule 8) Category 3: ≥40% and <60% CBD (Schedule 8) Category 4: CBD 2%-<40% (Schedule 8) Category 5: <2% CBD (Schedule 8)5 The categorisation system does not indicate the total strength or amount of THC, which can lead to misunderstandings in clinical practice. Standardising Cannabis Dosing Unlike opioids, where doses are standardised using measures such as oral morphine equivalents (OME), medical cannabis currently lacks a universally accepted standard dosing unit. Researchers have proposed using THC content as a common measure, such as defining a “standard THC unit” as 5 mg of THC6, which is considered a typical psychoactive dose.3 However, this concept is not yet universally adopted, as cannabis contains multiple active compounds, and individual factors (such as patient tolerance) play a significant role in how patients respond to cannabis.6 Clinical Implications and Best Practices Healthcare professionals should focus on the actual quantities of THC and CBD when determining dosages. This ensures safe and effective prescribing. When prescribing, always refer to the total milligrams (mg) of THC and CBD in the product, as this reflects the actual dose a patient will receive. Consider the patient’s tolerance when determining the appropriate dose. Cannabis-naïve patients should start with low doses and increase gradually. Be cautious with TGA categorisation: A product in the "CBD dominant" category may still have enough THC to cause psychoactive effects, so it’s essential to check the cannabinoid breakdown, not just the CBD percentage. Summary The strength of medical cannabis is described in multiple ways - through ratios, potency percentages, and total milligrams - making it vital for healthcare professionals to understand the clinical implications of each. To ensure accurate dosing and patient safety, always refer to the total amount of THC and CBD in the product, and consider patient factors such as experience and tolerance. As the medical cannabis market evolves, the need for clearer and more standardised labeling becomes increasingly important for effective prescribing and patient education. By adhering to these best practices, healthcare professionals can reduce medication errors, improve patient outcomes, and promote best practices in prescribing and dispensing medical cannabis.

The Endocannabinoid System and Clinical Care: Relevance Beyond Cannabis Published: July 2025 While many healthcare professionals are familiar with well-established physiological systems such as the sympathetic nervous system, which governs the body’s fight-or-flight response, fewer are aware of the more recently identified endocannabinoid system (ECS).1 The ECS has been increasingly recognised for its role in a range of regulatory functions, including pain modulation, immune response, stress and emotional regulation, appetite, body weight, and the control of nausea and vomiting.2 Yet, the ECS is not traditionally covered in medical education as highlighted by the Chief Scientific Officer of the Australian National Institute of Complementary Medicine: “I gave a talk at a hospital in Queensland late last year where I asked everyone in attendance—some 130 nurses, doctors, et cetera—whether they had had any training in the endocannabinoid system during their undergraduate training, and not one hand was raised.”3 Why isn’t the ECS taught in medical school? The ECS is relatively new in the context of medical science. The primary cannabinoid receptors—CB1 and CB2—were only identified in 1988 and 1993, respectively.4 Similarly, the two most well-characterised endocannabinoids, anandamide (AEA) and 2-arachidonoylglycerol (2-AG), were discovered in 1992 and 1995.4 This recency has contributed to its omission from traditional medical curricula, which can take years to evolve. Cannabis, which interacts with the ECS,5 has a long history of medical use, dating back over 5,000 years.6 However, by the mid-20th century, it was no longer viewed through a medical lens but instead reclassified as a prohibited substance under the United Nation’s Single Convention on Narcotic Drugs.6 This shift in legislation didn’t just criminalise its use—it also severely limited research.6 With tight restrictions on access to cannabis for scientific purposes, progress on understanding its potential therapeutic benefits, including its interaction with the ECS, stalled for decades. So what exactly is the ECS — and why it matters The ECS is a cell-signaling system composed of three primary components:Endocannabinoids—such as AEA and 2-AG—are lipid-based messengers naturally produced by the body that activate cannabinoid receptors.5 Cannabinoid receptors—CB1 and CB2—are primarily located in the central nervous system and the peripheral immune system, respectively, though both are also found in other tissues throughout the body.5 Enzymes—fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL)—are responsible for breaking down endocannabinoids.5 Endocannabinoids are released on demand by the body in response to physiological stimuli.7 Such stimuli may include: stress, obesity, food presentation, exercise, inflammation and tissue injury.2 The figure below outlines various stimuli reported to influence endocannabinoid levels and their observed effects from clinical studies: In neurons, endocannabinoids are released in response to stimuli (such as those mentioned above) and exert their effects through a process called retrograde signalling.12 They are synthesised in the postsynaptic neuron and travel backward across the synapse to bind to receptors on the presynaptic terminal, where they inhibit further neurotransmitter release.12 Emerging research suggests that deficient endocannabinoid signalling, collectively referred to as clinical endocannabinoid deficiency syndromes, may be involved in the pathogenesis of some diseases, including migraine, irritable bowel syndrome, depression, multiple sclerosis and Parkinson’s disease.13 This has led to growing interest in strategies to modulate levels of AEA and 2-AG, including targeting the enzymes that degrade them.13 Pain and inflammation A study by Ramsden et al. offers intriguing insights into the relationship between diet, endocannabinoid tone, and headache severity.14 In participants with chronic headaches, increasing omega-3 intake while reducing omega-6 fats led to lower circulating levels of 2-AG.14 Interestingly, this shift was accompanied by a reduction in headache hours, hinting at the ECS as a potential therapeutic target in managing chronic headaches.14 Stress and anxiety Research into the ECS and psychological trauma has revealed a complex picture.  Hill et al. found that individuals with post-traumatic stress disorder (PTSD) following the World Trade Center attack had low circulating levels of 2-AG compared to healthy controls.15 In contrast, Hauer et al. found the opposite trend in war refugees with PTSD, observing elevated levels of 2-AG compared to controls.16  These differing results suggest that the ECS may respond to psychological trauma in distinct ways depending on the context and intensity of the experience.16 While short-term ECS activation might serve as a protective mechanism during acute stress, prolonged or overwhelming trauma could lead to dysregulation—either depletion or overactivation—of this system.16 Looking ahead Although historically overlooked in medical education,3 the endocannabinoid system is now recognised as one of the key regulators of physiological balance—with roles spanning pain, inflammation, stress, mood, appetite, and immune function.2 As the clinical relevance of endocannabinoid signalling continues to be uncovered, research is rapidly advancing into ECS-targeted therapies—offering novel options for managing complex and chronic conditions, particularly amid growing patient interest in cannabis-based treatments.1,6,7 This evolving understanding carries practical implications for clinical care. While some patients may benefit from cannabis-based treatments, others may experience side effects or find them unsuitable.17 A deeper understanding of the ECS may allow healthcare professionals to identify alternative or adjunctive strategies, and support patient-centred decision-making.3,18,19 As with all areas of clinical science, ongoing research, cautious interpretation of emerging data, and patient-centred dialogue will be key to integrating ECS knowledge into thoughtful, responsible practice. Learn more about the ECS and its clinical implications with this fundamental module or our flagship accredited Medical Cannabis Fundamentals courses for doctors, nurses and pharmacists.

Forty-four-year-old Helen experiences intermittent periods of neurological symptoms affecting motor function, speech and balance. After ruling out multiple sclerosis (MS), Helen's doctor diagnosed her with functional neurological disorder (FND.) Despite trialling several first-line treatments, Helen continues to relapse periodically and uses black-market medical cannabis oil to control symptoms, though the dosage is inconsistent as the product is homemade. In this case study, we explore how Dr. Xie prescribed medical cannabis products to help reduce the frequency of Helen's relapses. Estimated Duration: 1 hour Access Duration: 12 months from date of enrolment Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of functional neurological disorder (FND) and identify common management strategies Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of FND Identify suitable candidates for medical cannabis treatment Devise treatment plans that consider patient safety and minimise risk Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in the management of FND

When chronic pain from repeated injuries forced legendary basketballer Lauren Jackson into retirement, her journey to recovery became a complex challenge. But Lauren defied the odds, returning to the court to play in the Australian squad for the FIBA Women's Basketball World Cup in 2022. This case study explores the challenges faced by female athletes in high-impact sports, including the prevalence of bone stress and joint injuries, the impact of hormonal factors, and the complexities of chronic pain management. It also addresses how medical cannabis was incorporated in Lauren's treatments. Healthcare practitioners will gain insights into: The pathophysiology of common injuries in female athletes, including bone stress and joint injuries Potential benefits and limitations of medical cannabis in managing chronic pain and aiding recovery Considerations for incorporating medical cannabis into treatment plans alongside conventional therapies. Strategies for discussing medical cannabis with patients while prioritiding safety and minimising risks Explore the evidence and evaluate how medical cannabis might fit within a broader approach to managing chronic conditions and sports-related injuries. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of common conditions and impact-based sporting injuries for female athletes and identify common management strategies Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of chronic sporting injuries and recovery from surgery Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of endometriosis Explain how medical cannabis treatment may integrate into and influence prescribed opioid treatment outcomes and effects Identify suitable candidates for medical cannabis treatment Devise treatment plans that consider patient safety and minimise risk Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in the management of chronic conditions, impact-based sporting injuries and recovery from surgery Disclaimer: Lauren has a financial interest in a medicinal cannabis company. Lauren is not receiving any financial remuneration from SAGED for her involvement in this case study.

Sixty-six-year-old David was diagnosed with irritable bowel syndrome (IBS) after hospitalisation for diverticulitis in 2016. He experiences abdominal pain, nausea, constipation, gas and bloating after meals. Stress exacerbates these symptoms. David has trialled several first-line treatments, including various dietary modifications, but none adequately relieved his symptoms. In this case study, we explore how Dr. Xie prescribed medical cannabis products to manage David’s symptoms and help to improve his quality of life. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of IBS  and identify common management strategies  Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of IBS Identify suitable candidates for medical cannabis treatment Devise treatment plans that consider patient safety and minimise risk Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in the management of IBS

Renal conditions can be challenging to manage due to the complexity of symptoms, limitations in treatment options and comorbidities.¹ Preliminary and emerging research has demonstrated medical cannabis' therapeutic potential for treating some symptoms of renal conditions, particularly neuropathic pain and uremia-induced pruritis.² Though it is theorised that medical cannabis treatment may present risks to those with renal conditions – particularly concerning drug-drug-interactions.³ As medical cannabis use continues to grow, healthcare professionals should stay informed about medical cannabis treatment applications in renal conditions, and equipped to provide the best evidence-based guidance.⁴ Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Describe the physiology and key functions of the kidneys Describe the pathophysiology of chronic kidney disease (CKD), acute kidney injury (AKI), autosomal dominant polycystic kidney disease (ADPKD) and renal cancer and recommended conventional treatment options Describe medical cannabis' therapeutic potential for treating symptoms of renal conditions Identify risks, risk management strategies and general considerations of medical cannabis treatment for individuals with renal conditions References Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney disease. The Lancet. 2017;389(10075):1238-1252. doi:https://doi.org/10.1016/s0140-6736(16)32064-5 Ho C, Martinusen D, Lo C. A Review of Cannabis in Chronic Kidney Disease Symptom Management. Canadian Journal of Kidney Health and Disease. 2019;6:205435811982839. doi:https://doi.org/10.1177/2054358119828391 Lappin J. Drug Interactions with Cannabis. Society of Cannabis Clinicians. Published July 10, 2024. Accessed February 27, 2025. https://www.cannabisclinicians.org/2024/07/10/drug-interactions-with-cannabis/ Rein JL. The Nephrologistʼs Guide to Cannabis and Cannabinoids. Current Opinion in Nephrology and Hypertension. 2020;29(2):248-257. doi:https://doi.org/10.1097/mnh.0000000000000590

Terpenes are plant-based compounds responsible for a plant's aroma,¹ likely contributing to pigmentation and offering protection against environmental threats, such as predators or adverse weather conditions.² They may also provide therapeutic effects when ingested or applied topically, although in some cases, they can cause side effects.¹ While research on terpenes is still in its early stages, some studies suggest they may influence and enhance mood, potentially through interactions with body systems like the endocannabinoid system.³ Cannabis plants are particularly rich in terpenes, with over 150 types identified across various cannabis cultivars.⁴ Emerging evidence also indicates that terpenes might interact with other compounds, such as cannabinoids and additional terpenes, to produce synergistic or cumulative effects.⁵ However, this area of study remains in its infancy.⁶ These findings highlight the diverse therapeutic potential of medical cannabis cultivars, shaped by their unique compound profiles and effects.⁶ A deeper understanding of terpenes' therapeutic potential can help health practitioners make informed clinical decisions, tailored to each patient's individual needs, preferences, and overall well-being. Preview this module by watching the video above. Estimated Duration: 1 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Define terpene Explain terpenes' functions in plants Discuss terpenes' hypothesised general functions in the body and potential interactions with other compounds Define terpenoid Explain the difference between terpenes and terpenoids Identify and describe characteristics of key terpenoid subclasses Explain the relevance of target boiling points for terpenes and terpenoids during medical cannabis administration Identify and describe key terpenes' and terpenoids' characteristics, mechanisms of action, therapeutic potential and target boiling point Identify current gaps in research and their implications for the clinical use of terpenes and terpenoids References: Paduch, Roman, et al. “Terpenes: Substances Useful in Human Healthcare.” Archivum Immunologiae et Therapiae Experimentalis, vol. 55, no. 5, Oct. 2007, pp. 315–327, https://doi.org/10.1007/s00005-007-0039-1. Yang, Jianming, et al. “Enhancing Production of Bio-Isoprene Using Hybrid MVA Pathway and Isoprene Synthase in E. Coli.” PLoS ONE, vol. 7, no. 4, 27 Apr. 2012, p. e33509, https://doi.org/10.1371/journal.pone.0033509. Christensen, Catalina, et al. “Decoding the Postulated Entourage Effect of Medicinal Cannabis: What It Is and What It Isn’t.” Biomedicines, vol. 11, no. 8, 21 Aug. 2023, pp. 2323–2323, https://doi.org/10.3390/biomedicines11082323. Booth, Judith K., and Jörg Bohlmann. “Terpenes in Cannabis Sativa – from Plant Genome to Humans.” Plant Science, vol. 284, July 2019, pp. 67–72, https://doi.org/10.1016/j.plantsci.2019.03.022. LaVigne, Justin E., et al. “Cannabis Sativa Terpenes Are Cannabimimetic and Selectively Enhance Cannabinoid Activity.” Scientific Reports, vol. 11, no. 1, 15 Apr. 2021, https://doi.org/10.1038/s41598-021-87740-8. Sommano, Sarana Rose, et al. “The Cannabis Terpenes.” Molecules, vol. 25, no. 24, 1 Jan. 2020, p. 5792, www.mdpi.com/1420-3049/25/24/5792, https://doi.org/10.3390/molecules25245792.

Twenty-six-year-old Lexi has primary vaginismus that causes vaginal spasming and burning in the vaginal canal during penetration. As a result, Lexi is unable to use tampons and has developed secondary anxiety around sexual intercourse. Lexi has trialled several first-line treatments, but none were suitable due to lack of efficacy and/or Lexi's work schedule. Lexi continues to experience vaginal pain during sex. In this case study, we explore how Dr. Xie prescribed medical cannabis products to reduce Lexi's pain and ease her anxiety towards sexual intercourse. Preview this case study by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this case study, you’ll be able to: Explain the pathophysiology of vaginismus and identify common management strategies  Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of vaginismus  Identify suitable candidates for medical cannabis treatment Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in the management of vaginismus  Devise treatment plans that consider patient safety and minimise risk

Palliative care focusses on relieving suffering and improving quality of life for individuals with life-limiting illnesses. Historically, practitioners applied palliative care only to cancer patients, but it's increasingly being introduced earlier in the course of illness.¹ This module examines the role of palliative care as part of person-centred health services, aligned with the World Health Organisation's framework, which highlights the importance of meeting individual needs and preferences.² Learners will explore challenges such as symptom management and the complexities of polypharmacy, which can limit the effectiveness of traditional treatments. The module also discusses the potential role of medical cannabis in addressing symptoms, reducing medication side effects, and improving quality of life for patients in palliative care. This module provides healthcare practitioners with knowledge to responsibly integrate medical cannabis into palliative care plans. Preview this module by watching the video above. Estimated Duration: 1 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Define palliative care Discuss the purposes and standard processes and approaches in palliative care Discuss the importance of goals of care in palliative care Discuss the role of services, supports and people involved in palliative care Explain how palliative care differs from end-of-life care Explain how the endocannabinoid system may influence symptoms and side effects experienced by those in palliative care Explain how health practitioners and professionals may facilitate medical cannabis treatment to manage symptoms and side effects commonly experienced by those in palliative care Identify clinical considerations that relate to medical cannabis use in palliative care References ¹ Lukas Radbruch, et al. “Redefining Palliative Care—a New Consensus-Based Definition.” Journal of Pain and Symptom Management, vol. 60, no. 4, 6 May 2020, pp. 754–764, www.sciencedirect.com/science/article/pii/S0885392420302475, https://doi.org/10.1016/j.jpainsymman.2020.04.027. Accessed 17 Oct. 2024.² Australian Institute of Health and Welfare. “Palliative Care Services in Australia, Summary - Australian Institute of Health and Welfare.” Australian Institute of Health and Welfare, 2023, www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia/contents/summary. Accessed 23 Oct. 2024.

In Australia, the Therapeutic Goods Administration (TGA) regulates the approval and monitoring of medications to ensure their quality, safety, and efficacy.¹ However, many medical cannabis products are classified as unapproved goods, as they have not undergone TGA evaluation. This module provides a detailed overview of the TGA's Authorised Prescriber Scheme, which enables registered medical practitioners to apply for the authority to prescribe unapproved medical cannabis products to multiple patients.² Learners will gain a clear understanding of the regulatory framework, the application process, and the responsibilities involved in prescribing unapproved medical cannabis products. This module is designed to equip healthcare practitioners with the knowledge to navigate the scheme effectively and confidently integrate medical cannabis into patient care when appropriate. Preview this module by watching the video above. Estimated Duration: 1 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Clarify the purpose of the Australian Register of Therapeutic Goods (ARTG) Outline the categories of unregistered therapeutic goods Identify and explain the regulated access pathways for unapproved goods Summarise the purpose and eligibility criteria for each category of the Special Access Scheme (SAS), including SAS-A, SAS-B, and SAS-C Identify the information required for a SAS-B application Identify the main categories of medical cannabis products based on their CBD and THC content Summarise the purpose and main characteristics of each Authorised Prescriber Scheme pathway Apply to become an authorised prescriber and fulfil reporting obligations Discuss prescribing practitioner considerations and obligations for providing medical cannabis treatment References ¹ Therapeutic Goods Administration. “Prescribe an Unapproved Therapeutic Good (Health Practitioners).” Therapeutic Goods Administration (TGA), 14 Dec. 2022, www.tga.gov.au/products/unapproved-therapeutic-goods/prescribe-unapproved-therapeutic-good-health-practitioners. ² Therapeutic Goods Administration. Unapproved products for multiple patients (Authorised Prescriber). Therapeutic Goods Administration (TGA). Published July 14, 2023. Accessed November 28, 2024. https://www.tga.gov.au/services/unapproved-products-multiple-patients-authorised-prescriber

This module explores the complexities of chronic pain and its management, with a focus on the potential role of medical cannabis. Learners will examine the factors influencing pain perception, the mechanisms of pain signaling, and the different aetiologies and pathophysiologies of pain. The module addresses the interplay between physical and psychosocial factors in the pain experience and the impacts of chronic pain on individuals and the Australian healthcare system. It also covers common treatment interventions, the therapeutic potential of medical cannabis for chronic pain and co-occurring conditions, and considerations for its use. Healthcare practitioners will gain insights into addressing barriers to medical cannabis treatment to support improved patient outcomes. Preview this module by watching the video above. Estimated Duration: 1 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Identify the factors that affect an individual's experience of pain Explain the pain signalling process Identify different pain aetiologies and pathophysiologies Explain the interplay between physical and psychosocial factors in the pain experience Define chronic pain and explain its impacts on individuals and the Australian healthcare and social support systems Describe common treatment interventions for chronic pain Describe medical cannabis' therapeutic potential for treating chronic pain and common co-occurring conditions Identify general considerations for medical cannabis treatment Explain common barriers to medical cannabis treatment and how to address them

This course is designed to equip pharmacist professionals with the knowledge and skills necessary to navigate Australia's evolving medical cannabis landscape. Designed for pharmacists, this course will help you gain essential knowledge for safely and effectively handling medical cannabis. Develop a practical understanding of the endocannabinoid system, crucial for dispensing, monitoring, and adjusting cannabinoid medications within Australia's regulations. Understand your distinct role as a pharmacist in patient care, and learn to lead discussions with your patients for their best health outcomes. Join a cohort of passionate pharmacists in Australia who have chosen to broaden their skills in medical cannabis prescribing. With this course, you can be part of improving treatment options for patients suffering from chronic conditions Australia wide.  Preview this course by watching the video above. Estimated Duration: 8 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Discuss the individual components of the cannabis plant Describe cannabis medicine options accurately Explain how the endocannabinoid system functions Assess the suitability of cannabis treatment for various chronic disease states Identify appropriate and inappropriate patient cohorts for medical cannabis treatment Discuss with patients about medical cannabis as a therapeutic option for symptom management Describe how to initiate, monitor and titrate cannabinoid medicines Apply critical safety considerations in patient-centred care Describe the role and responsibilities of pharmacists in relation to medical cannabis therapy Explain how pharmacists can educate patients on safe and effective use of medical cannabis Discuss how to collaborate with other healthcare providers to monitor patient outcomes and adjust treatment plans Describe requirements for storing medical cannabis Discuss quality control measures for medical cannabis products Explain the Australian regulatory frameworks surrounding medical cannabis provision Claim 17 CPD credits for eligible participants.

This course is designed to equip nursing professionals with the knowledge and skills necessary to navigate Australia's evolving medical cannabis landscape. DEVELOPER'S NOTE: As nurses, we understand the growing importance of holistic care and the role medical cannabis can have in managing a multitude of conditions. Join us in this meticulously crafted course to explore the history and botany of cannabis, understand the role of the endocannabinoid system and homeostasis. Learn how to navigate TGA processes, monitor and manage potential adverse side effects and other important aspects of cannabis treatment and patient care. This course is created and endorsed by nurses who believe in the potential of medical cannabis as a vital component of integrative, modern healthcare. Preview this course by watching the video above. Estimated Duration: 5 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Describe cannabis medicines accurately and demonstrate an understanding of the individual chemical components of the plant. Demonstrate an understanding of endocannabinoid system function. Assess the suitability of cannabis treatments in various chronic disease states. Identify appropriate patient cohorts for medical cannabis treatment. Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in symptom management. Monitor and provide titration advice around cannabinoid medicines.  Apply critical safety considerations in patient centred care. Navigate the regulatory frameworks surrounding medical cannabis provision in Australia.  Claim 5 CPD hours for eligible participants.

This accredited course provides doctors with a comprehensive introduction to the clinical and regulatory foundations of medical cannabis prescribing in Australia. As patient interest in cannabinoid-based therapies increases, it is essential for prescribers to be equipped with evidence-informed knowledge and practical skills to navigate this evolving space safely and effectively. Through this program, participants will explore the endocannabinoid system and its relevance to human physiology, examine the pharmacology of key cannabis constituents, and gain practical insight into initiating, monitoring, and titrating medical cannabis products. The course also addresses the Australian regulatory landscape and offers guidance on assessing patient suitability, facilitating informed discussions, and applying critical safety considerations in clinical practice. Designed to support evidence-based decision-making, this course empowers doctors to responsibly consider medical cannabis as part of a broader, patient-centred approach to managing chronic symptoms and conditions. Preview this course by watching the video above. Estimated Duration: 5 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Describe cannabis medicines accurately and demonstrate an understanding of the individual chemical components of the plant. Demonstrate an understanding of endocannabinoid system function. Assess the suitability of cannabis treatments in various chronic disease states. Identify appropriate patient cohorts for medical cannabis treatment. Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in symptom management. Initiate, monitor and titrate cannabinoid medicines.  Apply critical safety considerations in patient-centred care. Navigate the regulatory frameworks surrounding medical cannabis provision in Australia. 

‘Unapproved’ products: Prescriber access pathways explained Published: October 2025 Accessing medical cannabis in Australia can feel complex—for both patients and healthcare practitioners.1 While demand for medical cannabis has grown steadily, it is still considered an ‘unapproved’ therapeutic good under the Therapeutic Goods Administration (TGA) for most conditions.1 This means that, in most cases, practitioners must first demonstrate that conventional, registered medicines have been tried or deemed unsuitable before turning to medical cannabis.2 Yet for many patients, especially those living with chronic pain, conventional treatments provide limited relief3—highlighting the importance of clear, workable access pathways to ‘unapproved’ products. So how does this work in practice? How do Australian practitioners access medical cannabis for their patients? Accessing medical cannabis in Australia There are two primary pathways for accessing medical cannabis in Australia, each with two sub-categories:4 Special Access Scheme Category A notification pathway Category B application pathway Authorised Prescriber Established History of Use pathway Standard pathway Each of these pathways is designed for different clinical scenarios and levels of oversight. Let’s break them down. 1: Special Access Scheme (SAS) Through the SAS, Australian-registered practitioners can apply to use an ‘unapproved’ medicine—such as medical cannabis—for an individual patient on a case-by-case basis.2 1.1: SAS-A – notification for a seriously ill patient SAS-A allows practitioners to prescribe an ‘unapproved’ medicine, such as medical cannabis, for patients who are seriously ill*.2 This is a notification pathway – which means prior approval from the TGA is not required.2 Compared with SAS-B applications, SAS-A notifications are submitted less frequently.5,6 *Seriously ill is defined as: someone who is ‘seriously ill with a condition from which death is reasonably likely to occur within a matter of months, or from which premature death is reasonably likely to occur in the absence of early treatment’.2 1.2: SAS-B – application for all other patients SAS-B allows qualified practitioners to prescribe an ‘unapproved’ medicine for patients who don’t meet the Category A definition.2 When seeking approval to prescribe an unapproved medical cannabis product under the SAS-B pathway, the practitioner must provide clinical justification.4 This justification should be succinct yet comprehensive, and include:4 A summary of the patient’s symptoms and/or diagnosis Details of prior treatments or procedures that have been trialled or considered, with reasons why therapeutic goods currently included in the Australian Register of Therapeutic Goods (ARTG) are not clinically appropriate An appraisal of the anticipated clinical benefits of the proposed treatment weighed against the potential risks The SAS does not limit applications to specific medical conditions.4 The key requirement is that the prescriber has the necessary knowledge of the patient’s condition and of the product they wish to use.4 SAS-B is an application pathway – which means an approval letter must be obtained from the TGA before the product can be supplied to the patient.2 2: Authorised Prescriber (AP) Registered practitioners can apply to the TGA to become APs of certain medical cannabis products for groups of patients they care for.7 Approval lasts up to five years, and while practitioners don’t need to notify the TGA each time they prescribe, they must provide reports every six months.7 Additional approvals are only needed if the product isn’t already on the Established History of Use list.7 2.1: AP – Established History of Use pathway The TGA’s Established History of Use lists set out which medical cannabis products and conditions have a recognised track record.4 This applies only to Category 1 (CBD ≥98%), Category 2 (CBD ≥60% and <98%), and Category 3 (CBD <60% and ≥40%) oral liquids or capsules for a select few conditions, including refractory chronic pain, anxiety, cancer pain, sleep disorders and autism spectrum disorder.8 For these, doctors can become APs without needing Human Research Ethics Committee (HREC) approval or specialist college endorsement.4 2.2: AP – Standard pathway For medical cannabis products not included on the TGA’s Established History of Use lists, doctors can apply to become APs via the Standard pathway.4 To do so, doctors must first obtain approval from an HREC or endorsement from a specialist college, before lodging their application with the TGA.4 HREC approval or specialist college endorsement includes:9 Applying in writing to an HREC or specialist college for endorsement Providing evidence to justify use of the unapproved therapeutic good Details about the doctors’ training and experience Description of the unapproved therapeutic good the doctor intends to prescribe Clinical justification for use of the unapproved therapeutic good To find an HREC, check the list of HRECs registered with the National Health and Medical Research Council.9 If an HREC is unavailable, endorsement can be sought from a specialist college.9 The specialist college must have expertise relevant to the condition being treated. The list of specialist colleges can be found here.9 The infographic below summarises medical cannabis access pathways most commonly accessed in Australia. Download this infographic here To apply for the SAS or AP pathway, visit: https://compliance.health.gov.au/sas/ Need help deciding which pathway suits your practice needs? Get step-by-step assistance with your SAS-B or AP application from a SAGED Prescriber Support Specialist. Click here for support. Use of the SAS and AP pathway Despite being labelled as complex and time-consuming,1 the TGA’s dashboard shows that the SAS and AP pathway are well utilised, highlighting ongoing patient demand. In 2024 alone, registered practitioners submitted 177,751 SAS-B applications,6 although the SAS-A pathway was less frequently used with 376 SAS-A notifications.5 Over the same period, the TGA granted 22,066 AP approvals, with 407,434 treatments initiated under these approvals between July and December 2024.10,11 Leading conditions for medical cannabis prescription According to the SAS-A and SAS-B dashboards, chronic pain is the leading condition for which medical cannabis is accessed in Australia, followed by anxiety,5,6 reflecting their significant health burden. The Australian Institute of Health and Welfare reported that in 2016, 1.6 million (1 in 5) Australians aged ≥45 years were living with chronic pain.12 Current pharmacological treatments are often limited in effectiveness, with fewer than 20% of patients achieving ≥50% pain relief.3 In light of these limitations, it is estimated that around 600,000 Australians self-medicate with medical cannabis—most commonly for chronic pain.3 The most common conditions for SAS-A notifications and SAS-B applications in 20245,6 Summary Although the regulatory framework for accessing medical cannabis is perceived as complex time-consuming,1 the SAS and AP pathways provide routes for doctors to access unapproved products for their patients.4 The SAS enables case-by-case approvals, with SAS-A reserved for seriously ill patients2 and SAS-B requiring a clinical justification for all other patients.2,4 The AP pathway allows longer-term prescribing for groups of patients, with applications made via either the Established History of Use pathway or the more rigorous Standard pathway, which requires ethics or specialist college approval.4,9 Despite perceptions of complexity,1 these mechanisms are being used extensively.5,6,10 With 1 in 5 Australians over 45 living with chronic pain—and conventional treatments often falling short—medical cannabis may offer an additional therapeutic option, particularly when conventional treatments provide limited relief.3,12

Frances’ journey with fibromyalgia: Medical cannabis for chronic pain associated with fibromylagia Published: September 2025 Disclaimer: This is an anonymised patient case study, written with patient consent. The decision-making in this case study was undertaken by a doctor. The information in this document does not constitute medical advice or treatment recommendations. The use of cannabis based medications is the responsibility of a qualified medical professional who may initiate treatment after reviewing a patient's medical history. Most medical cannabis products are unapproved medicines and are regulated by the Therapeutic Goods Administration (TGA) Special Access Scheme (SAS), for which individual responses may vary. Meet Frances Frances* (pseudonym) is a 32-year-old woman living with fibromyalgia – one of an estimated 3–5% of Australians affected by this chronic condition, which is characterised by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties.1,2 Frances is seeking treatment for persistent pain, poor sleep and daily fatigue related to fibromyalgia. Despite trialling a range of conventional medications, she has experienced only limited relief. Her ongoing pain and exhaustion significantly affects her ability to work, exercise, and maintain daily life. Fibromyalgia presents with a variety of symptoms, including widespread pain, sleep disturbance, fatigue, headaches, mood disorders and irritable bowel syndrome (IBS) and is more common in women than in men.1,2,3 These symptoms often overlap with other conditions such as anxiety, depression, and chronic fatigue syndrome.1,3 Many people living with fibromyalgia describe conventional medical treatments as only partly effective, with burdensome side effects.2,3 Current management usually combines lifestyle and self-management strategies with medications such as antidepressants (e.g. duloxetine), anticonvulsants (e.g. pregabalin) and analgesics.2,3 However, many patients, like Frances, continue to struggle with persistent pain and impaired quality of life despite best-practice care. Frances’s consultation with her doctor Ongoing pain and fatigue, alongside variable responses to standard pharmacological treatments, led Frances and her healthcare team to consider other strategies. Use of medical cannabis is increasingly reported by patients with chronic pain conditions, with some users citing improved pain intensity, sleep, and overall wellbeing.4 These trends highlight the potential role of cannabis-based therapies as adjuncts in managing chronic pain conditions such as fibromyalgia.4 This case study explores how Frances’s medical team carefully assessed her presentation, medical history, risk factors, and possible drug interactions before initiating medical cannabis as part of her management plan. Frances’s doctor collected the following information: Patient information and presentation Presenting condition: Fibromyalgia Age: 32 years Symptoms Widespread musculoskeletal pain – particularly dull back ache Baseline back ache flares to sharp pain during physical exertion Insomnia with frequent night waking leading to daytime fatigue Anxiety – rapid heartbeat, clammy hands Pain assessment Position: Diffuse – neck, shoulders, hips but mainly lower back Type: Chronic with flare-ups after exertion or stress Severity Good days: 4–5/10 Bad days: 7–8/10 Triggers: Exertion, stress, lack of sleep, cold weather Personal and family medical history Medical history Fibromyalgia – diagnosed 2 years ago Generalised anxiety disorder Family history Grandfather – myocardial infarction Allergies: None known Current and past medications and treatments Current medications Amitriptyline – for nerve pain Tramadol Multivitamin Past treatments Sertraline for anxiety (ceased 3 years ago) Morphine and fentanyl during recent hospital admission Buprenorphine patches (ceased 1 year ago) Non-pharmacological treatments Stretches and regular exercises using cross trainer at home Sleeps supported with full body pillows Meditation and breathing exercises Specialist and other healthcare involvement Rheumatologist Ongoing GP management – last seen 6 weeks ago Psychologist Lifestyle factors Smoking: Never Alcohol: Nil Driving: THC liability verbalised Workplace drug testing: N/A Exercise: Stretches and regular exercises using cross trainer at home Support network: Lives with partner and child, parents are supportive Previous use of cannabis Black market cannabis flower intermittently since age 15 years – ceased 1 year prior, nil side effects noted Preferred treatment form: oils Frances' risk assessment & treatment plan Risk assessment Anxiety Given Frances’ history of generalised anxiety disorder, her doctor noted the importance of monitoring mood closely. While CBD may reduce anxiety, THC can in some cases exacerbate it.5 Regular reviews to monitor mood and anxiety symptoms A “start low, go slow” dosing approach6 Driving Inform Frances of the Therapeutic Goods Administration (TGA) guidance that patients must not drive while being treated with medical cannabis that contains THC, noting that measurable concentrations of THC can remain detectable in saliva for many hours after administration.7 Drug interactions CBD may inhibit CYP2C19, CYP2D6 and CYP3A4, which metabolise tramadol and amitriptyline.8 Careful titration and monitoring for side effects such as drowsiness were advised Treatment plan After reviewing Frances’s presentation and history, her doctor developed a personalised treatment plan for fibromyalgia symptom relief. Treatment goals Reduce baseline pain (particularly back pain) Manage pain flares Reduce anxiety Reduce insomnia Initial products prescribed Full spectrum balanced oil (THC 10 mg/mL, CBD 10 mg/mL) Start 0.1 mL twice daily Increase by 0.1 mL every to two days until symptom control is reached Maximum daily dose 3.0 mL Full spectrum indica-dominant oil (THC 20 mg/mL, CBD 1 mg/mL) Start 0.1 mL nocte After two days increase by 0.1 mL Increase by 0.2 mL every 2 days until symptom control is reached Maximum daily dose 1 mL Risk management plan Symptom diary – to record pain scores, doses, sleep quality, and side effects Pre-treatment Depression Anxiety Stress Scales (DASS) assessment – repeated at follow-ups Close monitoring for sedation, dizziness, or gastrointestinal upset Follow-up plan 4- and 8-week reviews, with monitoring of pain, sleep, mood, and functional status Treatment outcomes At 8 weeks: Frances was using 0.3 mL balanced oil in the mornings (already the maximum dose) and reported limited benefit, indicating that this formula was not strong enough to address her symptoms The full spectrum indica-dominant oil has assisted with sleep - Frances is currently using 0.2 mL at night Actions Replace the 10:10 balanced oil with a 25:25 balanced oil (THC 25 mg/mL, CBD 25 mg/mL) Continue with the indica dominant oil nocte Keep up the symptom diary What the research says Exploring the science in Frances’ case, what is the relationship between medical cannabis, the endocannabinoid system, and fibromyalgia? The endocannabinoid system (ECS) – comprising CB1 and CB2 receptors, endocannabinoids, and enzymes – plays a key role in modulating pain, sleep, mood, and immune responses.9 Research suggests that fibromyalgia may be linked to a concept called endocannabinoid deficiency, which may lead to heightened pain sensitivity, poor sleep, and mood disturbances.10,11 CB1 receptors in the brain and spinal cord regulate pain perception, sleep, and mood9 CB2 receptors in immune cells modulate inflammation and pain signalling9 It has been proposed that cannabinoids such as CBD and THC may help restore ECS balance and reduce fibromyalgia symptoms, preferably using a gentle approach with standardised whole-cannabis extracts.10 Clinical evidence for medical cannabis remains limited but is growing: Small randomised controlled trials and a large observational study report that medical cannabis can reduce symptom severity and improve quality of life in patients with fibromyalgia.11 A randomised clinical trial with nabilone, a synthetic cannabinoid, has shown improvements in sleep in patients with fibromyalgia compared to the standard amitriptyline therapy.12 Key Takeaways Fibromyalgia is a complex, multifactorial condition that imposes a substantial burden on quality of life and conventional treatments often provide incomplete relief.1,2 Emerging evidence suggests a role for the endocannabinoid system in fibromyalgia pathophysiology.10 While clinical trials remain limited, cannabinoids, particularly CBD and low-dose THC, may help reduce pain, improve sleep, and enhance wellbeing in select patients.4,10 Frances’s case illustrates how a careful, individualised, and evidence-informed approach – including risk assessment, slow titration and structured follow-up – can support safe and effective access to medical cannabis. Disclaimer: Medical cannabis products may be associated with adverse events. For more information please contact medinfo@saged.com.au. Medical cannabis products are not suitable for use during pregnancy or breastfeeding, for anyone with a history with psychotic disorders, or for those with unstable cardiovascular disease. Treatment for patients under 18 years is recommended under the guidance of a paediatrician. Patients should not drive or operate machinery while being treated with some forms of medical cannabis.

Medical cannabis for chronic non-cancer pain: A practical guide for doctors Published: September 2025 Introduction Chronic non-cancer pain (CNCP) remains one of the most significant challenges in Australian healthcare with one in five Australians experiencing chronic pain.1,2 Historically defined as continuous or recurrent pain that persists for a period of longer than three months 2,3, CNCP is a persistent, multifactorial condition arising from diverse pathophysiological mechanisms and shaped by cultural, psychological, and individual experience.2 It is estimated that between 20 and 40% of patient presentations to general practitioners involve chronic pain, making it one of the most common conditions encountered in primary care.2 Data from the Bettering Evaluation and Care of Health (BEACH) initiative has shown that most presentations of CNCP relate to musculoskeletal conditions such as osteoarthritis and lower back pain, however one in five presentations is neurological.2 Beyond the individual burden, CNCP has a broader societal impact, contributing to disability, unemployment, and significant healthcare costs.1,3-5 Standard pharmacological approaches - including paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, antidepressants, and particularly opioids - often fail to provide adequate long-term relief. 2,5,6 Opioids remain widely prescribed, but evidence for their long-term benefit in CNCP is limited, while risks of dependence, tolerance, overdose, and death are well established.4,7 Non-drug approaches such as physiotherapy and psychological interventions play important roles but are not universally effective.8 Against this backdrop, medical cannabis (MC) has emerged as a therapy of growing interest, offering an adjunctive option for patients who have exhausted conventional treatments.3,5 Evidence for efficacy Evidence supporting medical cannabis in CNCP, whilst limited, is steadily accumulating.3,5 It is theorised that the key active cannabinoids in MC exert complementary analgesic and anti-inflammatory actions: tetrahydrocannabinol (THC) by blocking nociceptive stimuli, and cannabidiol (CBD) by exerting anti-inflammatory and calming effects.3 A 2017 meta-analysis by the Therapeutic Goods Administration (TGA) concluded that medical cannabis was more likely than placebo to produce reductions in pain intensity and to achieve clinically meaningful improvements of 30–50% in pain scores.5,9 While there remains a lack of large randomised controlled trials (RCTs) investigating MC in CNCP, real-world evidence from large cohorts has contributed to the overall body of evidence: Author & Location Study Type & Population Duration Major findings Arkell et al10Australia Real World EvidenceN = 3148 15 months After commencing MC treatment, patients reported significant improvements relative to baseline on all 8 domains of the SF-36, and these improvements were mostly sustained over time (p<0.001) Bar-Lev Schleider et al11Israel Real World EvidenceN = 9985 6 months Prior to treatment initiation: 62.0% of patients reported their pain intensity of 8–10After 6 months of MC treatment:5.0% of patients reported a pain intensity of 8–10 (p<0.001) Safakish et al12Canada ObservationalN = 751 12 months MC treatment associated with improvements in pain severity and interference (p<0.001) observed at 1 month and maintained over 12-months.Significant improvements were also observed in the SF-12 physical and mental health domains (p<0.002); headaches, fatigue, anxiety, and nausea (p<0.002).In patients who reported opioid medication use at baseline, there were significant reductions in oral morphine equivalent doses (p<0.0001) Vickery13 et alAustralia Real World EvidenceN = 3961 2 years Statistically significant improvements (p<0.001) across all outcomes were sustained for over two years, including: clinical global impression; pain interference and severity; mental health scores for depression, anxiety, stress; insomnia; health status scores for physical functions and emotional well-being However, the evidence is not uniformly positive. Some trials have failed to demonstrate the benefit of MC in CNCP. De Vries et al., in a placebo-controlled trial of THC tablets for chronic abdominal pain, found no difference in pain reduction between active treatment and placebo.14 Similarly, Campbell and colleagues, in a study of patients using illicit cannabis in conjunction with prescribed opioids, found no evidence of improved outcomes or reduced opioid use.15 Although this data was collected over a four-year period, the lack of guidance from medical practitioners on optimal use of cannabis for CNCP could have contributed to less than optimal outcomes.15 Interestingly, a number of studies reported an opioid sparing effect in subjects who took medically prescribed cannabis concomitantly with opioid therapy.3,5,12 Taken together, the evidence base suggests that while medical cannabis is not universally effective in CNCP, it could offer benefit for some patients when used as part of an integrative approach.5 Limitations of the evidence Despite promising findings, limitations remain. The majority of positive evidence comes from longer-term large observational and real-world studies, however they are highly heterogeneous in terms of formulation composition, cannabinoid ratios, and delivery methods, whilst the lack of placebo controls may lead to overestimation of MC’s benefits.3 Safety and tolerability As with any therapy, safety is a key consideration. Across clinical trials and observational studies, the most frequently reported adverse effects included fatigue, somnolence, dizziness, cognitive impairment, dry mouth, gastrointestinal upset, and increased appetite. 3 Severe adverse events are rare but do occur, including hallucinations, dysphoria, and cardiovascular complications.3 Long-term safety data remain limited, although recent large-scale studies demonstrated that over 1-2 years of MC treatment, adverse effects, while frequent, were generally mild in nature.10,13 Nevertheless, caution should be exercised in vulnerable populations (see Patient Selection below). Patient selection Deciding which patients are appropriate candidates for medical cannabis is central to safe and effective prescribing.16 MC may not be suitable for all patients with CNCP, and careful consideration of risks, benefits, and alternatives is essential. Additionally, caution is advised in patients with a personal or family history of psychosis, those with unstable cardiovascular disease, and younger adults under the age of 25, due to neurodevelopmental concerns. Pregnant and breastfeeding women should also avoid cannabinoid therapy.3,16,17 Administering medical cannabis in CNCP Beyond the general TGA "Guidance for the use of medicinal cannabis in Australia”, which recommends a ‘start low go slow’ approach to MC dose titration16, there are few guidelines for the dosing and titration of MC in CNCP. A recent consensus-based review sought to define dosing and titration protocols for oral MC in CNCP. The consensus of twenty global experts across nine countries developed three such treatment protocols based on patient factors such as susceptibility to MC, adverse effects and prior cannabis use history: Routine protocol - recommended for most patients (unless sensitive to MC or requiring rapid pain relief).17 *Refer for expert consultation if considering >40 mg/day THC (Adapted from Bhaskar et al. 2021) Conservative protocol - recommended for patients more sensitive to MC’s effects (e.g.frail, complex co-morbidities).17 *Refer for expert consultation if considering >40 mg/day THC (Adapted from Bhaskar et al. 2021) Rapid protocol - recommended for patients in severe pain, requiring palliation, or with a significant history of prior cannabis use.17 *Refer for expert consultation if considering >40 mg/day THC (Adapted from Bhaskar et al. 2021) Breakthrough pain - The authors also made provision for the use of inhaled dried flower MC (either balanced THC:CBD or THC dominant) to be considered for patients experiencing breakthrough pain.17 Integrating medical cannabis into multimodal pain care Medical cannabis should not be viewed as a standalone therapy but as one element of a multimodal pain management plan.1,5 Comprehensive care should incorporate physiotherapy, cognitive behavioural therapy, lifestyle modifications, and social support alongside pharmacological measures.1,5 Within this framework, MC may provide incremental improvements in pain relief, mood, sleep, and overall quality of life, enhancing the effectiveness of other interventions.3,5 Summary Medical cannabis represents an emerging option for the management of chronic non-cancer pain.3,5 While it is not a panacea, evidence suggests that it may provide meaningful improvements in pain, quality of life, and function for selected patients, with an acceptable safety profile.510,13 For some patients, it may reduce reliance on opioids and other medications, and may offer a safer long-term alternative.3,5,12 Prescribers should approach cannabis with the same clinical rigour as any other therapy: starting with careful patient selection, initiating treatment at low doses, monitoring closely, and discontinuing if ineffective.15 When integrated into a multimodal pain management strategy, MC has the potential to enhance outcomes and provide relief for patients whose options have been limited.5 As research expands, doctors may gain greater clarity on optimal formulations, dosing strategies, and long-term outcomes. In the meantime, thoughtful, evidence-informed prescribing may help patients achieve the desired benefit from this evolving therapeutic tool. Disclaimer: Medical cannabis products may be associated with adverse events. For more information please contact medinfo@saged.com.au. Medical cannabis products are not suitable for use during pregnancy or breastfeeding, for anyone with a history with psychotic disorders, or for those with unstable cardiovascular disease. Treatment for patients under 18 years is recommended under the guidance of a paediatrician. Patients should not drive or operate machinery while being treated with some forms of medical cannabis.

Understanding Medical Cannabis Formulations: A Primer for GPs Published: August 2025 Australian general practitioners (GPs) who prescribe medical cannabis are faced with a diverse and rapidly evolving range of formulations to choose from. Beyond selecting a product with the appropriate cannabinoid profile for their patient's presentation, GPs must also consider the route of administration and formulation type, which could significantly impact onset, duration, tolerability, and patient adherence.1,2 This primer explores the key medical cannabis dosage forms currently available, their pharmacokinetic profiles, patient considerations, and practical prescribing tips to help guide formulation decisions. Overview of medical cannabis formulations The two primary active compounds in medical cannabis, Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), are available as various dosage forms.1,3 Each has distinct benefits and limitations, depending on the therapeutic goal and patient-specific factors.1 The most commonly available forms include: 1. Oral formulations: oils, pastilles, capsules Oral formulations, including oils, and softgel capsules, are the most commonly prescribed medical cannabis products in Australia.4 Oils typically come in bottles with graduated droppers, allowing for flexible dosing. Capsules and pastilles offer convenience and fixed doses.1 Pharmacokinetics: Onset: 60 -180 minutes1Peak effect: 2-4 hours5Duration: 6-8 hours1 Pros and Cons: Pros Cons Discreet and convenient to administer1 Patients with dexterity challenges may find oils difficult to administer9 Suitable for chronic conditions requiring longer-lasting relief1,5 Delayed onset may limit use for acute symptom control1 Slower onset and lower peak concentrations may potentially reduce risk of intoxication6,7,8 Low bioavailability due to first pass metabolism5 Prescribing tips: Start with a low dose, titrate slowly (e.g. “start low and go slow”).1 Oral absorption can be enhanced by administering in the presence of fats and oils thus ideally taken with food.1 2. Inhaled formulations: vaporised dried flower or inhalation oils Medical cannabis can be inhaled via a medical vaporiser device which delivers vapour containing cannabinoids and terpenes to the lungs.9 Smoking is not an approved method for medical cannabis administration in Australia.5 Use of a registered medical vaporizer device reduces exposure to potentially toxic compounds of cannabis smoke and helps to reduce variability in the cannabinoid content delivered.9 Pharmacokinetics: Onset: 5-10 minutes1Peak effect: 15-30 minutes5Duration: 2-4 hours1 Pros and Cons: Pros Cons Rapid onset may be useful for episodic or breakthrough symptoms1 Shorter duration of action than oral formulations with variable bioavailability7 Dose titration is patient-guided - patients stop when symptom relief is achieved (within daily THC limits)9 Not suitable for patients with respiratory disease (e.g. asthma, chronic obstructive pulmonary disease)2 Lack of first-pass metabolism may improve cannabinoid absorption6 May be associated with compliance issues10 Prescribing tips: Inhaled forms may be useful as an adjunct to oral formulations for conditions like chronic pain with breakthrough flares.1 Ensure patients have access to a TGA-approved vaporiser (details: TGA website).5,6 3. Oromucosal sprays These sprays are administered under the tongue or inside the cheek for mucosal absorption.10 Currently there is only one such product available in Australia (nabiximols THC 27mg: CBD 25mg oral spray), which is TGA-approved for spasticity in multiple sclerosis.12 Pharmacokinetics: Onset: 15-45 minutes1Peak effect: 1-2 hours10Duration: 6-8 hours1 Pros and Cons: Pros Cons Faster onset than oral ingestion1 May cause local irritation (dry mouth, oral ulcers) 12 Suitable for patients with swallowing difficulties 8 Can be more expensive than other forms 1 Fixed metred dosing facilitates dose titration and may be easier to administer than some oral formulations 5 TGA-approved for patients with multiple sclerosis only.12 * *Patients may be able to access via Special Access or Authorised Prescriber scheme for other conditions Prescribing tips: Consider oromucosal sprays when rapid symptom relief is needed but inhalation is contraindicated, such as in patients with respiratory disease.2,10 Six to eight sprays of nabiximols are generally required for symptomatic relief with a daily limit of 12 sprays.11 4. Topical preparations Topical formulations such as creams, ointments, or gels are suitable for localised symptoms such as dermatological conditions or arthritis pain.1 They exert their actions locally rather than systemically.1 THC is not well absorbed via the skin however CBD and the minor cannabinoid cannabinol (CBN) are much more permeable than THC.5 Pharmacokinetics: Onset: 5-120 minutes13Peak effect: variable 13Duration: variable13 Pros and Cons: Pros Cons May be useful for localised pain or inflammation 13 Limited clinical evidence to support efficacy1 Low risk of intoxication or systemic side effects13 Local side effects such as contact dermatitis13 Steady delivery of active compounds over prolonged period13 Variable absorption through the skin barrier13 Administration tips: Topical preparations should not be applied to broken skin.14 Advise patients not to rub the topical preparation into the skin vigorously.14 Factors to consider when choosing a formulation 1. Symptom profile and onset requirements Acute symptoms → inhaled or oromucosal.1 Chronic conditions → oral formulations.1 Mixed profiles → combination therapy.1 2. Patient preference and practicality Some prefer oils, capsules for discretion. Others prefer inhaled forms for feedback. Consider dexterity, cognition, access to devices. 3. Safety and contraindications Avoid inhaled in respiratory disease.2 Avoid THC in pregnancy, unstable CV disease, psychiatric history.5 Watch drug interactions with hepatic enzymes.5 4. Dosing control and titration Oral oils: flexible but delayed onset.1,10 Capsules/pastilles/sprays: consistent dosing.1,13 Inhaled: rapid but variable.1,8 Summary Clinicians prescribing medical cannabis have a considerable array of dosage forms to choose from. Understanding the factors that influence formulation selection may be central to safer more effective patient care.1,2 Choosing the most appropriate dosage form may enhance therapeutic outcomes, minimise side effects, and improve adherence.1,2 By familiarising themselves with the available formats (oral, inhaled, oromucosal, topical) and considering patient-specific needs and preferences, GPs may be better positioned to deliver personalised and evidence-informed care in this emerging therapeutic area. This article is intended for educational purposes and does not replace clinical judgment or regulatory requirements. Disclaimer: Medical cannabis products may be associated with adverse events. For more information please contact medinfo@saged.com.au. Medical cannabis products are not suitable for use during pregnancy or breastfeeding, for anyone with a history with psychotic disorders, or for those with unstable cardiovascular disease. Treatment for patients under 18 years is recommended under the guidance of a paediatrician. Patients should not drive or operate machinery while being treated with some forms of medical cannabis.

Cannabinoid Hyperemesis Syndrome: An Emerging Challenge in Patient Care Published: August 2025 Cannabinoid Hyperemesis Syndrome (CHS) is a condition increasingly observed among long-term users of cannabis.1,2 Despite cannabis being proposed for its antiemetic effects, this very same compound has been linked to CHS, a condition marked by recurring nausea, vomiting and abdominal pain, often severe enough to require emergency medical care.1,3 Increasing awareness and understanding of CHS among both patients and clinicians may play a key role in promoting safer, more effective treatment outcomes as early recognition and management of this syndrome may reduce the risk of potentially serious sequelae.1,2,4 What is Cannabinoid Hyperemesis Syndrome? Cannabinoid Hyperemesis Syndrome is a condition characterised by cyclical episodes of nausea, intractable vomiting, and abdominal pain following prolonged cannabis use.1 First described in 2004, CHS remains underdiagnosed and often mistaken for other gastrointestinal conditions such as cyclic vomiting syndrome (CVS).1,3 According to the Rome IV diagnostic criteria, CHS is defined by: Stereotypical episodic vomiting similar to CVS in onset and duration A history of prolonged cannabis use Relief of symptoms with sustained cannabis cessation.5 An additional defining feature of CHS is that patients often find relief through taking very hot showers or baths.1 Whilst the exact pathophysiology of CHS is not yet fully elucidated, it appears to be linked to the overstimulation of CB1 endocannabinoid receptors in the endocannabinoid system (ECS) by the cannabinoid tetrahyrdocannabidiol (THC), leading to changes in the body’s emetic control centres in the central nervous system and brainstem.1,2 Another proposed mechanism involves THC binding to the TRPV1 (transient receptor potential vanilloid 1) receptors, which is involved in pain and temperature perception and regulation of gut motility.1,2 Paradoxically, while low doses of cannabis exert antiemetic effects through ECS modulation and hypothalamus-pituitary-adrenal (HPA) axis suppression, chronic use of cannabis containing high-strength THC may have the opposite effect, leading to overstimulation of the ECS — one of the proposed mechanisms behind CHS.1,3,4 Cannabinoids at a Glance The two primary cannabinoids are: THC (Tetrahydrocannabinol): The psychoactive compound that binds to CB1 receptors in the central nervous system, and is believed to influence appetite, mood, pain, and nausea.2,6 CBD (Cannabidiol): A non-intoxicating cannabinoid with a weaker affinity for CB1/CB2 receptors, more commonly associated with anti-inflammatory and immunomodulatory effects.2,6 How common is CHS? The true prevalence of CHS is difficult to ascertain and likely underreported.1,2 This is partly because CHS symptoms overlap with other conditions, and in some jurisdictions, stigma and legal concerns around cannabis use lead patients to withhold disclosure of their medical cannabis use from healthcare providers.1,7 However, recent data highlight a growing concern: A study in a United States urban hospital estimated that 32.9% of chronic users of cannabis (20+ days/month) met the criteria for CHS, which extrapolates to approximately 2.75 million cases annually in the United States.7 In Australia, a six-year retrospective review undertaken at a Melbourne emergency department identified 142 CHS-related visits. The median patient age was 31 years, with nearly 69% male, highlighting its prevalence among younger adults.8 With cannabis potency and use increasing worldwide, the incidence of CHS may be expected to rise unless proactively addressed.1-3 Stages and management of CHS Patients experiencing CHS typically present to the emergency department whilst demonstrating acute gastrointestinal symptoms.7 However, according to the American Gastroenterological Association, CHS progresses through four distinct stages:2 Prodromal Phase – Early symptoms such as nausea, anxiety, and abdominal discomfort, often lasting months.2,3 Hyperemesis Phase – Acute onset of relentless vomiting, abdominal pain, dehydration, and compulsive hot bathing.2,3 Recovery Phase – Symptoms improve once cannabis use is stopped.2,3 Interepisodic Phase – Asymptomatic period between episodes; symptoms often return with cannabis reinitiation.2,3 Treatment strategies There is currently no specific pharmacological treatment for CHS. The current cornerstone of management is immediate and sustained cannabis cessation.1,9 Other strategies include: IV fluids and electrolyte correction to manage dehydration9 Hot showers or baths, which may provide temporary relief1 Antiemetics – though many are ineffective in CHS1 Capsaicin cream (a TRPV1 agonist) applied topically to the abdomen has shown some benefit in acute settings1,9 Importantly, failure to recognise and treat CHS can lead to serious complications, including electrolyte and fluid imbalance, renal failure and, in rare cases, death.1,10,11 Is CHS permanent? CHS appears reversible with cannabis cessation.1 Case studies have widely shown that symptoms resolve once cannabis use is stopped.12,13 However, due to limited long-term studies, it remains unclear whether some individuals may develop persistent or recurring symptoms even after cessation.12,13 Implications for medical cannabis use To date, CHS has been primarily associated with chronic recreational use of high-dose THC products.14 However, as medical cannabis becomes more widespread, and as higher-potency THC formulations become more accessible, it is possible that CHS may be increasingly observed among users of medical cannabis.1,2,15 Currently, there is insufficient data to draw conclusions about CHS prevalence in patients using medical cannabis. However, the following precautions are advised: Educate patients about the signs and symptoms of CHS before initiating treatment.4,15 Prescribe the lowest effective dose, especially with high-strength THC products.4,6 Consider CBD-dominant options where appropriate, as CBD has not been linked to CHS.14 Establish a thorough patient history of cannabis use, including prior and current recreational use, as past heavy use appears to increase risk.1,4,15 Summary Cannabinoid Hyperemesis Syndrome represents a growing but still under-recognised adverse consequence of long-term cannabis use.1,2 While it may seem contradictory that cannabis — which has proposed antiemetic effects — can cause intractable vomiting, this reflects the complex and dose-dependent biphasic nature of cannabinoid pharmacology.4 For healthcare professionals, particularly those prescribing medical cannabis, awareness and vigilance are essential.1,4,15 Patient education, careful product selection, and prompt cessation in response to symptoms could potentially reduce risks and improve patient outcomes.1,4,14,15 As the legal and medical landscape around cannabis continues to evolve, understanding CHS may be central to ensuring safe and responsible use of this emerging therapy. Disclaimer: Medical cannabis products may be associated with adverse events. For more information please contact medinfo@saged.com.au. Medical cannabis products are not suitable for use during pregnancy or breastfeeding, for anyone with a history with psychotic disorders, or for those with unstable cardiovascular disease. Treatment for patients under 18 years is recommended under the guidance of a paediatrician. Patients should not drive or operate machinery while being treated with some forms of medical cannabis.

Gina’s Story: Endometriosis, the Endocannabinoid System, and Emerging Approaches to Care Published: August 2025 Disclaimer: This is an anonymised patient case study, written with patient consent. The decision-making in this case study was undertaken by a doctor. The information in this document does not constitute medical advice or treatment recommendations. The use of cannabis based medications is the responsibility of a qualified medical professional who may initiate treatment after reviewing a patient's medical history. Most medical cannabis products are unapproved medicines and are regulated by the Therapeutic Goods Administration (TGA) Special Access Scheme (SAS), for which individual responses may vary. Meet Gina (pseudonym), a 38-year-old woman living with endometriosis—one of an estimated 10% of Australian women affected by this chronic condition, which involves the growth of endometrial-like tissue outside the uterus.1 Gina is seeking treatment for ongoing gastrointestinal and pain-related symptoms associated with endometriosis. Despite trialling a range of conventional medications, she’s experienced limited relief—particularly for her chronic pain, which significantly affects her ability to work and maintain daily functioning. Endometriosis is a condition that can cause a wide range of chronic pelvic pain symptoms, including dysmenorrhea (painful periods), dyspareunia (pain during intercourse), fatigue, dyschezia (pain during bowel movements), and dysuria (pain during urination).1 It may also co-occur with other conditions such as irritable bowel syndrome, rheumatoid arthritis, psoriasis, anxiety, depression, and chronic fatigue syndrome.1 Despite the substantial burden of endometriosis, many patients consider conventional medical treatments to be suboptimal—often citing limited efficacy and unwanted side effects.1 Current management typically involves a combination of medical and/or surgical interventions, including hormonal therapies, non-opioid and opioid analgesics, and neuropathic pain agents.1 While surgery can be effective, it carries high costs, long wait times, and high recurrence rates—often leading to the need for repeat procedures.1,2 Gina’s consultation with her doctor Limited access to surgery and variable responses to pharmacological treatments, have led patients with endometriosis to self-management strategies.1 Cannabis use—both prescribed and non-prescribed—is increasingly reported, with some individuals noting improvements in symptom severity.1 These trends highlight a need for more research into cannabis-based therapies as potential adjuncts in endometriosis care.1 This case study explores how Gina’s medical team carefully assessed her clinical presentation, medical history, potential psychological and cardiovascular risk factors, and possible drug interactions before initiating medical cannabis to support her pain management and overall wellbeing. Gina’s doctor collected the following information: Patient information and presentation Personal and family medical history Current and past medications and treatments Specialist and other healthcare involvement Lifestyle factors Discover Gina’s patient profile below. Presenting condition Female, aged 38 years Presenting condition – endometriosis Symptoms Excruciating dysmenorrhoea since menarche Vomiting, diarrhoea and nausea Low appetite and weight loss Headaches Pain assessment Position – lower abdomen Quality – severe, accompanied by sweating, crying or doubling over in pain Type – intermittent sharp pains and general abdominal tenderness Radiates – to arms or legs Severity Good days – 6–8/10 Bad days – 10/10 Timing – menstruation and ovulation Triggers – stress Personal and family medical history Medical history Endometriosis (stage 4) – diagnosed in 2019 Pericarditis post coronavirus – diagnosed 2022* Generalised anxiety disorder and depression – diagnosed 18 years prior Vitamin D deficiency Allergies Latex Medical history (family) Maternal aunt – endometriosis *This may be a risk factor for medical cannabis.3 Current and past medications and treatments Current medications Drospirenone – 4 mg/day Past medications Tapentadol Physiotherapy sessions – with minimal benefit Remedial massage sessions – with minimal benefit Specialist and other healthcare involvement Cardiologist review of pericarditis – referred back to GP care after diagnosis Lifestyle factors Smoking – No Social considerations Driving – drives to work 2 days per week and on occasional weekend trips THC roadside liability understood: Yes Workplace drug testing – N/A Operates heavy machinery – N/A Previous use of cannabis Use – non-prescribed cannabis daily between 2016 and 2019 Administration – flower via joint or pipe Amount – 2 g per day Effects – reduced pain, relieved bowel cramps, assisted with sleep Assessing risks After reviewing Gina’s profile, her doctor notes potential risk factors relating to her anxiety, cardiovascular health, driving and previous use of non-prescribed cannabis. Below, explore Gina’s potential risk factors and how her doctor managed them. Anxiety Given Gina’s diagnosis of generalised anxiety disorder, her doctor monitored her closely, with regular check-ins to assess mood and anxiety symptoms. As THC can cause feelings of altered mood and anxiety, it should be administered with caution in individuals with anxiety disorder.4 Her doctor ensured that Gina understands the potential mood-related side effects and equipped her with strategies to manage them effectively if they occur. Additionally, she emphasised the importance of starting on a low dose and gradually increasing the dosage as specified in the treatment plan. Cardiovascular health Before prescribing medical cannabis products, her doctor confirmed that Gina’s cardiovascular health is stable by: Reviewing previous cardiac assessments and reports from Gina’s cardiologist Obtaining approval from Gina’s cardiologist and consulting Gina’s regular GP before commencing treatment Monitoring Gina’s electrocardiogram and vital signs throughout the course of her treatment This is of particular importance as cannabis products with THC can cause tachycardia, and is not advised for patients with a history of angina or myocardial infarction.4 Driving As Gina drives to work occasionally, her doctor ensured that Gina is aware of the laws around driving. Current medical cannabis prescribing legislation does not exempt patients from THC-related drug-driving offences.4 THC can impair driving performance and increase crash risk—particularly in occasional users—with effects lasting up to eight hours after oral dosing.5 Patients using THC-containing products should avoid driving and other safety-sensitive tasks, especially during treatment initiation and shortly after each dose.5 In contrast, there is no evidence that CBD impairs driving.5 Patients taking CBD-only medicines can lawfully drive if they are not impaired.5,6 Non-prescribed use of cannabis Gina’s doctor is also concerned about her previous use of non-prescribed cannabis. Cannabis acquired on the black market is unlikely to achieve the desired results and can cause unpredictable and severe adverse reactions as it may contain hazardous ingredients and contaminants—such as microbes, heavy metals and pesticides.7,8 Devising a treatment plan After reviewing Gina’s presentation and medical history, her doctor created a treatment plan to help Gina manage her endometriosis symptoms. Developing a risk management and follow-up plan Gina’s doctor provided her with a risk management plan which included symptom tracking and monitoring of adverse effects, as well as follow-ups scheduled at 4 to 8 weeks to review progress and adjust treatment as needed. Discover Gina’s risk management and follow-up plan below Risk management plan Asked Gina to keep a symptom diary to record pain scores, doses and other symptoms Informed Gina of how to report and respond to adverse effects Conducted a pre-treatment Depression Anxiety Stress Scales (DASS) assessment and will follow up at each check-in Advised Gina to start low and go slow Reviewed Gina’s cardiovascular reports and test results, and obtained cardiologist and GP support before commencing treatment Follow-up plan Follow-ups scheduled for 4- and 8-weeks after initial treatment Review progress and adjust plan as required Monitor cardiovascular results Monitor psychiatric state via DASS results (conducted at each appointment) At 4 weeks: Gina reported that the CBD oil was moderately effective but not as effective as the inhaled product. In response, her doctor prescribed a different oil with the following profile and dosage instructions: THC 10 mg/mL : CBD 10 mg/mL Start: 0.1 mL twice a day After 2 days: increase by 0.1 mL Every 2 days thereafter: increase by 0.2 mL to full symptom control Maximum daily dose: 3.0 mL At 8 weeks: Gina shared that she found the new oil effective, and uses 1.5 mL daily. Gina and her doctor agreed to touch base again in 4 weeks. Exploring the Science in Gina’s Case What Is the Relationship Between Medical Cannabis, the Endocannabinoid System, and Endometriosis? Gina’s doctor has prescribed her with medical cannabis; understanding its proposed mechanism could provide insight into why it may have a role in Gina’s care. Studies have shown that cannabinoid receptors (CB1 and CB2) are highly expressed in ovaries with endometriosis, compared with stromal tissues surrounding the lesion.10,11 As cannabinoid receptors have been implicated in the management of chronic pain and inflammation, these findings suggest that medical cannabis may offer a targeted approach for managing endometriosis-related pain and inflammation at the lesion site.10,11 A recent literature review found that compared to conventional strategies such as analgesics and heat therapy, medical cannabis offered symptom relief for individuals with endometriosis.10 This flow diagram illustrates the potential key therapeutic targets within the endocannabinoid system that interact with cannabis compounds.10 Adapted from Cummings et al. 202410 However, there remains a lack of randomised controlled trials specifically evaluating medical cannabis efficacy for endometriosis-related pain.10 This gap in evidence highlights an important direction for future research—particularly in light of emerging findings that a dysregulated endocannabinoid system may contribute to the pathophysiology of endometriosis.10 Key Takeaways Endometriosis remains a complex condition that significantly impacts quality of life.1 While conventional treatments can help, many patients—like Gina—continue to experience debilitating symptoms despite best-practice interventions.1 Emerging evidence suggests a potential role for the endocannabinoid system in modulating inflammation, pain, and other symptoms associated with endometriosis.10,11 Though clinical research is still developing, the expression of cannabinoid receptors in endometriotic tissue, alongside promising patient-reported outcomes, highlights the potential role of medical cannabis as an adjunctive therapy in selected patients.10,11 Gina’s case illustrates how a personalised, cautious, and evidence-informed approach—grounded in thorough risk assessment and multidisciplinary collaboration—can support safe access to medical cannabis. As with any therapeutic decision, individual patient factors, clinical history, and shared decision-making remain central to guiding care. Adverse event monitoring: Medical cannabis products may be associated with adverse events. For more information please contact medinfo@saged.com.au. Medical cannabis products are not suitable for use during pregnancy or breastfeeding, for anyone with a history with psychotic disorders, or for those with unstable cardiovascular disease. Treatment for patients under 18 years is recommended under the guidance of a paediatrician. Patients should not drive or operate machinery while being treated with some forms of medicinal cannabis. Veeva job code: MONT-SGD-2025-0014Date of preparation: July 2025

Patient Conversations: Why Cultural Safety Matters in Medical Cannabis Prescribing Published: July 2025 As medical cannabis becomes an increasingly accepted therapeutic option in Australia, healthcare professionals should consider not only the clinical aspects of prescribing, but also the cultural safety of their practice. For many patients, particularly Aboriginal and Torres Strait Islander peoples and those from culturally and linguistically diverse (CALD) communities, engaging with the healthcare system can carry risks of misunderstanding, harm, and marginalisation if cultural needs are not recognised and respected.1,2 What exactly is “Cultural Safety”? Cultural safety is a patient-led concept that focuses on whether individuals feel respected, heard, and safe during healthcare encounters.3 It goes beyond merely being aware of cultural differences (i.e. "cultural awareness”) and requires healthcare professionals to reflect on their own biases, power, and privilege while actively adapting their care to meet the needs of the patient’s cultural identity and lived experience.4 Ultimately, it is the patient, not the healthcare professional, who determines whether an experience is culturally safe.3 Why is this important for medical cannabis? Medical cannabis use can be influenced by personal, cultural, legal, and social factors. Patients may have concerns regarding stigma, legality, or family and community expectations.5 For some, complementary medicines may resonate with cultural healing traditions.6 For others, medical cannabis may invoke social stigma from within their communities.6 For Aboriginal and Torres Strait Islander peoples, the impacts of colonisation, systemic racism, and intergenerational trauma can contribute to distrust of mainstream healthcare.1 For CALD communities, differing views about health, medicine, and healing may shape how medical cannabis is perceived.6 Practical considerations for culturally safe medical cannabis prescribing Stigma Acknowledge the historical criminalisation of cannabis and its disproportionate impact on some communities6,7: Be prepared to address patient concerns about legal issues, confidentiality, and fear of judgement. Recognise that concerns around stigma may be heightened among Aboriginal and Torres Strait Islander peoples and CALD patients, who may have previously experienced discrimination within healthcare and legal systems.8,9 Creating a safe, non-judgemental space is essential. This involves using inclusive and respectful language, and reassuring patients about the confidentiality of their care, and the legal and clinical appropriateness of prescribed medical cannabis.8 For Aboriginal and Torres Strait Islander patients, it is important to understand the impact of intergenerational trauma and to approach care with cultural humility and respect for their lived experiences.9 Access and equity Understand that cost, geographic barriers, and language barriers can impact access to medical cannabis.10 Share options and advocate for equitable prescribing pathways, such as the Compassionate Access Schemes offered in some states11 and through selected medical cannabis organisations. Provide translated information where available, engage with interpreters, and guide patients through application processes.8 For Aboriginal and Torres Strait Islander patients, consider the added importance of family and community in decision-making and support models: Collaborate with Aboriginal Health Workers or Aboriginal Community Controlled Health Services (ACCHSs) to provide culturally appropriate care.9 Cultural perceptions Some patients may see cannabis as an extension of traditional medicine6, while others may associate it with substance misuse or illegality6: Approach these discussions with curiosity, not assumptions. Explore patients’ beliefs about healing and medicine, and be open to integrating their cultural practices with medical care where safe and appropriate.8 For Aboriginal and Torres Strait Islander patients, acknowledge the importance of connection to Country, spiritual wellbeing, and traditional healing, and consider these when framing discussions about treatment.9 Supporting cultural safety with SPIKES When introducing sensitive treatments like medical cannabis, healthcare professionals can enhance cultural safety by using structured communication tools. One such tool, the SPIKES framework, was originally developed to aid communication of ‘bad news’ in healthcare12, and can be applied to fostering effective communication with diverse patients. Adapted from Buckman 2005 Summary Medical cannabis may offer symptom relief for some patients when clinically appropriate, but how it is introduced matters. Culturally safe practice, guided by structured, empathetic communication models such as SPIKES12, ensures that care is not only clinically sound but also respectful, empowering and patient-centred.3 Cultural safety isn’t a checkbox; it is an ongoing commitment to reflection, understanding, and partnership. Every conversation is an opportunity to make healthcare a safer, more inclusive space for all. Job code: MONT-SGD-2025-0005 | Date of preparation: July 2025

Managing Respiratory Depression Risk: Exploring CB1 Receptors and Safe Co-Prescribing in Pain, Anxiety, and Palliative Care Published: July 2025 Medical cannabis has gained increasing attention as a therapeutic option for managing pain, anxiety, and symptoms in palliative care. Respiratory depression—particularly associated with opioids and some anxiolytics—remains a significant safety consideration in these settings.1,2 Unlike these medications, cannabinoids do not significantly affect brain stem respiratory centres, due to the low density of CB1 receptors in those areas.3,4 This article explores the mechanisms behind this effect and considers the implications for co-prescribing medical cannabis alongside other agents used in symptom management. Understanding CB1 receptor distribution Cannabinoids exert their effects primarily through two receptors: CB1 and CB2.3,4 CB1 receptors are abundant in brain regions involved in mood, memory, pain, and motor control, while CB2 receptors are more prominent in organs and in the immune system.3,4 However, a key finding in neuropharmacology demonstrated that CB1 receptors are only minimally present in the brain stem, the part of the brain that regulates vital functions such as breathing and heart rate.3,4 In contrast, opioid receptors are densely concentrated in the brain stem.1 When opioids bind to these receptors, they can depress the respiratory centres, reducing the drive to breathe and leading to potentially fatal respiratory depression.1 Due to the lack of significant CB1 receptors in the brain stem, cannabinoids such as tetrahydrocannabinol (THC) do not suppress respiratory function in the way opioids do.5 This fundamental difference means: Medical cannabis use is not associated with respiratory depression.5 Unlike opioids and benzodiazepines, medical cannabis does not pose the same risk of fatal overdose via respiratory failure.5 Simplified diagram demonstrating CB1 receptor distribution in the brain.Figure adapted from Kayser et al. 20196 This safety profile is supported by clinical and preclinical studies showing that medical cannabis, even when used in combination with other medications, does not increase the risk of respiratory suppression that is seen with some other central nervous system (CNS) depressants.5,7,8,9 Implications for pain management Opioid medications form the mainstay of pain management in severe and some chronic pain conditions. They carry a well recognised risk of respiratory depression, overdose and dependence.1,9 Medical cannabis offers several potential benefits in this context: Opioid-sparing effect: Medical cannabis can reduce opioid dosage requirements by providing complementary analgesic effects via different mechanisms.5,7,8,9 Reduced respiratory risk: Lower opioid doses decrease the likelihood of respiratory depression, making the overall pain management regimen safer.8 Multimodal pain relief: Medical cannabis can alleviate different types of pain (e.g. neuropathic, inflammatory) via multiple complementary mechanisms, potentially improving pain control when combined with opioids.10,11 Despite these benefits, co-prescribing medical cannabis and opioids should be undertaken with careful medical supervision and opioid dose adjustment to avoid amplification of common opioid side effects, such as sedation and constipation.11 Considerations for anxiety Anxiety disorders are commonly treated with benzodiazepines and other anxiolytic medications, which also carry risks of sedation and respiratory depression.2,12 Medical cannabis could serve as an either adjunctive or alternative treatment in some patients due to: Anxiolytic effects in certain medical cannabis strains or formulations, especially those higher in cannabidiol (CBD).13 The risk of respiratory depression from benzodiazepines, especially with higher doses.2 The potential to lower benzodiazepine dosages, reducing the risk of developing side effects and/or dependence.7 Due to inter-patient variability in response to CNS medications and medical cannabis, a personalised approach with close monitoring is advised. High-THC products (>10%) may exacerbate anxiety or cause psychoactive effects in some patients.13 CBD is thought to mitigate THC-induced anxiety, highlighting the importance of selecting products with an appropriate THC:CBD ratio, particularly in patients with a history of anxiety.13 Additionally, cannabinoids may inhibit CYP450 enzymes, potentially affecting the metabolism of concurrent medications, including anxiolytics.11 Prescribers should assess drug interactions to minimise the risk of adverse effects such as excess sedation. The role of medical cannabis in palliative care Palliative care patients commonly present with complex symptoms requiring multidrug regimens, including opioids for pain, benzodiazepines or other sedatives for anxiety and agitation, antiemetics for nausea, steroids, and other supportive therapies.14 While clinical evidence on the efficacy of medical cannabis in palliative symptom management remains inconclusive, preclinical studies and case reports suggest potential benefits in managing: Pain relief without increasing respiratory depression risk8, especially in patients with chronic pain.15 Anxiety and insomnia, which are common concerns in palliative care and are frequently reported as having a negative impact on patients’ quality of life.15 Nausea and poor appetite, thereby reducing the risk of malnutrition and cachexia.14,15 Co-prescribing medical cannabis with opioids and other CNS depressants in palliative care requires careful dosing and patient monitoring but could offer a viable adjunctive therapeutic approach in this patient group.16 Broader safety considerations for medical cannabis While medical cannabis has a low risk of respiratory depression5, potential cognitive impairment, psychoactive effects, and possible interactions with other prescribed drugs should all be taken into account when co-prescribing medical cannabis.17 More rigorous clinical trials are needed to develop standardised guidelines for medical cannabis use in combination with other medications, particularly in complex conditions such as those found in palliative care. Summary The low density of CB1 receptors in the brain stem is thought to underlie the lack of respiratory depression associated with cannabinoid use3,4, in contrast to opioids and benzodiazepines which have a strong association with respiratory sequelae.1,2 Given its distinct pharmacological profile, medical cannabis may be considered as an adjunct in pain management, anxiety treatment, and palliative care, particularly where minimising respiratory depressant effects is a clinical priority. Whilst careful co-prescribing and patient-specific considerations remain essential, medical cannabis has the potential to improve therapeutic outcomes while minimising the risk of one of the most significant side effects associated with conventional medications for these conditions. Job code: MONT-SGD-2025-0001 | Date of preparation: July 2025

Understanding Medical Cannabis Strength: A Guide for Healthcare Professionals Published: July 2025 When prescribing medical cannabis, it’s essential to understand and accurately communicate the “strength” of the product. However, the lack of standardisation in the way cannabis strength is represented can lead to confusion, complicating safe prescribing, patient education, and effective transitions between products.1 In this article, we will simplify the key concepts used to describe medical cannabis strength and highlight how these terms impact clinical practice. Methods of Describing Medical Cannabis Strength Current methods for expressing medical cannabis strength are determined by the amount of the two primary cannabinoids, CBD (cannabidiol) and THC (tetrahydrocannabinol) in a product. THC is considered the primary psychoactive component, whilst CBD is thought to modulate THC’s effects.2 The dose at which THC’s psychoactive properties become clinically apparent is generally regarded to be 5 mg.3 Medical cannabis strength can be described in different ways, each with its unique meaning: Total Cannabinoid Content (mg) This measurement describes the actual amount of THC and/or CBD per unit, such as per capsule, gummy, or spray. For example, a capsule might contain 5 mg of THC and 5 mg of CBD. Total cannabinoid content is the most clinically meaningful way to describe cannabis product strength and aligns with the dosing nomenclature used for other medications. For example, a drug may be prescribed with a specific dose in milligrams (such as 5 mg of morphine), and cannabis dosing follows this same principle. Cannabinoid Ratios (e.g. CBD:THC) This ratio describes the balance of two primary cannabinoids in a product. For example, a product with a 20:1 ratio has 20 parts CBD for every 1 part THC. The ratio can help you quickly compare products but doesn’t indicate the actual dose of THC or CBD. For instance, both a 1:1 product containing 2.5 mg of each cannabinoid and one containing 25 mg of each would have the same ratio but differ in dose. Therefore, clinical decisions must reference the exact quantities or percentages of the cannabinoids, not just the ratio. Potency (%) Potency refers to the percentage of a product’s weight that consists of THC or CBD. For instance, a product labeled as 15% THC means each gram of dried flower contains 150 mg of THC. Potency is often used to describe the strength of products like oils, tinctures, and flower, helping to compare their strength quickly. This is especially helpful when assessing products used for inhalation or topical application. Patient tolerance - a key factor affecting dosage and strength Tolerance to cannabis varies significantly from patient to patient.4 Cannabis-naïve patients (first-time users or those with limited experience) are much more sensitive to cannabinoids.4 Therefore, it’s essential to start with a low dose and gradually increase as needed.1 Conversely, experienced users may require higher doses to achieve the desired effect and may benefit from short breaks in therapy to reduce the likelihood of developing tolerance.4 Prescribers should always consider the patient's history when determining dosage.1 TGA Categorisation In Australia, the Therapeutic Goods Administration (TGA) classifies medical cannabis products based on their CBD content.5 This classification can be confusing as it reflects only the proportion of CBD in the product, not its THC or other cannabinoid content. For example, products in the "CBD dominant" category may still contain significant amounts of THC, which could have psychoactive effects. The TGA categorises products into five categories based on CBD percentage: Category 1: ≥98% CBD (Schedule 4) Category 2: ≥60% and <98% CBD (Schedule 8) Category 3: ≥40% and <60% CBD (Schedule 8) Category 4: CBD 2%-<40% (Schedule 8) Category 5: <2% CBD (Schedule 8)5 The categorisation system does not indicate the total strength or amount of THC, which can lead to misunderstandings in clinical practice. Standardising Cannabis Dosing Unlike opioids, where doses are standardised using measures such as oral morphine equivalents (OME), medical cannabis currently lacks a universally accepted standard dosing unit. Researchers have proposed using THC content as a common measure, such as defining a “standard THC unit” as 5 mg of THC6, which is considered a typical psychoactive dose.3 However, this concept is not yet universally adopted, as cannabis contains multiple active compounds, and individual factors (such as patient tolerance) play a significant role in how patients respond to cannabis.6 Clinical Implications and Best Practices Healthcare professionals should focus on the actual quantities of THC and CBD when determining dosages. This ensures safe and effective prescribing. When prescribing, always refer to the total milligrams (mg) of THC and CBD in the product, as this reflects the actual dose a patient will receive. Consider the patient’s tolerance when determining the appropriate dose. Cannabis-naïve patients should start with low doses and increase gradually. Be cautious with TGA categorisation: A product in the "CBD dominant" category may still have enough THC to cause psychoactive effects, so it’s essential to check the cannabinoid breakdown, not just the CBD percentage. Summary The strength of medical cannabis is described in multiple ways - through ratios, potency percentages, and total milligrams - making it vital for healthcare professionals to understand the clinical implications of each. To ensure accurate dosing and patient safety, always refer to the total amount of THC and CBD in the product, and consider patient factors such as experience and tolerance. As the medical cannabis market evolves, the need for clearer and more standardised labeling becomes increasingly important for effective prescribing and patient education. By adhering to these best practices, healthcare professionals can reduce medication errors, improve patient outcomes, and promote best practices in prescribing and dispensing medical cannabis.

The Endocannabinoid System and Clinical Care: Relevance Beyond Cannabis Published: July 2025 While many healthcare professionals are familiar with well-established physiological systems such as the sympathetic nervous system, which governs the body’s fight-or-flight response, fewer are aware of the more recently identified endocannabinoid system (ECS).1 The ECS has been increasingly recognised for its role in a range of regulatory functions, including pain modulation, immune response, stress and emotional regulation, appetite, body weight, and the control of nausea and vomiting.2 Yet, the ECS is not traditionally covered in medical education as highlighted by the Chief Scientific Officer of the Australian National Institute of Complementary Medicine: “I gave a talk at a hospital in Queensland late last year where I asked everyone in attendance—some 130 nurses, doctors, et cetera—whether they had had any training in the endocannabinoid system during their undergraduate training, and not one hand was raised.”3 Why isn’t the ECS taught in medical school? The ECS is relatively new in the context of medical science. The primary cannabinoid receptors—CB1 and CB2—were only identified in 1988 and 1993, respectively.4 Similarly, the two most well-characterised endocannabinoids, anandamide (AEA) and 2-arachidonoylglycerol (2-AG), were discovered in 1992 and 1995.4 This recency has contributed to its omission from traditional medical curricula, which can take years to evolve. Cannabis, which interacts with the ECS,5 has a long history of medical use, dating back over 5,000 years.6 However, by the mid-20th century, it was no longer viewed through a medical lens but instead reclassified as a prohibited substance under the United Nation’s Single Convention on Narcotic Drugs.6 This shift in legislation didn’t just criminalise its use—it also severely limited research.6 With tight restrictions on access to cannabis for scientific purposes, progress on understanding its potential therapeutic benefits, including its interaction with the ECS, stalled for decades. So what exactly is the ECS — and why it matters The ECS is a cell-signaling system composed of three primary components:Endocannabinoids—such as AEA and 2-AG—are lipid-based messengers naturally produced by the body that activate cannabinoid receptors.5 Cannabinoid receptors—CB1 and CB2—are primarily located in the central nervous system and the peripheral immune system, respectively, though both are also found in other tissues throughout the body.5 Enzymes—fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL)—are responsible for breaking down endocannabinoids.5 Endocannabinoids are released on demand by the body in response to physiological stimuli.7 Such stimuli may include: stress, obesity, food presentation, exercise, inflammation and tissue injury.2 The figure below outlines various stimuli reported to influence endocannabinoid levels and their observed effects from clinical studies: In neurons, endocannabinoids are released in response to stimuli (such as those mentioned above) and exert their effects through a process called retrograde signalling.12 They are synthesised in the postsynaptic neuron and travel backward across the synapse to bind to receptors on the presynaptic terminal, where they inhibit further neurotransmitter release.12 Emerging research suggests that deficient endocannabinoid signalling, collectively referred to as clinical endocannabinoid deficiency syndromes, may be involved in the pathogenesis of some diseases, including migraine, irritable bowel syndrome, depression, multiple sclerosis and Parkinson’s disease.13 This has led to growing interest in strategies to modulate levels of AEA and 2-AG, including targeting the enzymes that degrade them.13 Pain and inflammation A study by Ramsden et al. offers intriguing insights into the relationship between diet, endocannabinoid tone, and headache severity.14 In participants with chronic headaches, increasing omega-3 intake while reducing omega-6 fats led to lower circulating levels of 2-AG.14 Interestingly, this shift was accompanied by a reduction in headache hours, hinting at the ECS as a potential therapeutic target in managing chronic headaches.14 Stress and anxiety Research into the ECS and psychological trauma has revealed a complex picture.  Hill et al. found that individuals with post-traumatic stress disorder (PTSD) following the World Trade Center attack had low circulating levels of 2-AG compared to healthy controls.15 In contrast, Hauer et al. found the opposite trend in war refugees with PTSD, observing elevated levels of 2-AG compared to controls.16  These differing results suggest that the ECS may respond to psychological trauma in distinct ways depending on the context and intensity of the experience.16 While short-term ECS activation might serve as a protective mechanism during acute stress, prolonged or overwhelming trauma could lead to dysregulation—either depletion or overactivation—of this system.16 Looking ahead Although historically overlooked in medical education,3 the endocannabinoid system is now recognised as one of the key regulators of physiological balance—with roles spanning pain, inflammation, stress, mood, appetite, and immune function.2 As the clinical relevance of endocannabinoid signalling continues to be uncovered, research is rapidly advancing into ECS-targeted therapies—offering novel options for managing complex and chronic conditions, particularly amid growing patient interest in cannabis-based treatments.1,6,7 This evolving understanding carries practical implications for clinical care. While some patients may benefit from cannabis-based treatments, others may experience side effects or find them unsuitable.17 A deeper understanding of the ECS may allow healthcare professionals to identify alternative or adjunctive strategies, and support patient-centred decision-making.3,18,19 As with all areas of clinical science, ongoing research, cautious interpretation of emerging data, and patient-centred dialogue will be key to integrating ECS knowledge into thoughtful, responsible practice. Learn more about the ECS and its clinical implications with this fundamental module or our flagship accredited Medical Cannabis Fundamentals courses for doctors, nurses and pharmacists.

While well-known systems like the sympathetic nervous system are widely understood, doctors may be less familiar with the more recently identified endocannabinoid system (ECS).1,2 The ECS is thought to be involved in regulating pain, immunity, stress, appetite, weight, and nausea, yet it remains largely absent from traditional medical education in Australia.3 What will you learn?This module aims to equip you with the skills and confidence to integrate medical cannabis into patient care when clinically appropriate. Drawing on current evidence and theoretical case studies, the module explores the ECS, cannabinoid pharmacology, proposed therapeutic effects, and the clinical implications of both ECS function and use of medical cannabis. Through interactive scenarios and evidence summaries, you’ll explore how this knowledge may be relevant to clinical applications—ranging from the potential involvement of the ECS in patient presentations to identifying possible treatment approaches. Estimated Duration: 4 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Identify the endocannabinoid system’s components, role and functions, as currently understood Describe how endocannabinoid system function and dysfunction may contribute to symptoms such as pain, anxiety, sleep disturbance and inflammation Interpret how the mechanism of the endocannabinoid system may inform the therapeutic potential of medical cannabis Explain the pharmacological effects of THC and CBD Identify clinical features suggestive of cannabinoid tolerance or receptor desensitisation Describe the limitations and uncertainties in the current evidence relating to the endocannabinoid system References Harvard Health Publishing. The endocannabinoid system: Essential and mysterious. https://www.health.harvard.edu/blog/the-endocannabinoid-system-essential-and-mysterious-202108112569 (accessed Aug 2025). Parliament of Australia. Current barriers to patient access to medicinal cannabis in Australia. https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/024403/toc_pdf/CurrentbarrierstopatientaccesstomedicinalcannabisinAustralia.pdf (accessed Aug 2025). Hillard CJ. Circulating Endocannabinoids: From Whence Do They Come and Where are They Going? Neuropsychopharmacology. 2018;43:155–172.

In Australia, the Therapeutic Goods Administration (TGA) regulates the approval and monitoring of medications to ensure their quality, safety, and efficacy.¹ However, many medical cannabis products are classified as unapproved goods, as they have not undergone TGA evaluation. This module provides a detailed overview of the TGA's Authorised Prescriber Scheme, which enables registered medical practitioners to apply for the authority to prescribe unapproved medical cannabis products to multiple patients.² Learners will gain a clear understanding of the regulatory framework, the application process, and the responsibilities involved in prescribing unapproved medical cannabis products. This module is designed to equip healthcare practitioners with the knowledge to navigate the scheme effectively and confidently integrate medical cannabis into patient care when appropriate. Preview this module by watching the video above. Estimated Duration: 1 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Clarify the purpose of the Australian Register of Therapeutic Goods (ARTG) Outline the categories of unregistered therapeutic goods Identify and explain the regulated access pathways for unapproved goods Summarise the purpose and eligibility criteria for each category of the Special Access Scheme (SAS), including SAS-A, SAS-B, and SAS-C Identify the information required for a SAS-B application Identify the main categories of medical cannabis products based on their CBD and THC content Summarise the purpose and main characteristics of each Authorised Prescriber Scheme pathway Apply to become an authorised prescriber and fulfil reporting obligations Discuss prescribing practitioner considerations and obligations for providing medical cannabis treatment References ¹ Therapeutic Goods Administration. “Prescribe an Unapproved Therapeutic Good (Health Practitioners).” Therapeutic Goods Administration (TGA), 14 Dec. 2022, www.tga.gov.au/products/unapproved-therapeutic-goods/prescribe-unapproved-therapeutic-good-health-practitioners. ² Therapeutic Goods Administration. Unapproved products for multiple patients (Authorised Prescriber). Therapeutic Goods Administration (TGA). Published July 14, 2023. Accessed November 28, 2024. https://www.tga.gov.au/services/unapproved-products-multiple-patients-authorised-prescriber

This module explores the complexities of chronic pain and its management, with a focus on the potential role of medical cannabis. Learners will examine the factors influencing pain perception, the mechanisms of pain signaling, and the different aetiologies and pathophysiologies of pain. The module addresses the interplay between physical and psychosocial factors in the pain experience and the impacts of chronic pain on individuals and the Australian healthcare system. It also covers common treatment interventions, the therapeutic potential of medical cannabis for chronic pain and co-occurring conditions, and considerations for its use. Healthcare practitioners will gain insights into addressing barriers to medical cannabis treatment to support improved patient outcomes. Preview this module by watching the video above. Estimated Duration: 1 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Identify the factors that affect an individual's experience of pain Explain the pain signalling process Identify different pain aetiologies and pathophysiologies Explain the interplay between physical and psychosocial factors in the pain experience Define chronic pain and explain its impacts on individuals and the Australian healthcare and social support systems Describe common treatment interventions for chronic pain Describe medical cannabis' therapeutic potential for treating chronic pain and common co-occurring conditions Identify general considerations for medical cannabis treatment Explain common barriers to medical cannabis treatment and how to address them

At the time of publishing, there are currently two approved medical cannabis treatments on the ARTG: Nabiximols (Sativex) – Approved to improve symptoms related to spasticity in people with MS, reporting lack of efficacy from other anti-sacity treatments² Cannabidiol (Epidyolex) – Approved as an adjunct treatment severe and rare forms of epilepsy in children aged 2+4 Yet, for those who are seriously ill, medical cannabis may offer subjective relief for a wide range of symptoms such as; chronic pain, nausea and vomiting; sleep and appetite disturbances, depressed mood  & stress where other treatments have been unable to provide effective relief.³⁴ Registered medical practitioners may apply for access to unapproved therapeutic goods via the TGA through the following pathways:¹ Special access scheme (SAS) – provide access for an individual patient on a case-by-case basis Authorised prescriber scheme (AP) – provide access for multiple patients with the same condition In cases where approved medications are unsuitable or ineffective, Australian healthcare practitioners can access unapproved therapeutic goods, such as medical cannabis, through the Special Access Scheme A (SAS-A) or the Authorised Prescriber (AP) pathways. This module explores these pathways, outlines approved and unapproved medical cannabis treatments, and provides insight into their potential role in managing symptoms for seriously ill patients. Preview this module by watching the video above. Estimated Duration: 1.25 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Clarify the purpose of the Australian Register of Therapeutic Goods (ARTG) Outline the categories of unregistered therapeutic goods Identify and explain the regulated access pathways for unapproved goods Summarise the purpose and eligibility criteria for each category of the Special Access Scheme (SAS), including SAS-A, SAS-B, and SAS-C Define the term seriously ill as it pertains to SAS-A Complete the online SAS form to notify the Therapeutic Goods Administration (TGA) and the relevant state or territory authorities regarding the medical cannabis prescription Discuss prescribing practitioner considerations and obligations for providing medical cannabis treatment References ¹ Therapeutic Goods Administration. “Prescribe an Unapproved Therapeutic Good (Health Practitioners).” Therapeutic Goods Administration (TGA), 14 Dec. 2022, www.tga.gov.au/products/unapproved-therapeutic-goods/prescribe-unapproved-therapeutic-good-health-practitioners. ² Therapeutic Goods Administration. Sativex Oromucosal Spray, Nabiximols 80 mg/mL Pump Actuated Metered Dose Aerosol (181978). Therapeutic Goods Administration (TGA). Published May 26, 2022. Accessed October 2, 2024. https://www.tga.gov.au/resources/artg/181978 ³ Herbert A, Hardy J. Medicinal Cannabis Use in Palliative Care. Australian Journal of General Practice. 2021;50(6):363-368. doi:https://doi.org/10.31128/ajgp-02-21-5831 ⁴ Therapeutic Goods Administration. Guidance for the Use of Medicinal Cannabis in the Treatment of Palliative Care Patients in Australia. Therapeutic Goods Administration (TGA). Published June 23, 2023. Accessed October 2, 2024. https://www.tga.gov.au/resources/resource/reference-material/guidance-use-medicinal-cannabis-treatment-palliative-care-patients-australia

This module provides healthcare practitioners with a comprehensive understanding of the biological components of medical cannabis and their therapeutic potential. As cannabis becomes more widely accepted, it's essential to grasp how its taxonomy, strains, chemovars, and key compounds interact within the body to provide treatment benefits. Through this module, practitioners will learn how to identify cannabis' taxonomic status, discuss the key components of strains, and explain how cannabinoids and terpenes affect the body. You'll also explore the factors that influence cannabis' effects and how practitioners can adjust treatment to account for clinical and individual patient factors, risks, and contraindications. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Identify cannabis' taxonomic status Identify and discuss key components of strains and chemovars Identify key compounds in medical cannabis and explain their potential interactions and effects within the body Describe the factors that impact medical cannabis' effects within the body Explain how practitioners may adjust medical cannabis treatment to account for clinical and individual factors, risks and contraindications

This module explores the endocannabinoid system (ECS) and its critical role in the effects of medical cannabis. It examines the discoveries that shaped our understanding of the ECS, its primary components—such as CB1, CB2, and TRPV1 receptors—and the mechanisms of retrograde cell signaling, which underpins how cannabinoids influence physiological processes. Participants will learn about the role of ECS ligands and non-ligand mediators in cannabis pharmacology, the concept of endocannabinoid tone, and factors that can affect it. Clinical considerations are addressed to provide a deeper understanding of how the ECS informs the safe and effective use of medical cannabis in patient care. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Describe the discoveries that shaped today's understanding of the endocannabinoid system (ECS) Explain the functions of the ECS, its main components, and how they interact Discuss the function and benefits of retrograde cell signalling Outline the roles and functions of cannabinoid receptors CB1 and CB2, and vanilloid receptor TRPV1 Identify ECS ligands and non-ligand mediators and describe their role in ECS function Define endocannabinoid tone and its influencing factors Discuss clinical considerations related to the ECS

In the current landscape, medical cannabis products are tightly regulated with stringent dispensing requirements. Medical cannabis dispensers (MCDs), and the businesses they represent, are responsible for adhering to all relevant legislation and policy while also implementing best practice dispensing for robust patient-centred care. This fundamental module equips pharmacists with the knowledge and skills to effectively fulfil their essential role in dispensing medical cannabis.  Beyond the technical aspects, pharmacists serve as key advocates for patient care, ensuring the safety, privacy, and well-being of patients throughout their medical cannabis journey. In this module, learners will explore methods to build trust with patients, provide comprehensive education on cannabis products, and ensure compliance with record-keeping and reporting standards. This module also emphasises the critical role of collaboration with healthcare teams to ensure safer, more effective treatment outcomes. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Identify the legal and ethical responsibilities of medical cannabis dispensers (MCDs) Implement respectful communication practices to educate and build safety, trust and rapport with patients Counsel patients on safe use of medical cannabis products – including dosage, titration, administration, storage and identifying and responding to side effects Explain how to store, monitor and maintain medical cannabis products securely Discuss pharmacists' record-keeping obligations when dispensing medical cannabis Collaborate with other health practitioners for a multidisciplinary approach to medical cannabis treatment

While medical cannabis is an effective treatment option for many patients, it’s considered an unapproved good on the TGA’s schedule of drugs. This course is designed to equip healthcare professionals with the skills, knowledge and confidence to navigate the TGA’s Special Access Scheme (SAS) and apply to prescribe medical cannabis to suitable individual patients on a case by case basis using the SAS-B pathway.  We’ll also delve into the broader legal and ethical considerations of prescribing medical cannabis as a treatment option, including risk-mitigation strategies so you can start prescribing medical cannabis to your eligible patients as soon as possible. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Define unapproved good Describe different pathways for accessing and prescribing unapproved goods Explain the differences and correct use of the SAS and Authorised prescriber pathways Apply to prescribe medical cannabis for individual patients using the SAS-B pathway Explain the legal and ethical considerations, and risk-mitigation strategies when prescribing medical cannabis via the SAS-B pathway

While medical cannabis is an effective treatment option for many patients, it’s considered an unapproved good on the TGA’s schedule of drugs. This course is designed to equip healthcare professionals with the skills, knowledge and confidence to navigate the TGA’s Special Access Scheme (SAS) and apply to prescribe medical cannabis to suitable individual patients on a case by case basis using the SAS-B pathway.  We’ll also delve into the broader legal and ethical considerations of prescribing medical cannabis as a treatment option, including risk-mitigation strategies so you can start prescribing medical cannabis to your eligible patients as soon as possible. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Define unapproved good Describe different pathways for accessing and prescribing unapproved goods Explain the differences and correct use of the SAS and Authorised prescriber pathways Apply to prescribe medical cannabis for individual patients using the SAS-B pathway Explain the legal and ethical considerations, and risk-mitigation strategies when prescribing medical cannabis via the SAS-B pathway

Forty-four-year-old Helen experiences intermittent periods of neurological symptoms affecting motor function, speech and balance. After ruling out multiple sclerosis (MS), Helen's doctor diagnosed her with functional neurological disorder (FND.) Despite trialling several first-line treatments, Helen continues to relapse periodically and uses black-market medical cannabis oil to control symptoms, though the dosage is inconsistent as the product is homemade. In this case study, we explore how Dr. Xie prescribed medical cannabis products to help reduce the frequency of Helen's relapses. Estimated Duration: 1 hour Access Duration: 12 months from date of enrolment Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of functional neurological disorder (FND) and identify common management strategies Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of FND Identify suitable candidates for medical cannabis treatment Devise treatment plans that consider patient safety and minimise risk Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in the management of FND

When chronic pain from repeated injuries forced legendary basketballer Lauren Jackson into retirement, her journey to recovery became a complex challenge. But Lauren defied the odds, returning to the court to play in the Australian squad for the FIBA Women's Basketball World Cup in 2022. This case study explores the challenges faced by female athletes in high-impact sports, including the prevalence of bone stress and joint injuries, the impact of hormonal factors, and the complexities of chronic pain management. It also addresses how medical cannabis was incorporated in Lauren's treatments. Healthcare practitioners will gain insights into: The pathophysiology of common injuries in female athletes, including bone stress and joint injuries Potential benefits and limitations of medical cannabis in managing chronic pain and aiding recovery Considerations for incorporating medical cannabis into treatment plans alongside conventional therapies. Strategies for discussing medical cannabis with patients while prioritiding safety and minimising risks Explore the evidence and evaluate how medical cannabis might fit within a broader approach to managing chronic conditions and sports-related injuries. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of common conditions and impact-based sporting injuries for female athletes and identify common management strategies Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of chronic sporting injuries and recovery from surgery Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of endometriosis Explain how medical cannabis treatment may integrate into and influence prescribed opioid treatment outcomes and effects Identify suitable candidates for medical cannabis treatment Devise treatment plans that consider patient safety and minimise risk Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in the management of chronic conditions, impact-based sporting injuries and recovery from surgery Disclaimer: Lauren has a financial interest in a medicinal cannabis company. Lauren is not receiving any financial remuneration from SAGED for her involvement in this case study.

Sixty-six-year-old David was diagnosed with irritable bowel syndrome (IBS) after hospitalisation for diverticulitis in 2016. He experiences abdominal pain, nausea, constipation, gas and bloating after meals. Stress exacerbates these symptoms. David has trialled several first-line treatments, including various dietary modifications, but none adequately relieved his symptoms. In this case study, we explore how Dr. Xie prescribed medical cannabis products to manage David’s symptoms and help to improve his quality of life. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of IBS  and identify common management strategies  Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of IBS Identify suitable candidates for medical cannabis treatment Devise treatment plans that consider patient safety and minimise risk Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in the management of IBS

Twenty-six-year-old Lexi has primary vaginismus that causes vaginal spasming and burning in the vaginal canal during penetration. As a result, Lexi is unable to use tampons and has developed secondary anxiety around sexual intercourse. Lexi has trialled several first-line treatments, but none were suitable due to lack of efficacy and/or Lexi's work schedule. Lexi continues to experience vaginal pain during sex. In this case study, we explore how Dr. Xie prescribed medical cannabis products to reduce Lexi's pain and ease her anxiety towards sexual intercourse. Preview this case study by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this case study, you’ll be able to: Explain the pathophysiology of vaginismus and identify common management strategies  Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of vaginismus  Identify suitable candidates for medical cannabis treatment Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in the management of vaginismus  Devise treatment plans that consider patient safety and minimise risk

Forty-eight-year-old David is seeking relief for depression and anxiety secondary to borderline personality disorder (BPD). David is currently using first-line treatments, but these have proved ineffective as David's still experiencing unwanted symptoms. In this case study, we explore how Dr. Xie prescribed medical cannabis products to help alleviate David’s symptoms and improve his overall quality of life. Preview this module by watching the video above. Estimated Duration: 1 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of borderline personality disorder and identify common management strategies  Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of borderline personality disorder Identify suitable candidates for medical cannabis treatment Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in the management of symptoms of borderline personality disorder Devise treatment plans that consider patient safety and minimise risk

Noel is a 57-year-old military veteran who developed PTSD and chronic pain due to several injuries sustained during service. Despite trialling several conventional treatment options, Noel is still experiencing debilitating mood symptoms that affect his sleep, as well as chronic pain from the injuries he sustained. In this case study, we explore how Dr. Xie prescribed medical cannabis in Noel's treatment plan. Preview this module by watching the video above. Estimated Duration: 1 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of PTSD and identify common management strategies  Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of PTSD Identify suitable candidates for medical cannabis treatment Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in the management of PTSD Devise treatment plans that consider patient safety and minimise risk

This microcredential offers healthcare professionals an in-depth look at how medical cannabis can be integrated into the management of chronic pain in complex patient cases. Through real-world scenarios, this microcredential highlights the therapeutic potential of cannabis while addressing concerns related to coexisting conditions, medication interactions, and patient quality of life. This microcredential includes: Clinical Case Study - ADHD Symptoms and Chronic Pain: Explore how medical cannabis helped Hayley, a 37-year-old patient with combined-type ADHD and chronic pain, manage her attention, anxiety, sleep, and physical discomfort. Clinical Case Study - Chronic Pain & Hepatic Dysfunction: Follow Stephen, a 56-year-old with hepatic fibrosis, as his healthcare team safely incorporated medical cannabis into his treatment plan for chronic back pain and gout, restoring his active lifestyle. Clinical Case Study - Chronic Pain, Insomnia & Cardiac Issues: Delve into Jen’s case, a 60-year-old with complex regional pain syndrome and stable cardiovascular disease, who found relief from chronic pain and insomnia through carefully managed medical cannabis treatment. Clinical Case Study - MS-Associated Chronic Pain and Spasticity: Examine how Johanna, a 39-year-old with multiple sclerosis, addressed her neuropathic pain and spasticity using an affordable, well-balanced cannabis treatment plan, overcoming challenges related to her other medications and financial constraints. This microcredential is designed to enhance practitioners’ understanding of medical cannabis' role in improving patient outcomes in chronic pain management, even in complex clinical scenarios. Preview this module by watching the video above. Estimated Duration: 4 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Demonstrate an understanding of the role of medical cannabis in managing chronic pain in patients with coexisting conditions like ADHD, hepatic dysfunction, cardiac issues, and multiple sclerosis. Evaluate real-world case studies to assess cannabis' therapeutic potential for symptom management. Apply critical safety considerations and risk mitigation strategies for patients with hepatic and cardiac concerns. Discuss potential drug-drug interactions and the safe use of medical cannabis in complex patient cases. Facilitate patient-centered discussions around medical cannabis for chronic pain, addressing sleep and psychological symptoms. Devise tailored cannabis treatment plans that consider patient safety, minimise risk, and enhance quality of life in complex cases.

Sixty-five-year-old Ryan is living with prostate cancer and is experiencing chronic pain and ongoing sleep disturbances. Despite undergoing chemotherapy and trialling several first-line medications, his symptoms have progressed, now significantly impacting his ability to manage daily activities without support. In this case study, we examine how Dr. Xie considered medical cannabis as part of a broader symptom management strategy. The module explores the rationale behind its use, the prescribing process, and the clinical considerations involved in supporting a patient like Ryan. Through this scenario, practitioners will engage with current evidence and frameworks for evaluating medical cannabis in the context of cancer-related symptom management, with attention to safety, patient suitability, and clinical outcomes. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of prostate cancer and identify common management strategies  Discuss the potential benefits and limitations of medical cannabis as a treatment option for secondary symptoms of prostate cancer (e.g. pain and sleep disturbances) Identify suitable candidates for medical cannabis treatment Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in the management of secondary symptoms of prostate cancer (e.g. pain and sleep disturbances) Devise treatment plans that consider patient safety and minimise risk

Peter, a 45-year-old with human immunodeficiency virus (HIV), is experiencing anxiety and insomnia as side effects of his current treatment regime. These side effects have caused Peter to feel significant fatigue, and he now finds it difficult to leave the house to participate in his regular social and community activities. In this case study, we explore how Dr. Xie prescribed medical cannabis products in addition to Peter’s current treatment regime to help manage his symptoms and get him out and about once more. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of Human immunodeficiency virus (HIV) and identify common management strategies  Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of HIV Identify suitable candidates for medical cannabis treatment Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in the management of symptoms of HIV Devise treatment plans that consider patient safety and minimise risk

Nickolas, a 65-year-old with motor neurone disease (MND), seeks treatment for his pain, stress, anxiety and depression. Despite trialling a range of treatment options, and consulting with several specialists, Nickolas is still experiencing primary and secondary symptoms that impact his quality of life. In this case study, we explore how Xie prescribed a medical cannabis product to help manage Nickolas’ symptoms, so he could mobilise with less pain and improve his psychological wellbeing. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of Motor Neurone Disease (MND) and identify common management strategies  Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of MND Identify suitable candidates for medical cannabis treatment Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in the management of symptoms of MND Devise treatment plans that consider patient safety and minimise risk Offer effective patient education and treatment advice on the therapeutic use of medical cannabis

Fibromyalgia (FMS) is a heterogeneous condition characterised by chronic pain throughout the body and is commonly associated with a range of other conditions and symptoms. It’s estimated that there are 1 million Australians with FMS and it’s more common in women than men. In this case study, Jordan, a 32-year-old with FMS, seeks treatment for anxiety and chronic pain. Jordan experienced pain relief while medicated in hospital, but since then hasn't found a solution. The pain and stress is beginning to impact their sleep and daily living.  In this case study, we explore how Jordan was prescribed medical cannabis oil products to help them manage their symptoms and improve their quality of life. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of fibromyalgia and identify common management strategies Discuss the potential benefits and limitations of medical cannabis as a treatment option for common symptoms of fibromyalgia  Identify suitable candidates for medical cannabis treatment Devise treatment plans that consider patient safety and minimise risk Offer effective patient education and treatment advice on the therapeutic use of medical cannabis

Trigeminal neuralgia (TN) is a painful condition characterised by severe electric shock-like or burning pain in the craniofacial tissues that connect to the trigeminal nerve. Anne, a 52 year old with TN, seeks treatment for chronic facial pain with regular nightly flare ups. Due to the pain, Anne’s been feeling nauseated and finding it difficult to sleep, and hasn’t been able to fully participate in daily life. Despite trialling and using a range of conventional medications, and regularly consulting specialists, Anne hasn’t found relief for her symptoms. She’s considering medical cannabis to manage her pain, nausea and sleep so she can get back to work and life. In this case study, we explore how Anne’s team incorporated medical cannabis products in her treatment plan. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of trigeminal neuralgia and identify common management strategies  Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of trigeminal neuralgia Identify suitable candidates for medical cannabis treatment Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in the management of symptoms of trigeminal neuralgia Devise treatment plans that consider patient safety and minimise risk Offer effective patient education and treatment advice on the therapeutic use of medical cannabis

Gina, a 32-year-old with endometriosis, seeks treatment for her gastrointestinal and pain-related symptoms.  Gina has tried a range of conventional medications and therapies, but they’ve offered little relief for her symptoms, in particular her pain which leaves her cyclically incapacitated and impacts her work as a hotel manager. In this case study, we explore how Gina’s team prescribed medical cannabis products to help Gina manage her pain and reduce the impacts on her work and wellbeing. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of endometriosis  and identify common management strategies  Discuss the potential benefits and limitations of medical cannabis as a treatment option for common symptoms of endometriosis Identify suitable candidates for medical cannabis treatment Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in symptom management of endometriosis Devise treatment plans that consider patient safety and minimise risk Offer effective patient education and treatment advice on the therapeutic use of medical cannabis

Lauren is a 35-year-old with hypermobile Ehlers-Danlos Syndrome (hEDS). Despite currently trying to manage her symptoms with a wide range of pharmaceutical and non-pharmaceutical interventions, Lauren is still experiencing pain, sleep problems, moments of low mood and nausea. These symptoms are stopping her from being able to fully participate in life. In this case study, we explore how Lauren's team prescribed medical cannabis products to help her manage her symptoms so she can enjoy life day-to-day. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of EDS and identify common management strategies  Discuss the potential benefits and limitations of medical cannabis as a treatment option for common symptoms of EDS Identify suitable candidates for medical cannabis treatment Devise treatment plans that consider patient safety and minimise risk Offer effective patient education and treatment advice on the therapeutic use of medical cannabis

Chad, a 19-year-old autistic male, seeks supports to help him manage his meltdowns and secondary anxiety and depression.  Despite already implementing a wide range of supports and medications to alleviate his distress and manage his aggressive behaviour, Chad's mother Linda, is looking to medical cannabis to supplement his current plan. In this case study, we explore how Chad's team prescribed a combination of medical cannabis products to address Chad's distress and improve his quality of life. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Define "neurotype" Explain the purpose of neuroaffirming patient-centric practice Identify strategies to deliver neuroaffirming practice Explain the similarities and differences between autistic and allistic individuals Discuss conventional treatment options for managing distress in autistic individuals Discuss the potential benefits and limitations of medical cannabis as a treatment option for autistic individuals with anxiety and depression Identify suitable candidates for medical cannabis treatment Facilitate clinical discussions with patients and carers around medical cannabis as a therapeutic option for distress secondary to autistic traits Devise treatment plans that consider patient safety and minimise risk Offer effective patient education and treatment advice on the therapeutic use of medical cannabis

Hayley, a 37-year-old female, presents with chronic pain and combined-type ADHD.  Despite her diagnosis 27 years prior, her ADHD is unmanaged, and she’s seeking particular help with attention, anxiety and sleep, as well as pain management for chronic lower back and shoulder pain. In this case study, we explore how Hayley’s team prescribed a combination of medical cannabis products, including medicated edibles, to treat Hayley’s symptoms and restore her quality of life. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain how and why ADHD and chronic pain affects patients Discuss the potential benefits and limitations of medical cannabis as a treatment option for ADHD and pain symptoms Identify suitable candidates for medical cannabis treatment Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in ADHD and chronic pain symptom management Devise treatment plans that consider patient safety and minimise risk Offer effective patient education and treatment advice on the therapeutic use of medical cannabis

Lucy, a 60-year-old female, presents with a frozen shoulder with secondary constant pain with flare ups on movement. Her quality of life is severely impacted, due to reduced range of motion in her shoulder, and she’s now unable to work. This is causing anxiety and poor sleep quality.  In this case study, we explore how Lucy’s team prescribed a combination of medical cannabis products to manage her pain symptoms and restore her quality of life. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of chronic pain, anxiety and sleep issues  and identify common management strategies  Discuss the potential benefits and limitations of medical cannabis as a treatment option for patients with chronic pain, anxiety and sleep issues Identify suitable candidates for medical cannabis treatment Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in symptom management of chronic pain, anxiety and sleep issues Devise treatment plans that consider patient safety and minimise risk Offer effective patient education and treatment advice on the therapeutic use of medical cannabis

Marta, a 49-year-old female, presents with a range of intrusive symptoms secondary to unmanaged Crohn's disease. These symptoms often interrupt Marta's work and sleep, causing anxiety. In this case study, we explore how Marta’s team prescribed a combination of medical cannabis products to treat her symptoms and improve her quality of life. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of Crohn’s disease and identify common management strategies  Discuss the potential benefits and limitations of medical cannabis as a treatment option for common symptoms of Crohn’s disease Identify suitable candidates for medical cannabis treatment Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in symptom management of symptoms of Crohn’s disease Devise treatment plans that consider patient safety and minimise risk Offer effective patient education and treatment advice on the therapeutic use of medical cannabis

Mario, a 40-year-old male presents with respiratory symptoms and sleep difficulties associated with his diagnosis of chronic obstructive pulmonary disease.After being hospitalised 3 times in recent months, despite following his current treatment plan, Mario is seeking a more effective solution.In this case study, we explore how Mario’s team prescribed non-inhaled medical cannabis products to treat his respiratory symptoms, restore his sleep quality, and improve his quality of life. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of COPD and identify common management strategies Discuss the potential benefits and limitations of medical cannabis as a treatment option for patients with COPD Identify suitable candidates for medical cannabis treatment Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in symptom management of COPD Devise treatment plans that consider patient safety and minimise risk Offer effective patient education and treatment advice on the therapeutic use of medical cannabis

Rachel, a 40-year-old female, presents with migraines, insomnia and chronic abdominal pain secondary to a recent nephrectomy due to chronic kidney disease.After trying many medications with only minimal symptom relief, Rachel’s desperate to find an alternative solution.In this case study, we explore how Rachel’s team prescribed medical cannabis to help manage her pain and insomnia and improve her overall quality of life. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain how and why chronic renal kidney disease affects patients Discuss the potential benefits and limitations of medical cannabis as a treatment option for chronic renal kidney disease, nephrectomy, migraines and nausea and vomiting Identify suitable candidates for medical cannabis treatment Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in symptom management of chronic renal disease, nephrectomy, migraines, nausea and vomiting Devise treatment plans that consider patient safety and minimise risk Offer effective patient education and treatment advice on the therapeutic use of medical cannabis

Jen, a 21 year old woman experiences a couple of seizures per week due to photosensitive epilepsy. This case study explores how Jen's team helped her reduce the duration and the frequency of her seizures with medical cannabis. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Demonstrate an understanding of safe prescribing and risks associated with medical cannabis and Epilepsy  Assess the suitability of cannabis treatment in patients with Epilepsy  Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in symptom management Monitor and provide titration advice around cannabinoid medicines Apply critical safety considerations in patient centred care Navigate the regulatory frameworks surrounding medical cannabis provision in Australia

46 year old Robert is dealing with a lot of stress at work. This is affecting his quality of sleep. Explore how Robert's team helped him combat situational stress and prescribed medical cannabis to improve his overall sleep quality. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptomatic management of patients with insomnia Identify suitable candidates for medical cannabis treatment Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in symptom management for insomnia Apply critical safety considerations & provide patient education & treatment advice regarding MC treatment

Violet, a seventy-seven year old woman, is in palliative care and undergoing radiation therapy.  As she enters her end of life (EOL) period, she's looking to medical cannabis to improve her comfort and alleviate the pain caused by the side effects of the other therapies she's undergoing. In this case study, we explore how Violet's team devised a suitable treatment plan that addressed her side effects and improved her quality of life (QOL) during her EOL period. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Define the palliative approach to care and outline key clinical assessments  Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptomatic management in palliative care Identify suitable candidates for medical cannabis treatment Apply critical safety considerations/risk mitigation strategies for patients using medical cannabis in palliative care Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in palliative care Discuss product usage and critical safety considerations with patients in patient-centred care

Zoey, a 46 year old female is seeking treatment for her chemotherapy-related symptoms. Zoey is currently undergoing chemotherapy as she was diagnosed with breast cancer at the start of 2023. There is risk of hepatic injury as medical cannabis and chemotherapy can both effect the liver.  This case study explores how Zoey's team managed the symptoms of her chronic pain, fatigue, low mood and lack of appetite using medical cannabis to to combat Zoey's chemotherapy symptoms and regain her sense of self.  Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptomatic management of chemotherapy and breast cancer Identify suitable candidates for medical cannabis treatment Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in symptom management of Breast cancer and chemotherapy Apply critical safety considerations & provide patient education & treatment advice regarding MC treatment

Lee has experienced anxiety for much of her adult life, but her symptoms have recently intensified—interfering with work, sleep, and daily functioning. Having previously trialled SSRIs with limited success, she is now exploring medical cannabis as a potential treatment option. This case study follows Lee’s clinical assessment and treatment planning process, highlighting the key factors considered by her healthcare team in determining suitability for medical cannabis. Practitioners will examine how THC and CBD interact with anxiety symptoms, how patient history informs treatment planning, and what safety precautions are critical in minimising adverse effects—particularly with THC. The module also explores regulatory considerations under the TGA framework and provides practical guidance on how to approach patient education and shared decision-making when discussing medical cannabis for anxiety management. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Discuss the relationship between THC, CBD and anxiety Discuss the TGA requirements, potential benefits and limitations of medical cannabis as a treatment option for anxiety Identify patients with anxiety who are suitable candidates for medical cannabis treatment Collect detailed patient information Apply critical safety considerations and provide patient education and treatment advice regarding medical cannabis treatment for anxiety  Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in symptom management for anxiety

“I’m not even 40 but I feel like I’m 80.” Johanna presented with chronic neuropathic pain and spasticity in her hands and feet due to multiple sclerosis. It was impacting her mobility and sleep, the effects of which had flowed into her career and finances. Living with her parents while awaiting NDIS support, medical cannabis seemed like a promising treatment option but posed a risk with her Natalizumab use, requiring sound management to avoid potential hepatic injury. Financial constraints added complexity to accessing medical cannabis. Discover how Johanna's team crafted an affordable and effective medical cannabis treatment, addressing her pain, sleep issues, and restoring her sense of self. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Demonstrate an understanding of the pathophysiology of MS Discuss common treatment options for MS Discuss how cannabinoid-based therapies may be an effective treatment option for symptom management in patients with MS Explain the TGA guidance for providing medical cannabis as a treatment for patients with MS Collect detailed patient information Apply critical safety considerations/risk mitigation strategies for patients presenting with potential for hepatic injury Discuss product usage and critical safety considerations with patients in patient-centred care

Sixty-year-old Jen was hesitant when she walked into the consultation room. She had been experiencing severe ankle pain caused by chronic regional pain syndrome and her treatments to date hadn’t done the trick. But medical cannabis? Wouldn’t she end up walking around “like a zombie”? To complicate matters further, Jen has a history of now-stable cardiovascular disease. THC and CBD can affect cardiac functioning and interact with common POAC drugs.  But, all hope was not lost! In this case study, find out how Jen’s team safely treated her pain and secondary insomnia using medical cannabis, and minimised psychotropic effects so she remained her lively, vital self throughout treatment. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the cardiac effects of medical cannabis Discuss the potential benefits and limitations of medical cannabis as a treatment option in patients with cardiac disease Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in symptom management Apply critical safety considerations/risk mitigation strategies for patients presenting with cardiac concerns Discuss potential drug-drug interactions Provide medication safety education to patients around drug-drug interactions

Fourty-three year old Luna has been experiencing a lot of mental health ups and downs. But recently there have been more “downs” than “ups”. Despite taking pharmaceutical treatments, her anxiety and depression are out of control, and it’s affecting her sleep. But Luna has a coconut and lavender allergy – both of which can be caused by compounds also found in medical cannabis. And, there is evidence to suggest that THC can exacerbate anxiety and in some cases cause paranoia. In this case study, explore how Luna’s team safely prescribed medical cannabis so she was feeling better and sleeping soundly in no time. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain why coconut and lavender allergies, and anxiety, are risk factors for using medical cannabis Identify ingredients in medical cannabis products that commonly cause allergic or hypersensitive reactions  Apply critical safety considerations/risk mitigation strategies for patients presenting with allergies and anxiety concerns Facilitate discussions with patients around medical cannabis as a therapeutic option for symptom management  Provide medication safety education to patients

Fifty-six year old Stephen, an avid gardener, has hit a rough patch. He’s out of action because of the chronic pain in his back, and gout pain in his wrists and ankles. He’s considering medical cannabis as a therapeutic option. The complication? He has hepatic fibrosis from fatty liver of moderate severity, resulting in reduced hepatic function. In this case study, explore how his team safely prescribed medical cannabis to Stephen, helping him manage his pain and get back onto his feet – and into his garden. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain how medical cannabis interacts with the body, including the mechanisms of action and metabolism Apply critical safety considerations / risk mitigation strategies for patients presenting with hepatic dysfunction or impairment Discuss the potential benefits and limitations of medical cannabis as a treatment option for patients with hepatic dysfunction Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in symptom management Educate patients (on their individual case) on how to safely apply their treatment with medical cannabis

Palliative care focusses on relieving suffering and improving quality of life for individuals with life-limiting illnesses. Historically, practitioners applied palliative care only to cancer patients, but it's increasingly being introduced earlier in the course of illness.¹ This module examines the role of palliative care as part of person-centred health services, aligned with the World Health Organisation's framework, which highlights the importance of meeting individual needs and preferences.² Learners will explore challenges such as symptom management and the complexities of polypharmacy, which can limit the effectiveness of traditional treatments. The module also discusses the potential role of medical cannabis in addressing symptoms, reducing medication side effects, and improving quality of life for patients in palliative care. This module provides healthcare practitioners with knowledge to responsibly integrate medical cannabis into palliative care plans. Preview this module by watching the video above. Estimated Duration: 1 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Define palliative care Discuss the purposes and standard processes and approaches in palliative care Discuss the importance of goals of care in palliative care Discuss the role of services, supports and people involved in palliative care Explain how palliative care differs from end-of-life care Explain how the endocannabinoid system may influence symptoms and side effects experienced by those in palliative care Explain how health practitioners and professionals may facilitate medical cannabis treatment to manage symptoms and side effects commonly experienced by those in palliative care Identify clinical considerations that relate to medical cannabis use in palliative care References ¹ Lukas Radbruch, et al. “Redefining Palliative Care—a New Consensus-Based Definition.” Journal of Pain and Symptom Management, vol. 60, no. 4, 6 May 2020, pp. 754–764, www.sciencedirect.com/science/article/pii/S0885392420302475, https://doi.org/10.1016/j.jpainsymman.2020.04.027. Accessed 17 Oct. 2024.² Australian Institute of Health and Welfare. “Palliative Care Services in Australia, Summary - Australian Institute of Health and Welfare.” Australian Institute of Health and Welfare, 2023, www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia/contents/summary. Accessed 23 Oct. 2024.

This module provides healthcare practitioners with a foundational understanding of mental health conditions, focussing on their prevalence, underlying mechanisms, and clinical impact—particularly in the Australian context. By examining the characteristics and pathophysiology of common conditions, practitioners will better understand current treatment limitations and the growing interest in alternative or adjunctive options such as medical cannabis.The module explores the potential mechanisms through which medical cannabis may alleviate specific symptoms associated with mental health conditions, while also addressing the limitations and risks of its use in this context. Evidence-based strategies for risk mitigation and safe prescribing are presented to support informed, patient-centred decision-making.Upon completion, practitioners will be better equipped to evaluate the appropriate role of medical cannabis in mental health care and to integrate it safely and effectively into treatment plans where clinically appropriate. Preview this module by watching the video above. Estimated Duration: 1 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Define mental health and mental health conditions Explain the prevalence and impact of mental health issues in Australia Identify key risk factors for developing mental health conditions in Australia Describe the characteristics, pathophysiology, and treatment options for common mental health conditions Explain how medical cannabis may alleviate symptoms of mental health conditions through its primary mechanisms of action Describe the therapeutic potential of medical cannabis for treating symptoms of common mental health conditions Outline potential risks of medical cannabis treatment for mental health symptoms and discuss risk management strategies where appropriate

This module focuses on Breast, endometrial and ovarian cancers (BEOC), which are among the most prevalent cancers affecting individuals assigned female at birth (IAFABP). Learners will explore the categories, pathophysiology, risk factors, symptoms, and treatment options for these cancers, noting that early symptoms, particularly for ovarian and endometrial cancers, can often go unnoticed, leading to a poorer prognosis. While common treatments can be effective, they frequently come with significant side effects that impact daily life and overall well-being. By the end of this module, learners will be able to explain the pathophysiology and symptomatology of BEO cancers, identify treatment options and their adverse effects, and discuss the therapeutic potential of medical cannabis for alleviating treatment-related side effects, including chemotherapy-induced nausea and vomiting (CINV). Additionally, the module will cover important considerations for selecting appropriate medical cannabis products and outline general conditions related to prescribing these treatments. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain BEOC pathogenesis and pathophysiology Identify benefits and drawbacks of conventional interventions for BEOC Discuss medical cannabis’ therapeutic potential for treating BEOC symptoms and treatment-related side effects Identify considerations for selecting a medical cannabis product to treat symptoms of BEO cancers

This module explores the complexities of cancer, including its pathogenesis, common types, grading criteria, and contemporary treatment options. Learners will gain insights into the rising incidence of cancer in Australia and the significant advancements in survival rates, alongside the challenges posed by treatment side effects. A key focus will be the emerging role of medical cannabis, examining its therapeutic potential for alleviating cancer symptoms and mitigating treatment side effects, as well as its implications for palliative care. By the end of the module, learners will be equipped to explain cancer's biological mechanisms, identify various cancers and their treatments, and assess the benefits and risks of medical cannabis in cancer care. This knowledge aims to enhance understanding and support improved patient outcomes in the evolving landscape of cancer treatment. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathogenesis and pathophysiology of cancer Identify and describe the main types of cancers and tumours Identify and describe the common cancer-grading criteria Identify and explain contemporary cancer treatments, their benefits, risks and side effects Explain medical cannabis’ therapeutic potential for treating cancer symptoms and treatment side effects Identify risks associated with medical cannabis treatment for those with cancer Explain how medical cannabis may play a role in palliative care for those with cancer

A person with ovaries is typically born with about one million ovarian follicles.¹ By puberty, this number decreases to between 250,000 and 400,000¹, continuing to decline throughout life. Between the ages of 45-56, the diminishing ovarian follicle count leads to hormonal shifts that can cause various symptoms, including irregular menstruation and vasomotor or organ-related issues.¹ This transitional phase is known as perimenopause, while menopause marks the final menstrual cycle. This module explores the potential of medical cannabis to alleviate disruptive symptoms associated with menopause, offering an alternative option for symptom management. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the physiology, symptomatology and effects of menopause Identify conventional interventions for symptoms of menopause and describe their potential strengths and drawbacks Discuss medical cannabis' mechanisms of action and therapeutic potential for treating symptoms of menopause Identify considerations and risks for selecting medical cannabis products to treat symptoms of menopause References ¹ Peacock, Kimberly, and Kari M. Ketvertis. “Menopause.” NIH, StatPearls Publishing, Jan. 2024, www.ncbi.nlm.nih.gov/books/NBK507826/. Accessed 26 June 2024.

Emotional fluctuations after childbirth are common and typically subside within two weeks.¹ However, when these symptoms persist and interfere with a person's ability to care for themselves or their infant, it may indicate postpartum depression (PPD).¹ Affecting an estimated 6-12% of Australian women², PPD is widespread, yet many hesitate to seek treatment due to concerns around privacy³, fear of judgement, and a lack of adequate support⁴. Even when treatment is sought, conventional options often fall short in fully addressing the symptoms. This module explores the potential role of medical cannabis in helping individuals with PPD, offering an alternative path toward symptom relief. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology, symptomatology and effects of PPD Identify conventional interventions for PPD and describe their potential strengths and drawbacks Discuss medical cannabis' mechanisms of action and therapeutic potential for treating symptoms of PPD (e.g. pain, low mood, anxiety and sleep problems) Identify considerations and risks for selecting medical cannabis products to treat PPD References ¹ Mughal, Saba, et al. “Postpartum Depression.” PubMed, StatPearls Publishing, Jan. 2023, www.ncbi.nlm.nih.gov/books/NBK519070. Accessed 17 June 2024. ² Ogbo, Felix Akpojene, et al. “Determinants of Antenatal Depression and Postnatal Depression in Australia.” BMC Psychiatry, vol. 18, no. 1, Feb. 2018, https://doi.org/10.1186/s12888-018-1598-x. Accessed 17 June 2024. ³ Brummelte, Susanne, and Liisa A. M. Galea. “Postpartum Depression: Etiology, Treatment and Consequences for Maternal Care.” Hormones and Behavior, vol. 77, Jan. 2016, pp. 153–66, https://doi.org/10.1016/j.yhbeh.2015.08.008. Accessed 17 June 2024. ⁴ Zauderer, Cheryl. “Postpartum Depression: How Childbirth Educators Can Help Break the Silence.” Journal of Perinatal Education, vol. 18, no. 2, Jan. 2009, pp. 23–31, https://doi.org/10.1624/105812409x426305. Accessed 17 June 2024.

Premenstrual dysphoric disorder (PMDD) is a complex and disabling condition¹ marked by cognitive, emotional, and physical symptoms in the lead-up to menstruation². Affecting an estimated 3-8% of menstruating individuals³, with 5-8% experiencing severe distress or significant impairment in daily activities⁴, PMDD remains a challenging condition to manage. Without a clear cause, current treatments focus on symptomatic control—targeting mood regulation or hormonal balance—though many patients find limited relief. This module explores the potential of medical cannabis as a therapeutic option for resistant PMDD symptoms, offering a non-hormonal alternative to traditional treatments that may carry reproductive side effects. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology, symptomatology and effects of PMDD Identify conventional interventions for PMDD and describe their potential strengths and drawbacks Discuss medical cannabis' mechanisms of action and therapeutic potential for treating symptoms of PMDD (e.g. pain, low mood, anxiety and sleep problems) Identify considerations and risks for selecting medical cannabis products to treat PMDD References ¹ Osborn, Elizabeth, et al. “Women’s Experiences of Receiving a Diagnosis of Premenstrual Dysphoric Disorder: A Qualitative Investigation.” BMC Women’s Health, vol. 20, no. 1, Oct. 2020, https://doi.org/10.1186/s12905-020-01100-8. Accessed 26 June 2024. ² Hantsoo, Liisa, and C. Neill Epperson. “Premenstrual Dysphoric Disorder: Epidemiology and Treatment.” Current Psychiatry Reports, vol. 17, 2015, https://doi.org/10.1007/s11920-015-0628-3. Accessed 26 June 2024. ³ Halbreich, Uriel, et al. “The Prevalence, Impairment, Impact, and Burden of Premenstrual Dysphoric Disorder (PMS/PMDD).” Psychoneuroendocrinology, vol. 28, no. 3, Aug. 2003, pp. 1–23, https://doi.org/10.1016/s0306-4530(03)00098-2. Accessed 26 June 2024. ⁴ Slavin, Melissa, et al. “Cannabis and Symptoms of PMS and PMDD.” Addiction Research & Theory, vol. 25, no. 5, Mar. 2017, pp. 383–89, https://doi.org/10.1080/16066359.2017.1294165. Accessed 26 June 2024.

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder¹ , affecting 12-21% of women of reproductive age.² Despite its widespread occurrence, only 30% of those with PCOS are diagnosed², often only when complications begin to severely impact their quality of life.³ This module explores the potential of medical cannabis as an adjunct treatment for PCOS, offering new hope for managing symptoms and improving patient outcomes. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology, symptomatology and effects of PCOS Identify conventional interventions for PCOS and describe their potential strengths and drawbacks Discuss medical cannabis' mechanisms of action and therapeutic potential for treating symptoms of PCOS (e.g. pain, low mood, anxiety and sleep problems) Identify considerations and risks for selecting medical cannabis products to treat PCOS References ¹ Amiri, Fatemeh Nasiri, et al. “The Experience of Women Affected by Polycystic Ovary Syndrome: A Qualitative Study from Iran.” International Journal of Endocrinology and Metabolism, vol. 12, no. 2, Apr. 2014, https://doi.org/10.5812/ijem.13612. Accessed 26 June 2024. ² Boyle, Jacqueline, and Helena J. Teede. “Polycystic Ovary Syndrome.” Australian Family Physician, vol. 41, no. 10, Oct. 2012, www.racgp.org.au/afp/2012/october/polycystic-ovary-syndrome. Accessed 26 June 2024. ³ Singh, Samradhi, et al. “Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics.” Journal of Clinical Medicine, vol. 12, no. 4, Feb. 2023, p. 1454, https://doi.org/10.3390/jcm12041454. Accessed 26 June 2024.

Endometriosis, a condition marked by the growth of endometrial tissue outside the uterus, causes severe and debilitating symptoms, making it the leading cause of chronic pelvic pain. Affecting 1 in 9 people assigned female at birth¹, endometriosis accounted for over 3,600 emergency department visits in 2021-2022 alone². Despite its prevalence, current treatment options are often invasive and carry significant health risks. This module explores the potential of medical cannabis as an alternative treatment for endometriosis, offering symptom relief with fewer side effects. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology, symptomatology and effects of endometriosis Identify conventional interventions for endometriosis and describe their potential strengths and drawbacks Discuss medical cannabis' mechanisms of action and therapeutic potential for treating symptoms of endometriosis (e.g. pain, low mood, anxiety, sleep problems and nausea) Identify considerations and risks for selecting medical cannabis products to treat endometriosis References ¹ Armour, M., Ciccia, D., Yazdani, A., Rombauts, L., Niekerk, L. V., Schubert, R., & Abbott, J. (2023). Endometriosis research priorities in Australia. Australian and New Zealand Journal of Obstetrics and Gynaecology ,  63 (4), 594-598. https://doi.org/https://doi.org/10.1111/ajo.13699  ² “Endometriosis, Emergency Department Presentations.” Australian Institute of Health and Welfare, 14 Dec. 2023, www.aihw.gov.au/reports/chronic-disease/endometriosis-in-australia/contents/treatment-management/ed-presentations. Accessed 26 June 2024.

Dysmenorrhoea, characterised by painful cramping in the lower abdomen or back during menstruation, affects 88% of menstruating Australians aged 16-291. Despite being the most common gynaecological condition in menstruating years, it is often inadequately treated, leaving many with diminished quality of life. This module examines the potential of medical cannabis as a therapeutic option for dysmenorrhoea, offering symptom relief with potentially fewer side effects than conventional treatments. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology, symptomatology and effects of primary dysmenorrhoea Identify conventional interventions for primary dysmenorrhoea and describe their potential strengths and drawbacks Discuss medical cannabis' mechanisms of action and therapeutic potential for treating symptoms of primary dysmenorrhoea (e.g. pain, low mood, anxiety, sleep problems, and nausea and vomiting) Identify considerations and risks for selecting medical cannabis products to treat primary dysmenorrhoea References ¹ Subasinghe, Asvini K., et al. “Prevalence and Severity of Dysmenorrhoea, and Management Options Reported by Young Australian Women.” Australian Family Physician, vol. 45, no. 11, Nov. 2016, pp. 829–34, pubmed.ncbi.nlm.nih.gov/27806454/. Accessed 26 June 2024.

Estimated to affect over a billion people globally, hepatitis is a major global health crisis. Characterised by inflammation of the liver, hepatitis is responsible for severe consequences including liver damage, failure and death.¹ But it is preventable and treatable. The World Health Organisation (WHO) and its member states (including Australia) have pledged to reduce hepatitis infections by 90% and hepatitis B and C related deaths by 65% by 2030 through vaccination, diagnostic testing, medication, and educational initiatives.¹‚² The use of medical cannabis in the treatment of hepatitis symptoms is a relatively new and evolving area of research, with findings that have sometimes been contradictory. While more research is needed to reach definitive conclusions, early evidence suggests that medical cannabis may have the potential to improve the quality of life for those living with hepatitis by addressing primary and secondary symptoms. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Describe the prevalence, pathogenesis, pathophysiology, symptoms and impacts of, and diagnostic methods for hepatitis and its subtypes Identify common hepatitis treatment interventions and explain their pharmacology Explain how medical cannabis treatment may benefit people with hepatitis Identify and explain potential risks and clinical considerations when recommending medical cannabis treatment for people with hepatitis References ¹ World Health Organisation. Hepatitis. www.who.int. Published 2024. Accessed August 30, 2024. https://www.who.int/health-topics/hepatitis/elimination-of-hepatitis-by-2030 ² Coalition for Global Hepatitis Elimination. About Hepatitis Elimination. CGHE. Accessed August 30, 2024. https://www.globalhep.org/about/about-hepatitis-elimination#:~:text=In%202016%2C%20the%20World%20Health

This module explores the growing interest in medical cannabis as a therapeutic option for managing autoimmune symptoms like pain and inflammation.  Autoimmune diseases occur when the immune system mistakenly attacks the body's own cells, leading to chronic conditions. Despite their prevalence, their causes remain unclear.  With some traditional treatments, such as NSAIDs and opioids, causing risks to health and wellbeing, emerging research suggests that medical cannabis may be a viable complement or alternative for managing pain and inflammation.  This module offers an overview of autoimmunity, explaining the theorised pathophysiology, symptoms, impacts, diagnostics, and conventional treatments for common presentations, and explores contemporary research findings explaining how medical cannabis may help to manage these symptoms and improve quality of life for people with autoimmune disease. Preview this module by watching the video above. Estimated Duration: 1.25 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Describe the immune system, its purpose, components and key actors Describe the purpose, functions and actors of the innate and adaptive systems Describe autoimmunity, including its causes and effects Explain how autoreactivity can cause autoimmune responses Identify causes, symptoms and impacts of common autoimmune diseases Describe common diagnostic methods for autoimmune disease Describe conventional treatments for autoimmune disease, and some side effects and drawbacks With reference to research, analyse how medical cannabis may assist in autoimmune disease symptom management

This microcredential offers healthcare professionals an in-depth look at how medical cannabis can be integrated into the management of chronic pain in complex patient cases. Through real-world scenarios, this microcredential highlights the therapeutic potential of cannabis while addressing concerns related to coexisting conditions, medication interactions, and patient quality of life. This microcredential includes: Clinical Case Study - ADHD Symptoms and Chronic Pain: Explore how medical cannabis helped Hayley, a 37-year-old patient with combined-type ADHD and chronic pain, manage her attention, anxiety, sleep, and physical discomfort. Clinical Case Study - Chronic Pain & Hepatic Dysfunction: Follow Stephen, a 56-year-old with hepatic fibrosis, as his healthcare team safely incorporated medical cannabis into his treatment plan for chronic back pain and gout, restoring his active lifestyle. Clinical Case Study - Chronic Pain, Insomnia & Cardiac Issues: Delve into Jen’s case, a 60-year-old with complex regional pain syndrome and stable cardiovascular disease, who found relief from chronic pain and insomnia through carefully managed medical cannabis treatment. Clinical Case Study - MS-Associated Chronic Pain and Spasticity: Examine how Johanna, a 39-year-old with multiple sclerosis, addressed her neuropathic pain and spasticity using an affordable, well-balanced cannabis treatment plan, overcoming challenges related to her other medications and financial constraints. This microcredential is designed to enhance practitioners’ understanding of medical cannabis' role in improving patient outcomes in chronic pain management, even in complex clinical scenarios. Preview this module by watching the video above. Estimated Duration: 4 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Demonstrate an understanding of the role of medical cannabis in managing chronic pain in patients with coexisting conditions like ADHD, hepatic dysfunction, cardiac issues, and multiple sclerosis. Evaluate real-world case studies to assess cannabis' therapeutic potential for symptom management. Apply critical safety considerations and risk mitigation strategies for patients with hepatic and cardiac concerns. Discuss potential drug-drug interactions and the safe use of medical cannabis in complex patient cases. Facilitate patient-centered discussions around medical cannabis for chronic pain, addressing sleep and psychological symptoms. Devise tailored cannabis treatment plans that consider patient safety, minimise risk, and enhance quality of life in complex cases.

This microcredential offers healthcare professionals a comprehensive overview of medical cannabis, its pharmacological properties, and treatment options. Through a series of focussed modules, learners will gain a deep understanding of how cannabis interacts with the endocannabinoid system and its therapeutic potential.Modules Include: The Endocannabinoid System and Medical Cannabis – An Introduction Explore the foundational science behind medical cannabis and its interaction with the human body's endocannabinoid system. Understand key mechanisms of action that make cannabis a unique treatment option. Medical Cannabis Taxonomy, Genetics, Strains, and Compounds Delve into the biological diversity of cannabis. Learn about the taxonomy, genetics, and various strains, and examine the wide range of cannabinoids and terpenes that influence its therapeutic effects. Introduction to Medical Cannabis Products Gain an essential overview of medical cannabis products, covering their categorisation, administration methods, and key components like THC and CBD, including factors influencing the safety and efficacy of medical cannabis products, such as speed of onset, bioavailability, and duration of effects. Preview this module by watching the video above. Estimated Duration: 3 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this microcredential, you’ll be able to: Describe the discoveries that shaped today's understanding of the endocannabinoid system (ECS) Explain the functions of the ECS, its main components, and how they interact Discuss the function and benefits of retrograde cell signalling Outline the roles and functions of cannabinoid receptors CB1 and CB2, and vanilloid receptor TRPV1 Identify ECS ligands and non-ligand mediators and describe their role in ECS function Define endocannabinoid tone and its influencing factors Discuss clinical considerations related to the ECS Identify cannabis' taxonomic status Identify and discuss key components of strains and chemovars Identify key compounds in medical cannabis and explain their potential interactions and effects within the body Describe the factors that impact medical cannabis' effects within the body Explain how practitioners may adjust medical cannabis treatment to account for clinical and individual factors, risks and contraindications Define endogenous and exogenous cannabinoids Describe the properties of THC and CBD, including their potential therapeutic and medicinal effects Describe different medical cannabis product categorisations Identify, for different administration methods, speed of onset, bioavailability and duration of effects Explain considerations when selecting medical cannabis products to improve safety and efficacy for patients

Designed for pharmacists, this course delves into a range of conditions that are uniquely prevalent among people assigned female at birth and intersex individuals with female reproductive organs. These conditions often go under-recognised and can profoundly affect health and quality of life. Conventional treatments sometimes fail to fully address these issues and can carry significant risks. With medical cannabis emerging as a promising alternative, this course offers evidence-based insights into its potential for managing symptoms of: Endometriosis Dysmenorrhoea Polycystic Ovary Syndrome (PCOS) Premenstrual Dysphoric Disorder (PMDD) Postpartum Depression (PPD) Breast, ovarian, and uterine cancers Perimenopause and menopause Additionally, it covers critical pregnancy-related contraindications for medical cannabis. Healthcare professionals will gain crucial knowledge and skills to expand their therapeutic toolkit, integrating both traditional and cannabis-based approaches to enhance patient outcomes. This is an opportunity to stay at the forefront of medical advancements and provide innovative care options for your patients. Preview this course by watching the video above. Estimated Duration: 4 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Assess when and how medical cannabis may improve treatment outcomes for IAFABP Make informed recommendations to patients and their doctors around medical cannabis as a treatment option Deliver exceptional patient-centred care by understanding your patients' experiences and exploring their options, you will be equipped to offer compassionate, professional and attentive care when your patients ask questions or come to dispense their medications

Designed for nurses, this course delves into a range of conditions that are uniquely prevalent among people assigned female at birth and intersex individuals with female reproductive organs. These conditions often go under-recognised and can profoundly affect health and quality of life. Conventional treatments sometimes fail to fully address these issues and can carry significant risks. With medical cannabis emerging as a promising alternative, this course offers evidence-based insights into its potential for managing symptoms of: Endometriosis Dysmenorrhoea Polycystic Ovary Syndrome (PCOS) Premenstrual Dysphoric Disorder (PMDD) Postpartum Depression (PPD) Breast, ovarian, and uterine cancers Perimenopause and menopause Additionally, it covers critical pregnancy-related contraindications for medical cannabis. Healthcare professionals will gain crucial knowledge and skills to expand their therapeutic toolkit, integrating both traditional and cannabis-based approaches to enhance patient outcomes. This is an opportunity to stay at the forefront of medical advancements and provide innovative care options for your patients. Preview this course by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Assess medical cannabis’ therapeutic potential for treating symptoms of dysmenorrhoea, endometriosis, PCOS, PMDD, PPD, menopause, and breast, ovarian and uterine cancers considering its pharmacological interaction with the condition’s pathophysiology and efficacy, and drawbacks of current recommended treatments Identify characteristics of suitable medical cannabis strains, compounds, product types and administration methods for treating symptoms of the particular condition affecting IAFABP Identify and explain pregnancy-related contraindications for using medical cannabis

Designed for doctors, this course explores a range of health conditions that disproportionately affect people assigned female at birth and intersex individuals with female reproductive organs—many of which are historically under-recognised and undertreated. These conditions can significantly impact physical, mental, and reproductive health, often requiring nuanced, multidisciplinary approaches. With medical cannabis emerging as a potential adjunct for symptom management, this course provides evidence-based insights into its role across conditions including: Endometriosis Dysmenorrhoea Polycystic Ovary Syndrome (PCOS) Premenstrual Dysphoric Disorder (PMDD) Postpartum Depression (PPD) Breast, ovarian, and uterine cancers Perimenopause and menopause The course also addresses key safety considerations, including contraindications during pregnancy and lactation. Clinicians will leave with a deeper understanding of how to safely integrate medical cannabis into patient-centred care plans alongside conventional therapies. Preview this course by watching the video above. Estimated Duration: 5.5 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Describe and explain the causes, symptoms, effects, and risk factors for various reproductive health conditions, including perimenopause, menopause, breast, ovarian, and uterine cancers, dysmenorrhoea, endometriosis, polycystic ovarian syndrome (PCOS), premenstrual dysphoric disorder (PMDD), and postpartum depression (PPD) Identify and evaluate common conventional treatment options for these conditions and their potential drawbacks Discuss the therapeutic potential of medical cannabis for treating symptoms of these reproductive health conditions Identify considerations for selecting suitable medical cannabis products for treating symptoms related to these conditions Identify TGA guidelines on contraindications for medical cannabis use during pregnancy and chest-feeding Discuss potential short and long-term risks of early cannabis exposure Explain the role of the endocannabinoid system in reproductive function Describe the risks of cannabis use during pregnancy, planning to become pregnant, and postnatal phases for both the foetus or infant and the birth-giver

This course is an intermediate-level exploration of how to tailor medical cannabis dispensing for patients by considering their prior exposure to cannabis (medical or otherwise). With a focus on identifying patients' exposure levels, pharmacists will learn to account for patients’ prior cannabis exposure when dispensing medical cannabis products to patients. Over the course of 7 modules, discover cannabis’ interactions with the body, as well as the key identifiers, considerations and recommendations for safely dispensing medical cannabis products to patients. Examine the biological composition of cannabis and its pharmacological interactions with the body, gaining insight into how prior exposure affects tolerance and experience. This course forms part of a comprehensive learning path covering factors to consider when offering medical cannabis care and treatment. Preview this course by watching the video above. Estimated Duration: 3.5 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Identify cannabis’ biological constituents and explain their effects on the body Explain how the endocannabinoid system (ECS) maintains homeostasis and describe cannabis’ interactions with the ECS, including how exposure affects endocannabinoid tone Identify the 2 dimensions of prior cannabis exposure, and explain how to identify them in patients Explain how prior exposure may impact treatment goals and discuss considerations and recommendations for setting personalised treatment goals based on prior exposure Identify and describe common medical cannabis products and explain the considerations and recommendations for product selection based on prior cannabis exposure Discuss general recommendations for dosage and titration based on patient’s prior cannabis exposure

This course is an intermediate-level exploration of how to tailor medical cannabis treatment for patients by considering their prior exposure to cannabis (medical or otherwise). With a focus on identifying patients' exposure levels, nurses and nurse practitioners will learn to account for patients’ prior cannabis exposure when offering care during medical cannabis treatment. Over the course of 7 modules, discover cannabis’ interactions with the body, as well as the key identifiers, considerations and recommendations for offering safe and effective treatment. Examine the biological composition of cannabis and its pharmacological interactions with the body, gaining insight into how prior exposure affects tolerance and experience. This course forms part of a comprehensive learning path covering factors to consider when offering medical cannabis care and treatment. Preview this course by watching the video above. Estimated Duration: 6 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Identify cannabis’ biological constituents and explain their effects on the body Explain how the endocannabinoid system (ECS) maintains homeostasis and describe cannabis’ interactions with the ECS, including how exposure affects endocannabinoid tone Identify the 2 dimensions of prior cannabis exposure, and explain how to identify them in patients Explain how prior exposure may impact treatment goals and discuss considerations and recommendations for setting personalised treatment goals based on prior exposure Identify and describe common medical cannabis products and explain the considerations and recommendations for product selection based on prior cannabis exposure Discuss general recommendations for dosage and titration based on patient’s prior cannabis exposure

This course is an intermediate-level exploration of how to tailor medical cannabis treatment for patients by considering their prior exposure to cannabis (medical or otherwise). With a focus on identifying patients' exposure levels, doctors will learn to customise care and treatment to safely and effectively unlock the therapeutic benefits of medical cannabis. Over the course of 7 modules, discover cannabis’ interactions with the body, as well as the key identifiers, considerations and recommendations for offering safe and effective treatment. Examine the biological composition of cannabis and its pharmacological interactions with the body, gaining insight into how prior exposure affects tolerance and experience. This course forms part of a comprehensive learning path covering factors to consider when offering medical cannabis care and treatment. Preview this course by watching the video above. Estimated Duration: 6 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Identify cannabis’ biological constituents and explain their effects on the body Explain how the endocannabinoid system (ECS) maintains homeostasis and describe cannabis’ interactions with the ECS, including how exposure affects endocannabinoid tone Identify the 2 dimensions of prior cannabis exposure, and explain how to identify them in patients Explain how prior exposure may impact treatment goals and discuss considerations and recommendations for setting personalised treatment goals based on prior exposure Identify and describe common medical cannabis products and explain the considerations and recommendations for product selection based on prior cannabis exposure Discuss general recommendations for dosage and titration based on patient’s prior cannabis exposure

This course is designed to equip pharmacist professionals with the knowledge and skills necessary to navigate Australia's evolving medical cannabis landscape. Designed for pharmacists, this course will help you gain essential knowledge for safely and effectively handling medical cannabis. Develop a practical understanding of the endocannabinoid system, crucial for dispensing, monitoring, and adjusting cannabinoid medications within Australia's regulations. Understand your distinct role as a pharmacist in patient care, and learn to lead discussions with your patients for their best health outcomes. Join a cohort of passionate pharmacists in Australia who have chosen to broaden their skills in medical cannabis prescribing. With this course, you can be part of improving treatment options for patients suffering from chronic conditions Australia wide.  Preview this course by watching the video above. Estimated Duration: 8 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Discuss the individual components of the cannabis plant Describe cannabis medicine options accurately Explain how the endocannabinoid system functions Assess the suitability of cannabis treatment for various chronic disease states Identify appropriate and inappropriate patient cohorts for medical cannabis treatment Discuss with patients about medical cannabis as a therapeutic option for symptom management Describe how to initiate, monitor and titrate cannabinoid medicines Apply critical safety considerations in patient-centred care Describe the role and responsibilities of pharmacists in relation to medical cannabis therapy Explain how pharmacists can educate patients on safe and effective use of medical cannabis Discuss how to collaborate with other healthcare providers to monitor patient outcomes and adjust treatment plans Describe requirements for storing medical cannabis Discuss quality control measures for medical cannabis products Explain the Australian regulatory frameworks surrounding medical cannabis provision Claim 17 CPD credits for eligible participants.

This course is designed to equip nursing professionals with the knowledge and skills necessary to navigate Australia's evolving medical cannabis landscape. DEVELOPER'S NOTE: As nurses, we understand the growing importance of holistic care and the role medical cannabis can have in managing a multitude of conditions. Join us in this meticulously crafted course to explore the history and botany of cannabis, understand the role of the endocannabinoid system and homeostasis. Learn how to navigate TGA processes, monitor and manage potential adverse side effects and other important aspects of cannabis treatment and patient care. This course is created and endorsed by nurses who believe in the potential of medical cannabis as a vital component of integrative, modern healthcare. Preview this course by watching the video above. Estimated Duration: 5 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Describe cannabis medicines accurately and demonstrate an understanding of the individual chemical components of the plant. Demonstrate an understanding of endocannabinoid system function. Assess the suitability of cannabis treatments in various chronic disease states. Identify appropriate patient cohorts for medical cannabis treatment. Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in symptom management. Monitor and provide titration advice around cannabinoid medicines.  Apply critical safety considerations in patient centred care. Navigate the regulatory frameworks surrounding medical cannabis provision in Australia.  Claim 5 CPD hours for eligible participants.

This accredited course provides doctors with a comprehensive introduction to the clinical and regulatory foundations of medical cannabis prescribing in Australia. As patient interest in cannabinoid-based therapies increases, it is essential for prescribers to be equipped with evidence-informed knowledge and practical skills to navigate this evolving space safely and effectively. Through this program, participants will explore the endocannabinoid system and its relevance to human physiology, examine the pharmacology of key cannabis constituents, and gain practical insight into initiating, monitoring, and titrating medical cannabis products. The course also addresses the Australian regulatory landscape and offers guidance on assessing patient suitability, facilitating informed discussions, and applying critical safety considerations in clinical practice. Designed to support evidence-based decision-making, this course empowers doctors to responsibly consider medical cannabis as part of a broader, patient-centred approach to managing chronic symptoms and conditions. Preview this course by watching the video above. Estimated Duration: 5 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Describe cannabis medicines accurately and demonstrate an understanding of the individual chemical components of the plant. Demonstrate an understanding of endocannabinoid system function. Assess the suitability of cannabis treatments in various chronic disease states. Identify appropriate patient cohorts for medical cannabis treatment. Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in symptom management. Initiate, monitor and titrate cannabinoid medicines.  Apply critical safety considerations in patient-centred care. Navigate the regulatory frameworks surrounding medical cannabis provision in Australia. 

A Closer Look at Medical Cannabis & Chronic Pain An evidence-based webinar exploring the role medical cannabis could play in the treatment of chronic pain. Date: Tuesday 30th September  |  Time: 7–8pm (AEST)  |  Format: Online (Zoom) Hosted by SAGED & Dr Joel Wren, GP Have you experienced challenges in managing patients with chronic pain? This webinar aims to provide you with evidence, case studies, and practical tools you can use right away. SAGED invites you to attend a free, RACGP- and ACRRM-accredited webinar, designed for Australian GPs interested in the evolving role of medical cannabis in chronic non-cancer pain (CNCP). Led by Dr Joel Wren, a GP with experience in prescribing medical cannabis, this 60-minute session will cover: Current evidence on medical cannabis in chronic non-cancer pain management Clinical insights on medical cannabis and neuropathic pain Practical case studies, dosing, and product selection Don’t miss your chance to hear from one of Australia’s leading medical cannabis practitioners on chronic pain. Designed for Australian GPs, this session aims to support safe, evidence-based prescribing in general practice. Learning Outcomes By attending this webinar, you will be able to: Identify when and why medical cannabis may be appropriate in CNCP management Understand the current evidence base supporting the use of medical cannabis in CNCP, with a focus on neuropathic pain Apply clinical insights to case examples, including product selection, dosing, and safety considerations