With the passage through the Dáil of the Cannabis for Medicinal Use Recreation Bill, the Republic has drawn significantly closer to the reality of doctors here legally prescribing the drug.
The State already licenses one cannabis-based medicine – Sativex – for the treatment of multiple sclerosis. However, a doctor may only prescribe cannabis products if granted a licence by the Minister for Health. Similar contradictions exist in the US, where, despite medicinal cannabis being made legal in over 20 states, the federal government still precludes its prescription by doctors.
To obtain marketing approval, the manufacturers of Sativex had to satisfy drug regulators that it improved the symptoms of MS sufferers with moderate to severe muscle spasticity. There is no evidence to suggest its restricted availability has led to greater recreational use.
What does the medical literature say about the effectiveness of medicinal cannabis in various illnesses? While a notably cautious Cochrane group review was somewhat neutral in its conclusion, two 2015 reviews in the Journal of the American Medical Association were less circumspect. One stated that the use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence. The other concluded there was moderate-quality evidence to support the use of cannabis for the treatment of chronic pain and spasticity.
Whether this evidence would be sufficient to elicit a positive response to a licence application from the Health Products Regulatory Authority cannot be prejudged. A decision to proceed is likely to involve tight restrictions on prescribing and ease of access. It would be helpful if, as occurs in Colorado, the licence was accompanied by a specific mandate to research patient experience here.
There is understandable concern that a passage of cannabis legislation will be the thin end of a wedge towards full recreational use of the drug. With suitably restrictive legislation, this is unlikely. The time is right to offer patients and doctors the choice of using medicinal cannabis in line with scientific evidence.