Australia's healthcare watchdog has issued new guidelines for medicinal cannabis after cases of patients in emergency departments with induced psychosis, consults lasting less than a minute and doctors issuing more than 10,000 scripts in a six-month window.

The Australian Health Practitioner Regulation Agency (AHPRA) is responding to evidence of poor practices, including over-serving and ethical grey areas, which have raised concerns that practitioners were putting profits ahead of patient care.

APHRA found some practitioners had issued prescriptions just because a patient asked, provided multiple prescriptions for a single patient so they could find one that suited them and failed to assess mental health.

In some cases, practitioners prescribed medicinal cannabis to people under 18 after not checking their identity. 

AHPRA said the current prescribing data raised red flags that practitioners were not meeting their professional obligations, including eight who issued more than 10,000 scripts in six months and one who issued more than 17,000 scripts in that time.

"We will investigate practitioners with high rates of prescribing any scheduled medicine, including medicinal cannabis, even if we have not received a complaint," AHPRA chief executive Justin Untersteiner said.

Untersteiner also warned of inherent conflicts of interest for practitioners working at businesses and dispensaries that only prescribe medicinal cannabis.

"Some business models that have emerged in this area rely on prescribing a single product or class of drug and use online questionnaires that coach patients to say 'the right thing' to justify prescribing medicinal cannabis," he said.

"This raises the very real concern that some practitioners may be putting profits over patient welfare."

Australia legalised cannabis for medicinal use in 2016 through a special access scheme, which allows doctors and qualified nurse practitioners to prescribe the drug.

According to data from the Therapeutic Goods Administration (TGA), there are about 3270 practitioners approved under the scheme who have issued a combined 72,300 prescriptions since 2016.

APHRA published the new guidelines today to clarify that medicinal cannabis is never a first line of treatment. 

Under the guidelines, practitioners must only prescribe to patients once they have conducted a thorough assessment, identified a therapeutic need, created and implemented a management plan, maintained medical records, facilitated continued care and developed an exit strategy.

The national boards have raised similar concerns and are working alongside AHPRA, the TGA and state and territory authorities to understand the patterns of prescriptions and stay ahead of any concerning trends.

"We don't prescribe opioids to every patient who asks for them, and medicinal cannabis is no different," Medical Board of Australia Chair Dr Susan O'Dwyer said.

"Patient demand is no indicator of clinical need."

"Nurses and other registered practitioners must provide holistic care in all areas of their practice," Nursing and Midwifery Board of Australia Chair Veronica Casey said.

"They must take their professional responsibilities with them no matter where they work."

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