Medicinal cannabis has a short history in Ireland. Work began on the establishment of the programme in 2017 on foot of conclusions from the Health Regulatory Authority Report, “Cannabis for Medical Use: A Scientific Review”. While this review was conducted by medical professionals there were no experts on medicinal cannabis which leaves patients questioning the accuracy of the review.
In 2019 the MCAP was finally signed into law and established on a pilot basis for five years. There followed an uphill struggle to ensure medicinal cannabis products became available under the scheme to the detriment of many patients in Ireland. Eventually, in November 2021 the first patient was able to gain access to medicinal cannabis for an aggressive form of epilepsy. Today a total of 12 patients have gained access to the MCAP with many others relying on the ad-hoc system of ministerial licences for a range of conditions.
The MCAP makes it possible for a medical consultant to prescribe a cannabis-based treatment to patients under their care only when the patient has failed to respond to standard treatments. It is only when all other avenues have been explored when patients do not respond to pharmaceutical medication, that cannabis will be considered a viable treatment leaving patients with no autonomy in the conversation.
Three limited conditions qualify for the MCAP, Spasticity associated with multiple sclerosis, Intractable nausea and vomiting associated with chemotherapy and Severe refractory (treatment-resistant) epilepsy. Although pain and chronic pain were excluded from the programme due to concerns about the subjectivity of pain and concerns regarding misuse, several products approved for the MCAP are ones that are often also prescribed to treat pain in other jurisdictions.
While some patients celebrated the launch of the MCAP many found themselves unable to access it due to reluctance from health professionals to apply to the scheme. This reluctance is seen across the medical profession with doctors stating they will “shun the State’s Medicinal Cannabis Programme” and associating access to medicine with a legalised and regulated market. This attitude from doctors and medical professionals and the reluctance to engage with the MCAP has left many patients without access to a programme they qualify for and can benefit from. With the reluctant attitude of medical professionals, it is often difficult for patients to approach their doctors
to discuss this issue for fear of being criticised or stigmatised. Dr Peter Grinspoon recently stated “My advice for patients is to be entirely open and honest with your physicians and to have high expectations of them. Tell them that you consider this to be part of your care and that you expect them to be educated about it, and to be able to at least point you in the direction of the information you need.”
With a review of the MCAP due in 2022, patients and campaigners are hopeful the availability of the MCAP will be expanded to cover other conditions such as chronic pain and fibromyalgia. In 2021 the Joint Committee on Health heard that “This review will seek to build on evidence found in the earlier study and will assess if there is new information to support the addition of any other clinical indications to the MCAP.”
Since 2017 there has been an increase in the number of countries permitting access to cannabis for medical and/or recreation purposes, alongside this is an increase in the number of scientific studies and research that has been conducted. 5 years is a long time in medical research with new reports released almost every day.
One question remains open regarding the review process, what data and information will be used to shape the discussion? We often hear calls that “we need more Irish research”, but patients that currently avail of medicinal cannabis either through ministerial licence or MCAP are not being monitored or studied. If we are serious about employing cannabis as a medicine into the future, we need to utilise the data and information available to us through Irish patients.
