IRELAND now has its first patient through the state-approved Medical Cannabis Access Programme (MCAP) some four years after it was launched – but experts warn the scheme is still unfit for purpose.
The development marks a ‘significant milestone’ in the ongoing campaign, spearheaded by People Before Profit-Solidarity politician Gino Kenny, to improve access to medical cannabis for tens of thousands of patients across the country.
Ryan Gorman, 26, will now be the first patient to receive CannEpil, a high-CBD, low-THC formula manufactured by MGC Pharmaceuticals which was made available in Ireland through MCAP in 2019, before being approved for the Primary Care Reimbursement Service making it free of charge in June 2021.
In what he described as ‘wonderful news’, Ryan’s father and full-time carer, Brendan Gorman told BusinessCann: “For those people out there that have been waiting so anxiously to see when I’m gonna get access to it, finally the day has arrived. It can only be described as wonderful news, and hopefully the benefits will be there for everybody.
Breaking Down The Barriers
“It’s not about being first or being last or in the middle. What is important is that if it becomes accessible, and the barriers are broken down, it’s almost like the Berlin Wall, one goes through then the rest will follow.”
Mr Kenny, who Mr Gorman thanked for ‘breaking the ice’ in terms of bringing medical cannabis into the political limelight, said: “I believe it is a significant milestone in regards to the MCAP and families trying to get access to medicinal cannabis products in Ireland.”
MCAP currently only offers medical cannabis as treatment for three specific conditions including nausea induced by chemotherapy, spasticity associated with multiple sclerosis, and severe forms of epilepsy.
Mr Gorman is one of around 37,000 people in Ireland who suffer from epilepsy, and one of around 800 with intractable epilepsy, meaning it is resistant to current drug treatments.
Under current MCAP rules, only consultants are allowed to prescribe medical cannabis, and the patient must have systematically tried every alternative medication before it is considered.
Mr Gorman said the current products available haven’t worked in ‘terms of reducing the strength of the seizures, and the profile, and the number of seizures’.
Dr Colin Doherty, consultant neurologist at St James’s Hospital, became the first professional to prescribe CannEpil, which has a 20:1 ratio of CBD to THC, only after ‘many, many years of deliberation’.
“He was very much behind the process from day one, but was hesitant about the level of THC, I have to stress that. He possibly feels like I do. There’s no other middle ground here. We have to give it a try.”
Switch From Commercial CBD Products
Numerous Irish medical professionals have spoken out against the use of medical cannabis and particularly THC for the treatment of epilepsy.
Professor Bryan Lynch, a Consultant Paediatric Neurologist in Temple Street Children’s Hospital, told the Oireachtas health committee in September that there was ‘no evidence base’ for benefits to epileptic patients from cannabis products that contain THC.
“For us clinicians looking after patients with epilepsy the evidence base is for pure CBD products,” he said.
Mr Gorman, of Dublin, says he had tried commercially available CBD products with an unknown potency for around a year, but that ‘it didn’t become effective enough that would make any difference’.
Furthermore these products were not included under the access scheme, meaning Mr Gorman was forced to pay thousands out of his own pocket.
“It was something in the region of €80 to €90 per week we were spending on that out of our class. And that went on for a year, which was not reimbursed in any shape, because it wasn’t under the present government scheme.”
A recent review from Imperial College London conducted by Professor David Nutt and PhD candidate Rayyan Zafar found combined CBD and THC-based products to be highly effective in treating patients diagnosed with severe childhood-onset epilepsy.
While the study had a sample size of just 10 participants, it found that carers reported a 97% reduction rate in the frequency of seizures when they received whole plant extract cannabis treatments.
Irish System ‘Built to Fail’
Despite the positive step forward for MCAP, even its strongest proponents remain staunchly skeptical of its framework and its potential as an effective way forward for medical cannabis access.
Mr Kenny said: “The programme is far too restrictive and needs to include other conditions so it can fulfil its potential. I know there continues to be frustration with the torturously slow progress of the programme but hopefully with this news this can be a precedent for further progress.”
Speaking to the Irish Times in August this year, Dr Doherty described MCAP as a ‘farce’, adding that he was receiving ‘frustrated calls everyday from patients telling me the scheme has been launched, but there is nothing on it for them.’
“This is supposed to be the solution, but it can’t, won’t and never will, in its current form, deliver for patients and their families.”
Drug policy specialist Natalie O’Regan explained that MCAP was launched after Vera Twomey, whose daughter also had a rare form of drug-resistant epilepsy, began a 150-mile protest walk from Cork to Dublin in 2016 to try and persuade the government to legalise cannabis for medical purposes.
“She was instrumental in even being able to have an open discussion about medicinal cannabis and not get called a stoner. She brought the conversation to the media, she brought the conversation to everybody’s dinner table.
“She got so much passion and compassion out of people that the government knew that Vera wasn’t just going to shut up about it, and that everybody in Ireland was on her side. So they had to look like they were doing something.”
Five Year MCAP Review Imminent
In May this year, a poll conducted by Red C on Behalf of The Journal found that not only were 93% of respondents in favour of medical cannabis in Ireland, but 39% were in favour of recreational legalisation.
Ms O’Regan believes that MCAP was set up to ‘appease’ growing demand from the population, but ‘now it’s actually up and running they don’t really know what to do with it.’
“They don’t know how to further it. And I don’t think that they have an appetite for it either.”
A five year review of MCAP is understood to be set to take place in the near future, however one of its key flaws according to Ms O’Regan is that no patients are supervised or monitored, leaving ‘no raw data to inform the next steps’.
In order to see real change, she believes products other than CannEpil will need to become available via MCAP, which will require ‘another couple of patients’.
“I think at the moment with the one product, there’s not much availability, so it’s not really much of a cash fight for products. Whereas once the patient base expands, they may want to try different medicinal products that aren’t included under the scheme. I think it’s only then that conversations will start happening about the products that are available.”
She concluded: “Regardless of what may be wrong with the programme, somebody is going to have a better quality life over the decision.”
In a statement to BusinessCann the Irish Health Service Executive (HSE) said: “The HSE is implementing the Medical Cannabis Access Programme (MCAP) system as per instruction from the Department of Health.
“A number of patients have been registered under the programme, however the HSE would not be aware whether the consultant neurologist has proceeded with prescribing for an individual until claims are submitted from pharmacies.”