Professor David Finn:

I have been taking notes and, therefore, I will try to address as many of the questions as I can in the order they were asked.

I am 100% apolitical in this. I am not a member of a political party. I have no association or relationship with any member of the People Before Profit Alliance. I have been invited in my capacity as a professor of pharmacology at NUIG, president of the Irish Pain Society and as somebody who has worked on cannabinoids and the endocannabinoid system for 16 years in the UK and Ireland. My main motivation is to inform the debate as best I can and provide evidence-based input into the debate. A question was asked about my research funding. I have had funding from Science Foundation Ireland, the Health Research Board, the International Association for the Study of Pain, other charitable organisations and peer-reviewed grant agencies. This is peer-reviewed grant funding from the Government and other agencies around the world primarily for basic science research, much of which has been around cannabinoids and pain.

There was a question about my peers and where they stand on the issue. It is a complex question and, therefore, there is not absolute consensus. It may depend on which body of peers one looks to. A paper was published in the Harm Reduction Journal, by Crowley et al, earlier this year. It was a survey of Irish GPs and the finding was that a majority are supportive of a move towards authorisation or legalisation of cannabis for medical use and the figure increases if they have additional training in dependency or addiction.

I am president of the Irish Pain Society. The society represents the health professionals who study, research, education and manage pain. Our executive committee released a statement recently in which we came out in support of the inclusion of chronic pain as a fourth indication. The HPRA recommended three indications - spasticity in MS, chemotherapy induced nausea and vomiting, and epilepsy. The executive committee feels there is a sufficient body of evidence and a significant unmet clinical need to justify inclusion of chronic pain as a fourth indication. A paper was also published in The Journal of Pain,which is the primary journal of the American Pain Society, which also supports the use of medicinal cannabis and cannabinoids for chronic pain.

There is a really excellent review by the National Academies of Medicine in the USA, McCormick et al. It is hundreds of pages long. It is an outstanding review and was published in 2017. That review is authored by many leading experts in the world in cannabinoids and cannabis-based medicine. They conclude that there is a body of evidence in support of medical cannabis for some indications but not for others. By and large, those indications reflect and concur with the indications supported by the HPRA, but, importantly, chronic pain is one for which the National Academies of Medicine review says there is a substantial body of evidence. A number of my peers in the cannabinoid field and members of the International Cannabinoid Research Society co-authored that report.

There are at least two world bodies that meet and comprise experts in cannabinoids, cannabinoid science and cannabinoid medicine. These are the International Cannabinoid Research Society, ICRS, of which I am a member, and the International Association for Cannabis as Medicine. In terms of where could doctors go for their continuing professional development and to find information, I guess they could go to those annual conferences. Those are excellent conferences and they would be a forum to provide continual professional development for doctors and health professionals. They would not be the only source of such information but they would be good sources of that information.

There was a question around the formulations and tablets versus drops versus smoking versus vaping. All of these exist and they are possibilities. One of the complexities is that there are so many different potential formulations and routes of administration, some of which have been researched more than others. There is a formulation which has been approved by the HPRA. I referred to it earlier. It is nabiximols or Sativex, which is a oromucosal sublingual spray in an ethanolic suspension. Then there is dronabinol and nabilone, which are, I believe, capsules or tablets, as well. Certainly, I would feel that smoking is not the best way to go. There are risks of bronchitis and, potentially, lung cancer. Vaping is probably safer than smoking. Drops and oils are another option which has been studied, and probably have a more favourable side effect profile, at least in terms of bronchitis, versus smoking.

On the question of research, I am a researcher and an educator. I absolutely support the need for further research. That was a strong statement in the HPRA report. It was nice to see that the HPRA is supportive of trying to create a framework within Ireland to facilitate more research. As a researcher, I would be supportive of that. We certainly could do with more research. I would feel that there is already - the systematic reviews and meta-analysis, particularly on chronic pain, that I cited earlier - a strong body of evidence in support of medical cannabis and cannabinoids for chronic pain and that has moderate to strong efficacy, depending on the study and the type of pain.

I agree one can always have more research. Two of the limitations perhaps are that some of the studies done are relatively short term and more long-term studies would be useful, and-----