Monday, May 29, 2023

It’s time to expand the MCAP programme

The Medicinal Access Programme (MCAP), established in 2019, has helped patients who availed of it – now let’s expand it

The Medical Cannabis Access Programme was a welcome step, but still isn’t working for many patients, says a Professor of Palliative Medicine at the National University of Ireland, Galway.

“It’s simply inexplicable that someone working in palliative medicine cannot prescribe cannabis-based medicines to their patients – our patients need these medicines the most,” said Professor Dympna Waldron, speaking to Irish Medical Times.

While patients under the current system can acquire medicinal cannabis products if they suffer from certain conditions – such as MS, chemotherapy-induced nausea, and epilepsy – other patients who might benefit from medicinal cannabis are left without access.

People with terminal cancer, many of whom have ceased chemotherapy, cannot access cannabis-based medicines for their nausea, for example.

“It’s so important that these patients have access to a drug that gives them an appetite – their nausea persists after chemo, yet they can’t keep getting a medicine that helps them, it makes absolutely no sense,” Waldron says.

If a patient is suffering from nausea, they can’t swallow or keep down a tablet. The only medicine that will work is a syringe driver, which is a burden to the patient and a significant cost the healthcare services as this requires a nurse visiting daily to change the driver every 24 hours.

And one of the side effects of the drugs currently available to doctors is Akathisia, which is under-reported in Ireland, says Professor Waldron.

“As medical cannabis is available through vaporisation it ensures the cannabinoids are adequate delivered to the patient and does not have the side effects of Akathisia,” she says. “I want the government to understand the cost benefit and the benefit to patient with less side-effects.”

Waldron, who has decades of experience as a healthcare professional, believes the current version of the MCAP is failing patients across the country.

“When I was a junior doctor in 1985, with Professor Ernest Egan, I was involved in a study in Galway using Nabilone, a synthetic cannabinoid, for nausea of cancer,” she says. “Here we are now, almost four decades later, and I cannot prescribe for my patients.”

There is no reason why the MCAP should not include all patients who have medical conditions which could potentially be treated using medicinal cannabis, Waldron says.

This means including things like PTSD, and those who are in palliative care. It also means expanding the array of products currently available to patients to include those with higher levels of THC.

A restrictive regime
GPs are also unable to prescribe medical cannabis, even if they feel a patient could benefit from it.

A knock-on effect of this is the exclusion of people on low incomes from access to cannabis-based medicines, as they cannot afford costly consultations. Rural people also face difficulty in this regard, as many of them are far away from a specialist consultant who can prescribe cannabis-based medicines.

Some patients have even moved abroad to countries like Spain to get treatment.

This includes people like Alice Maher, who in 2022 told the Irish Examiner that her medical card does cover not the cost of her medication, which a consultant had prescribed for pain relief. Had she stayed in Ireland, her medication would have cost around €1,000 a month, she said.

Richard Creagh, co-founder of Oleo, says the MCAP foundations for helping patients are in place, but far too many patients are still losing out on the benefits of cannabis-based medicines.

“It’s clear that we need to expand the MCAP,” he says. “We hear so many stories of patients who could potentially benefit from this but can’t access it. This also facilitates a black market; patients will sometimes just acquire the drugs illegally.”

In January 2023, Oleo added two new products to the MCAP for the treatment of Spasticity associated with multiple sclerosis. Oleo will continue to add products that allow patients greater choice and access as the programme expands.

“We’re going to keep on with our mission: providing as many high-quality cannabis-based medicines to the Irish market as we possibly can,” he says. “Sooner or later, we hope the government sees the extent to which patients are currently missing out.”

The Irish Cannabis Summit
Oleo also recently sponsored the Irish Cannabis Summit, a one-day event held at the RDS, which was hosted by Niall Neligan, INCBA and Eoin Long from The Cannabis Review.

The event was attended by Industry Leaders from the around the world and it was a day of discussion and strategy concerning Ireland’s potential in the Medical Cannabis Industry, Creagh says.

“We have similar conferences planned this summer in London, Berlin, Mexico, and Las Vegas – we will meet with the best and brightest talent in the global medical cannabis industry,” says Creagh.

“There’s so much potential for us to help patients in Ireland – why are we so afraid to do it?”

When you compare Ireland to the Netherlands where there are over 170,000 cannabis-based flower prescriptions – with a population just over three times that of Ireland – it becomes clear that we’re not using the MCAP as we’ve had just one cannabis-based flower prescription, he says.

“The figures show that we’ve completely underutilised this programme. We really feel like Ireland need to be doing more to understand the benefits of cannabis-based medicines.”

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