Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the witnesses. I have a few questions, answers to some of which may have already been provided.

For a patient with co-morbidities or multiple morbidities, on multiple prescriptions, where is the evidence to support the case that medicinal cannabis is a safe product or medicine, if it is being prescribed as medicinal cannabis, and that it is safe to use with other medicines for other conditions and co-morbidities? That is one matter in which I am interested.

I am also interested in why there is no reference in the Bill to the Health Products Regulatory Authority, HPRA, since, ultimately, we have a statutory authority that oversees the licensing of health products in this country. I understand the purpose of the Bill but, at the same time, I believe there has to be some interaction with the agency that is statutorily obliged to oversee that. It also takes into account people who are on multiple prescriptions, ensuring that medicines are compatible with each other, etc.

Primum non nocere- first, do no harm - is the point from which most clinicians start from. Reference has been made to how nobody has ever died from an overdose of cannabis. It would be impossible to say that nobody has died because of use of cannabis in the sense that a person may have contracted psychiatric problems and there may be depression or anxieties which may have caused a situation where people may have died by suicide, for example. Is there research on that or is it just anecdotal that people could suffer from side-effects from using cannabis in whatever guise?

There are 750 chemicals in the plant itself and over 100 cannabinoids. When the witnesses talk about prescribing for a condition, is the whole plant being prescribed or would there be reference to parts of it, whether tetrahydrocannabinol, THCs, or cannabidiol, CBDs? What would be the prescribing format, particularly as there are so many chemicals and cannabinoids in the plant? Is it possible to break it down? Can that be done through pharmacology and, if so, what is the evidence to support that concept?

The witnesses referenced a medical practitioner. Every doctor in the country is entitled to prescribe this, like everything else. Is there any obligation on the doctor to use anything other than his or her ethical conscience when prescribing this product or is there an obligation on him or her to actually see his or her patient? Would there just be the normal ethical process on the basis of which clinicians in this country operate? Could the witnesses envisage a situation where a particular medical practitioner would be in a position to prescribe quite a lot of cannabis? Is there any obligation on medical practitioners to have interaction with patients other than the ethical obligations that are there already through their oath, etc.?

That is about it. We may come back to the matter again. There is a broader debate on where we should stand on the criminalisation or decriminalisation of drugs in general. If one considers Lisbon and other cities or areas in which decriminalisation of many drugs - not just cannabis - has been tried, one could argue that there is evidence to support us examining that particular concept. Perhaps we have been looking at drugs in the context of the criminal justice system for too long when we should be looking at them more in terms of the health system. That is a matter for another day. Is there any concern that there would be a leakage of the medicinal product out to the broader community? As we know, these drugs are often supplied through criminal markets because they are illegal substances. Are there concerns that there could be leakage into that grey, criminal area?