Professor David Finn:

I speak from a position of having worked on cannabinoids, the endocannabinoid system and cannabis for 16 years as a researcher and academic.

I am a professor of pharmacology at NUI Galway and president of the Irish Pain Society. For the information of the committee, my research interests have included cannabinoids and pain and anxiety in particular.

I have a great respect for the Health Products Regulatory Authority and the HPRA report. Those involved had a limited amount of time to do the job they did. On the whole, there are many good aspects to the report. There is, however, a substantial body of evidence in support of cannabinoids and cannabis to treat chronic pain. There are at least four thorough, comprehensive and excellent systematic reviews or meta-analyses. That is the way those of us in science, research and medicine gather together all the primary original research articles that have been done on a topic. We synthesise the literature and come up with a conclusion based on it. Whiting et al, Hill et al, McCormick et aland the Barnes report are excellent peer-reviewed published articles in the Journal of the American Medical Association, JAMA, and other leading international reviews. Their conclusions are that, on the whole, the weight of evidence is that cannabinoids or medical cannabis or cannabis - whatever we want to call it - has moderate to substantial efficacy for the treatment of chronic pain. That is where we are at.

The second point is a point of information. There is precedent in Ireland for the HPRA having approved a cannabinoid product already. It is called nabiximols or Sativex. It has been approved for spasticity in multiple sclerosis. That compound or drug contains tetrahydrocannabinol, THC, and cannabadiol. It is an oromucosal spray. We also have a situation where another cannabinoid compound, nabilone, which is a synthetic form of THC, is under Schedule 2 to the relevant regulations in Ireland and can be prescribed. It is authorised for the treatment of chemotherapy-induced nausea. Dronabinol is another form of THC which is listed under Schedule 1, but I believe the HPRA report recommended that this classification be reviewed with the possibility to include it under Schedule 2.

We have had some history of the HPRA approving some cannabinoid-based medicines. The HPRA has left some room for three indications within the latest report, namely, spasticity related to multiple sclerosis, chemotherapy-induced nausea and vomiting, as well as epilepsy. The report states that chronic pain is the condition that is most researched, and that is true. Most studies have examined chronic pain.

I will refer back again to the meta-analyses and the systematic reviews. The body of evidence is substantial. The studies suggest, depending on which one is cited, moderate to substantial effect.