There was great joy in the Dáil last Thursday with the passing of the People Before Profit Cannabis for Medicinal Use Regulation Bill 2016 through its second stage. The Dáil gallery was overflowing with people who use medicinal cannabis, parents with children using medicinal cannabis and their friends, family and supporters.
The international movement to improve access to safe, quality-controlled medicinal cannabis, most notably in the United States, has shown strong support from both the scientific and political realms. A good example of this confluence is the Barnes Report published in May this year. Dr Mike Barnes is a professor of neurology with Newcastle University, who, with his daughter Dr Jennifer Barnes, a clinical psychologist with the NHS, was commissioned by an all-party parliamentary group on drug policy reform in the UK to report on the scientific evidence for the effectiveness and safety of cannabis as a medicine.
To do this they carried out a systematic review, with strict criteria similar to the respected Cochrane reviews which are now out of date for cannabis, and listing the evidence in terms of "good", "moderate", "limited" and "theoretical". The "good" evidence covers such common ailments as chronic pain and anxiety as well as muscle spasms, nausea and vomiting, but the report also notes that: "Overall, we conclude there is considerable literature demonstrating the efficacy of cannabis and/or available cannabis products in a number of important indications."
Moralistic view
The all-party parliamentary group, representing the diversity of political parties in the UK parliament, co-chaired by Baroness Meacher, an independent from the House of Lords, and Caroline Lucas, a Green Party MP from the House of Commons, accepted the report in full, noting:
"At the UN General Assembly Special Session held in April 2016, we witnessed both the USA and the UN leadership reject a moralistic and prohibitionist approach to the global drug problem. Instead, the UN and US leaders called for all our proposed changes to global drugs policy. As far as the UK is concerned, it seems clear that the legalisation of cannabis for medical use fulfils the above objectives. There is now a sound evidence base for such a policy. Legalisation and licensing will promote the health and welfare of very sick people and the policy respects human rights and public health values."
The basis for approving the use of medicines in Ireland is that: the benefits of using a health product should always outweigh the potential risks. One positive effect of the wave of legalisation across the world is the increase in quality research on the risks and benefits of cannabis-based medicines. While the research base for some types of epilepsy is still "limited", consultant neurologist and epilepsy specialist Dr Colin Doherty summed up current knowledge about cannabis's role in epilepsy treatment at a recent Dáil committee: "Already, it is possible to state with confidence that this drug will not work for everyone, will cause intolerable, but probably not dangerous, side-effects in a few; but for those for whom it will work, it may be lifesaving."
No lethal dose
There are obvious areas for monitoring and further research, such as the link with mental health complications such as drug dependency and psychosis, and caution will be required in populations at risk. Fortunately risk/benefit analysis in individual cases is exactly what doctors do every day for every other medication. Legal protection and funded research provided for in the People Before Profit Bill should also mean an improvement in the quality of information available to both doctors and patients on these risks and benefits.
Cannabis as a medicine has the uncommon property of having no lethal dose which means that it has never killed any patient, ever. There is a huge advantage in this, such as substituting cannabis for more dangerous drugs in terms of dependency and death, such as opioid painkillers and benzodiazepine sedatives. The benefit of fewer side-effects and overdoses is already being seen in countries which improve access to medicinal cannabis.
We are very grateful to the patients and parents who have supported the campaign for safe access to medicinal cannabis. We look forward to passing the Bill through its final stages with any necessary amendments to ensure that medicinal cannabis is available to those who would benefit from it where those benefits outweigh the risks.
Gino Kenny is TD for Dublin Midwest. Dr Peadar O'Grady is People Before Profit health policy adviser and a consultant child psychiatrist