Medicinal cannabis has gone mainstream. But Australia is struggling to cope

Medicinal cannabis is becoming a routine part of health care in Australia faster than many expect.

What began in 2016 as a tightly controlled approach for patients with complex conditions that have not responded to other treatments has grown into a large, mainstream prescribing market. Today, medicinal cannabis is increasingly delivered through telehealth and online platforms.

But our healthcare system was not designed for this demand, nor for changes in prescribing practice. So many of the protections for other drugs are not available for medicinal cannabis.

Now, Australia’s drug regulator is deciding how to update the prescription and regulation of medicinal cannabis to make it safer.

Its yet-to-be-published review focuses on “unapproved” medicinal cannabis products, those that are legal but haven’t been evaluated to make sure they’re safe, of good quality and actually work.

Growth and development of medicinal cannabis

The prescription of medicinal cannabis has grown rapidly since 2019. By the end of 2025, the publicly available Therapeutic Goods Administration (TGA) data I analyzed shows almost one million approvals for medicinal cannabis in Australia.

However, the systems needed to monitor safety, efficacy and long-term outcomes have lagged behind this rapid growth.

Doctors told us about their concerns about the prescription of medicinal cannabis by 2018 (in a study published in 2021). They explained how the rollout was made before the system was fully ready.

At the time, they raised the possibility of fragmented care (patients seeking health care from multiple professionals, not all knowing what others are recommending), limited guidelines for prescribing, and a lack of routine mechanisms to monitor benefit and harm.

These concerns persist as the market has grown, and changed.

From oil to flower, and telehealth

Over time, the publicly available TGA data I analyzed shows a shift in the type of medicinal cannabis prescribed.

Herbal products—like dried flowers that you smoke and inhale—are increasingly being offered at higher prices than healing oils that contain cannabis extract. It converts from oil to herbal products.

Inhaled cannabis is rapidly absorbed through the lungs, with effects felt within minutes, making it one of the fastest ways cannabis works in the body. But fat is absorbed more slowly through the gut, has a delayed onset, and can take several hours to reach its peak effect.

But this shift toward inhaled cannabis (with its rapid onset) is challenging traditional medicine. This will start with a low dose, then monitor the effects (known as the “start low and go slow” approach).

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Prescriptions for medicinal cannabis have skyrocketed in Australia, mostly for legal but unapproved products that we don’t even know work or are safe. In this series, experts reveal what makes medicinal cannabis grow, the result and what it needs.

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Approvals for THC (tetrahydrocannabinol)-dominant products are also on the rise, according to publicly available TGA data I analyzed.

THC is psychoactive and can cause side effects such as impaired cognition, anxiety and, in some people, psychosis.

When medications, including low-psychoactive cannabidiol (CBD) products, are prescribed by someone other than a person’s regular physician, it is often unclear who is responsible for monitoring any harm.

There has also been an increase in product-specific telehealth consultations to prescribe medicinal cannabis. With this, there is often limited contact with the patient’s regular physician.

This is an issue because many patients prescribed marijuana are also taking antidepressants, sedatives, opioids, or other medications with many side effects.

Products containing THC can cause drowsiness, dizziness, and cognitive impairment. Both THC and CBD can interact with other drugs, altering blood levels and increasing the risk of harm.

So we end up with a system in which prescription often happens in one place, while oversight happens somewhere else, or rather nowhere.

Limited evidence, social media fills the gap

Many others have written about the limited and strong evidence for whether medicinal cannabis works for a range of conditions, including anxiety, pain and sleep. Based on the evidence so far, it is unlikely to reduce your anxiety, pain or help you sleep.

Reviews show similar evidence for a wide range of mental health conditions and for substance use disorders.

This is one of the many reasons Australia offers medicinal cannabis.

This means that health professionals often prescribe medicinal cannabis in the absence of clear criteria for benefit, harm or treatment.

So patients are increasingly turning to social media, online forums, and Internet searches to share experiences, compare products, discuss dosing strategies, and explain side effects.

While shared experience can be valuable, it is a poor substitute for medical supervision, especially for patients using multiple medications or using cannabis inhalation products where dose, timing and drug interactions are important.

What else is needed?

The federal government has announced reforms that require medications prescribed online or via telehealth for any clinical condition to appear in my health record.

This means patients and doctors will have a complete picture of someone’s medication, including medicinal cannabis. This is especially the case if they are offered in different settings.

But just looking isn’t enough to prevent the safety issues I’ve highlighted.

We need to look at how medicinal cannabis is promoted and prescribed, how it is used in mental health care and by young people, how safety risks are managed, and whether current regulatory arrangements are fit for purpose.

We need to move to nationwide oversight and monitoring of the prescription of medicinal cannabis. This may include analyzing secure, de-identified data from electronic medical records, linked to care settings, providing real-world evidence needed to support safe prescribing, detecting emerging harms, and informing policy.

If we had it, we could answer:

• Who uses medicinal cannabis, and for what conditions?

• Which health professional initiates treatment, and how?

• What benefits do patients have?

• What adverse effects, interactions and long-term damage can occur?

Medicinal cannabis is now part of routine health care, and it should be monitored with the same level of scrutiny expected of any other widely used drug.