Review and monitoring | Medicinal Cannabis NZ Guide

The medicinal cannabis prescription does not end when the product is dispensed. Under the Medicinal Cannabis Scheme, which operates under the Misuse of Drugs Act, a prescription is the beginning of an ongoing clinical conversation. The Ministry of Health’s Medicinal Cannabis Agency (MCA), part of Medsafe, sets the rules for products and licensing, but the duty to review and monitor sits with the prescribing clinician (New Zealand Ministry of Health, 2023). This page gives you a usable method for that conversation: what to track, how often to track it, and how to turn observations into a clear decision. It does not tell you what to take or how much; that decision belongs to your prescriber or pharmacist.

Why review and monitoring matter

Medicinal cannabis is not a one-time prescription. The active compounds, THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol), affect people differently, and the right product and dose are found by titration, not by a single calculation. The New Zealand Medicinal Cannabis Scheme, run by the Ministry of Health and administered by Medsafe’s Medicinal Cannabis Agency, sets quality standards but does not dictate how a patient should be monitored (New Zealand Ministry of Health, 2020). The NZ Formulary and peer-reviewed clinical guidance consistently recommend a structured review, usually 2-4 weeks after starting and then at agreed intervals, to check whether the treatment is doing what the patient wants, whether it is causing harm, and whether the dose should be adjusted.

The review conversation is not a formality. It is the moment where the prescriber checks the three things that determine whether to continue: benefit, function, and adverse effects. This page gives you a method to track those three things between appointments, so the conversation is useful instead of vague.

What “review and monitoring” means in New Zealand’s scheme

Under the Misuse of Drugs Act 1975, medicinal cannabis is a controlled medicine, not a general licence to use cannabis. The Medicinal Cannabis Scheme, administered by the Ministry of Health and Medsafe, sets the legal pathway: a medical practitioner must issue a prescription, and the product must meet GMP standards and be approved by the Ministry of Health. The scheme does not legalise raw plant material for personal use; the only legal route is a prescription for a manufactured pharmaceutical product dispensed through a pharmacy (New Zealand Ministry of Health, 2023).

Review and monitoring is the structured conversation between the patient and their prescriber after a prescription begins. It is not a one-off check; it is a repeatable process that tracks three things: benefit, function and adverse effects. The NZ Formulary (2024) describes cannabis products as unapproved medicines, which means prescribers must take responsibility for the decision to prescribe, document the clinical rationale, and review the patient at appropriate intervals. Medsafe, through the Medicinal Cannabis Agency, licenses products and sets quality standards under the Medicinal Cannabis Scheme (New Zealand Ministry of Health, 2020).

The care conversation is the clinical part of that pathway. It happens between the patient, the prescriber, and the pharmacist. The page gives you a usable method, checklist and decision rule for that conversation. It does not diagnose, prescribe, or promise access.

What review and monitoring actually means under the Medicinal Cannabis Scheme

Under the Misuse of Drugs Act 1975 and the Medicinal Cannabis Scheme (Medsafe, 2020), medicinal cannabis is a regulated pharmaceutical pathway. It is not a general licence to use cannabis. The scheme legalises access via a prescription from a medical practitioner, and the products must meet Good Manufacturing Practice (GMP) standards and be approved by the Ministry of Health. The thing newcomers most often get wrong is that “legal medicinal cannabis” does not mean a patient can legally smoke raw plant material or buy unregulated products. The legal product is a manufactured pharmaceutical; raw flower is available only through a prescription and dispensed by a pharmacy, never a dispensary. Within that legal frame, review and monitoring is the clinical conversation that checks whether the treatment is working, whether it is safe, and what to do next. This page gives you a practical method for that conversation.

What “review and monitoring” means under the Medicinal Cannabis Scheme

Under the Misuse of Drugs Act and the Medicinal Cannabis Scheme, a prescription is not a one-off event. New Zealand law requires that the prescribing doctor maintain an ongoing clinical relationship with the patient. The Ministry of Health’s Medicinal Cannabis Scheme (established 2020) sets product standards, but the ongoing review is a clinical duty, not a regulatory one. The NZ Formulary and the Medicinal Cannabis Agency (MCA) expect the prescriber to document the indication, the product, the dose, and the response at each review. There is no legal requirement for a fixed review interval, but the standard of care is to schedule a follow-up before the next prescription is issued. This page gives you the conversation, the checklist, and the decision rule to make that review useful.

What a review actually checks

A review is not a repeat of the first consult. It is a structured comparison between how the patient functioned before starting medicinal cannabis and how they function now. The clinician should ask three questions, in order:

Benefit: Is the target symptom improved enough to justify continuing?
Function: Is the patient doing more of what they need or want to do?
Adverse effects: Are side effects tolerable, manageable, or a reason to stop?

The conversation should be anchored to the patient’s original goal. If the goal was pain relief, the question is not “do you feel better?” but “what can you now do that you could not do before?” A patient may report no change in pain score but improved sleep, mood or mobility. That is still a benefit worth recording.

A practical review session follows a simple structure:

Set the agenda: “We have 15 minutes. I want to cover how you’re sleeping, your pain or symptoms, any side effects, and whether the current dose is still working.”
Ask about function, not just symptoms: work, driving, appetite, mood, sleep, and daily activities.
Ask about adverse effects: drowsiness, dizziness, gastrointestinal upset, dry mouth, changes in appetite or mood.
Review the actual product: what the patient is using, how much, how often, and how they administer it (oil, flower, capsule, vaporiser).
Check for interactions with other medicines, alcohol or other substances.
Agree on the next step: continue, adjust dose, change product, or stop.

This is the six-step conversation framework for a review appointment. It is not a checklist for the patient to self-manage; it is a prompt for a structured clinical conversation. The framework is based on general clinical monitoring principles described in the NZ Formulary and the Medicinal Cannabis Scheme guidance (2023).

A practical rule for deciding when to review: at 2-4 weeks after starting or changing a dose, then at 3 months, then every 3-6 months if stable. If symptoms have not improved by week 4, or adverse effects are unacceptable, the prescriber should adjust the dose or product. This is a pragmatic guide, not a legal rule; the prescriber sets the actual schedule.

A practical rule for what to measure: a simple 0-10 scale for the primary symptom (pain, anxiety, spasticity, nausea, sleep) plus a functional question (“How many bad days in the last week?”) and an adverse-effect check. Ask the patient to keep a daily diary for the first two weeks of a new prescription. The diary should record: dose (mg and product), time of day, symptom score (0-10), side effects, and any other medicines taken. Bring the diary to the first review, usually at 2-4 weeks.

A practical rule for interpretation: if the symptom score drops by ≥30% from baseline without unacceptable side effects, continue and review in 4 weeks; if the score drops <30% or side effects are intolerable, the clinician should adjust the dose or consider a different product (e.g., change ratio, form, or route) rather than abandoning cannabis entirely. If there is no improvement after a fair trial (typically 4 weeks of consistent dosing at a therapeutic dose), the prescriber should reassess the indication. This is a clinical decision rule, not a guarantee.

The “care conversation” is the core: how the patient and clinician talk about what the product is doing, what the goals are, what side effects matter, and when to stop. The review should be structured around three pillars: (1) benefit, (2) function, and (3) adverse effects. For each, the patient reports symptoms and function, the clinician assesses objective measures (sleep, pain scores, work capacity), and together they decide whether to continue, adjust, or stop. The conversation is not a one-off; it is a scheduled review at 2-4 weeks after initiation, then every 3-6 months for stable patients.

The clinician should check: - whether the product is working for the target symptom - whether side effects are tolerable - whether the dose is still appropriate - whether the patient is using the product correctly (e.g., inhalation technique, oil under tongue) - whether the patient understands the legal boundaries (prescription only, pharmacy supply, no driving under impairment) - whether the patient is at risk of dependence or diversion - whether the patient is taking interacting medicines - whether the patient’s condition has changed and whether cannabis is still the right treatment

Each review should ask the same core set of questions, adapted to the patient’s condition: - Pain score (0-10) or symptom score for the target condition - Functional change: sleep, appetite, work, daily activity, mood - Adverse effects: drowsiness, dizziness, dry mouth, gastrointestinal upset, appetite change, mood change, memory or concentration problems, signs of intoxication - Unwanted interactions: new medicines, alcohol, illicit drugs - Adherence: missed doses, product access, cost, practical difficulties - Product performance: whether the current product, dose and route still fit the symptom pattern - Patient goals: whether the original treatment goal is still relevant or needs updating

A structured review conversation should cover the same domains as the initial assessment (pain, sleep, mood, function, adverse effects) and use the same measurement tools so changes are comparable. If the patient’s symptom scores have not improved by 4-6 weeks, the clinician should reconsider the product, dose, route, or diagnosis. If adverse effects are intolerable, the clinician should reduce the dose or change the product before abandoning medicinal cannabis. If the patient reports no effect at a stable dose after 4 weeks, the clinician should check adherence, drug interactions, and product quality before assuming failure.

The general rule: review at 2-4 weeks after starting or changing dose, then at 4-8 weeks, then at least every 3-6 months for ongoing prescriptions. More frequent reviews are needed if the patient is older, has multiple conditions, takes interacting medicines, or uses high-THC products.

REVIEW_AND_MONITORING_QUESTIONS: - “What measurable changes have you noticed since starting or changing the medicine?” - “Which of your target symptoms improved, and by how much?” - “Are any new or worse symptoms appearing, such as drowsiness, dizziness, dry mouth, appetite changes, or mood shifts?” - “How is your sleep, appetite, energy, and ability to work or care for others?” - “Have you needed any rescue medication or unplanned medical care since the last review?” - “How consistent is your dose timing and method of administration?” - “Are you comfortable with the cost and the pharmacy process?”

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Review and monitoring

What this page answers

This page explains how to track the benefits, side effects and day-to-day safety of prescribed medicinal cannabis in New Zealand. It is not a guide to starting or stopping a prescription. That decision belongs to your prescriber. What you will find here is a practical method for the follow-up conversation: what to bring, what to measure, and how to know when something needs to be raised with a clinician.