Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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82. To ask the Minister for Health if he acknowledges that the medical cannabis access programme, MCAP, is not fulfilling its potential given that only 12 persons have been registered on the MCAP, the limitations to date and the programme’s upcoming clinical review. [38141/22]

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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My question relates to a report commissioned five years ago, namely, Cannabis for Medical Use - A Scientific Review, which was commissioned from the Health Products Regulatory Authority, HPRA. One of the main recommendations was an access programme. That was five years ago. The programme has been extremely restrictive and has omitted many people who could benefit from medical cannabis. I want to get the Minister's views on the programme itself.

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy and acknowledge his ongoing advocacy work on this area and indeed on the MCAP. The programme was initiated following a ministerially commissioned expert report some time back on cannabis for medical use. Access to cannabis for medical purposes for the treatment of three specified conditions was the recommendation, when all other treatments had failed. The programme commenced in July 2021 and I was very happy to initiate that. It is operated by the HSE. There have been some initial issues with availability of products and I am happy to come back to that. Most issues have now been resolved and one additional product will be available in the coming weeks.

We must recognise there are of course limitations to the programme. Products are not authorised medicines and assurances regarding the safety, quality and effectiveness are not the same as they would be for an authorised medicine. The required structures have been put in place to function as expected for the programme to function as expected. However, it is a clinical decision whether to prescribe these products. Currently 20 patients out of 22 applicants have been accepted onto the programme. In parallel there are 40 patients assessing cannabis for medicinal use through the ministerial licence scheme.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I think the Minister will agree with me the policy of a ministerial licence was from the outset overly bureaucratic and very arduous for parents. Many parents had to fight tooth and nail to get access for their children. I have always found it strange that with the more than 40 people who have ministerial licence, there is no joined-up thinking. There is no research done or joined-up thinking. The access programme gives that kind of joined-up thinking. Twenty people is a very small number to be benefiting from medical cannabis. If we look at the Danish medical cannabis programme, which I will allude to in the next part, it has been broadened out with more conditions. The clinical review is very important.

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy. I think the question he is posing is whether we can extend the programme to different conditions. As we were discussing, the original report recommended its use for three conditions once other treatments were no longer deemed viable. The question is whether we can broaden that. The Department of Health has now commissioned an evidence review. This is examining the efficacy and the safety of the cannabis-based treatments for a wider range of conditions. When that is completed a clinical group is going to be convened to assess the evidence and provide guidance to the Government on any potential amendments to that list. That is something that would potentially widen access. As I was saying to the Deputy, two products are currently available and there is a third product, Tilray, that will be available shortly. I am aware there are some clinicians who have been waiting for that specific product for their patients.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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If the programme is not broadened in its conditions, I do not see it going anywhere for medical and commercial reasons. The Danish medical cannabis access programme has been open since 2018 and 2,500 patients have got medical cannabis products via prescription. Some of the conditions it is being prescribed for are not in the medical access programme here. One particular example of that is neuropathic pain. The evidence around the effect of cannabis on neuropathic pain is very good. Access programmes throughout the world allow cannabis for the treatment of chronic pain or neuropathic pain. Chronic pain is a very broad term. The omission of chronic pain in the initial report was very controversial. A whole host of people could benefit from medical cannabis, particularly for neuropathic pain.

Stephen Donnelly (Wicklow, Fianna Fail)
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Let us see what the research comes back with. I acknowledge the Deputy's position and I know there are others here and around the world who share his view. I want to see what the evidence comes back with and we can then look at clinical recommendations about expanding the conditions.

Part of why it might be more limited than would have been expected is good news. Approximately 85% of the expected cost for the programme was specifically being attributed to refractory epilepsy patients. In December last year, the HSE agreed to reimburse a product called Epidiolex. It is a licensed cannabis-based medicine that the clinicians have been going for, I imagine in part because it is licensed rather than unlicensed.