Medicinal cannabis has gone mainstream. But Australia’s struggling to cope

Medicinal cannabis has become a routine part of health care in Australia far more quickly than many expected.

What began in 2016 as a tightly controlled pathway for patients with complex conditions that had 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 health system was not designed for this demand, nor for the shift in prescribing practices. So many of the safeguards in place for other medicines don’t exist for medicinal cannabis.

Now, Australia’s medicines regulator is deciding how best to update medicinal cannabis prescribing and regulation to make it safer.

Its yet-to-be released review is focusing on “unapproved” medicinal cannabis products, ones that are legal but that it hasn’t assessed to make sure are safe, of good quality and actually work.

The rise and rise of medicinal cannabis

Prescribing of medicinal cannabis rose sharply from 2019. By the end of 2025, publicly available Therapeutic Goods Administration (TGA) data I analysed shows close to one million approvals for medicinal cannabis in Australia.

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

Doctors told us as far back as 2018 (in research published in 2021) of their concerns about medicinal cannabis prescribing. They described how the rollout had occurred before the system was fully prepared.

At the time, they raised the potential for fragmented care (patients seeking health care from multiple professionals, not all aware of what the others were prescribing), limited guidance for prescribers, and the absence of routine mechanisms to monitor benefit and harm.

These concerns have persisted as the market has grown, and changed.

From oils to flower, and telehealth

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

Herbal products – such as dried flowers you smoke and inhale – are increasingly prescribed at higher rates than oral oils containing cannabis extract. This shift from oils to herbal products matters.

Inhaled cannabis is absorbed rapidly through the lungs, with effects felt within minutes, making it one of the fastest ways cannabis acts in the body. But oils are absorbed more slowly through the gut, have delayed onset, and can take hours to reach peak effect.

But this shift towards inhaled cannabis (with its rapid onset) challenges the conventional way medicines are prescribed. This would be to start off with a low dose, then monitor the effects (known as the “start low and go slow” approach).