On Monday The Irish Times published a letter by 20 prominent doctors claiming Ireland was "sleepwalking" into the legalisation of cannabis on the back of a "one-sided debate" on recreational and medicinal forms of the drug.
Cannabis, associated with increased risk of development of severe mental disorders particularly psychosis, is now the most common drug involved in new treatment episodes at addiction services nationally, they pointed out.
The letter sparked debate on the issue, and highlighted the imminence of change in Government policy. An access scheme for medical cannabis is set to be introduced over the summer, while the Cabinet is likely to consider proposals next month to decriminalise the possession of a small amount of cannabis for personal use.
Here are some voices in the debate.
THE PATIENT
Brian Kelly is the father of Lucia, who is five, and takes cannabis oil to control her epileptic seizures
Next month Brian Kelly will fly again to the Netherlands to buy a consignment of cannabis oil for his daughter Lucia (5), who has epilepsy, and for other families and their children.
Lucia was diagnosed with Dravet’s syndrome, a rare and drug-resistant form of the condition, at nine months, and began taking cannabis-containing products at the age of two.
These have dramatically cut the length of her seizures, from up to 45 minutes to five or six minutes, as well as improving her cognitive abilities and reducing hospitalisations. “She was non-verbal when she started on the oil. Now we can’t keep her quiet.”
While about 16 other families have secured licences from the Department of Health to import cannabis product to treat their children, Kelly has not needed one as the oil used by Lucia contains CBD alone and no THC, which is the psychoactive constituent of the plant.
He still has to travel abroad, however, as the product sold in Ireland cannot guarantee the levels of CBD. Lucia’s seizures can be life-threatening, so even small dose changes could have drastic consequences.
I have no interest in recreational use of cannabis. People are using hard cases to further an agenda which is slowing progress for our medical campaign
Kelly admits to being confused about which side to support in the wider debate about cannabis. His experience has shown a licence is not needed to import the product, but cost – about €12,000 a year – is a major impediment.
The family cannot afford to increase her dose, he says, and efforts to secure reimbursement from the HSE have so far come to nothing.
“We’re caught between two stools; we have the support of a HSE doctor who is prescribing her the product, and we have measured results showing it is working. Yet access to it is only abroad, which makes it difficult and expensive to obtain.”
He says he is in contact with a handful of other families in the same position, some with older children who need a bigger – and more expensive – dose.
“I only want to focus on the medical campaign for the specific conditions that are laid down. I have no interest in recreational use of cannabis. People are using hard cases to further an agenda which is slowing progress for our medical campaign.”
THE ADDICTION SPECIALIST
Pauline McKeown is chief executive of Coolmine drug and alcohol treatment centre, in north Dublin
Cannabis is currently the main drug involved in 10 per cent of admissions to Coolmine’s services, according to chief executive Pauline McKeown. “There’s been a slight but incremental increase over the last few years. Young people have always abused cannabis, but the potency has increased, resulting in wellbeing issues quicker.”
Some teenagers use it to regulate their mental health and to deal with the stresses and strains of modern life, she says. Eight out of 10 schools in Dublin 15 have reported its use on their grounds.
“Cannabis is being used as a tool for a period of time, like an anti-depressant. It’s a rite of passage for most people. They move on as the situation changes.
“On occasions, though, there are environmental factors – homelessness in the family, say, or severe deprivation – and the resilience others have is missing.”
Cannabis use doesn’t always prove to be detrimental and problematic, she says, thanks to these resilience factors such as environment or family structures.
“So not all adolescents who use cannabis will have a problem and become dependent. But a proportion will, and at the moment we don’t have the healthcare supports to prevent that.”
She sees cannabis at “the start of the gateway” to more problematic drugs such as heroin and crack cocaine. Along with alcohol, it enjoys greater social acceptance.
The strains of cannabis now in use “tend to cause more psychosis, so when people stop using it they can get very paranoid and agitated. And that can result in aggression or attempts on their own life. That wouldn’t be unusual for all drugs”.
McKeown is not enthusiastic about legalisation, but she says decriminalisation of small amounts of cannabis for personal use would make the lives of her clients easier.
“They would not have a list as long as your arm of possession changes that prevent them getting a job in the future. They would get healthcare intervention as opposed to court intervention.”
Under decriminalisation the sanction would require diversion to a drug treatment centre for assessment and care.
Such a system would make little sense if the resources are not in place to handle demand. The waiting list to go on Coolmine’s women’s treatment course has doubled to 64 in the space of a year.
McKeown says resources need to be pumped into treatment and prevention if any new system is to work.
“It’s about giving them the tools and resources to change behaviour so they don’t rely on cannabis anymore, because they’re engaged again in society, they have employment and somewhere to live, and their children are back in their lives.”
She says 70 per cent of Coolmine’s clients are drug-free two years after completing their course. The cost of treating men is €13,500 a year, and of mothers and children €23,000. Yet this is cheaper than the average €67,000 a year price of a prison place.
THE PRO-LEGALISATION GP
Garrett McGovern is a general practitioner and addiction specialist
“Sometimes I believe I’m the only person who thinks the way I do,” says Garrett McGovern, a trained GP and addiction specialist who is unabashedly pro-cannabis legalisation, “but more and more people say privately ‘I agree with you but can’t say it’.”
Despite being a minority in his profession, McGovern asserts that “all the heavyweight articles written on this” reject the claim that cannabis is a gateway drug, and support harm reduction measures over criminalisation.
Working in Dublin’s south side and south inner-city, he says he has not noticed any huge increase in the number of patients requiring treatment for cannabis.
Medicinal cannabis seems to be very safe, safer than a lot of what I prescribe. People are using it where conventional medicine has failed. In that case, why not?
“What I do see is that cannabis is among other issues in their lives; they’re usually depressed, or have personal or family problems. People rarely wake up one morning and become dependent on anything. They don’t set out to be addicted.”
He says Potency has increased but so has quality, as many people are growing their own product.
McGovern says he is strongly in favour of legalisation and taxation of cannabis. “The economy could do with it for a start. We’re spending millions policing it.”
Claims about increased potency and more patients requiring treatment are actually arguments for regulating the drug properly through legalisation, he says.
McGovern doesn’t believe cannabis will be legalised in his lifetime, and is sceptical about proposals to decriminalise the drugs by sending small users for health supports instead of court sanctions.
“I’m not in favour of making money out of people who don’t have a problem with cannabis. I don’t think you need to be seen by a doctor just because you’ve taken cannabis.”
The issues surrounding medicinal cannabis and recreational cannabis are “chalk and cheese”, he says, and there is no “backdoor” from one to the other.
“Medicinal cannabis seems to be very safe, safer than a lot of what I prescribe. I admit the evidence isn’t great, but people are using it where conventional medicine has failed. In that case, why not?”
“If my child developed a problem I wouldn’t want him to be in an illegal market,” the father-of-three says. “I’ve seen the impact of people owing money. I wouldn’t like to be dealing with drug dealers; I’d prefer to be dealing with a retailer.”
THE RECOVERED ADDICT
Bernard West, who is 42, is a recovered addict
Drug-wise Dubliner Bernard West has done it all – alcohol, cannabis, heroin, cocaine, crack cocaine. Failed attempts at recovery. Robbery, prison. Homelessness. Recovery.
Notwithstanding the breadth of his drug experiences, cannabis occupies a place of special notoriety for him. After drinking, which started at age eight, it served as a gateway to all the other drugs, he says.
“Smoking the weed, it left me in a bad place. It brought my mental health into a state where I wanted to die, I couldn’t wait to die. What it did to my mind, it destroyed me.”
He says he has tried to take his own life. “I was depressed, paranoid over my relationship, didn’t feel I was part of anything. The mindset was gone.”
Twice he weaned himself off hard drugs and stayed clean, but relapsed after smoking cannabis served as a gateway to heroin.
From Dublin’s inner city, West came from a dysfunctional background involving drug abuse. “My brother smoked a lot, and I looked up to him. I’d bring him seeds home from Amsterdam, and he’d grow his own plants.”
His brother killed himself, says West.
Today he sees the cycle repeat itself as people from his community head to Barcelona to source “the better strain”.
“I’ve seen people so bubbly, and what the marijuana today does to them; it destroys them. I’ve seen a big increase over time, girls and mothers [using] now. It’s not even the tablets or heroin; it’s the weed, and it’s destroying them.
“They’re doing anything for it. What people did for heroin in the 1980s and early 1990s, they’re doing now for cannabis.”
He describes the rise of more potent forms of cannabis as an epidemic: “It has destroyed the whole community down there. What heroin did before, the strain of marijuana around now is doing the same. It’s after destroying the area.”
He predicts that were cannabis to be legalised, the drug dealers running marijuana clubs abroad would be quick to set up similar clubs in Ireland.
At 42, he is drug-free again, and has a roof over his head.
THE ANTI-LEGALISATION GP
Ray Walley, general practitioner in north Dublin
It was Ray Walley’s idea to bring together a group of doctors to express their shared concerns about the debate on cannabis in Ireland. Having garnered support from medical colleagues, he wrote a letter to The Irish Times, signed by 20 GPs, psychiatrists and neurologists, which was published last Monday to explosive effect.
Walley, a father of young children, says the impetus came from a recent discussion he had with a group of young people about the drug. “They all had a favourable view of cannabis. They told me the only place they see anything about it is the business section. They weren’t hearing anything negative. They put it up to me to do something really.”
From his own work as a GP in Dublin’s north inner city, Walley had developed a very different view of cannabis. “In my practice you see patients on cannabis linked to suicide, seizures, wasted lives, psychosis.”
Walley considers himself liberal and open-minded on most issues. He is a methadone provider, and deals with addictions issues “every day of the week at the coalface”.
The doctors in the Cannabis Risk Alliance are advocating in their spare time and have no outside funding. “We’re not a bunch of do-gooders. What we are horrified by is the potential for ill-effects if this is legalised.”
Walley has researched the issue and carries around a sheaf of press clippings. He quotes a UK study pointing to a five-fold increase in psychosis among users, Canadian research suggest a 327 per cent increase in suicides, the use of cannabis in ice-cream and food products, the tobacco industry’s move into cannabis.
A frequent comparison made by Walley and other anti-liberalisation advocates is with the thalidomide scandal in the 1960s. Cannabis is “something that hasn’t been researched, and hasn’t been subject to the same assurance of patient safety that you have for other projects”.
He is accepting of a limited access scheme for medicinal cannabis – “if there is something it’s very narrow” – but insists it must be consultant-led rather than something farmed out to GPs.
“This is a bit like the anti-vaxx debate. The problem is that scientific evidence has been replaced by anecdote and ideology. All of this should be based on public health policy and safety, and it’s not.”
Walley sees decriminalisation as a slippery slope leading to legalisation, citing the experience of Canada which moved to full liberalisation over a 15-year period. Doctors in the UK and Canada “sat back” while the debate was “hijacked by pseudo-science” but the point of the Cannabis Risk Alliance is to ensure this doesn’t happen here.
“We expect to be vilified for this. But at the end of the day we have children, we work with this, we’re at the coalface. We’re willing to speak up because we’re not willing to have people say ‘I told you so’.”
