Project Overview:

Requests to Veterans’ Affairs Pharmaceutical Advisory Centre (VAPAC) for funding of cannabinoids for medicinal purposes over the last few years have rapidly increased with approximately 95% of prescriptions for the treatment of chronic pain.

Current clinical guidance documents for Australian prescribers of cannabinoids are becoming dated given the rapid expansion of research and academic interest in cannabinoids as a treatment option; further, there are no domestic or international clinical guidelines available to support prescribers who wish to treat veterans with cannabinoids for chronic non-cancer pain (CNCP). There is an urgent need for clinical resources to be made available that guide veteran healthcare providers in the therapeutic use of cannabinoids to ensure veterans with CNCP receive treatment that aligns with the right care for their overall health needs.

We will identify and synthesise the best available scientific evidence and guidance material on the initiation, monitoring and deprescribing of cannabinoid products when treating veterans with CNCP. We will examine the evidence base for delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in particular, alone or in combination, for CNCP for which cannabinoids have been advocated and/or commonly prescribed with a focus on assessments in either randomised controlled trials or observational studies. In collaboration with a Guideline Development Group, we will develop clinical guidelines and client education materials.

Project Collaborators External:

• Dr Gabrielle Campbell, The University of Queensland
• Professor Suzanne Nielsen, Monash University
• Professor Wayne Hall, The University of Queensland
• Professor Jennifer Martin, University of Newcastle
• Dr James Manley, prescribing clinician
• Professor Robert Ali AO, The University of Adelaide
• Ainslie Cahill AM, Chair of NHMRC Consumer and Community Advisory Committee
• Professor Nicola Fear, King's College London
• Dr Ian Gardner, Former Chief Health Officer for the Department of Veterans’ Affairs
• Professor Bridin Murnion, Pain Management and Research Institute
• Lara Shallard, community representative
• Dr Hester Wilson, NSW Ministry of Health

Design and methods:

This project will follow a staged approach, including a review of evidence on the medical use of cannabis and existing guidelines, consultation with a multidisciplinary Guideline Development Group, and the development of clinical guidelines and client education materials.

1. Systematic review of peer-reviewed published literature: This review will build on previous reviews we conducted on the therapeutic use of cannabinoids for CNCP commissioned by the TGA. We will incorporate new evidence since the previous reviews were conducted.
2. Search and review of existing guidelines: A search for existing clinical guidelines will draw on those relating to the initiation, monitoring and deprescribing of cannabinoids for the therapeutic treatment of chronic pain. As with the systematic review, the search will capture guidelines for the general population as well as veteran-specific guidelines, where available.
3. Development of clinical guidelines: Clinical guidelines on the therapeutic use of cannabinoids for chronic pain will be developed using a modified approach based on the NHMRC 2016 Standards for Guidelines. A formal consultation process will be conducted throughout clinical guideline development to ensure the guidelines address priority concerns and are fit for purpose. A multidisciplinary Guideline Development Group will be formed to guide development. It will include clinical experts and community representatives in chronic pain, veteran health, and the therapeutic use of cannabinoids, alongside researchers and public health policy experts.
4. Development of client education material: Client education product/s will be drafted, reviewed and further developed in consultation with the Guideline Development Group. In this phase of the work we have partnered with INHSU, an NGO that is focused upon the development of clinical education and client guidance materials to assist healthcare providers and veterans in the initiation and monitoring of medicinal cannabinoids for chronic pain. INHSU has longstanding experience in translating complex clinical guidelines into accessible, evidence-informed tools.

Benefits:

This project will address a critical gap in current clinical practice by providing up-to-date, actionable guidance tailored to the unique health needs of veterans. By synthesising the best available evidence and incorporating expert and consumer input, the guidelines will support informed, consistent, and safe prescribing practices. Additionally, the creation of accessible educational resources will empower both healthcare providers and veterans and improve treatment outcomes.

Funding support:

• Department of Veterans’ Affairs