Deputy Micheál Martin: It is now nearly two years since the Minister for Health, Deputy Harris, promised to establish a compassionate access scheme for the medicinal use of cannabis in certain circumstances and for patients with specific conditions, namely, drug-resistant epilepsy, spasticity in multiple sclerosis patients and nausea and sickness in cancer patients who are being treated with chemotherapy. However, progress in establishing this scheme has been very slow. It is close to two years since the original promise was made. We are all aware that there are many families under great stress and strain because of the absence of such a scheme. I meet them on a regular basis. We all know the story of brave Vera Twomey who had to spend three months in Holland with her daughter Ava under the supervision of a paediatrician with an interest in neurology so as to validate the utilisation of cannabidiol, CBD, and tetrahydrocannabinols, THC, for Ava's epilepsy. Ava is doing well and her quality of life has improved. However, there are many other families under stress and strain.

There are now 12 patients in Ireland who receive CBD and THC via an import licence arrangement. That involves families of patients with cancer or other very difficult conditions having to travel to Holland, in the main, to secure the medicine in the Transvaal Pharmacy. As many in the House will recall, the access programme was proposed as an alternative to the legislation that was put to the House by Deputy Gino Kenny, which many of us felt was not a realistic or pragmatic approach. The medicinal cannabis access scheme was recommended by the Health Products Regulatory Authority, HPRA, expert group and would allow for the monitoring of usage, refinement of dosage and so on. The absence of a compassionate access scheme represents the absence of compassion for the many families and patients who seek legal access. Unfortunately, many families are accessing this medicine illegally, which has its own dangers.

I received a letter yesterday from the Minister for Health, Deputy Harris. It is a bit disingenuous towards the end in suggesting that the Department has no control over commercial operators. It also refers to difficulties in sourcing medicinal cannabis thus: "The Department of Health has no control in relation to business decisions taken by commercial product manufacturers and has no powers to compel companies to supply their products to the Irish market." No-one ever said that the Department had such powers. What is required here is proactive and intensive engagement with companies. I am aware that there has been engagement, although the correspondence does not suggest so. I also understand that it is within the capacity of a company to supply medicinal cannabis here in the first quarter of 2019 if a push can be made in terms of intense engagement between the HPRA, the Department of Health and the company concerned. It is simply not sustainable that people would continue to access this medicine through importation licences.

Minister for Agriculture, Food and the Marine (Deputy Michael Creed): I thank Deputy Martin for raising this issue and I appreciate that there is cross-party interest in it. The Deputy made reference to Vera Twomey and her daughter Ava. I am very familiar with their case and have attended meetings on this issue with the Minister for Health and colleagues of Deputies Martin and Gino Kenny. There are two distinct issues at play here, as Deputy Martin has outlined. There is the issue of medical cannabis which has the component THC and is available under the ministerial licence system. It is my understanding that up to 12 families have been approved under that system to date. There is also the parallel issue of a medicinal cannabis access programme. The process of setting up such a programme is under way in the Department. Departmental officials recently visited Denmark to see at first hand how the process there works. We are looking at best international practice in this area to make sure that any actions we take are appropriate, consistent and medically informed in the best interests of those families who have an interest in this. We are, in many respects, breaking new ground in this country. A limited number of families have access to the product containing THC and I do not believe that any consultant led application for such access has been refused. That said, I appreciate that there is a second part to this issue and the Department is currently considering how best to progress in that regard. This involves looking at international best practice and there has been engagement with stakeholders in other jurisdictions on the matter.

Deputy Micheál Martin: The Minister's letter states: "Until suitable cannabis products are made available in Ireland, it will be a matter for the presciber and their patient to source the prescribed product." We know this already. The letter also says that the Department is aware that "a Canadian company is in discussions with an Irish-based distributor to supply their products to the Irish market". It adds that "no further details are available on the date of availability of these cannabis products and no import licence application has yet been sought by the Irish distributor to bring these products into the country". The Minister signed the letter but the person who wrote it knows full well why an import licence application has not been made. This company supplies all of Europe and the bottom line is that someone needs to get moving on this. Having officials go to Denmark and elsewhere is simply going off in new directions. We are two years on from the initial promise. The Government must remember that many in this House co-operated constructively with the Minister for Health on this issue. The agreed approach was to set up a medicinal cannabis access scheme but progress has been too slow. This issue can be resolved. The product can be made available in Ireland early next year if a push is made. There has been an institutional resistance to this in certain areas. There has also been a cultural issue among some medical professionals. I understand the concept of a clinical, evidence based approach and the importance of clinical trials.

The bottom line is that this House and the Minister for Health committed to this two years ago. It is time to get this sorted on a compassionate basis for the sake of the many patients and their families who need this medicine.

We should not be forcing families to travel to Holland and elsewhere every three months to access it.

Deputy Michael Creed: I appreciate the points made by the Deputy. I do not believe there is any foot-dragging in the Department as the Deputy seems to allege there is. The Department established an expert group to assist in dealing with this issue. It comprised all of the appropriate expertise required to make an informed decision. Collectively, there is a willingness to move, but we need to make sure that in so doing we will not be taking any undue risk in accessing the product. The Minister for Health has engaged with many people, including individual families who have an interest in accessing the product. I am certain that there is no resistance politically. I am not aware of any resistance medically, but we have to make sure the steps we take will be in the best long-term interests of patients.