Drug policy specialist Natalie O’Regan on Ireland’s faltering Medical Cannabis Access Programme
THE Medical Cannabis Access Programme (MCAP) was launched in 2017, four years later and the first product is now being made available for patients.
A working group was established in 2017 to inform the government on implementing medicinal cannabis in Ireland.
While the group consisted of medical professionals, there were no experts in medicinal cannabis, this was the first of many mistakes made with implementation of the MCAP.
Although patients and activists are welcoming of this long-awaited programme there are already many issues with its implementation. One of the main issues with the programme highlighted by patients and activists is the limited scope of its application.
An Uphill Struggle
The programme itself is applicable to only three conditions; Spasticity associated with multiple sclerosis, intractable nausea and vomiting associated with chemotherapy and severe, treatment-resistant epilepsy, meaning patients have to try all available medication before cannabis is considered as a viable treatment.
The working group in 2017 decided to exclude pain from the list of qualifying conditions, while at the same time the Health Products Regulatory Authority (HPRA) have authorised cannabis products that are intended to treat pain to be accepted on the MCAP.
Studies have shown that the majority of medicinal cannabis is used to treat pain, additionally a more recent study in The British Medical Journal has shown that chronic pain can be improved by use of medicinal cannabis.
Currently only one product is confirmed to be available in October, the CannEpil, which is an oral based solution intended for treatment resistant epilepsy. Although CannEpil is a low THC product (Ratio 20:1 CBD:THC) it still faces an uphill struggle for acceptance from the medical profession.
Professor Bryan Lynch, a Consultant Paediatric Neurologist in Temple Street Children’s Hospital, recently indicated to the Health Committee that THC and cannabis based medicinal products have no evidence as an effective treatment of epilepsy, he went on to say that himself and colleagues will not be prescribing CannEpil to patients, signalling severe reluctance from the medical profession.
Other Neurologist’s recently wrote a letter to the Irish Times stating they will shun the programme due to ‘inappropriate and potentially harmful’ products.
With an estimated 40,000 people in Ireland suffering from epilepsy, the resistance to cannabis based medicinal products and these statements from the medical profession have left patients and activists worried for the future of the programme. Without support from the medical profession there is a growing fear that the MCAP is doomed to fail from the start.
A second obstacle in implementing access to cannabis-based medicine in Ireland is the 1977 Misuse of Drugs Act, under this act any product with a trace of THC is classified as a controlled substance.
It was noted at the recent Health Committee by Lorraine Nolan, Chief Executive of the Health Products Regulatory Authority, that as THC is a controlled substance legislative change is needed to make low THC/High CBD products available legally in Ireland.
Despite the introduction of the MCAP, a large volume of studies showing the benefits of medicinal cannabis – and the United Nations commission on Narcotic Drugs voting to recognise those medicinal benefits – cannabis is still a scheduled illegal drug in the 1977 act, and considered to have no scientific or medicinal value.
Forced to Go Overseas
This means patients excluded from the scheme, who may rely on the illegal market, or patients that access cannabis abroad and wish to return home are risking arrest and imprisonment for possession of an illegal substance. One recent example of this is Alicia Maher.
Alicia has a prescription for medicinal cannabis in Ireland. Unfortunately her medication under this scheme is not covered by the HSE (Health Service Executive) and, along with many other patients, this results in a cost that can often not be covered by the patient themselves.
In order to access medication Alicia moved to Spain where she enjoys easier access and a wider range of cannabis products to treat her chronic pain.
She recently contacted Stephen Donnelly the Minister for Health to seek permission to bring her mediation home while visiting family for the first time since the beginning of March 2020. She was denied permission, and warned that she would risk arrest.
Once in Ireland, Alicia had to resort to the illegal market to access cannabis which has done little to treat her condition. Political reluctance to implement proper access to medicinal cannabis no longer has public support; a poll conducted in May 2021 showed an overwhelming support for medicinal cannabis in Ireland with 93% of people in favour of cannabis as a medicine.
The current system of access to medical cannabis in Ireland and the implementation of the long-awaited MCAP is doomed to fail by design.
The cost of this failure will rest solely at the feet of those who need it to work the most – the patients.
Natalie O’Regan is a legal specialist in drug policy and a medical cannabis advocate.
For more on the Irish authorities on-going struggles to understand the progressive developments with hemp and cannabis see this recent BusinessCann article.