Glossary
First-line therapy
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The treatment approach with the strongest evidence and lowest risk for a given condition — tried before alternatives.
First-line therapy is the treatment approach for a given condition that has the strongest evidence base, the most favourable risk–benefit profile, and the lowest barriers to access — and is therefore the medical default. Standard care typically progresses through first-line, then second-line (alternatives if first-line fails or is poorly tolerated), then third-line (refractory or specialist options).
In cannabinoid prescribing, this concept matters constantly: cannabinoids are **almost never first-line for any indication**. They are considered when first- and often second-line therapy has been trialled with documented inadequate response or intolerable side effects. Examples: - Chronic pain — first-line is paracetamol, NSAIDs, physiotherapy, structured pain management; cannabinoids may be considered after these. - Insomnia — first-line is CBT-I (cognitive behavioural therapy for insomnia); cannabinoids are second-line or adjunctive. - Anxiety disorders — first-line is SSRIs and psychotherapy; cannabinoids are adjunctive at best. - Epilepsy — first-line is conventional anti-seizure medications; CBD is for refractory cases.
Doctors filing Section 21 applications without documented first-line trials see those applications declined more often. SAHPRA expects clear evidence that conventional pathways have been worked through.