FAQ

What is cannabis? Cannabis is a flowering plant with fibrous stalks. The leaves, flowers, and roots have been used for medicinal purposes.
On the mature plant, the leaves and flowers are covered with trichomes - tiny glands of resinous oil containing cannabinoids and terpenes that, when consumed, can provide physical and psychoactive effects.

This describes a situation where a medical consultant prescribes the use of an acceptable cannabis-based product for treatment of a specified medical condition in a patient under his, or her care.
Dried cannabis plant material, for example, dried flowers, or products that have been manufactured from components, known as cannabinoids, extracted from the cannabis plant can be used as medical treatments.
Oils may also be manufactured using extracts from the cannabis plant.

Cannabinoids are the chemical compounds secreted by cannabis flowers. There are also compounds called terpenes – chemical compounds that give cannabis its unique aroma.
The concentrations and combinations of the cannabinoids and terpenes vary from plant to plant and among the different strains of cannabis.
When inhaled, consumed as an edible, or used on the skin as a topical preparation, the cannabinoids bind to cannabinoid docking sites or receptors in the human body and alter nerve transmission in the brain.

The two major cannabinoids in cannabis that have been studied are:

THC (tetrahydrocannabinol, also known as delta-9-tetrahydrocannabinol), is thought to be the most psychoactive substance (i.e., a substance that changes brain function and alters perception, mood, consciousness or behavior) in cannabis.
The concentration of THC in cannabis varies between 1% and 24%.
Under the Misuse of Drugs legislation, products containing THC are strictly controlled and possession is unlawful, except under Ministerial licence or the MCAP.

CBD (cannabidiol) is the major non-psychoactive cannabinoid found in cannabis. The concentration of CBD in cannabis is typically less than 1%, but many strains have higher CBD concentrations.
CBD is not controlled under the Misuse of Drugs legislation. Products containing only CBD therefore do not require a Ministerial licence for use.

A controlled drug is an illegal drug where the substance, product or preparation is specified in the Schedule of the Misuse of Drugs Act 1977.
The Act has been amended on several occasions by subsequent legislation.
The main objective of the Act is to ensure the availability of controlled drugs for medical and scientific purposes only and to prevent the non-medical use of those drugs.

There are many ways to take medical cannabis. Some of the more common methods of administration are Orally (Oral-mucosal spray, sublingual oil or orally ingested capsules or tablets) or through vaporisation using a medically approved vaporiser/inhaler.
Smoking and oromucosal sprays (administration to the oral mucosa, specifically the oral cavity and/or the pharynx) are not recommended as part of the programme.
Your doctor will discuss the best way to consume medical cannabis for your symptoms.

Vaporisation results in more rapid absorption and high blood levels. Given the rapid onset of action, vaporising cannabis-based products is best for symptoms or conditions where rapid relief is required.
Oils or liquids are more slowly absorbed than products administered by vaporising. Given the slower onset and longer duration, it is expected that taking cannabis-based products via the oral route would be more useful for medical conditions or symptoms where control over longer periods of time is sought — similar to the use of slow release medications.

Medicinal cannabis is not considered to be a ‘first line’ treatment for any health condition. It should only be considered as a treatment if standard approved treatments have not worked effectively.
Before starting any medicine, seek advice from your doctor or pharmacist about how much to take, how to take it and what side effects you need to be aware of.
There are no precise dosing or established dosing schedules for products such as cannabis flowers or oils. Dosing is highly individualised and relies on titration of the product, regardless of the cannabinoid content, using the premise ‘starting low and going slow’.

Not everyone is suitable for medical cannabis treatment like any other medicine. People with active schizophrenia, for example, may not be suitable as well as some people with heart rhythm problems.
There is a possibility of a clinically significant interaction between concomitant medicines and cannabis-based products.
Your doctor will check out whether it is suitable for you before prescribing and monitored carefully for side effects.

The known side effects from medicinal cannabis treatment include, but are not limited to; fatigue and sedation, dizziness, confusion, nausea and vomiting, fever, decreased or increased appetite, dry mouth, and diarrhoea.
Products high in tetrahydrocannabinol (THC) has been associated with feeling ‘high’ or feeling dissatisfied, depression, confusion, hallucinations, paranoid delusions, psychosis, and cognitive distortion (having thoughts that are not true).
Medicinal cannabis side effects are commonly dose-dependent, so it’s important to follow the dosing recommendations. Medicinal cannabis should only used under medical advice because it may interact with other medicines or cause side effects.
For more informtion please look at our Patient Leaflet

Overdose can usually be prevented by preparing a treatment protocol. The risk of a fatal cannabis overdose is small in comparison to the risks of opioid and stimulant drug overdoses.

Although the risk of a fatal cannabis overdose is small, acute exposure to cannabis increases heart rate and blood pressure and there is some evidence that suggests an increased risk of heart attack during acute intoxication.

Adapted from the HPRA's document 'Cannabis for Medical Use - A Scientific Review'

It is a 5 year pilot programme. The purpose of the programme is to facilitate access to acceptable cannabis-based products for medical use that are of a standardised quality and which meet the requirements outlined in the Misuse of Drugs (Prescription and Control of Supply of Cannabis for Medical Use) Regulations 2019.
The Medical Cannabis Access Programme is to provide access for patients with the following medical conditions which have failed to respond to standard treatments:

• spasticity associated with multiple sclerosis;
• intractable nausea and vomiting associated with chemotherapy;
• severe, refractory (treatment-resistant) epilepsy.

It is important to note that a listed cannabis-based product is not an authorised medicine in that it has not undergone the rigorous testing, both in laboratory and clinical trials, and authorisation process required before such medicines can be placed on the open market.
The prescribing and use of a cannabis product for the purposes of the Medical Cannabis Access Programme, is a matter for the patient and their medical consultant.
Where a cannabis product, legally permitted for medical use in connection with the Access Programme is prescribed and used, this does not signify any endorsement whatsoever by the Minister for Health as to the safety, quality or efficacy of the cannabis product for the indication prescribed.

All medical cannabis products which meet the requirements in the legislation will be listed in Schedule 1 to the Misuse of Drugs (Prescription and Control of Supply of Cannabis for Medical Use) Regulations 2019.
The signing of this legislation by the Minister for Health allows for the commencement of the operation of the Access Programme, the first stage of which will be for potential suppliers to apply to have their medical cannabis products assessed for suitability for medical use.
Currently no medical cannabis products are available in Ireland, however, this new secondary legislation now means that commercial operators whose cannabis products meet the specified requirements set out in the legislation will be able to supply these products to the Irish market.
Cannabis products will only be listed in Schedule 1 of the Misuse of Drugs (Prescription and Control of Supply of Cannabis for Medical Use) Regulations once they have been assessed as suitable for medical use under the Medical Cannabis Access Programme.

The MCAP was initiated in March 2017 on foot of the conclusions from the Health Products Regulatory Authority’s (HPRA) report ‘Cannabis for Medical Use – A Scientific Review’, which was prepared at the request of the Minister in 2016.
The review concluded that, in certain cases where all other routes have been exhausted, medical cannabis is an option to treat patients who have been diagnosed with any of the three specified medical conditions.

A registered medical consultant with specialist training in a specified medical condition, as described in the Misuse of Drugs (Prescription and Control of Supply of Cannabis for Medical Use) Regulations 2019.

Cannabis for medical use should only be prescribed once other suitable and appropriate treatments have failed and based on a prescription from your consultant.
You may find it helpful to familiarise yourself with the Clinical Guidelines and further information contained on the Department of Health’s website
You may also discuss this with your general practitioner and your medical consultant.

The Medical Cannabis Access Programme aims to provide access for patients with the following medical conditions which have failed to respond to standard treatments and who have been prescribed cannabis treatment by their medical consultant:
• spasticity associated with multiple sclerosis;
• intractable nausea and vomiting associated with chemotherapy;
• severe, refractory (treatment-resistant) epilepsy.

You should familiarise yourself with the new legislation which sets out the obligations for pharmacists under the operation of the MCAP.
You should also familiarise yourself with the Clinical Guidelines as prepared by the Expert Reference Group.
These are available on the Department of Health Website

A Consultant working in a medical specialty directly related to a specified medical condition, wishing to prescribe cannabis for medical use for a patient under his or her care must register with the HSE in order to access the HSE portal and they must register the patient through this portal.
If registration is approved, then the Consultant can issue a prescription Contact details for the HSE will be added shortly.
You should familiarise yourself with the new legislation which sets out the obligations for prescribers under the operation of the MCAP.
You should also familiarise yourself with the Clinical Guidelines as prepared by the Expert Reference Group. These are available on the Department of Health Website

The pilot programme will be reviewed after 5 years or as scientific evidence comes to light to support the use of cannabis for the effective and safe treatment of other medical conditions.

Depending on the patient, a medical consultant may prescribe medical cannabis for up to 6 months, in line with their legal obligations in respect of the prescribing of controlled drugs.

Enrolment on the MCAP does not automatically mean approval for reimbursement.
Reimbursement of approved cannabis products, supplied through community pharmacies for patients with a qualifying condition, will be on a named patient basis and according to the patient’s eligibility under the community drug schemes overseen by the HSE, with the following conditions:

• treatment is consultant-initiated;
• online reimbursement approval is required for each patient;
• all standard approved treatments have been exhausted for that patient;
• new patients are initiated on Irish pharmacy-supplied medical cannabis products.

There is a possibility of a clinically significant interaction between other prescription or over the counter medicines and health products you may be taking and cannabis-based products.
Please discuss this with your medical practitioner or pharmacist.
You should also read the information leaflet for the cannabis product.

While both the Access Programme and the Ministerial licence route will run in parallel initially, it is possible that many of the patients currently accessing cannabis treatment via the Ministerial licence route might, where that is possible, be enrolled onto the Access Programme by their medical consultant.
This may involve their treating consultant switching their current prescribed cannabis product to a product that can be prescribed under the MCAP.
It may not be possible for all the current Ministerial licence holders to transfer immediately; however, this will be based on a clinical decision between the patient and their prescriber.