...Deputy Gino Kenny: I think I flagged this already with the Department of Health. My next question is about an extensive report by the Health Research Board on the future of the medical cannabis access programme. The MCAP is a good concept but only 55 patients have had access to medical cannabis since it was conceived. That is a very small number of people who can get access via prescription. A clinical review is to be done. When will it happen? Does the Department envisage that the programme will expand, as it will according to the report by the HRB? If it does not, I am fearful that it will become almost redundant in terms of people getting access to medical cannabis.

Dr. Siobhán Ní Bhriain: I can give an update on the current state of affairs. As the Deputy knows, medical cannabis is licensed at this point in time or available for use for people with three particular conditions, namely, spasticity, intractable nausea and vomiting associated with chemotherapy, and severe and refractory epilepsy. It is underpinned by a number of aspects of legislation.

At this time, the Deputy is correct in saying we have had 55 patients treated. There were 38 in the first category, that is, spasticity associated with MS, who have been resistant to all other standard therapies and interventions, three patients for the intractable nausea and vomiting related to chemotherapy and 11 patients with severe refractory epilepsy. That is the data on those.

It is very hard for me as a psychiatrist not to say that I am very conscious of the difference between the cannabinoids and the THC-containing medication. It is important that we do not conflate the use of those particular products in treating people. As the Deputy will know, THC is a psychoactive substance and does lead to quite severe adverse effects in the people who take it rather than CBD, subject to cannabidiol. The issue of reviewing the policy is with the Department of Health but I think we will be waiting for more evidence to emerge. That said, speaking to my clinical colleagues, it is available for those very specific indications.

Deputy Gino Kenny: The HRB report is very extensive, running to more than 200 pages. It recommends that the programme be expanded, particularly to neuropathic pain for which there is quite good evidence. A tiny number of people - 55 - have got access to medical cannabis over four years. The whole idea of the programme was to give people access rather than people having to go to the black market, which is happening, or doing without. It is really important that this programme expands to include other conditions, particularly neuropathic pain where there is good evidence. The Danish medical cannabis programme includes other conditions, particularly neuropathic pain. When will the clinical review take place? This has been going on forever at this stage.

Dr. Siobhán Ní Bhriain: I will have to come back with a specific date for when the review will happen.

Mr. Robert Watt:  We will come back to the Deputy on the specifics. It is a very complex area. We will obviously be guided by the best clinical practice and advice. We will come back with a note on the specific timeframes. As the Deputy said, it is a very detailed and comprehensive report and the numbers benefiting from the programme are very modest. That is driven by the clinical guidelines and practice. We will come back with a timeframe.

Deputy Gino Kenny: Does Mr. Watt agree that having only 55 people benefit from the programme over the past four years is a tiny number?

Mr. Robert Watt: It is a modest number but I do not know the number of people who would fall into those categories in general. There are three categories. In addition, clinical decisions will have been made about whether the treatment would have been appropriate for people who have any of the three conditions that were mentioned.

Dr. Siobhán Ní Bhriain:  Our clinicians are very aware of this availability. There is a lot of new medication on the market for dealing with intractable nausea and vomiting in chemotherapy. That may be a reflection of that particular fact. Our clinicians, particularly those who deal with multiple sclerosis and epilepsy, our neurology colleagues, are very aware of this programme. I have absolutely no doubt they would make use of it if they thought it was necessary.

Mr. Robert Watt:  We can come back with a more detailed note for the Deputy. The reasons we will be given is that there are clinical reasons for this. It is a clinical explanation.

Deputy Gino Kenny: I understand.

Mr. Robert Watt: It is up to individuals who are the carers, the medical advisers, of people with those conditions and are making those decisions on their behalf. We will come back on the numbers. They are modest but that does not necessarily mean that they are too small. We will come back with detail on the numbers and a note on the timeline for the review.