Dr. Lorraine Nolan:

I am happy to start and I may bring in my colleague, Ms Power, on some of the questions. To answer Deputy Kenny's question, he is right that the Danish system includes chronic pain as one of the indications for which cannabis can be accessed. When we looked at this back in 2016 to 2017, we really felt that although at one level it appeared there were clinical trials that had looked at the area of chronic pain, the evidence base just was not there to stand over its inclusion as one of the indications, and there were many reasons for that. First, the quality of the clinical trials was quite poor. Many of them were not what we call randomised controlled clinical trials, which would really be considered best design, with the removing of bias. Therefore, one could not draw conclusions from them. Pain had been studied across multiple different areas, using different cohorts of patients, using different formulations, and the evidence just was not there.

Honestly, from what we know about this, I would say the situation possibly has not moved on a huge amount since that period. A comprehensive review has been carried out by the International Association for the Study of Pain, IASP. I will ask Ms Power to come in on this point because she has all the expertise on it. I would honestly say to the Deputy that, from our viewpoint, I do not think the situation would be different. As Mr. O'Connor indicated at the beginning, in the re-establishment of the clinical expert referencing group, from the Department's perspective, one of the first tasks will be to consider a piece of evidence on how that might be carried out because a comprehensive review is warranted, as I definitely acknowledge. Ms Power might like to come in with regard to the IASP review findings.