Patient Profiles

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