Cannabis for Medicinal Use Regulation Bill 2016: Second Stage [Private Members]

I move: "That the Bill be now read a Second Time."

This is not similar to ordinary Private Members' time on Tuesdays and Wednesdays. There is no provision in Standing Orders for a set sequence of speakers. I have before me a list of speakers who have indicated. I would need two hours and 20 minutes for everyone but I do not have that time. To give everyone an opportunity, I appeal for some self-discipline, or maybe Members would consider sharing time. I will commence with Deputy Kenny, who has 15 minutes. In the meantime, others might think of sharing time to accommodate all.

I welcome everyone in the Gallery today. Usually, this is a quiet and lonely place, but it is great to have the visitors here and it is good to see friends.

I thank the other political parties for facilitating this Private Members' Bill. It is being fast-tracked and I commend the other political parties on allowing it to happen. I commend the efforts of a former Member, Luke Flanagan, who put forward a Bill in 2013 dealing with medical cannabis. He is in Brussels at the moment, probably a better place to be.

He is probably stoned out of his head.

Today I stand here under circumstances of my choosing, but the circumstances of many individuals and families suffering throughout the country are certainly not of their choosing.

I will put a question to those in the House and those listening or watching the debate. What would they do if their child, parent, sister, brother or friend was diagnosed with an illness that could be treated with a medicine that was unobtainable? Less than nine months ago, my knowledge of medical cannabis was limited. I had certain vague ideas, perhaps even ignorance, on the subject of medicinal cannabis. My journey so far is part of an ongoing journey of education, seeking out the medical benefits of cannabis in order that I can represent the tens of thousands who need this medicine and who would benefit greatly from improvements in its accessibility.

During the past six months I have met and corresponded with some extraordinary people in extraordinary circumstances.

Some of the life stories I have heard are truly remarkable. The story of Marie Fleming's battle with multiple sclerosis and her husband Tom helping her to relieve the pain using cannabis is harrowing on the one hand but, on the other, a story of love that shows the medical benefits of using cannabis when other standard medicines have failed. Extraordinary too is the story of Mark Gaynor and his struggle to bring comfort and relief to his five year old son, Ronan, who suffers from a rare childhood cancer. I would like to mention one person in particular who I think the people of this country have taken to their hearts. Vera Twomey's campaign for her daughter, Ava, has been the catalyst that has not only won the hearts and minds of the public, but also forced the Government to review its policy on medical cannabis. Vera's courage and determination has meant that she has spoken up not only for Ava, but also the countless others who find themselves in similar distressing circumstances. We owe Ms Twomey, her family and many others who have come out publicly on this issue an enormous amount of gratitude for having told their personal stories.

In the 19th century, a man probably largely forgotten in Irish history, William Brooke O'Shaughnessy, a doctor from Limerick in the early part of that century, popularised medical cannabis. Dr. O'Shaughnessy's vision and forward thinking encouraged modern medicine to engage with the healing benefits of cannabis. His legacy lives on in his contribution to the greater good in treating people with medical cannabis. Unfortunately, however, over the past five decades, the cannabis plant has been stigmatised, criminalised and demonised by governments and corporations with their own vested interests. The war on drugs has been a miserable failure, and all over the world governments are now picking up the pieces.

The Bill provides that patients can receive a legally protected, secure supply of a quality controlled cannabis-based medicine that is safe and effective. This includes provision for a regulatory authority to issue licences for importation and supply and to ensure products are labelled accurately for contents, including THC and CBD, the two best studied cannabinoids with established medicinal value. The Bill provides for the funding of a research institute to improve knowledge about the use and effects of cannabis-based medicines. It allows for legally protected access to cannabis-based products by patients with a recommendation from a doctor to the effect that they suffer from a condition that responds to cannabis-based medicines. Under the regulations for retail licences, labelled, quality assured cannabis-based medicines would only be available from a pharmacist. Advertising or promoting cannabis-based medicines and sale directly to children would be prohibited.

Regarding the benefits of the Bill, its essence is to relieve people's unnecessary suffering from a variety of medical conditions and to promote recovery through improving safe access to an effective medicine. The recent report to the UK all-party parliamentary group for drug policy reform, the Barnes report, outlined evidence for the medicinal use of cannabis-based products in a wide range of medical conditions, such as chronic pain, spasticity, nausea and vomiting, particularly in the context of chemotherapy, cancer, fibromyalgia, epilepsy, Parkinson's disease - the list goes on and on. There is also increasing evidence that when patients use cannabis-based medicines, the use of more toxic alternatives such as opioid painkillers and sedatives is reduced, as are the more severe side effects of and deaths from these drugs. It is genuinely remarkable and an amazing medical advantage that no patient has ever died as a result of using cannabis.

There is a tide in the affairs of men,

Which, taken at the flood, leads on to fortune.

The fortune here today is not the fortune of war but the fortunes of our suffering constituents, children and adults who have within their grasp a medicine with great promise. Let us now put medicinal cannabis within their reach. I commend the Bill to the House. Make it medicine. Make it happen.

I understand why the people in the Gallery applauded Deputy Kenny. He highlights a very important issue. Having engaged with him over the past week, I fully accept and understand his sincerity and desire to try to do the right thing by Irish patients and those suffering. I thank him for the Bill and the opportunity his tabling it provides us to try to debate and progress the very important issue of medicinal cannabis. I do not propose to move the reasoned amendment to the Bill on the Order Paper after the engagement I have had with Deputies Kenny and Boyd Barrett during the week because I think we have found much common ground on the issue.

I believe the Bill is very well intentioned. Deputies from across the House have met patients and their carers who believe that medicinal cannabis should be available as a treatment option for various health conditions. Some of these conditions are extremely distressing for both the sufferers and their carers, and I recognise the urgency and constant worry they feel as they watch their loved ones in pain which they believe could be alleviated.

I, too, have met personally a number of patients and carers of patients who are seeking a change in legislation to permit use of medicinal cannabis in Ireland. While I am slow to name individuals, I, too, have had a number of meetings with Vera Twomey, and her passion and determination to do right by her young daughter, Ava, is a story that has touched all our hearts and made very clear to us in a very real and tangible sense the importance of this issue to families throughout the country. I thank Vera for her leadership in this regard. There is a strength of feeling among the public that the use of cannabis-based products should be allowed for the alleviation of symptoms associated with certain conditions. That is my view too, and I acknowledge the numerous representations from members of the public and public representatives to my Department on this issue.

I share Deputy Kenny's concern for patients who believe that medicinal cannabis should be a treatment option and I expressed this to him and his colleague, Deputy Boyd Barrett, when we met earlier this week to discuss the Bill. I share the view that medicinal cannabis could play an important role in alleviating pain and suffering, subject to medical advice. It will not come as a surprise to the Deputy that I also have significant and serious issues with parts of the Bill which I do not take lightly and to which I will return in my speech for the record of the House later. Before I do so, I would like to set out some of the facts we must consider in addressing this important issue.

The issue of the use of cannabis as a medical treatment is quite complex, and there is a range of views among the public and the medical and scientific community. Medicinal cannabis is a broad term referring to the use of part of the dried cannabis plant material or products which have been manufactured from chemicals known as cannabinoids, extracted from the cannabis plant, for medical treatment. It is important to clarify that the cannabis plant contains a range of cannabinoids, some of which are psychoactive, meaning they affect the mind, and some of which are not. The element commonly known as THC, for example, is a psychoactive cannabinoid, whereas cannabidiol, commonly known as CBD, is not psychoactive.

Under Irish law, cannabis is considered to be a drug of abuse and is controlled under the Misuse of Drugs Acts. Cannabis is the most widely used illegal drug, and I think that most people in the House would acknowledge that there are significant concerns about the recreational use of cannabis, especially among young people. Apart from being illegal, there is a body of research linking cannabis to certain mental health problems.

Under current legislation, cannabis and products which contain THC or its related derivatives are subject to strict controls, as Members will know. Cannabis is prohibited other than in specified circumstances where all activities relating to cultivation, manufacture and supply of cannabis, and products containing THC, are subject to licence. CBD is not controlled under the Misuse of Drugs Acts.

While cannabis is not viewed under Irish legislation as a product having medicinal use, it is currently open for an Irish-registered doctor to apply for a licence for cannabis-based preparations for an individually named patient. Such applications can be considered case by case. A number of families campaigning on the issue of medicinal cannabis would be aware of this provision, but I feel the need to highlight and reiterate that this option is available.

While many countries have the same approach as Ireland, a number of countries have introduced changes to their drugs legislation to remove some prohibitions to permit the medicinal use of cannabis in certain circumstances.

In Europe, countries where such changes have been introduced include the Netherlands, Croatia, Malta and the Czech Republic. Denmark and Germany have also recently announced their intention to progress similar changes. Beyond Europe, schemes for medicinal access have been introduced in Australia, Canada, Israel and a number of US states. Internationally, the schemes in place are focused primarily on controlling the quality and supply, principally of dried cannabis for medicinal use, as prescribed by a doctor. Other than synthetic cannabinoids and Sativex, countries have not authorised medicinal cannabis as a medicine due to the limitations of currently available clinical data on safety and effectiveness.

I believe Ireland should now consider how we might make medicinal cannabis available as a treatment option for certain conditions. As Minister for Health, as Deputies and patients will appreciate, I have a duty to carefully consider the evidence and follow the view of the medical expertise available to me. For that reason, I have taken action. On 3 November, a few weeks ago, I commenced an official review of policy on medicinal cannabis and requested the Health Products Regulatory Authority, HPRA, to provide me with expert advice. The HPRA's statutory role is to protect and enhance human health by regulating medicines and other health products. It has clinical and scientific expertise, which will contribute significantly to this review.

Specifically I have asked the HPRA for an overview of products that have been authorised in other countries; the wider ongoing and emerging clinical research in new indications; the different regulatory regimes in place in countries that allow cannabis to be used for medicinal purposes; and the legislative changes that would be required to allow use of cannabis for medicinal purposes in Ireland. This review is being progressed as speedily as possible and I have asked the HPRA to conclude it by the end of January. Deputies should be aware that this review is of the highest priority for the HPRA, as it has reflected to me, and it has convened a working group to include input from clinicians actively practising in the therapeutic areas in which cannabis is believed to be of benefit. It is a priority issue for me and the HPRA. I hope and expect to receive its advice by the end of January.

It is a difficult task as this is a complex issue that needs to be appropriately dealt with so that all the needs of patients in Ireland who may benefit from medicinal use of cannabis can be considered. This review also needs to take account of any concerns that have been expressed on potential harm from exposure. I remind Deputies that in other countries where medicinal cannabis has been authorised, it is made available only on the basis of a prescription from a doctor. The appropriateness of any particular treatment is a matter between the patient and a doctor, and that is a very important relationship in this country. My understanding is that currently many Irish doctors would be quite cautious about recommending a cannabis-based treatment for a patient in the absence of robust clinical evidence that underpins authorised medicines. It is therefore very important that we listen to the voice of medics, as I know Deputies wish to in this debate, and that is why I particularly welcome the role of clinicians in the HPRA's review.

The Oireachtas Joint Committee on Health, under the chairmanship of Deputy Harty, who is present, is also examining the issue of medicinal cannabis. The committee recently held hearings on that and heard from a wide range of views, which would have been very informative. I look forward to receiving the output of its work alongside the HPRA's report by the end of January. If we get to the end of that month with the reports from the HPRA and the Oireachtas health committee, as well as being informed by this evening's debate, we will then be in a position to consider future policy and progress any legislative changes that may be recommended.

I have already acknowledged that Deputy Gino Kenny and his colleagues have brought forward this legislation with the intention of helping patients who may benefit from medicinal cannabis. I share the concerns of patients and their carers who believe that cannabis should be a treatment option. Although I am anxious to proceed as quickly as possible - I have outlined to the House my timeline - my preference is to have the expert advice before deciding on possible changes to legislation. That makes sense and by the end of January we will have that advice. I have no wish to pre-empt the HPRA report but it is worth remembering too that the possibility exists it may not recommend new primary legislation and could inform me I can make the necessary changes through statutory instrument under the Misuse of Drugs Acts. This could well be the quickest way to make medicinal cannabis available to Irish patients. We have a common aim in trying to make medicinal cannabis products available to Irish patients on the basis of a doctor's clinical view. When we get to the end of January we will have that advice. I assure the House I will act quickly on it as I know this is an important issue for many families.

At the outset I indicated there are some elements of the Bill with which I have serious concerns and I have discussed them with Deputies Gino Kenny and Richard Boyd Barrett. In particular, I reference the amendments proposed in section 42, which remove cannabis and its derivatives from the Schedule and various sections of the Misuse of Drugs Acts. This would, in effect, mean that cannabis would no longer be a controlled drug and possession for recreational use would not be an offence. I accept this is an unintended consequence of the legislation, as I heard Deputy Gino Kenny mention this morning on the radio. Nevertheless, we should rectify the matter if the Bill is to progress this evening, as I hope and expect it will.

I have always made it clear that medicinal cannabis is a completely different debate to the issue of recreational cannabis and we are here tonight speaking about how we can help patients and families who are suffering. A debate about the recreational use of cannabis is entirely different and I would have a different view in that compared to my view of the use of medicinal cannabis. Most Members in this House would be concerned if we inadvertently legalised cannabis for non-medical purposes. That is not what tonight's debate is about but I need to highlight the unintended consequence within this legislation. I understand there is a willingness on behalf of the Deputy to amend the draft legislation to ensure we are just dealing with the issue of medicinal cannabis.

Another issue of concern is that the Bill as proposed would provide for two new agencies, the cannabis regulation authority and the cannabis research institute. In my view there is genuinely no need to create new quangos. If a decision is taken to change the regulatory regime for medicinal cannabis, the appropriate agency to oversee this would be the HPRA, as it has the statutory role and experience in the protection of human health in respect of medicines and other health products. The HPRA is already the statutory regulator for controlled drugs and it regulates our medicine. If this is to become another medicinal product, it is appropriate for it to sit under the umbrella of the HPRA. There is openness from Deputies to engage in that regard, as the roles set out in the Bill for the proposed new agencies could be appropriate to the HPRA. It would negate the need for us to establish any more agencies for regulation of medicinal cannabis that would come at an additional cost to the State. We need to do this in as simple a manner as possible and by using existing authorities. I am putting those concerns about the Bill on the record of the House.

There are many people here this evening and following this debate so closely because people have a desire to access medicinal cannabis products. As I have said, I truly accept that and thank the Deputy for putting forward this Bill. I also accept his bona fides on this and share the desire to make progress on this matter. Clearly there is much common ground on all sides of the House and with people in all parties and none. That is why, despite having significant objections to some elements of the Bill, as I outlined, it would send the wrong message to so many people who have contacted us all with their personal stories to divide the Dáil. They want to see action and the Dáil moving on this issue. I do not intend to oppose the Bill on Second Stage; in passing that Stage, it would send a strong message to the people and patients of Ireland and their families and carers that we want and intend to see progress in this area. My caveat, as Minister for Health, is that I need to receive the HPRA and clinical medical advice before I would be in a position to act. I expect to receive that at the end of January. I must have due regard to my duties and obligations as Minister for Health and I want to stress the importance of receiving the recommendations of the HPRA before we could perhaps move the Bill to the legislative scrutiny stage at committee. I am hopeful these recommendations will coincide with the output of the committee’s own deliberations.

I believe we are all united in wanting to do the best for patients here but we will achieve the best for patients by acting on the best advice. That is why I have, for the first time in this country, initiated an expert medical review of medicinal cannabis. I look forward to receiving it as quickly as possible and having it very early in the new year. I will act on its recommendations with a view to trying to make medicinal cannabis available to patients in this country. I also look forward to sharing the information with Oireachtas colleagues so we can all proceed to the right solutions in the best interests of patients. I am thankful for this debate and the opportunity provided by the Deputy in tabling this Bill to inform the people and patients of Ireland of my intentions in this regard. I look forward to working with people on all sides of the House in trying to make progress on the issue.

The three speakers from Fianna Fáil are dividing their time.

I welcome the opportunity to speak to this and I compliment Deputy Gino Kenny on tabling the Bill. It is timely and it can be accepted before being amended and improved if there is concern about some elements of the Bill. Fianna Fáil supports the overall principle of the Bill. The Minister has indicated the HPRA will revert with an expert opinion on the issue of medicinal cannabis.

There is no doubt that many families believe through experience that suffering can be alleviated by medicinal cannabis. While we may not yet have the required expert medical opinion from the HPRA, we must acknowledge that there are many in the State who are using medicinal cannabis to alleviate suffering. We certainly do not want them to be criminalised or potentially criminalised and the Bill addresses that issue.

I am a member of the Oireachtas Joint Committee on Health. When Ms Vera Twomey addressed it this week, she outlined her experience with her daughter, Ava. She presented very brave testimony on the subject. We also heard testimony from Dr. Colin Doherty, a neurologist. It was very impressive to hear the views of a person who had spent years trying to find medication that would alleviate the suffering of her daughter. She told the committee about all that she had to go through to try to find something that would help Ava. It is also noteworthy that the eminent consultant Dr. Colin Doherty stated that in the case of epilepsy medicinal cannabis had huge potential. That said, I accept that all of this must be done with the best scientific supporting data available in the context of bringing forward regulations to allow medicinal cannabis to be made available. I do not believe it should be treated differently from any other medicinal product. It should be assessed by a regulatory authority and go through proper due diligence like any other medication. If it is found to be safe and effective in addressing various illnesses and diseases and alleviating suffering, it should be made available on prescription from clinicians and physicians and dispensed accordingly.

We support the principle of the Bill, but there are elements of it about which I have expressed concern. The Minister has said he supports the spirit of the Bill, but I hope he will not use Standing Order 179(2) to push it down a side junction. The Government has acknowledged that there could be some cost implications for the State, but I ask the Minister not to use the aforementioned Standing Order to stall the Bill's progress. Many people are waiting in hope and expectation that we can progress the Bill in conjunction with the best advice available from the HPRA to the Oireachtas Joint Committee on Health which is discussing it and the Minister.

I compliment Ms Twomey and Deputy Gino Kenny. I also compliment the Minister and his Department on being open-minded on the issue. We can have a broad-ranging debate on Committee Stage, amend the Bill and assess the advice of the expert groups, from whom the Minister has requested information. Fianna Fáil supports the principle of the Bill and hopes it can make its way through the legislative process and, at the end of the day, alleviate the suffering of the many people for whom other medicines are ineffective.

An estimated 1.65 million Irish people suffer from chronic pain, 21% of whom have been living with such pain for more than ten years. Pain can be caused by underlying conditions such as multiple sclerosis and arthritis. It can also result from isolated events such as road traffic accidents. Chronic pain is debilitating and impacts on peoples' ability to work, sleep and do the simple things in life. It can effectively destroy their quality of life. There is some evidence to suggest medicinal cannabis can alleviate chronic pain and decrease reliance on other powerful prescriptive drugs such as opiates and can give people back some quality of life. We already allow the prescribing of morphine, a close cousin of heroin. We would not dream of denying access to morphine for those who are in extreme pain or dying of cancer. Cannabis-based medicine, on prescription, has the potential to decrease pain and improve people's quality of life. There is evidence that it is effective for those with epilepsy, multiple sclerosis, arthritis and other conditions.

This is about showing compassion, giving people hope and ending suffering by giving them access to medicine. Everyone has suffered pain at some stage, whether it be from a broken bone or whatever else. Imagine what it must be like to live with such pain on a daily basis, year after year. It must be horrendous. We have a moral duty to help people where we can.

As I said, research demonstrates that cannabis-based medicine can lower reliance on powerful opiates, reduce pain killer abuse and decrease the incidence of hospitalisation. There is no reason cannabis-based medicine cannot be treated like other medicine such as morphine. I do not believe in the slippery slope argument as it has not applied to other powerful prescriptive medicines. We should trust medical professionals and allow them to prescribe these pain relieving drugs if they believe it is medically appropriate to do so.

I commend Deputy Gino Kenny on bringing the Bill before the House; it is not before time and I am glad that Fianna Fáil is supporting it. I support it, although I have some concerns about technicalities at the edges of the Bill. However, they can be dealt with on Committee Stage.

I support the Bill and thank Deputy Gino Kenny for bringing it to the House. It is a number of years since I first met Vera Twomey, a constituent of mine from Aghabullogue. Her daughter, Ava, suffers from Dravet syndrome, a rare form of epilepsy. It is a very severe condition characterised by repeated, violent and multiple seizures every day. The family have tried various medicines throughout Ava's life, but none of them has proved successful. With Ava's condition worsening, the family came upon Charlotte's Web and the improvement was dramatic. I understand there are no authorised medicines to treat Ava's condition. The Minister outlined the process by which a person could prescribe unauthorised medicine, under his or her own responsibility, in order to meet the specific needs of a patient. However, this is done on a case-by-case basis and, according to Ava's family, it is not done easily. Meanwhile, Ava's suffering continues. Parents will walk to the ends of the earth for the benefit of their children. I know that other Deputies have similar examples from their constituencies of people suffering from multiple sclerosis and various other conditions.

The Bill provides for the regulation of cannabis for medicinal use in order that patients can receive a legally protected and secure supply of quality controlled cannabis-based medicine from a pharmacy. It is a good move and I am happy to support any measure that will allow cannabis-based medicines to be prescribed by qualified medical professionals to alleviate suffering, but naturally, it should be strictly controlled. It is no different from any other medicine in that regard.

The Bill makes provision for a new regulatory body, but I believe the HPRA is the appropriate regulator. It would be relatively straightforward to change this provision on Committee Stage. I note that proposed changes to the Misuse of Drugs Act could effectively make it legal for anyone to possess cannabis, including for recreational purposes. That is an unintended consequence and, again, something that could also be changed on Committee Stage.

I am pleased to note that the Barnes report on medical cannabis found evidence of effective medicinal use for patients with a wide range of conditions, including those undergoing chemotherapy and suffering from multiple sclerosis. It also found evidence of effectiveness in dealing with treatment-resistant epilepsy, including Dravet syndrome. I am keen to be clear in my support for clinically sound measures that will enable cannabis based medicines to be prescribed for patients by doctors where it is appropriate to do so. The aim is to alleviate their suffering. I commend the Bill to the House.

I will start by saluting all those in the Visitors Gallery who have come to listen to this debate. I also salute those in the audio-visual room which, I understand, is absolutely packed.

On 2 November a woman left her house in Aghabullogue, County Cork to set off on a 300 km walk to Dublin. She had her coat, a phone, a bottle of water and a couple of pears. She has put her hand over her face at the mention of the couple of pears she was carrying. We can only imagine the despair Vera Twomey must have felt the previous evening when she saw her daughter, Ava, aged six years, have a particularly serious seizure.

As has been mentioned, Ava has Dravet syndrome and has often experienced seizures up to 15 or 20 times a day. Vera must have felt this was the last straw and thought she had to do something for her child. She set about walking 300 km to Dublin - what determination that shows. She was nine hours down the road, I believe around the Mallow area, when the phone call came through from the Minister. She suspended the walk on the promise that action would be taken, and here we are.

Of course, it is not just Dravet syndrome. As other Deputies have mentioned, for people who have had chemotherapy and who as a side effect have serious vomiting, medicinal cannabis can be a real assist, as it can be for people with multiple sclerosis who are suffering from muscle spasms and for those with high levels of anxiety, sleep disorders and chronic pain. We are talking about tens of thousands of people in this country.

The Barnes report from the UK has been mentioned. It was undertaken on foot of the work of the all-party parliamentary commission, which commissioned Professor Mike Barnes, a consultant neurologist, to produce the document, Cannabis: The Evidence for Medical Use. That report calls for legislation to legalise medical cannabis and that this be done as a matter of urgency. I note the comment of Professor David Nutt, the former chief government drugs adviser in the UK, and now professor of neuropsychopharmacology at Imperial College London, who said:

Cannabis has been a medicine for more than 4,000 years, and in the UK was in the pharmacopoeia until 1971 when the USA forced us to remove it as part of the war on drugs. Now, over 200 million Americans have access to medicinal cannabis whereas we do not...

What he is making reference to is the fact that medicinal cannabis has now been legalised in 25 US states. That is also the case in 11 European countries, including Germany, Spain and the Netherlands.

The point has to be made in this discussion that successive Governments in this country, led by both Fianna Fáil and by Fine Gael, have kept medicinal cannabis illegal for decades. There has been a lot of talk in recent times about populism. This was cheap populism of the worst kind because, in striking an anti-drugs pose, and there were probably votes in it at a certain point, this was done at the expense of the health and well-being of tens of thousands of ordinary people. To add insult to injury, those who went out to buy cannabis in order to relieve their pain, or who grew it at home or in their back garden, were criminalised or left themselves open to criminal prosecution. It is my opinion that those people are owed an apology, and I hope the Minister will consider offering an apology to those people at some stage over the course of this debate, whether tonight or in the course of the next weeks as this debate continues.

Thankfully, change is in the air. There has been a sea change in popular attitudes and the campaigning work of many activists, patients and sufferers throughout the country, including the recent brave campaigning work of one Cork mother, has moved this issue very much up the agenda. I also salute the work that is being done by Deputy Gino Kenny in this regard. It has dragged the Government to the point where we are now on the verge of recognising some kind of reality in regard to these issues. It is very important that, after a good debate tonight and the passing of Second Stage, we move quickly and urgently to real progress on this issue in the short weeks and months ahead.

I call Deputy Clare Daly, who is sharing time with Deputy Mick Wallace.

The Chair has asked us to make our speeches short in order to facilitate all Members but I wish to take the time to congratulate Deputy Gino Kenny on producing the Bill and I thank the AAA-PBP for the unusually dogged determination that has succeeded in getting this Bill into the House, a success I think that was guaranteed because of people power and people being willing to expose their own personal tragedies and put their own stories on the line which has meant we are in the situation we are in tonight. The debate has moved on massively since we discussed it in the last Dáil, when I was one of only eight Deputies who supported the Bill of former Deputy, Luke 'Ming' Flanagan, to legalise cannabis, albeit to legalise it for all circumstances. I believe in the legalisation of cannabis in all circumstances.

It is correct to remind ourselves there has been a certain degree of hysteria and political baggage around this discourse on cannabis, which I believe has distracted and caused unnecessary delay in the research and delivery of this product, which could offer such vast relief for so many citizens. We should point out that, at the end of the 19th century, cannabis was widely used in Ireland for seizures, epilepsy, convulsions and other conditions, and there is a certain hypocrisy in that. Obviously, human health, medical care and end-of-life decisions are very personal and traumatic, and anything that can help in these situations should be facilitated. Other Deputies have pointed out very clearly the massive benefits of cannabis as pain relief for arthritis, multiple sclerosis, nausea, cancer and all the rest. That is not something that is unique. Many plants have medicinal properties and we derive medicines from plants all the time - it is the basis of most medication.

It is regrettable that prominent Irish universities and research facilities have not been developing science in this regard because science and medical care have really been subsumed by the justice system, which has denied people the benefit of this. Obviously, recent scientific evidence has helped to create a better picture, better even than the one we had two years ago. It is interesting that organisations such as Epilepsy Ireland were still very cautious about the perceived benefits of seizure prevention, even as recently as two years ago. Epilepsy is one of the reasons we are here today and is one of the ten top causes of death in young people, with 37,000 sufferers. Parents putting their tragic stories into the public domain has been a huge factor in enlightening other people. The research speaks for itself and research in the US and the UK demonstrates that this product can bring benefits.

The medication needs to be available so we do not have a situation where parents have the costly option of travelling to other countries, such as the US, and in some cases emigrating altogether. That is the situation being proposed for people with cystic fibrosis, whom we met in the Dáil today, due to not being able to access Orkambi. People are going to take these drastic steps if we do not provide medicine that they deserve for the quality of life that should be open to all citizens. There is an urgency in this situation. This debate will potentially offer a lot of much needed hope for people who have been shouldering an awful lot, in particular the families living with these debilitating conditions, in that we can point to the delivery of new treatment options they so badly need. I also hope it is a harbinger of further research into this area. It is a disgrace it has taken so long to drag us to this point.

I too welcome the Bill and fair play to Deputy Gino Kenny and the AAA-PBP for bringing it forward. It will certainly help to ease pain for thousands of people in Ireland suffering from a wide range of medical conditions, such as multiple sclerosis, cancer, epilepsy, chronic pain syndrome and numerous other conditions. The evidence for this has been reported recently in the Barnes report, which states there is increasing evidence that when patients use cannabis-based medicines, their use of dangerous prescription medicines is reduced, which I welcome.

The Bill will provide security of supply and quality and will enable the provision of safe and effective medicinal cannabis.

It will also initiate a repositioning or recategorising of cannabis as a public health issue rather than a criminal justice one. The Bill advocates handing responsibility for cannabis policy to the Department of Health and is a step in taking responsibility away from the Department of Justice and Equality, which is certainly positive. Criminalising the efforts of people to alleviate the severe pain and discomfort they are suffering is a particularly cruel policy. Criminalising those with addictions is similarly doubling down on punishment for people who are already victims of the regressive laws surrounding prohibition in Ireland.

Last summer, the British Medical Association called for a move to prioritise treatment over punishment of individual drug users at its annual meeting. Repressive drug policies create far more harm than the drugs themselves. Furthermore, the so-called war on drugs is disproportionately a war on people who are poor, disadvantaged and marginalised. Despite more than 40 years of criminalising the user, drugs have never been more in demand, as cheap or as widely available. There is no police force or government anywhere in the world that can claim or demonstrate that prohibition of drugs is a solution to the problem surrounding them or their use. Thankfully, there are many examples from all over the world of how relaxing drug laws brings positive outcomes for everyone involved. Portugal and Switzerland have shown us how progressive drug policies work. Why are we so committed to punishing those who need care and help? Why do we introduce such regressive laws when the evidence clearly shows that prohibition does not work? The legalisation of cannabis will eliminate the illegal trade and associated crime and control the quality of the product, yield valuable tax and reduce policing costs. Globally, according to an article in the Harvard International Review in 2015, it is estimated that the illicit drug trade constitutes the largest revenue stream for organised crime in the world. Ruth Dreifuss, former President of Switzerland and chairperson of the Global Commission on Drug Policy, recently stated that the need for more effective and humane drug policies is more urgent now than ever. She argues for a pragmatic approach to drug policy reform, starting with the recognition that the idealised notion of a society without drugs is an unattainable fantasy.

Drug use is a reality in Ireland. It is a fact of life. The Government’s attitude to drug policy has been much like its attitude to abortion. An estimated nine girls and women travel every day from Ireland to the UK for abortions, according to statistics by that jurisdiction's Department of Health. A total of 3,450 women from Ireland presented for abortions in the UK in 2015. Abortion is a reality in Ireland. Even a person who opposes abortion, for whatever reason, must realise that an idealised notion of an abortion-free Ireland is a fantasy. Abortion exists here. We should legislate for it and decriminalise and support these women, offering them the care they need and deserve. Likewise, we should decriminalise and support drug users. To those who think of cannabis as harmful, I would argue that regulating a harmful substance is not a new idea. We already regulate several harmful substances. We should regulate the drug trade and become global leaders in that area.

I am in a difficult position because I fully support legalising medicinal cannabis as a medical product and I believe it is important that the Dáil gets this legislation right. Unfortunately, however, I oppose the Bill. Cannabis-based products, as outlined in the Bill, are products which contain any quantity of cannabis that can be sold in wholesale or retail outlets and be imported into or grown in Ireland. As outlined in the Bill, cannabis for medicinal use includes smoking cannabis, which is fundamentally flawed. There is a subtle but critically important difference between the terms "cannabis for medical use" and "medicinal cannabis". Medicinal cannabis refers to oils that contain a high percentage of cannabidiol, CBD, and a low level of tetrahydrocannabinol, TCH, cannabinoids. These are extracted from the cannabis plant and produced in the form of oils or nasal sprays which have beneficial effects for patients and which have minimal or no psychoactive properties. Traditionally, cannabis for medical use over centuries was smoking cannabis. However, smoking cannabis is a gateway drug which often leads to developing more destructive misuse of drugs and which, in susceptible individuals, may precipitate lifelong psychotic illness. I have direct evidence of that in my practice.

This Bill is designed to legalise the smoking of cannabis for recreational purposes under the guise of promoting it for alleviation of medical symptoms. The Bill proposes a cannabis regulatory authority separate from the Health Products Regulatory Authority. If medical cannabis is to be approved, licensed, regulated and monitored, why would a separate body be required? The Bill establishes a cannabis research unit to study the consumption of cannabis for smoking, medical use and recreation. This Bill promotes awareness of cannabis use, including the advancement of education relating to the safe use of cannabis. This implies that cannabis will be used outside medical parameters. The Bill proposes that cannabis can be grown at certified premises and amounts grown will be determined by the demand for cannabis. The sale of cannabis will be through a licensed wholesaler, retailer or registered pharmacy. No prescription is required, just a certificate from a registered doctor stating that the patient has a condition for which a trial of cannabis is a reasonable course of treatment. The maximum quantity of cannabis sold on such a certificate at any one time is 1 oz. There is no reference in the Bill to what medical conditions are to be covered or how they will be selected.

Last week, the Oireachtas Joint Committee on Health examined the use of CBD oil for the treatment of specific neurological conditions such as profound epilepsy. Evidence was given that high percentage CBD-low percentage THC oil has the potential to greatly improve this condition and possibly other neurological conditions such as chronic pain, multiple sclerosis and spastic muscular conditions. The Health Products Regulatory Authority and expert witnesses outlined the criteria and the medical evidence which was needed to allow high percentage CBD-low percentage THC oil to be considered as a medical product. This product would be approved if found to be safe, effective, be of consistent quality, be efficacious and based on peer-reviewed clinical and scientific data. I fully endorse that position. In other words, it would be viewed as a medicine with ongoing surveillance. It would be prescribed by a suitably qualified doctor and dispensed by a qualified pharmacist. At no time during the hearing was the smoking of cannabis promoted or accepted as a treatment for any medical conditions nor is the authority contemplating the regulation of smoking cannabis as a treatment in the future. This Bill proposes to deregulate the possession of cannabis for smoking under the guise of promoting it as equal or similar to CBD-based oils. The report of Michael and Jennifer Barnes in May 2016, entitled Cannabis: the Evidence for Medical Use, states that medical recommendations would be that cannabis should not be taken as a smoked product as there are safer ways to administer it, such as orally, by vapour or oromucosal spray or in food.

This Bill proposes to remove cannabis from the list of drugs prohibited under the Misuse of Drugs Act 1977 and other statutory instruments. Lest there be any doubt about the intention of the Bill, section 44 proposes to amend the Public Health (Tobacco) Act 2002 which bans tobacco smoking in the workplace. This amendment includes the banning of smoking cannabis in the workplace. This implies that smoking cannabis outside the workplace will be legal under the Bill. This legislation will not assist the cause of those families that desperately want approval of CBD oil because it links the availability of CBD oil to the sale of smoking cannabis. Medicinal cannabis should be viewed as a medicine, with suitable criteria applying. This Bill does not fulfil those criteria. On the points I have raised this evening, I feel this Bill is so flawed that it should not be given a Second Reading.

I am supporting Deputy Gino Kenny's Bill in the hope that we can make it possible for some of our country's sickest children and adults to be free from pain and suffering. I am supporting it for children such as Ava Barry. I have received many e-mails asking me to support the Bill and explaining how necessary it is to improve the quality of life for those suffering seizures and chronic pain.

I will read an excerpt from an e-mail I received from a parent yesterday. It states:

Finally when he was 17, we managed to source the medicinal marijuana in the form of cannabinoid that we had so long been looking for. His seizures decreased by about two thirds very quickly. He became more like his old self. He began to be able to study again, to understand and to interact educationally. Watching him on this cannabinoid for nearly a year now, I have seen the original boy coming back. His eyes are brighter, less tired and exhausted, he is more confident.

I do not believe that medicinal cannabis should be used as a first resort but it should be used as a last resort. I acknowledge that there are mixed reviews among health professionals on the use of cannabis for medicinal purposes and on that basis I would recommend including the provision that cannabis-based drugs should be prescribed only when other available medications have proven to be ineffective or inadequate to the therapeutic needs of the patient.

I also believe it is essential to clearly separate the medical use of cannabis as a drug delivered in a controlled dose from its recreational abuse through smoking. Smoking is shown to be one of the least reliable methods of administration for therapeutic purposes, as it has poor dosage control and a high number of pollutants. We do not want to end up with a situation, as in some states in the US, in which the use of therapeutic herbal cannabis-based preparations has created a largely unregulated market and encouraged abuse. Medicinal cannabis, like other controlled drugs, should only be available through a pharmacy. Medicinal cannabis has been legalised in over ten European countries, in Canada and Australia and in 30 US states. While I am giving my support to this Bill tonight, I want to make it clear that I in no way support the legalisation of recreational drugs. I would ask that these provisions be examined yearly and that the benefits and consequences of the provisions be evaluated. This legislation needs to be closely monitored and amended as necessary to ensure that its purpose is still valid and that it is not being abused.

I again reiterate what I said in my opening statement. I support this Bill. I grew up all of my life hearing that we lived in a caring country. Today, I listened to sufferers of cystic fibrosis. Tonight, we talk about legalising medicinal cannabis. Where is the caring in this society? There is none. This is essential legislation. There are people dying and suffering in this country. I have to commend people like Ms Vera Twomey and Mr. Paul Barry, who have travelled throughout the world to find a cure for their daughter, a cure that could be found and administered in this country. I congratulate these people and many more like them who have suffered far too long in their efforts to introduce medicinal cannabis in Ireland.

I also commend Deputy Kenny on tabling this legislation. We in Sinn Féin support the Bill and its passage to Committee Stage. In response to the comments of Deputy Harty, I believe it is very disingenuous of any Member of this House to suggest that Deputy Kenny has put forward this Bill as a Trojan horse to try to allow for the legalisation of cannabis for recreational purposes. I believe that does no service to the debate that we are having. From the outset, this debate has been about the provision of cannabis for medicinal purposes. If there were any unintended consequences in the drafting of this legislation, Deputy Kenny has already given a commitment to the Minister for Health that they will be addressed on Committee Stage. Deputy Kenny might clarify that himself if he gets the opportunity. Anyone who suggests that this debate is about anything other than the provision of cannabis for medicinal purposes has either not listened to the discourse of the debate over the last number of months or is intentionally trying to muddy the waters in terms of what is being proposed tonight.

It is even more disappointing given that the Deputy in question is the Chairman of the Joint Committee on Health, which is overseeing the deliberations on the provision of medicinal cannabis. I completely accept the bona fides of Deputy Harty when he said that he wants to see the provision of cannabis for medicinal purposes. There is no division in the House on that. If that is the common ground that we can all focus on, then I ask Deputy Harty to consider not objecting to the legislation and to let it progress to Committee Stage. Any concerns he may have with the legislation may be addressed on Committee Stage.

We have a commitment from the Minister on a timeline. In the almost seven years I have been a Deputy, getting commitment from a Minister on a timeline is a very difficult thing to do. We have such a commitment from the Minister, Deputy Harris, on the timelines around the debate on the provision of cannabis for medicinal purposes. We will have a HPRA report. Deputy Harty was present at the committee when it was discussed with Ms Lorraine Nolan, the chief executive of the HPRA. She discussed the very strict terms of reference under which she is working. I believe the report will be published on time. She said as much in her own contribution to the committee.

I accept the bona fides of the Minister with regard to the legislation. That is probably a first as well because it is very unusual for Opposition Deputies to accept the word of a Minister. However, on this issue I know that the Minister, Deputy Harris, is very supportive of the cause, which is the provision of cannabis for medicinal purposes. I know that is his own personal view and that he has probably worked very hard behind the scenes at Cabinet level to ensure that is also the Government position, no more so than I have had to work at my own party level to make sure this was the position we took tonight.

I encourage and implore Deputy Harty not to divide the House on this issue. To do so would send out the wrong message to those patients and carers who are hanging on this debate to get some hope that this issue can finally be resolved in a very unified, cross-party way, which would again be very unique in terms of legislation that is dealt with by the House.

I have no doubt that the report will come in on time. We cannot pre-empt the report but one of the recommendations may be that we will not even need primary legislation to enable this to happen, as the Minister, Deputy Harris, has said. This may be able to happen as secondary legislation via a statutory instrument. I believe that we should await that report.

I have spoken to Deputy Kenny about the legislation. We have some concerns around the agencies which are being proposed. We believe it should come under the remit of the HPRA. When Deputy Kenny was drafting the legislation, I am sure that it was not his intention to set up a quango. He is probably the last person in the Oireachtas who would want to set up a quango.

Two quangos, yes. I accept the bona fides of Deputy Kenny and those of the Minister.

I had a speech I was going to make but I feel so passionate about this that I do not want to see the House divided on this. I ask Deputy Harty, the Chairman of the Joint Committee on Health, to consider not dividing the House on this legislation. I understand his own personal position on the recreational use of cannabis. That is a completely separate debate. If we were having that debate, there would not be a unified voice coming from all sides of the Chamber. We would have varying opinions on that issue. I am not even going to give my own opinion on that because it is irrelevant to this debate.

The fact that Deputy Kenny has tabled this legislation can be used as a bit of leverage. If the timelines are not implemented, though I believe they will be, we will have this Bill sitting on Committee Stage. If necessary, I am sure there will be enough support across the Chamber to progress this legislation in a speedy fashion. It would also be a sign to the patients and carers who are waiting for this development to take place that if the timelines are not implemented and if the Minister, Deputy Harris, is not sincere in what he said tonight, though I believe he is, we will seek to progress this legislation, which will be sitting on Committee Stage, and amend it if necessary.

I think the debate is no longer about whether we should provide cannabis for medicinal purposes. I think the debate is now about when that should happen. My opinion is that it should happen sooner rather than later.

I ask Deputy Harty not to divide the House on this issue. Despite the flaws in the drafting of this legislation, the concerns the Minister and I have about it and the Deputy's recognition that areas within this Bill would have unintended consequences, I do not think any other Bill has received such cross-party support in the seven years I have spent in this House. I would like to think we can get the support of all 158 Deputies for it. I would not like to see anyone dissenting from it.

I am sure Deputies realise that I am endeavouring to ensure everyone gets a chance to speak.

I commend Deputy Gino Kenny on his fantastic work on this Bill. I would also like to mention the members of his back-office team who have put a great deal of work into it. I am very proud of the Deputy and of the fact that we are here to do something that will benefit many people and alleviate the suffering they are going through. I thank the other political parties that have facilitated the taking of this Bill and the Deputies who have indicated either that they are willing to support the Bill or that they will not oppose it so that it moves on to Committee Stage. I acknowledge that the Minister and his officials have engaged with Deputy Kenny, and more recently with me, in a genuine way to discuss this Bill with a view to trying to get agreement across the House on how we can make progress with it. Regardless of how sceptical I might be at times about the so-called new politics, I think this is an example of how new politics can function in a progressive way. The biggest thanks have to go to the people in the Gallery, particularly people like Vera Twomey who have fought this case on behalf of others who are enduring suffering. Vera has been determined to get medicine to alleviate the suffering of her daughter, Ava. When this Bill is eventually passed, with whatever changes are necessary to get it through, I think we should call it Ava's Bill as a tribute to the love of a mother for her daughter. That is what this is about.

I take seriously the concerns of people like Deputy Harty regarding this Bill. I respect our differences of opinion in this regard. It seems to me that if we can do something to help the tens of thousands of people like Ava who are ill and whose suffering can be alleviated by medicinal cannabis, that must be our priority and it must override absolutely everything else. I assure Deputy Harty that it is not the intention of this Bill to do something by the back door. We have differing views on the wider question of the decriminalisation and recreational use of marijuana. We make no bones about saying we want to have a debate on that question on another day. We had it before when a Bill was introduced by Luke 'Ming' Flanagan. I was on his side on that occasion. I commend him on all the work he has done. However, the intention of Luke 'Ming' Flanagan's Bill is not the intention of this Bill.

We have indicated clearly that we are willing to work with the Government and the other parties to amend the Bill before the House. This is why the Government has agreed to let it go to Committee Stage. There may be debates and disputes about how best to proceed on Committee Stage. I will move on to some of the issues that have been raised. We do not fully agree with some of the Government's concerns and some of the other concerns that have been raised. If there is agreement that at the end of this process, medicinal cannabis should be made available to anybody whose suffering and illness could be alleviated by it, we have a duty and an obligation to ensure that is what happens. That is what is driving us. We are inspired by Vera Twomey and others. We are determined to have the legislative clock ticking so that this has to happen. That is not to say that there is not a great deal of work yet to be done. Deputy Gino Kenny and our Anti-Austerity Alliance–People Before Profit colleagues would be the first to admit that we are not perfect legislators. There are issues with this Bill that have to be dealt with, but we want it to happen for the sake of the people who will benefit from it. I join Deputy Jonathan O'Brien in appealing to Deputy Harty not to cause a division on this Bill. We need to work on it and make it the best legislation it can be. It seems that despite Deputy Harty's difficulties with the Bill as it stands, he shares the objective of ensuring medicinal cannabis is available to those who desperately need it. That seems to be a shared objective of all Members of the House.

Others have made the point that there is substantial evidence that cannabis-based products can be of assistance across a range of suffering and illness. I do not doubt that this significant evidence needs to be researched more. It seems to me that we should not be in any way conservative about trying to explore the considerable experiential and anecdotal evidence that the suffering and pain associated with a wide range of illnesses can be alleviated by medicinal cannabis products. I know the Minister has expressed concerns about the proposed research institute. If that is an obstacle to making progress with this legislation, we are quite willing to take it out. I suggest the idea of further research in this area is something we should all be in favour of, even if it is not part of this Bill. While there is significant evidence that cannabis could make a difference to those with Parkinson's disease, psychoneurological disorders and so on, we do not have all the evidence in respect of those conditions. It seems to me that if there is even the slightest chance that these products could be beneficial, we have an obligation to research that stuff. If all that can be rolled into the Health Products Regulatory Authority, we are absolutely open to that. The main thing is to get it through. We can work out our differences of opinion on Committee Stage.

I believe the stigma that has been attached to cannabis has prevented us from exploring some of its benefits. That should not be the case. There are concerns about the possible adverse effects of cannabis, but the truth is that there are multiple concerns about all sorts of other drugs that are already legally available. As Deputy Gino Kenny said, there is no known instance of a fatal overdose from the use of cannabis or cannabis-based products. That cannot be said about almost any other drug. One could quite easily overdose on a range of other drugs that are legally available. The evidence suggests that the possibility of addiction arising from the use of other drugs is far greater than the possibility of addiction to cannabis-based products. I am not saying that there cannot be side effects, or that there are no side effects. We need to look at and be concerned about some of those anxieties.

However, there is no evidence whatsoever that anything we might say about cannabis in that regard would lead one to say there is a range of other drugs that should not be available that are available and whose regulated provision is accommodated already. We need to get rid of the stigma because the prize of alleviating a wide range of illnesses and suffering is such a big one that we have to go to the nth degree to do that. There is considerable evidence that it would replace drugs already being dispensed by the health system which are more damaging and dangerous.

People should read a very good article in The Irish Times today about a Canadian study that has shown that almost 500 medicinal marijuana patient surveys reported that 80% of those surveyed successfully substituted cannabis for prescription drugs in the treatment of pain-related conditions. In other words, cannabis has become a more beneficial, less dangerous replacement for drugs that have worse side effects. For that reason, we should progress this Bill as quickly as possible and not be frightened of doing so.

The next slot is shared by Deputy Catherine Martin and Deputy Joan Collins.

Ba mhaith liom a rá don Teach seo anocht go bhfuil an Comhaontas Glas fíor-shásta tacaíocht a thabhairt don Bhille seo. I commend Deputy Kenny on bringing this Bill before the House, which I will support. The Green Party has long called for appropriate legislation to decriminalise the use of cannabis for medicinal purposes, and our recent submission to the national drugs strategy supports this position.

As long as the use of cannabis for medicinal purposes remains illegal, our citizens, many in agonising pain, remain at the mercy of dealers and this secret world for people suffering pain is unsupervised and unregulated, with no safe or reliable expert advice. If charged and convicted in the criminal courts of justice, they currently face a fine of up to €2,750 and a 12-month prison sentence for a third offence.

A recent all-party parliamentary group in the United Kingdom has called for legalisation of cannabis for medicinal use. They heard many compelling stories of the dramatic improvements to their health that some cannabis users have experienced. An expert review feeding into this group’s work found good evidence that cannabis oil can help with chronic pain, muscle spasms often associated with multiple sclerosis, and the management of anxiety, nausea and vomiting, particularly when caused as a side effect of chemotherapy.

Here in Ireland we have heard from people like the brave and inspiring Vera Twomey who is doing everything she can to advocate for her little girl, Ava, who has Dravet syndrome and is subject to ever-increasing seizures. Last year, after 18 consecutive seizures in close succession, Ava suffered an especially severe seizure and after trying every medication available, doctors eventually were running out of options. That is when Vera turned to cannabis oil as her last hope. She has said that her daughter’s quality of life has been transformed since then.

It is difficult to put a number on the many people who are using medicinal cannabis in Ireland, but considering the number of people who have epilepsy, cancer, multiple sclerosis or any other brain or muscle related condition, there are probably thousands in agonising pain who are hoping against hope that we, as legislators, will speak up and act for them tonight. These people need practical support, translating words, however genuine, into doing our utmost to take action. They deserve our compassion and support, not potential criminal records or a lifetime of pain.

I will not take too much time because I am aware of the time constraints but I want to take the opportunity to express my support for the Bill. I was one of the eight Members who supported the Bill brought forward by the then Deputy Luke 'Ming' Flanagan on the decriminalisation of cannabis. I welcome him to the Dáil tonight. He came here specifically to support the Bill and the people in the Gallery who were the catalysts in terms of pushing this issue. He brought forward a wider Bill but the legalisation of medicinal cannabis was contained in it. I recall the Minister of State at the time, Alex White, speaking about the plans to bring in medicinal cannabis for multiple sclerosis patients, but he further stated that while people agree with possible medicinal cannabis being legalised, there is no evidence of any significant public support for that change in policy. There was a lot of public support but it was not being reflected by the Government at the time, which had a huge majority and would not take any advice or evidence from Members on this side of the House on these issues.

I have read Professor Mike Barnes's report and the evidence is very clear. It was sufficiently compelling for a large number of countries to legalise access to medicinal cannabis, including countries mentioned earlier such as the Netherlands, Germany, Spain and 24 states in the United States. They made the point that for thousands of years, going back to 4000 BC, cannabis has been used for medicinal purposes. That is the backbone of this debate.

I want to highlight the fact that doctors currently can apply for this product on behalf of patients but they rarely do so without the backing and guidance from the Health Service Executive to ensure that what they are doing is right and that they are not stepping over the line or doing anything illegal. I note the point made by the Minister, Deputy Harris, when he stated:

While cannabis is not viewed under Irish legislation as a product having medicinal use, it is currently open for an Irish registered doctor to apply for a licence for cannabis-based preparations for an individually named patient. Such applications can be considered case by case. A number of families campaigning on the issue of medicinal cannabis would be aware of this provision [which would allow a doctor apply for a licence].

I read that quote into the record of the House because I want the media to take it up and get the message out to people that they can do that because while many of the e-mails we got expressed the hope that the Bill will be passed very quickly, some were under the impression that it would be passed this week, next week or next month. However, it will take a period of time even though there is the will on the part of Members of the House to move it along. The message must be sent out that doctors can do this case by case, and they should. People should know that and contact their doctors about it.

We have not only read the Barnes report but we have also listened to many people in recent years on this issue, particularly at the time of Luke 'Ming' Flanagan's Bill. We know this product can have a huge impact on chronic pain and on a range of illnesses and potential illnesses. I received an especially poignant e-mail from a young mother whose son has Dravet syndrome, similar to Ava Barry's illness. She made the point clearly that the reason she wants to see this Bill passed is because to date in 2016, her son has had 523 of the most severe seizures, not to mention all the smaller seizures and the ones that are missed. In 2015, he had 683, in 2014, he had 648 and in 2013, he had 305. That young boy and his family are hoping against hope that this Bill will be passed very quickly.

I listened to Mark speak on "Morning Ireland" this morning about his son Ronan, who has diffuse intrinsic pontine gliomas, DIPG. He accesses the CBD drug on Amazon through the manufacturer and pays a good deal of money for it. People should not be expected to have to go through that process. They should be able to access it here for their sister, brother, mother or father who has a need for medicinal cannabis.

Deputy Gino Kenny has been genuine in his approach to this Bill. He is bringing it forward as a way to alleviate pain when all other choices do not work.

It is not in any way a Bill being brought in as a Trojan horse to open up the use of cannabis in general.

I congratulate Deputy Gino Kenny on bringing this into the Dáil. I also congratulate all the groups in the Dáil who facilitated this as with that sort of support and the genuine all-party approach that seems evident, the Bill will progress quickly although probably not quickly enough for some people. The message must go out that doctors can do as I indicated.

In the next slot, there are Deputies Fitzmaurice and Shortall.

First, I commend Deputy Gino Kenny on bringing this Bill forward. There are a lot of issues we might not agree on but I agree with the Deputy on this. This has to be done. There is right on our side. As a legislator, any Deputy who has bothered to look at e-mails or has picked up a phone to talk to somebody who has gone through such suffering and torture and endured such pain - be it with multiple sclerosis, cancer treatment, epilepsy or different problems - must do what is right.

Deputy Harty spoke earlier. As Deputies, we have to be responsible in what we do. I heard Deputy Kenny this evening speaking on the news and, in fairness to Deputy Boyd Barrett, they have explained clearly. No individual is perfect or has the machines of Government behind him or her to put something together and have it 100% perfect. In fairness, the ball is being thrown into the air today and it is ready to go. If there some aspects that are not workable, as legislators, we can solve this together in committee.

We need to remain focused on the people who have suffered, are suffering and will suffer until this is solved. Earlier it was interesting to hear Deputy Joan Collins state a way forward is available for the time being until this Bill is put through and that doctors have an opportunity to perhaps help some of those suffering people.

It is great to see people - Ms Vera Twomey is to be congratulated - with a determination, a desire and a vision of where they want to go. I refer to the heart that is in such people to get out there to make a sacrifice for their neighbour, their family or someone belonging to them in a fight to make that person's life a bit more comfortable. They are the people who started this off. There is much happening around the country that Deputies might not know of until somebody comes to us and explains.

This morning, in the AV room, we heard about young people with cystic fibrosis who are suffering. We have listened to the stories of different people who are sick and who are looking to get medicinal cannabis. Unless one has a heart like a stone, it has to affect one. There is talk of Deputies who do not seem to have a heart but in fairness, while we disagree and argue frequently, it is commendable that right around the House tonight, everyone wants to see this Bill progress although Deputies may be a bit sceptical. Deputies want to see people being able to get their hands on medicinal cannabis. I have seen one such person at home who suffered from multiple sclerosis and nobody deserves the torture and suffering that person had to go through.

Whatever way we can make their lives a bit better or can help them - maybe it can cure them - we should not be afraid to research something. We should not be afraid of that word of which everyone was once afraid. We should be prepared to look into it. It may help other people in different situations. I am not against that whatsoever.

I have made it clear I am not in favour of having it willy-nilly on every street corner but I am for the people concerned here. It needs to be sorted and to be driven on. In fairness to the Minister, he stated he is focused on it, and we take him at his word. In fairness to Fianna Fáil, it has backed this Bill. Basically in this House, unless the two big guns do not back something, one is in trouble with a Bill. It is good in the new type of politics that, for once in our life round this House tonight, there is general consensus that this should be done. It is what is right; it is what we are here for as legislators. All I can say is, I commend Deputy Gino Kenny on bringing this forward and I will support it.

The Social Democrats supports the principal thrust of this legislation, which is to allow greater use of cannabis-based medications. Such medications are fairly widely available in many EU states, and, indeed, in many states in the US, without any apparent evidence of negative consequences. They are providing, in the main, important relief to people with difficult and severe conditions. We must learn from what is happening in other places and ensure best practice in that regard.

I commend Deputy Gino Kenny on bringing this legislation forward and on putting this issue centre-stage. While it has been an issue in the background and people who are directly affected by the lack of such medication are all too conscious of the associated problems, in the main this has not been brought centre-stage or to the top of the political agenda. It is a good day's work that Deputy Gino Kenny has done this and has created the conditions whereby we have this debate tonight. Hopefully, we can move forward within a reasonably short timeframe to ensure that effect is given to the expressions that we have heard here tonight.

I also pay tribute to the many people who are in the Gallery and those listening in the AV room, as well as to those who have written to us over recent weeks and who have opened up their hearts to us to explain the kind of significant difficulties they are encountering in their lives, often on a daily basis, with children, with loved ones in their families, and for many themselves who are coping with severe conditions. I thank them for doing that. It is not easy to come forward and talk about one's own personal circumstances like that. Certainly, their efforts have contributed significantly to bringing this to the point tonight where it is becoming a real political issue that demands early response and that is a good development.

While there have been many significant advances in modern medicine, there are still several conditions which are not eased by available medications. When efforts have been made to try to access cannabis-based medication, and when people have gone to all kinds of lengths to get those for their loved ones, they have found that such medication brings very significant relief. Whether these are various chronic conditions, whether it is people suffering from cancer and the side effects of cancer treatment or people in chronic pain with seizures, with spasms or with severe anxiety, these and others are situations and conditions where people have found relief from cannabis-based medications. There is a consensus here that we now need to move forward.

Clearly, the question of quality control and safety has to be paramount. The State cannot lightly give the go-ahead to a medication and there has to be proper rigour in terms of ensuring quality control and safety.

As well as licensing these medications, they must also be reimbursed.

Four years ago, when I was Minister of State at the Department of Health, I started the process to introduce Sativex. While that medication is legal now, it is not reimbursible. That is one of the problems. It is a legal drug, but people must pay for it directly. It is important that we get to a point where the Health Products Regulatory Authority, HPRA, can give the go-ahead, so those products can become reimbursible.

I welcome the fact that we are focused on this matter tonight and that there will not be a vote on it. If there had been a vote on it and the measure was defeated, one can be sure that this would not be a live issue but would be buried again. The fact that it appears the legislation will pass Second Stage means that a clear focus will be kept on it. In addition, all of us will take on the responsibility of ensuring that the Minister keeps to the timeframe he outlined.

First, I commend Deputy Gino Kenny on bringing this Bill forward. It gives each of us a great opportunity. I have listened to the speakers and, despite what people think, we are human beings, we have feelings and we take matters on board. We are well aware of what is happening outside the House. This is a clean and fair debate. When Deputy Harty spoke earlier I looked at the opening line of my remarks. It states simply that the policy of a Government should be to do the most good while doing the least harm. We can tweak things but once the legislation passes this Stage there will be genuine consensus to do the right thing.

There has been a wide range of debate both here and across the world in recent years on cannabis. There is a great variance of opinions. In this case, however, there is little room for debate. The evidence is quite clear that in some cases cannabis can and should be prescribed to relieve debilitating symptoms of life limiting conditions. Medicinal cannabis use, where deemed appropriate by a doctor and his or her patient, can have a profoundly positive effect, with no more severe potential for harm than that posed by any prescription drug currently available. I am not a scientist or a doctor but I have read many of the conclusions and I have spoken to many people about this. It is clear that we must move this issue forward to the next phase. We are talking about Sativex spray and CBD oil, which contain low-THC, the psychoactive ingredient in recreational cannabis. These medicinal products have been proven to improve the quality of life dramatically for people suffering from conditions such as MS or Dravet syndrome. In fact, in the case of Dravet syndrome it offers the potential to be life saving, given the severity and regularity of seizures related to that condition.

I have spoken many times to Vera Twomey about her daughter Ava, who suffers greatly with Dravet syndrome. One must pay tribute to the family and their relations. Perhaps Vera might consider running for President some day. One never knows. I am a parent, and parents take solace from people as well. It makes me angry and distraught at times to consider the position Vera is in at present. If it was me in the same position, I would do the same thing. I would fight to the bitter end for my child. That is what parents do. No parent should have to beg for his or her child's life. In 2016, are we at a stage where parents must come here and beg for their child's life? That is very hard.

We must do the right thing. We have a fantastic and amazing opportunity to improve the lives of many people on this island dramatically, including little Ava's. All of us have a responsibility to do this and I hope we will take it. For that reason I and Sinn Féin support this Bill.

I thank Deputy Gino Kenny for bringing this Bill forward. It is an important step along the road to improving the health care and lives of many of our citizens. I believe the Bill is very well intentioned. Elements of the Bill have my full support, particularly the parts relating to the provision of medicinal cannabis for the treatment of people and to alleviate the pain they are suffering. Obviously, I have concerns about certain elements of the Bill and the introduction of a medicinal product to the wider market, perhaps circumventing some of the regulatory processes which I, as a pharmacist, hold dear. However, we are lucky to have the HPRA. Its role is to ensure that products are safe, effective and of appropriate quality based on clinical and scientific data. I always believe that we must take an evidence-based approach.

However, there are people who are needlessly suffering and children who are having dozens of seizures daily. I met with Ava's mother, Vera. When she attended the briefing in the AV room and when she appeared before the health committee I thought of how brave she was and of how somebody who had that in their daily lives would travel up to see us and tell us her story. However, sitting at home last night thinking about it, I thought, "Well, maybe it was a break for her". Her daily life must be exceptionally challenging. I cannot imagine what it is like to have that on one's plate every day.

I acknowledge the points made by Deputies about the side effects of heavy-duty prescription items that are used in the treatment of epilepsy. The side effect profiles of any drugs that have neurological effects will obviously be fairly hefty, but there is a balance. Anything we do regarding this Bill should be directed towards harm reduction, improving people's quality of life and treating people in a humane and holistic manner. If families have a member who is suffering, it is very important for them to see that their offspring or loved one has a good quality of life in so far as possible. I understand the HPRA has been asked by the Minister to provide him with all the data and that this is being fast-tracked. We might have a report on this perhaps by the end of January.

I am not sure how I will vote on this measure yet. I find it difficult to balance the circumventing and I understand the limitations of the Bill. I might choose to abstain. However, I am supportive of the principle involved. I am a member of the health committee and we have discussed this matter previously. We will debate it again and we will make it work. We will fix it. It is clear that, as Deputy Fitzmaurice said, we have thrown the ball into the air, so let us use the organs of this House to try to improve people's lives.

It is important to note for anybody outside the House who might be confused that we are not trying to legalise recreational drugs. I do not believe that Deputy Gino Kenny is trying to use this as a Trojan horse. However, I must support Deputy Harty's comments and concerns to some extent. I have had many dealings with Deputy Harty during my time in the House and he is a kind man and is committed to medicine. I fully understand his issues with the Bill, but I ask him not to hinder its progress. I assure him that I will work with him on the health committee to bring this, hopefully, to a positive conclusion. It is clear that we can all work together to come to an appropriate conclusion. Obviously, I have issues with elements such as another regulator, although I realise Deputy Gino Kenny has no intention of introducing another quango or the like.

We can all work together to make this happen in a safe and appropriate manner.

I support Deputy Gino Kenny's Bill. I will work to the best of my ability to make this product and its derivatives available to people who require it. We will do our best to do what we were elected here to do, to be Teachtaí Dála and messengers of the people who have come and spoken to us. We will try to do our best for the people of this country.

I am not on a member of the health committee, I am more involved on the mental health side. I was at the briefing in the Audio Visual Room when Ms Vera Twomey made a presentation to us. I could not be but be moved by her presentation and on seeing the anguish and the pain written all over her face in speaking about caring for her daughter who suffers from Dravet syndrome. I did not know much about her condition. The impact of it was compounded last Monday when a constituent from my parish visited my clinic, with her three year old daughter who also has Dravet syndrome, to speak to me about this Bill. She presented me with the detail of what she has gone through during the past three years. It impacted on me even more to meet the three year old girl who has the condition. Her mother explained the cocktail of medications her daughter is on and the side effects of those. Anything we could do to alleviate pain and give these people a quality of life must be supported and we must assist them in any way we can. I am speaking here tonight on behalf of that constituent from my parish and her daughter who I did not realise had that condition. It was a huge learning curve to hear about it.

I acknowledge Deputy Gino Kenny's work on the Bill. I have spoken to him about it since I spoke to that constituent. I take on board his sentiments that some of the challenges around the fringes of the Bill need to be addressed and they can be addressed on Committee and Report Stages. The ethos of this Bill is to improve the quality of life of these people. Therefore, I will not stand in the way of its passage. I will work constructively on it. It is a breath of fresh air that no political footballs are being bandied about here tonight and that we are having a constructive debate with constructive solutions. It has happened in other debates around mental health. It is very much welcomed. As a new Deputy, I want to see more of that and that we would work constructively together. We will not agree on everything. Members come from different political ideological backgrounds but it is very welcome when we can reach consensus on measures such as this and bring forward solutions rather than problems.

This Bill is about three words, families, compassion and hope. It is about families on a daily basis who have to comfort their loved ones who, because of a serious illness, live a nightmare on a 24-7 basis. Sometimes politicians are not seen as being compassionate or having compassion in abundance. However, a new pathway, the new politics we all hear a great deal about from all sides, has been ignited.

Having listened carefully to all the speakers, I thank all of them for their valuable contributions to the debate on this important issue. In particular, I thank Deputy Gino Kenny and other speakers, including Deputy Harty who may not share the same view on this issue that we have. I have great respect for him and some of the issues he raised are also very important.

People care very deeply about this issue and I understand the concern of many people who believe that cannabis should be a treatment option for certain medical conditions. The Government has decided to urgently review policy on medicinal cannabis. The Health Products Regulatory Authority, HPRA, has been requested to report by the end of January This review will provide us with expert advice and recommendations on how medicinal cannabis can be regulated in Ireland.

While the Members might think that a lot of research has been carried out on the use of medicinal cannabis, much of the evidence is anecdotal and not the type of clinical research that is normally required to authorise a medicine. There is still a good deal that is not known about the side effects of cannabis and about its interactions with other medicines that patients may already be taking. It is vital, therefore, that we appropriately weigh up the potential risks against the potential benefits in order to build a solid evidence base to support the safety and effectiveness of the use of medicinal cannabis by patients, many of whom may already be very ill.

It is important to understand that we are talking only about medicinal cannabis. The issue of recreational cannabis is a completely different issue. As the Minister of State with responsibility for the national drugs strategy, I am conscious that cannabis is the most widely abused illegal drug in Ireland.

I understand this Bill is intended to make medicinal cannabis available on prescription to patients. Like the Minister, Deputy Harris, and other Deputies, I have concerns about aspects of the Bill, in particular the amendments which would have removed cannabis from the Misuse of Drugs Act and legalised possession for person use. I understand that this was not the intention of Deputy Gino Kenny and that there is a willingness to amend this element of the Bill on Committee Stage.

Like the Minister, I do not see the need to establish two agencies. I believe the HPRA already has extensive experience in regulating health products in this country and we will stick with products that it regulates.

Despite concerns about the Bill, we share a common desire to progress it. As the Minister, Deputy Harris, has said, we will not oppose it. We look forward to receiving the HPRA report on medicinal cannabis early in January 2017. At that stage, we can consider what changes we might need to make to legislation to have the safest and best outcomes for patients. I again thank all Members who spoke on this important topic.

We will now have the concluding remarks and ten minutes remain. I call Deputy Bríd Smith who has not spoken already to be followed by the proposer of the Bill, Deputy Gino Kenny.

I recommend that all Members read the executive summary of the Barnes report from the United Kingdom. I have it here, and it is very interesting. Rather than go through the list of the evidence that it found where cannabis offers potential alleviation from a plethora of medical problems and psychotic problems, I have asked Deputy Gino Kenny to put this executive summary up on his website. I ask Members to check it out.

It has been interesting over recent weeks to see the response in the House to this Bill. At this stage, Deputy Gino Kenny probably knows more Deputies than any other Deputy because everywhere we go, and I go for lunch with him frequently, I hear, "Gino, can I have a word with you?". All the Deputies stop him to congratulate him and are excited that we are getting to a point where an issue that we are all interested in, have common ground on and that will do a lot of good for people in all of our constituencies is before the House.

Although Deputy Harty is the only dissenting voice here tonight he has been very honest in expressing his concerns. The Minister stated in his opening remarks that there are many doctors who would be cautious about this measure. That is the case, and Deputy Harty is one of them. Deputy Kate O'Connell expressed some caution as a pharmacist. There will be that concern but there are also many doctors and other medical people who are quite excited about the potential of this measure.

I want to address the concerns about gateway drugs. The argument has always been used if we allow a small amount of cannabis to be legal in society, we are telling people to go ahead and get stoned, have a great time and not to worry about it, and that it will be legal in no time. However, in this instance we have to be careful about framing it in that way because it is very clear from the Bill that this is not about a Trojan horse or a gateway drug to the legalisation of cannabis.

When I was young I smoked cannabis, and I still do occasionally, but I was never addicted to it. However, what I got addicted to, which could have killed me and it killed my father, was tobacco. Tobacco kills hundreds of people in this country every week. When we look at the problem of illegal drugs we see the products that have always been illegal that one gets high on but then there are the legal ones like tobacco and alcohol, which are advertised and promoted, although tobacco is no longer advertised, with which society does not seem to have a problem.

The biggest gateway drug for people who smoke cannabis is tobacco and it is one of the biggest killers. Deputy Harty referred to the provision relating to smoking in the workplace. That was inserted because it is not recommended that people who take cannabis for medicinal purposes should smoke it but if some patients do, we have to guard against passive smoking, particularly in workplaces. The same applies to vaping as a method of taking cannabis.

The Barnes report describes how "the human brain and other organs contain naturally occurring cannabinoid receptors as well as chemicals that bind to those receptors". These have "a range of important natural functions, including modulation of pain, control of movement, protection of nerve cells and a role in natural brain adaptability (plasticity), as well as a role in various metabolic, immune and inflammatory processes" and they are in us naturally. THC and CBD mimic, exaggerate and help to stimulate the effects of the human system. That is why they alleviate spasmodic episodes, pain and nervousness to help people relax, etc. Medicinal cannabis is an efficient drug. It can help alleviate a long list of complaints and ailments and big pharma worries about this. George from Ballyfermot is in the Visitors Gallery and is dying to get his hands on this for his granddaughter, Ellie, who also suffers from severe fits just like Ava Twomey. If the legislation was passed, within a matter of months, we would be able to dispense with many more poisonous and harmful drugs such as opiates, benzodiazepines and other chemicals we constantly have to put into our bodies to relieve the symptoms of cancer, fits and so on. I have a friend whose husband is also in the Visitors Gallery. She has been having cannabis treatment over the past few months to alleviate the effects of radiotherapy on her body. It is remarkable to see the difference in a matter of weeks in respect of the relief she is getting and the change in her body, which means she can sleep and eat better.

This is a big issue in working class areas. We have held public meetings and campaigned on this in our constituencies. People in working class areas are aware of medicinal cannabis and they have been researching it on the Internet. I acknowledge that is not sufficient for us to pass legislation, hence the Bill and the question of us going through the proper process in the House. Nevertheless, this will be an amazing breakthrough for us if we can get the legislation through. It should not only be about the tough cases; it should be about multiple sufferers of cancer, MS and Parkinson's disease. Many people could benefit.

When I was a young one, I was big into reggae. Peter Tosh on his album, "Legalise It", sang that cannabis was a cure for glaucoma and that has always stuck in my head. All he talked about was glaucoma. If THC and CBD were part of a medicinal treatment, there is a long list of diseases they could alleviate for humanity. The end game for us is to create a better and more pain-free society for everybody and this is a small contribution on that road. I congratulate Deputy Gino Kenny and I congratulate everybody in the Visitors Gallery for coming in and for sticking with us. They should not go away because we have not got the Bill through yet.

It has been a healthy debate and I have taken everybody's view on board. It has been quite an emotional and hard week for me but not as hard as some people's circumstances. I can see people in the Gallery whom I have gotten to know over the past few months and I consider the likes of Ava, Paul, Colette, Mark and a few others whose names I forget to be my friends. It has been a fantastic five or six months, even though I have heard about the hard circumstances of their lives. There has almost been a reawakening of goodness to want to help people.

I accept the bona fides of every Member. I disagree with much of what the Minister says but he is genuine on this issue. I disagree with Deputy Harty and I am slightly disappointed by some of his comments. It is his own opinion. I respect him but I am disappointed.

Many provisions in the Bill could be amended, including those relating to the research institute and the cannabis authority. That was intentional because I am new to this game. The last thing I want to do is set up another quango.

I would not be called Gino Kenny then; I would be called Quango Kenny.

It has been a healthy debate. There is no going back, just like Vera Twomey's walk. When she first suggested it to me, I thought, "Oh God, what is she doing?", but it did awaken people and it did awaken the Minister and he acted. It is up to the House now to act for the benefit of many people. It is a healthy day for democracy in Ireland that we can agree on something very valuable to many valuable people.

Question put and agreed to.