Dail Éireann · 2024-05-02
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On a second positive note, since we launched MCAP, which is for the unlicensed medicinal cannabis products, we now have several licensed cannabis products. What I hear back from the clinical community, is that the preference of clinicians, where possible, is to prescribe on the licensed programme because they argue that there is greater clinical evidence from trials, and we are seeing prescriptions under the licensed programme increase, which is very positive.
I think nine medical cannabis products are listed, which is better than it was perhaps 18 months ago, but there is enormous frustration with the restrictions and limitations of the MCAP, under which medication can only be prescribed by a consultant. If MCAP does not expand, I do not see where the programme will go.
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Earlier this year the Health Research Board, HRB, published a very extensive report on the efficacy and safety of the medical cannabis access programme. The programme has been in place since 2019. Could the Minister give me his thoughts on the report and what the Department of Health intends to do next?
I thank the Deputy for his question and acknowledge his ongoing work in this area, both in terms of the MCAP initially and the evolution of the programme. As he will be aware, we launched the medical cannabis access programme in 2021 for three conditions initially: refractory epilepsy, spasticity as a result of MS and nausea from chemotherapy. Since the inception of the programme, 55 separate patients have availed of it - 52 adults and three minors, mainly for spasticity associated with MS. There were 38 patients in that category.
As the Deputy quite rightly said, we have conducted a review now that we have the programme in place to see if there is a clinical case for it to be expanded. It certainly is something that I am very open to. At my request, the HRB was requested to carry out an exercise of initial evidence-gathering, the results of which have been published. The publication is now subject to clinical review. We want to ascertain whether there is sufficient evidence to broaden the scope of the conditions that could be treated under MCAP. I am certainly very open to it. I will be entirely led by the clinicians on the board. As the Deputy will be aware, I allocated significant funding to get the MCAP initiative moving.
On a second positive note, since we launched MCAP, which is for the unlicensed medicinal cannabis products, we now have several licensed cannabis products. What I hear back from the clinical community, is that the preference of clinicians, where possible, is to prescribe on the licensed programme because they argue that there is greater clinical evidence from trials, and we are seeing prescriptions under the licensed programme increase, which is very positive.
The concept of the medical cannabis access programme is a good idea, because the licensed system is very bureaucratic and, in some instances, archaic. Since the inception of MCAP, only 55 people have got access. That is a tiny number of people given that the legislation was introduced in 2019 and the access programme in 2021. The HRB report says there is significant evidence of good efficacy of medical cannabis for neuropathic pain. The programme must expand, otherwise, it will become redundant. If that happens, people will either go to the black market or go without. There is a huge amount of frustration with the limitations of the programme thus far.
I accept the Deputy's position. It is a smaller number of people. We know from the clinicians that in many cases they are nervous about prescribing, even though the MCAP is in place for the unlicensed products. As I said, we will do a clinical review of the HRB findings. I am very open to expanding the programme. We will be led by the clinical view on this.
What is interesting though is that while I take the Deputy's point that there are only 55 patients, which is a low number, we are seeing a much higher number now on licensed cannabis medicine products. For example, as he will be aware, Epidiolex is one of the medicines used for seizures associated with Dravet syndrome and Lennox-Gastaut syndrome, among others. More than 144 patients have been prescribed on that and, therefore, the clinical community would appear to be more engaged with the licensed products.
I understand the appeal of licensed products, but the MCAP was set up for those who have tried every known medication for their condition and they want to be in a position where they could try a number of these other medications. I think nine medical cannabis products are listed, which is better than it was perhaps 18 months ago, but there is enormous frustration with the restrictions and limitations of the MCAP, under which medication can only be prescribed by a consultant. The number of medical professionals in this field is very limited. Another limitation is that it is confined to the three conditions. If MCAP does not expand, I do not see where the programme will go. The Danish medical cannabis access programme has a number of conditions where the evidence for the use of medical cannabis, in particular relating to neuropathic pain, is very good.
I take the Deputy's point. I think that is all very fair. We have now a pathway to address exactly those issues. I will ask my officials to bear all of that in mind. The unit dealing with this will take note of our interaction this morning.
The first question is whether we expand from the three conditions. I am very open to that. Second, what we need to do is engage with the clinical community as well and ask even if we do expand, whether clinicians are still nervous of prescribing under MCAP versus licensed products, and if there is anything we can do there. We could expand the conditions and try to understand if there are other barriers or concerns that clinicians have. I am very open to a clinical recommendation coming back as well on whether we expand beyond consultants. I will certainly be led by the clinical advice coming back. I am very open to all the points the Deputy made.