Tuesday, 2 July 2019

Questions (46)

Gino Kenny

Question:

46. Deputy Gino Kenny asked the Minister for Health if other conditions such as chronic pain will be considered for inclusion in the pilot of the commencement of the medical cannabis access programme; and if he will make a statement on the matter. [28227/19]

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Oral answers (6 contributions) (Question to Health)

Will other conditions be included in the medical cannabis access programme?

To break out a bit of harmony after the previous question, I thank Deputy Gino Kenny for his role in advocating for medicinal cannabis. We may not fully agree on the approach to take but I acknowledge the Deputy's sincere commitment on the issue of medicinal cannabis and helping people from a compassionate point of view. I also acknowledge Deputy Micheál Martin's work on this issue. Deputies Gino Kenny, Micheál Martin and I worked for a lengthy period on this issue, which is beyond politics. Other Deputies also worked on it. I was pleased to be able to sign into law legislation underpinning the medical cannabis access programme on 26 June. It is fair to say, as Deputy Kenny acknowledged, that this is a significant milestone and represents the outcome of more than two years of detailed work involving the Health Products Regulatory Authority, HPRA, an expert reference group of clinicians, since it was important to get clinical buy-in, the Health Service Executive and my Department.

With this legislation in place, for the first time in Ireland potential producers and suppliers can apply to the HPRA to have cannabis products assessed for suitability for medical use in this programme. The programme is intended for patients with certain conditions for whom conventional medicines have not worked. This is not the first line of treatment but for people who have tried everything else for these conditions where conventional medicine is not working and their treating consultant believes this to be an appropriate course of action. Once suitable products are available, it will be possible for a medical consultant to prescribe a listed cannabis-based treatment for a patient under his or her care for the following medical conditions where the patient has failed to respond to standard treatments, namely, spasticity associated with multiple sclerosis, intractable nausea and vomiting associated with chemotherapy, and epilepsy. Work on establishing this programme began in March 2017 and follows on from the roadmap laid out by the Health Products Regulatory Authority’s expert report titled, Cannabis for Medical Use - A Scientific Review, published in March 2017.

The HPRA report did not recommend the inclusion of chronic pain in the access programme, but I reassure the Deputy, who has taken a close interest in the development of the programme, that this position will be kept under review and if better clinical evidence becomes available in the future, the inclusion of conditions such as chronic pain can be considered. For patients with conditions such as chronic pain, the ministerial licence route is an option to access medicinal cannabis outside of the programme.

This has been a long journey and the end of that journey last Wednesday, when we finally saw the law being changed and people being given access, was one of the proudest days in my time in the Dáil. I am contacted daily by people who want to see progress on this issue. To be fair to the Minister, he wants to see progress. We probably differ on certain issues but we got there in the end. It has been a brutal, protracted process. An issue that has been raised over the last three years is the omission of chronic pain from the guidelines, especially from the HPRA's scientific report. The efficacy of cannabis for chronic pain has been well researched. It is viable as a substitute for opiate-based medicines. In the five-year pilot project, will other conditions, especially relating to chronic pain, be added to the programme?

My approach to this, which the Deputy and I have discussed on many occasions, is that I have to be led by the views of clinicians. I take that approach because they are the people who have the medical expertise and we need them to buy into the programme. In some countries politicians have pretended to introduce programmes that had no clinical support whatsoever. The success of this programme so far, torturous as it has been, is that there is significant clinical buy-in. Clinicians themselves have quite rightly drawn up the guidelines for it. Other conditions will be kept under review. We have the clinical expert group in place and it can be reconvened from time to time. I want to say to people who are not covered by the three conditions in the medical cannabis access programme that the ministerial licence scheme, under which a consultant may apply to the Minister of the day for access to a product that is not authorised, is still available. I have never refused an application and I do not think any of my predecessors or successors would do so either. If a consultant seeks access to a product, my Department generally recommends acceptance and the application is handled quickly. The consultant or treating doctor has to believe a person needs the treatment. We are happy to keep these matters under review. We have made significant progress in establishing this first programme.

The current licensing system, under which 21 licences have been granted, is cumbersome and is not workable. The majority of the licence-holders cannot be reimbursed. Last week, I raised the cases of two families who have to spend more than €10,000 a year. They have to travel to Holland four times a year to get a prescription. I do not think there is any other drug or substance for which people must leave the State if they wish to bring it in under licence. That is somewhat bizarre.

When Britain changed the law on 1 November, medical cannabis could be prescribed for chronic pain as part of the programme. Under the Danish system, which we are seeking to emulate, neuropathic pain is part of the programme. I know that chronic pain is a broad term.

When one considers that one person in six suffers from chronic pain and 40% of those who suffer do not have any relief whatsoever from opiate-based medicines, because of the crisis in the over-use of opiates, not only in Ireland but across the world, medicinal cannabis should definitely be a viable option for the very many who suffer excruciating chronic pain.

Different countries do slightly different things. If my memory serves me correctly, the Danish programme referenced by Deputy Gino Kenny does not include children and our programme does. Different countries are trying different things because we are at a very early stage in terms of continuing to assess the medical evidence. I approach the issue from a very simple point of view; if one is sick and in pain and nothing else will work and a doctor believes medicinal cannabis will help, I want - as we all do - to be able to respond compassionately, but I must move with the clinical community, with the evidence and with the regulator as well. We have made good progress.

I wish to pursue the points the Deputy made about reimbursement and travel because I think we can make progress on both of those. With the changes I made to the law last Wednesday, it may be possible to now start stocking some of those products in pharmacies for patients who are authorised, which might reduce the need to travel. We have made some progress on the reimbursement, but I think we can do more. For people who are on the cannabis access programme, the cost of the cannabis product will be met by the HSE. If one has a medical card, one will just pay the prescription charge and if one is on the drug payment scheme it will be the same as any other trip to the pharmacy as well. I am happy to continue to interact with Deputy Gino Kenny for patients who need cannabis for a medical reason to lessen their pain after everything else has been tried. We can keep these things under review.