Cannabis will soon be made legally available for the first time in Ireland. Who is it aimed at and how will it work?
When will it be available?
In 2012 the Irish Medicines Board approved the cannabidiol drug Sativex for use on prescription. The drug is used for the treatment of multiple sclerosis (MS), which is a progressive, degenerative neurological condition that affects the motor, sensory and cognitive functioning of the body.
It was approved in Canada in 2005, and is currently available for this purpose in a host of countries, including throughout the UK.
However, before GPs in Ireland can start to prescribe the drug, legislation is needed. According to the Department of Health, the matter is being progressed "as quickly as possible". It previously indicated it had hoped to bring forward legislative proposals in "mid-2013".
Minister of State at the Department of Health Alex White recently added his perspective, saying the Government was at "quite an advanced stage in preparing regulations" and that he hoped these would be introduced "in the coming months".
A potential complication in bringing forward the legislation may be the fact that the Department of Justice will also be involved in the process.
Does this mean that cannabis will be legalised?
No, the Government is not considering a Netherlands-type situation.
Under the Misuse of Drugs Act, 1977, the “manufacture, production, preparation, sale, supply, distribution and possession of cannabis or cannabis-based medicinal products are unlawful except for the purposes of research”.
However, as indicated, it will shortly be legal to use it for medical reasons, so the Department of Health has been engaging with experts to identify how best to legally prescribe authorised cannabis-based medicinal products, while maintaining existing controls on cannabis and cannabis substances.
Who will be entitled to use the drug?
The drug is primarily aimed at those with MS, and the Government's current review is aimed at examining how authorised cannabis-based medicinal products for patients' suffering may be legally prescribed by medical practitioners and used by patients for the treatment of MS in Ireland.
There are 8,000-10,000 people with MS in Ireland.
The condition is usually diagnosed between the ages of 20 and 40, with more than twice the number of women as men diagnosed.
There is currently no cure for MS, a common symptom of which is spasticity, which refers to muscle stiffness, cramping and involuntary spasms.
“It’s about being able to carry on with your daily life: to hold a cup of tea; to hold a child if you have children; to type at your computer. All these are very difficult if you have tremors,” says Emma Rogan, policy and information officer with MS Ireland.
Cannabis has been found to help ease the symptoms of spasticity. Indeed at present, some Irish people with MS buy the drug from dealers in order to manage their symptoms, while it is estimated that 10-30 per cent of MS patients in Europe smoke cannabis to ease the pain and other symptoms of the condition.
Will patients smoke the drug?
No. Unlike its recreational use, medical marijuana is typically absorbed into the body in different ways. Sativex, for example, is a peppermint-flavoured mouth spray, which is sprayed under the tongue.
It is, however, possible to take medical marijuana or approved cannabis in different ways, including eating it.
In states such as California in the US, medical marijuana dispensaries have sprung up, offering a wide range of ways to absorb the drug.
One such shop in Harbor City, California, for example, has an extensive menu from which pre-approved customers can buy a range of medicated goodies, including “edibles” such as chocolate fudge brownies, peanut butter, cookies and lollipops.
However, it’s unlikely that we will see something similar in Ireland, as to date only the oral spray has been approved by the Irish Medical Board.
Does cannabis work as a medicine?
Given it is now widely used across the world, there is strong support for the drug, with plenty of studies finding in favour of Sativex.
In May last year, for example, the Canadian Medical Association Journal (CMAJ) published a study which showed that marijuana helps alleviate pain and muscle tightness in patients with MS.
And there is a groundswell of support for its introduction, with a recent survey from the National Advisory Committee on Drugs and Alcohol showing that two-thirds of people surveyed agreed that cannabis use should be permitted for medical reasons.
However, there are some dissenters who argue that the drug is not all it aspires to be. A survey in the December issue of Drug and Therapeutics Bulletin, for example, found that there was no strong evidence to back the use of cannabis extract in the treatment of MS.
Are there side effects?
Given that we hear so much about the damage cannabis can wreak on the body, is it reasonable to expect that there might be similar side effects with Sativex?
While it’s administered as an oral spray, which ensures that the patient’s health will not be harmed by the impact of smoking, the drug nonetheless has other effects, although not everyone taking the drug may experience them.
These include dry mouth, sickness and diarrhoea, as well as “cannabinoid intoxication”, which may leave the patient feeling drunk, disoriented, disassociated and euphoric.
The manufacturer also warns that some people may feel depressed or confused or over-excited; may lose touch with reality; may have difficulties with memory or trouble concentrating; and may feel sleepy or giddy.
In this respect, alcohol is not recommended. The drug may also affect a person’s ability to drive and carry out complicated tasks.
How much will it cost?
In Spain, Sativex sells for €4.40 per day but MS Ireland expects the drug will cost about £175 (€ 200/€ 6.60-€ 13.00 per day) for a two-week/monthly prescription.
