Pat Gallagher (Donegal, Fianna Fail)
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So that there is no confusion, let me be very clear in respect of the first speakers. First we will have the chair of the committee, Deputy Michael Harty, then we will have the Minister. With the approval of the House, I will then call on the Deputy responsible for this Bill, Deputy Gino Kenny. Agreed? Agreed. I remind the Deputies that they can share time.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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Those Deputies did not come in for ages. We were in the queue long before them.

Pat Gallagher (Donegal, Fianna Fail)
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I only came into the Chair now.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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We were queuing by the Chair and were told to sit down.

Pat Gallagher (Donegal, Fianna Fail)
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The Deputy knows the practice.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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I do not.

Pat Gallagher (Donegal, Fianna Fail)
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I am here a long time and I know the practice.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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I am not. I have only been here a short time.

Ruth Coppinger (Dublin West, Solidarity)
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The practice is that Deputies stand by the Chair and give their names. That is the normal practice.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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An bhfuil cead agam dul amach go dtí an leithreas?

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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Níl cead ag an Teachta. Suí síos.

Pat Gallagher (Donegal, Fianna Fail)
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There are only ten-minute slots anyway.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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May I make a suggestion on that?

Pat Gallagher (Donegal, Fianna Fail)
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The Deputy may if it is helpful.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The arrangements would only allow for seven slots.

Pat Gallagher (Donegal, Fianna Fail)
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No, the slots are ten minutes each.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The Government and the committee have 50 minutes between them.

Pat Gallagher (Donegal, Fianna Fail)
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They have 15 minutes each. That is 30 minutes.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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They have 30 minutes between them to begin and then a further ten minutes each at the end. That leaves only 70 minutes for the rest of us.

Pat Gallagher (Donegal, Fianna Fail)
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There will only be seven slots if everyone takes ten minutes.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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That is precisely my point. I suggest we change that and make them five-minute slots.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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That should include Government speakers.

Joan Collins (Dublin South Central, Independent)
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Or the ten-minute slots could be shared.

Pat Gallagher (Donegal, Fianna Fail)
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We can do that if we get agreement. Are the Government and the chairman going to take 15 minutes each, as they are entitled to?

Simon Harris (Wicklow, Fine Gael)
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I do not need that much time.

Pat Gallagher (Donegal, Fianna Fail)
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The Minister is being helpful.

Michael Harty (Clare, Independent)
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I will need 15 minutes.

Pat Gallagher (Donegal, Fianna Fail)
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The chairman is taking 15 minutes and the Minister is taking ten.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I will only need five.

Pat Gallagher (Donegal, Fianna Fail)
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Will someone run out and get a few more speakers? We will have too few.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The Leas-Cheann Comhairle need not worry, we will fill the time.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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The Leas-Cheann Comhairle should not forget to take a few women as well.

Ruth Coppinger (Dublin West, Solidarity)
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We need a gender quota or something.

Pat Gallagher (Donegal, Fianna Fail)
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I will not respond to that. In the times we are in, I will not say anything.

Joan Collins (Dublin South Central, Independent)
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Are we being given ten-minute slots?

Pat Gallagher (Donegal, Fianna Fail)
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Let the chairman begin and I will work it out.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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What are we doing?

Pat Gallagher (Donegal, Fianna Fail)
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We will go for five minutes.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Five minutes. And will everybody be allowed speak?

Pat Gallagher (Donegal, Fianna Fail)
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I am trying to let everybody in. Let me work out the list while Deputy Harty begins. There is no point in delaying.

Michael Harty (Clare, Independent)
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I move:

That Dáil Éireann accepts the recommendation of the Joint Committee on Health in its Report entitled 'Report on Scrutiny of the Cannabis for Medicinal Use Regulation Bill 2016 [PMB]', copies of which were laid before Dáil Éireann on 12th July 2017, that the Bill should not proceed to Committee Stage for the reasons set out in the Report, and orders accordingly.

I should say at the outset that the Joint Committee on Health has been interested in the medicinal benefits of cannabinoids since November 2016. It set the issue as a priority and devoted a meeting to examining these benefits on 24 November 2016. At this meeting the committee heard evidence from the Health Products Regulatory Authority, a specialist neurologist with an interest in epilepsy and the mother of a young girl who suffers from intractable epilepsy. The Joint Committee on Health is very supportive of making medicinal cannabinoids available to patients who do not respond to conventional medication. On 19 January 2017 the committee produced a report on medicinal cannabinoids. In that report the committee noted that, despite the encouraging medicinal possibilities offered by cannabis and cannabinoids, there is still a shortage of peer-reviewed evidence for the efficacy and safety of cannabinoid treatment for many conditions and that potential benefits had to be balanced against risks. The report stated that we should therefore pursue a careful yet committed course of action in engaging with medicinal cannabinoids.

Also in November 2016, the Minister for Health tasked the HPRA with producing a report on the subject of cannabinoids and their medicinal efficacy. That HPRA report, Cannabis for Medicinal Use - A Scientific Review, was completed on 31 January 2017 and published by the Minister for Health on 12 February. The health committee held a meeting to discuss the report on 7 March. Thus, it has demonstrated a commitment to making available regulated, safe, efficacious cannabis-based products for patients through prescription for conditions that have a proven response and in respect of which the products are well tolerated.

The Cannabis for Medicinal Use Regulation Bill 2016 was debated in the Dáil on Second Stage on 1 December 2016, after which it was referred to the health committee without a vote. The committee decided to conduct a detailed scrutiny of the Bill before it proceeded to Committee Stage. In that regard, it met on 5 April 2017 when it heard evidence from the Bill's sponsor, Deputy Gino Kenny, who was accompanied by a consultant psychiatrist and a professor of pharmacology.

The committee held a second meeting on 13 April when it heard evidence from officials of the Department of Health, together with officeholders from the Pharmaceutical Society of Ireland, on their respective views on the content of the Bill. Thus, the committee has held four meetings on this issue in the past year.

Based on its consideration, the committee has determined that the Bill has technical issues and implementation difficulties, that it may have unintended policy consequences, including leakage of supply of cannabis to recreational markets and a lack of safeguards against harmful use of cannabis by patients. It also determined that there were major legal issues, given that the numerous amendments that would be necessary to reconcile the Bill with existing law would be onerous, and that access to medicinal cannabis in Ireland would be better achieved through an access programme and secondary legislation, which the committee has been informed is under preparation. Therefore, it recommended that the Cannabis for Medicinal Use Regulation Bill 2016 not proceed to Committee Stage.

The purpose of the Bill is to make cannabis available as a medicinal product for individuals who receive certification from a registered doctor. To that end, it proposes the foundation of a cannabis regulatory authority that would regulate the sale of medicinal cannabis and oversee a system allowing pharmacies to receive licences to sell medicinal cannabis.

While the committee appreciates Deputy Gino Kenny's statement that his aim in sponsoring the Bill is to alleviate unnecessary suffering, aspects of the Bill cause it to be concerned that it may not be possible to reconcile the Bill with its above-mentioned careful approach to medicinal cannabis. The committee is concerned that the Bill proposes the removal of cannabis from the Misuse of Drugs Act 1977 as a controlled substance, meaning that it could have major unintended policy consequences, decriminalising cannabis in non-medicinal circumstances. This seems to conflict with the intention of the Bill which is to make cannabis available specifically for medicinal use, as expressed in the Title. It is the view of the committee that the decriminalisation of cannabis is not a safe course of action as the cannabis plant has many psychoactive effects that are potentially harmful. The Bill is as much about decriminalising the use of cannabis as it is about promoting it for medicinal use. The Minister for Justice and Equality is the relevant Minister quoted in the Bill, indicating that decriminalisation is the Bill’s main focus.

The committee is also concerned that the Bill's proposal to establish a cannabis regulatory authority to regulate cannabis would establish a parallel system of regulation, duplicating the functions of the HPRA, and allow a substance that has not received authorisation from the HPRA to be considered a medicine. This would be an unusual departure which would subvert the agency’s regulatory authority and ignore its expert advice that herbal cannabis is not capable of being authorised as a medicine and could create an undesirable precedent.

Advocates of the Bill state the HPRA is not willing to regulate cannabis. It is not possible, however, to regulate the whole-plant extract of the cannabis plant which has over 100 varieties and several hundred components. Authorised medicines must be of high quality, safe and effective. Furthermore, the system of access to medicinal cannabis proposed in the Bill appears to the committee to be too loose to guard effectively against leakage of supply to recreational users, could lead to overuse by patients and could have unanticipated harmful effects owing to side effects and interactions with other medicines.

The Bill would allow a doctor to certify a person as having a condition that could be reasonably treated by cannabis without having to stipulate a dosage or a finite period for treatment. There is no provision in the Bill for stipulating the type of cannabinoid product a patient should be treated with. There is no reference in the Bill to the medical indications for cannabis certification by a doctor. A lack of specific indications for a product that has no authorisation from the HPRA would raise many legal and medical indemnity issues.

A certificate is fundamentally different from a prescription. Evidence was given to the committee by the Bill's sponsor that a doctor's certification was to be used as evidence to protect the holder of the certificate from prosecution and unnecessary criminalisation if found in possession of cannabis. Doctors could be pressurised to provide certificates for reasons other than medicinal purposes. Evidence was given to the committee that regulation of medicinal cannabis was key to its availability, yet the Bill does not define what the term "medicinal cannabis" means. Therefore, it would be very difficult to regulate an ill-defined product.

Embedded in the cannabis plant are cannabinoids which act on the endocannabinoidal system in the human body and have medicinal properties. Whole-plant extract, however, also contains many other chemicals that are psychoactive and potentially harmful. The isolation of cannabinoids which have proven medicinal beneficial effects and scientifically proven efficacy and safety is the key to developing medicinal cannabis products that can be legally prescribed and dispensed.

Although the Bill limits the maximum amount of cannabis to be sold per transaction as one ounce, the committee cannot identify any provision which limits the number of transactions. The committee cannot identify any provision in the Bill for medical follow-up or supervision beyond initial certification, to monitor potential negative side effects or interactions with other medications. It is, therefore, worried that any individual who receives certification from a doctor would then be able to buy as much cannabis as he or she wanted indefinitely, without continued medical supervision.

Normally medication is prescribed with reference to strength in milligrams and instructions are given on frequency and length of use. Such stipulations are not mentioned in the Bill.

The sponsor of the Bill proposes that whole or full plant extract be made available in whatever form, including smoking cannabis, when used for medicinal purposes. The method of consumption would the patient's prerogative. That is entirely unacceptable to the committee. Smoking cannabis is not recommended as an acceptable method of use for medicinal purposes.

The committee also wishes to draw attention to the use of the word "consumer" rather than "patient" in the Bill to describe medicinal users of cannabis. The Bill's use of imperial measurements which implies selling cannabis by weight rather than strength in milligrams which is the convention in medical prescriptions is unacceptable. Also, the Bill suggests the proposed cannabis research institute commission research on cannabis for recreational use, as well as medicinal use. Additionally, the institute would promote public awareness of cannabis as to its safe use. This element of the Bill seems contrary to its purpose.

Although the committee has outlined a number of discrete problems in the drafting of the Bill, some of which may be more easily fixed through amendments than others, the underlying approach of the Bill proposes a system of access to medicinal cannabis that would be much looser than the committee considers prudent. Therefore, a central element of the Bill is irreconcilable with the committee's views on how medicinal cannabis should be approached. The committee favours a gradual introduction of medicinal cannabis that is evidence-led for each condition for which access is approved, as endorsed by the usual regulatory authority for medicines in this jurisdiction and which has the benefit of close monitoring by medical professionals of the effects of treatment. The committee has been informed that such an approach is being pursued by the Minister for Health and his officials. Departmental officials told the committee members in their engagement with them on 13 April that an expert reference group had been established and that it was drafting guidelines to facilitate the use of cannabis treatments under an access programme. That work is being informed by the HPRA.

The committee understands the Department will progress statutory instruments to advance the access programme. The committee views such an access programme as a more careful and desirable method of introducing medicinal cannabis to Ireland and, therefore, views the continued advancement of the Bill under scrutiny as duplicative and undermining of the access programme proposed.

Having received legal advice, the committee is satisfied that enacting the Bill as it stands would create legislative contradictions between the Bill and existing Acts. Resolving such contradictions by amendment of this Bill or of other Acts appears to the committee to be an onerous undertaking, quite apart from the further redrafting which would be necessary to avoid undesirable policy consequences.

The committee understands that sections 42 and 43 of the Bill, as drafted, would legalise cannabis entirely, as the 1977 Act would cease to apply to cannabis. That seems to conflict with the intention of the Bill, which is to make cannabis available specifically in medicinal circumstances. If those sections were to proceed without significant amendment, they may also necessitate amendment of the Criminal Justice (Spent Convictions and Certain Disclosures) Act 2016, as well as having complicated implications for extradition law.

The Bill may necessitate amendment to the Health Acts 1947 to 2015, the Pharmacopoeia Acts 1931 and 1977, the Poisons Acts 1961 and 1977 and the Pharmacy Acts 1875 to 1977, and other legislation, affected by the medicinal prescription of cannabis. Differing definitions of cannabis between the Bill and the Misuse of Drugs Act 1977 creates a possibility that the differing interpretations could be exploited in the criminal justice context. The enactment of the Bill would possibly give rise to the need to amend the Criminal Justice (Psychoactive Substances) Act 2010 and Misuse of Drugs Act 1984.

The Bill's creation of offences without prescribing corresponding penalties conflicts with the 1977 Act which provides both offences and penalties. Sections 16, 18 and 19 of the Bill, respectively, provide for licences to wholesale, import, and cultivate cannabis. The committee understands that those would require the amendment of sections 3, 15, 15A, 15B, 17 and 19 of the Misuse of Drugs 1977 Act. Section 3 of the Criminal Justice Act 1994, which defines drug trafficking, might need to be amended. Section 15 of the 1977 Act would need to be amended to allow a parent to give medicinal cannabis to their child. Based on all the considerations, as outlined above, the committee recommends that the Cannabis for Medicinal Use Regulation Bill 2016 should not proceed to Committee Stage.

Simon Harris (Wicklow, Fine Gael)
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I welcome the opportunity to have this report. I begin by thanking the Joint Committee on Health and all its members for the incredible work they put into considering this issue and for the unanimous report they produced which we are debating today on the floor of the Dáil. The last time we met to debate the Cannabis for Medicinal Use Regulation Bill 2016, we agreed not to divide this House because there is much common ground between us. We all wish to help patients for whom medicinal cannabis may be a treatment option.

I again acknowledge the significant work undertaken by Deputy Harty and all the members of the committee on this Bill. The committee heard testimony from a number of interested parties, including the Bill's sponsor, Deputy Gino Kenny, the Department of Health, the Pharmaceutical Society of Ireland and the Health Products Regulatory Authority. The committee members carefully considered the views and concerns expressed and they went further in seeking their own legal advice on the Bill. While the committee has determined that the Bill has technical and implementation issues and that it may have unintended policy consequences it also decided unanimously that the best way to proceed is on the grounds of a compassionate access programme. Today, the Government finds itself in a rather bizarre position in that it supports the unanimous cross-party report on the Bill only to find out that the authors of the Bill may now have a different view on how to proceed. I am happy to tease that out because ultimately we all want to try to help patients who might benefit from the use of medicinal cannabis.

Deputy Gino Kenny said the intention of the Bill is to make cannabis available to patients, but he is aware there is a number of worrying provisions in the Bill, including references to recreational use of cannabis, as well as proposed amendments to the Misuse of Drugs Act which would mean that cannabis would no longer be a controlled drug and possession for personal or recreational use would not be an offence. It is important to remember that we are talking about cannabis and we should proceed carefully. As many of us are very much aware, cannabis is the most widely used illegal drug in this country and that it is younger people who are particularly at risk from the effects of cannabis use, which can damage their mental health and their future prospects in life. That is the medical evidence by the way not just my own view. I think that most people in this House would acknowledge that there are significant concerns about the prevalence of recreational use of cannabis among people in society. People can continue to distort this if they wish but while I strongly believe that Ireland should allow medicinal cannabis to be made available as a treatment option for certain medical conditions, I also strongly believe, that as Members of Dáil Éireann, we have a duty to be guided by evidence-based best practice and consequently we must follow the advice of the medical and scientific community on how best to make the wish I think we all share a reality in terms of people's health.

Deputy Gino Kenny's Bill also proposes the establishment of two new State agencies, namely, the cannabis regulation authority and the cannabis research institute. He has views in terms of how that could be addressed. Those provisions would be in my view an attempt to bypass the existing regulatory systems that are in place for health products. We discussed earlier the importance of those regulatory systems. Like the health committee, I too do not see the need for more regulators in the area of health products when the HPRA already has extensive experience in regulating products for medical use, including controlled drugs used in the health care setting. I have voiced those concerns in the past and the committee has similarly concluded that many of the provisions in this Bill would have undesirable consequences for the regulation and safe provision of health care so it is clear there is significant work to be done.

The question of providing access to cannabis products that are not authorised as medicines is a complex but important matter. While it has been reported that a lot of research has been carried out on the use of medicinal cannabis, there is much anecdotal evidence but not the type of clinical research that is the norm when medicines are authorised in this country or in other countries. There is still a lot that is not known about the side effects of cannabis and about its interactions with other medicines that patients may already be taking. Some cannabis products contain a chemical known as THC, which is psychoactive, meaning it has mind-altering effects and for that reason it is strictly controlled in this country under the Misuse of Drugs Acts. Other cannabis products that are of particular medical interest are those containing a single active ingredient known as CBD, which is not psychoactive and so is not controlled under the Misuse of Drugs Acts and can be prescribed by doctors without a need for a special licence.

Given the complexities involved, any measures put in place to allow access to cannabis for medicinal purposes will need to be done in a cautious and controlled way and with the appropriate level of medical involvement for patients with long-term illnesses. While we are looking for a solution to providing access to medicinal cannabis for those who need it, this has to be done with the appropriate involvement of medical consultants who are treating patients with complex illnesses. That is where this Bill and I part company. I want to put in place an access programme for medicinal cannabis that is authored by doctors. This Bill is an attempt to put in place legislation from politicians. We are not neurologists. I have brought people together to try to progress that view and to make sure we have clinical buy-in. I will address that in a moment. I think we all share a common desire to make progress on the issue of medicinal cannabis. We have accepted that approach and made progress as an Oireachtas in that regard. I and many of my Government colleagues and Deputies from across the House have met with patients and their carers who passionately believe that cannabis should be available as a treatment option for various health conditions. They want to do what is right for their patients, child, loved one or relative.

I wish to make clear once again that, while cannabis is not currently viewed under Irish legislation as a product having medicinal use, there are already provisions under the Misuse of Drugs Acts to allow an Irish-registered consultant to apply for a licence for cannabis-based products for an individual patient. The Chief Medical Officer, the top doctor, has advised that licences should only be granted in cases where a consultant has endorsed the proposed course of cannabis treatment. Such applications can be considered on a case-by-case basis. I have granted two licences for two separate individuals following receipt of valid licence applications. Any application I receive endorsed or supported by a consultant will be granted. That is the approach I have taken.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Two.

Simon Harris (Wicklow, Fine Gael)
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I have received two applications from consultants. Neither Deputy Boyd Barrett nor I are consultants. Such applications from doctors will be considered because they know an awful lot more about this issue than Deputy Boyd Barrett or I do. Separately and importantly, we are progressing well with work on the cannabis for medical use access programme. That follows on from a commitment I gave to this House that there are better ways than primary legislation to achieve the same outcome whereby we can have a doctor-led compassionate access progress for medicinal cannabis.

In February, I published the country's first ever policy review on this area, namely, the HPRA's report, Cannabis for Medical Use - A Scientific Review. On foot of the conclusions of the regulatory body, namely, the HPRA - we know what happens in this country when we do not listen to regulators - I announced that I would establish a cannabis for medical use access programme for patients under the care of a consultant, for the following medical conditions, on the basis that they were the medical conditions recommended by the HPRA.

The conditions are spasticity associated with multiple sclerosis, MS, nausea and vomiting associated with chemotherapy, and treatment-resistant epilepsy. I then put together an expert group chaired by the eminent Dr. Máirín Ryan from the Health Information and Quality Authority, HIQA. I established the group in March to develop operational, clinical and practise guidelines for the access programme. There is no point having a piece of paper or report that cannot actually work in a doctor's office. Dr. Ryan brought together an expert group to put the clinical and operational guidelines in place. The group included medical consultants who treat epilepsy, MS, cancer and other serious illnesses, along with patient representatives, pharmacists and health regulators. Considerable work has been undertaken by my officials and my Department to try to put in place the new access programme for medicinal cannabis for the first time ever in the country.

I am pleased to inform the House that the expert group has drafted clinical guidelines. The group has completed the targeted consultation and finalised the guidelines. I thank Dr. Ryan, the patient representatives and the doctors who dedicated an extraordinary amount of time to ensuring that we can have clinical guidelines for a compassionate access programme. Officials in my Department are now working on secondary legislation in the form of three statutory instruments that will underpin the access programme. These statutory instruments will be finalised in December. The expert reference group has made significant progress in developing the clinical guidelines for the programme. However, further work is required in terms of how we source suitable quality-controlled cannabis-based products. We must ensure we have a source for any product that can be accessed under the new scheme.

I have no wish to conflate the issues, but should the point come up during the debate, I inform the House that my colleague, the Minister of State at the Department of Health, Deputy Catherine Byrne, will put in place a review group under the national drugs and alcohol strategy to look at alternatives to criminal sanctions for personal use for some drugs. The intention is to take a health-based approach in respect of drugs and drug addiction. Shortly, the Minister of State will appoint a chairperson. This is a key recommendation of our new national drugs strategy.

I believe the Bill to be well-intentioned. I have no doubt about that or about the commitment, passion and dedication of Deputy Kenny. I do not believe this is a party political issue for him. I accept his bona fides on the matter. However, I have to take heed of the advice available to me as well as the advice, legal and otherwise, available to the Joint Committee on Health. The advice was agreed unanimously by that committee. The Bill would require significant amendment before it can proceed any further. It is in this vein that I hope we can tease out the issues this afternoon.

Pat Gallagher (Donegal, Fianna Fail)
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This system is not a good one, but we have lost five minutes already. Next we have Deputy Kenny. Deputies Kelleher and MacSharry have agreed to share five minutes, with two and a half minutes each. Then we will have Deputy Boyd Barrett and Deputy O'Reilly. I had thought Deputy Barry and Deputy Bríd Smith might share, but let me work on this. Deputy O'Connell will come after that, followed by Deputy Michael Collins. Deputies Eamon Ryan and Healy are sharing five minutes. Deputy Joan Collins and Broughan are sharing five minutes. Deputies Cowen and Brassil are sharing five minutes. Deputies Ellis and Buckley are sharing five minutes. Then we have Deputy Coppinger, Deputy Jonathan O'Brien and Deputy Clare Daly.

Ruth Coppinger (Dublin West, Solidarity)
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I will pull out to let in Deputy Barry.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following:

“ , notwithstanding the recommendation of the Joint Committee on Health in its Report entitled ‘Report on Scrutiny of the Cannabis for Medicinal Use Regulation Bill 2016 [PMB]’, copies of which were laid before Dáil Éireann on 12th July, 2017, agrees that the Bill should proceed to Committee Stage in order that amendments may be made to the Bill.”

I welcome everyone in the Public Gallery. Unfortunately, Vera Twomey is not here today. She collapsed outside the Dáil today. I hope she gets well soon. I know she is here in spirit and that she will be back with us very soon.

I stood on this spot a year ago with a great deal of hope in my heart. Obviously, the country was probably behind what we are trying to do. We are trying to give safe and legal access to cannabis for people who need the medication. The hundreds of people I have met over the past year shared my hope that they would be recognised as medical patients. They had hoped that they could have safe and legal access to medicinal cannabis. They had hoped to be able to come out of the shadows of darkness brought about by their illness. It was not an illness they chose. The illness chose them.

Today I stand here with despair, unfortunately. I hope I am wrong. This place can grind a person down sometimes, and we are all human. I have been left with a sense of despair. I will never give up in any sense.

Over the course of the past year, I believe our Bill has been completely sabotaged. I was rather shocked by the shambolic nature of the pre-legislative scrutiny. I believe it was politically motivated in some ways. It was rigged. Some of the comments made in the Joint Committee on Health were extraordinary, although I am not going to go into them now. I believe the Committee on Health looked for every excuse to stymie progress of our Bill. It is as simple as that. Deputy Harty has said every conceivable negative thing about our Bill. He has never said one positive thing about it, but there are positives aspects to it.

I am not saying the Bill is perfect by any means. However, it is always amendable in my eyes. Let us consider all the international evidence. Those responsible had to abandon the compassionate access scheme in Germany because it was so restrictive. The Minister's compassionate access scheme is extremely restrictive. I will explain how restrictive it is.

The situation of Ava Barry is instructive. I went to see her in the Netherlands. It was a bittersweet experience. It was sweet to see a child doing very well. However, it was a bitter experience to see an Irish citizen in medical exile in Holland. I came back ten times angrier. I was angry that a child should have to go to another country to get simple medicine. Over there, she can go to the pharmacy. The pharmacist gives out the medication. She gives her money and comes back to her house. Is it not shambolic that an Irish citizen has to go to another country to do that? Ava has been almost seizure-free since she went over there. Under the compassionate access scheme that the Minister is promoting, she would be unable to access the scheme. That is the simple truth.

I am keen to dispel some myths about our legislation. I find it rather incredible that one of the pretexts set out in the Committee on Health report was that it would be too onerous to go through the Bill. We are lawmakers. We are elected to the Dáil to change laws. That is our job. If it is an onerous task, then it is worth it. I do not understand that point.

What really annoys me is the point about a shortage of peer-reviewed evidence. The evidence is available. It is coming out of people's ears. Of course we need more research. However, it seems that people want to hide behind that until kingdom come. They say there is not enough peer-reviewed research, but there is. It is only that certain people choose to look away. There is ample evidence that people can greatly benefit from the Bill.

I have always said that we would look at the Bill objectively with anyone in this room, regardless of political persuasion. I have no problem if people want to take out certain provisions. The main thing is to give people legal access to medicinal cannabis.

I have a message for the Deputies in the Chamber who will be voting on this next week. In my eyes, they will be on the wrong side of history, science, public opinion and international recognition. No matter what happens after next week, our fight will continue. The political establishment might be giving up on people, but we will never give up on the people who are in the Gallery. They will never walk alone.

Billy Kelleher (Cork North Central, Fianna Fail)
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I went to the Joint Committee on Health with an open mind. We facilitated pre-legislative scrutiny when we discussed the Bill in the Dáil previously. We intend to look at the option of allowing it to go to Committee Stage again. However, there is no point in saying otherwise. The Bill, as drafted, is seriously flawed. This was highlighted in the discussions during pre-legislative scrutiny. The Joint Committee on Health has overwhelmingly rejected the Bill in terms of its suitability for Committee Stage.

I have listened to what has been said by the sponsors. I hope they put on the record a willingness to accept the flaws highlighted in the pre-legislative scrutiny process. There may need to be substantial amendments. I hope all parties embrace this issue to ascertain whether we can produce meaningful legislation that will allow for access to medicinal cannabis in limited circumstances.

It is easy to make sweeping statements in the House setting out the pros of cannabis and claiming it is all good but it is a psychoactive drug which has highly damaging consequences for health. Benzodiazepines may be legal medicines that are prescribed daily but they have catastrophic effects on people. Just because a drug is prescribed does not mean it will always have only positive effects. We must tread carefully on this issue.

As I stated, Fianna Fáil is willing to facilitate the Bill's passage to Committee State to enable a discussion to take place on how we can progress it in such as a way as to ensure the intentions outlined by the sponsors are realised. We must not have cannabis becoming freely available, through prescription, to people other than those who need it for the reasons set out by the Minister in his access programme. The programme is excessively restrictive, however. It is appropriate that the Minister acts on the advice of the Health Products Regulatory Authority, HPRA, on this issue but we must consider how the programme can be opened up, through consultants and the HPRA, to help people access it on a controlled basis. As drafted, the Bill is deeply flawed. I hope Deputies accept that and that if it proceeds to Committee Stage, it will be embraced in a non-partisan manner.

Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I thank the Joint Committee on Health for the work it has done on this issue and Deputy Gino Kenny for introducing legislation on medicinal cannabis as it has focused minds on the issue. I agree with Deputy Kenny that if a task is onerous, it does not mean it cannot be done. It is not a question of laziness in the Civil Service or political circles. If the Bill is flawed and requires work, as Deputy Kenny has acknowledged is the case, let us do the work.

I am glad the Fianna Fáil Party will facilitate the Bill's passage to Committee Stage and, onerous or not, the necessary improvements will be made to the compassionate programme in order that people will have access to medicinal cannabis. I do not want cannabis to become available in every sweet shop for recreational use, nor is that the intention of anyone else. Cannabis clearly has a medicinal benefit in treating a variety of conditions, although I appreciate that research in this area is ongoing. In fairness to the Minister, he has tasked people with carrying out various reviews and producing proposals. Let us move this issue forward quicker. Refusing to allow the Bill to proceed to Committee Stage to allow us to try to make improvements to it, however onerous, and kicking it out on the never-never would be a betrayal of the many patients who could benefit from medicinal cannabis.

Last night, I received a text from someone who is known to me and is not a typical recreational drug user. He states he is unable to live the life he should be living, is on disability allowance and is not fit to attend college or full-time work, despite having tried to do so. If, he asks, there is a plant that can relieve his pain, why can it not be safely prescribed by his doctors who want to help. They have not been trained but want to be trained. The text, which goes into much more detail, highlights the type of people and the variety of conditions who are holding out hope that Deputies, rather than pontificating endlessly, will make an honest effort to get this Bill to Committee Stage and make the necessary changes. We must maintain the unanimity that was evident in the House on Second Stage in order that medicinal cannabis can be made available to patients who need it.

Pat Gallagher (Donegal, Fianna Fail)
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I thank Deputy Marc MacSharry for observing the time limit.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I appeal to the Government to drop its opposition to the Bill proceeding to Committee Stage. It is not too late to change its position. I welcome the engagement with Fianna Fáil and Sinn Féin over the past week or two. Notwithstanding their concerns and those of the Joint Committee on Health about aspects of the Bill, which must be taken seriously, they are willing to engage. This is what is necessary because tens of thousands of people in this country are suffering from chronic pain, multiple sclerosis, the effects of nausea from chemotherapy and a host of other conditions for which there is, to quote the experts, strong evidence of the efficacy of medicinal cannabis. That is the view of Professor Mike Barnes, a consultant neurologist who did the authoritative report on this issue for the British Parliament. Professor Barnes has refuted the argument made by the Minister and the joint committee and he, unlike the Minister and members of the committee, is an expert.

Simon Harris (Wicklow, Fine Gael)
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I have experts.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The Health Products Regulatory Authority is not an expert body either.

Simon Harris (Wicklow, Fine Gael)
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It is the regulator.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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When members of the joint committee asked representatives of the HPRA what specific expertise they had in the area of medicinal cannabis, the answer they gave was "None".

Simon Harris (Wicklow, Fine Gael)
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That is a slur.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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David Finn, a professor of pharmacology at NUI Galway who has studied medicinal cannabis for 16 years, stated the decision to leave chronic pain out of the Minister's compassionate access programme made no sense. Professor Finn, Dr. Cathal Ó Súilleabháin and representatives of the Irish Medical Organisation stated the strongest evidence-----

Simon Harris (Wicklow, Fine Gael)
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The Deputy is misrepresenting people.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I do not know why the Minister is shaking his head. He should read the Barnes report and stop interrupting me. He spoke earlier and will have more time to respond.

Witnesses at the committee stated the strongest evidence in respect of medicinal cannabis was on pain. The joint committee's report states that pain is complex, which is correct. However, we do not mind allowing opiates to be prescribed when there is widespread opiate addiction caused by opiate based painkillers and benzodiazepines. We can regulate these products with the complexities of pain but cannot do so with medicinal cannabis, even though all the evidence shows that opiates are much more dangerous than medicinal cannabis.

There is no evidence to back up the statement that there would be leakage to recreational use. Professor Barnes and Dr. Ó Súilleabháin stated that no evidence of increased recreational use of cannabis or increased problems relating to cannabis has emerged. Specifically, there is no evidence of diversion of medicinal products to the illicit market. As in Ireland, illicit cannabis is so widely available in the countries in question as to make diversion insignificant. We have diversion with prescription painkillers, yet the Minister has not banned them. We have diversion of opiate based drugs, even though their use is not based on the prescriptions given. The Minister has not banned those drugs or argued that they cannot be regulated, as he has argued in the case of cannabis, despite the absence of any supporting evidence.

Why can Germany, the Netherlands and a number of US states do what is proposed in the Bill? The problem with the HPRA regulating this issue - this concern was raised by Sinn Féin and Fianna Fáil - was that its compassionate access programme did not provide access. Other countries abandoned their access programmes and introduced laws similar to what we have proposed. They dealt with the issue by having their version medicinal products regulatory authorities establish a new subdivision to deal specifically with cannabis. We are open to an amendment providing for such a change. This could be easily achieved on Committee Stage if there was a will to do so. If this Bill is not the vehicle for doing so, it will be two years before we have another Bill on this issue, on which we have spent a year already.

Vera Twomey collapsed with stress outside the House and her daughter is in Holland. It is disgraceful that thousands of people will be left out in the cold. The alternative is to work together as parliamentarians and progress the Bill. Professor Mike Barnes and representatives of the IMO will come to the House next week.

Pat Gallagher (Donegal, Fianna Fail)
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The Deputy's time has concluded.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Will the Minister meet them and allow the Bill to pass?

Pat Gallagher (Donegal, Fianna Fail)
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Please, Deputy.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I went five seconds over my time.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I welcome our visitors in the Gallery. This is a very serious and emotive issue, on which there is a wide range of views and opinions that the House should acknowledge. Previous speakers referred to the work done by the Joint Committee on Health. I did not attend the hearings with a closed mind or with a view to being negative in any way, shape or form.

At all times I approach my work with the committee in the same way I approach my work in here, which is with an open mind. However, I also come in here as a Sinn Féin Deputy and I represent my party's policy.

It is our policy that we look at the issue of medicinal cannabis from a medical and a health perspective, and that we should in all instances defer to the medical experts and the patient advocacy groups. That equally means that when it comes to legislating for medicinal cannabis, we must look to ourselves, as legislators, to see what it is we can do. That is what Sinn Féin has sought to do right throughout this process.

On Second Stage, I outlined the many concerns that I and my party have about the Bill and the possible unintended consequences. At that point, I stated that we would reserve the right to scrutinise the Bill at the Joint Committee on Health and amend it to make it fit for purpose and to bring it into line with our party policy.

I still hold some of those concerns, but I believe that the process of legislating and scrutinising should continue so long as there is an acceptance that the Bill is flawed in many ways but that the drafters are willing, as they indicated - Deputy Boyd Barrett pointed out that they had indicated that to us outside the Chamber and now on the record - to work with us and others who support the objective to ensure that the legislation can be amended and made fit for purpose.

I have spoken with the drafters. They have accepted the concerns that we had raised around the complexities and the unintended consequences. They have liaised with myself and some of my colleagues in the interests of progressing this Bill and working towards legalising medicinal cannabis. They have agreed to compromise on a range of areas in the Bill which are beyond the scope of legalising medicinal cannabis. I respect the drafters, as colleagues and legislators. I accept their bona fides when they show that they are willing to compromise and amend sections of the Bill in order to ensure it is only for the legalisation of medicinal cannabis. I am sure I and others can work well with them in the spirit of co-operation in order to deliver for those who need medicinal cannabis, namely, these are the people who we must have at the forefront of our thoughts.

Sinn Féin supports the legalisation of medicinal cannabis where it has been deemed medically necessary for a patient by his or her clinician, in consultation with the patient and-or parents or guardians, as appropriate. We have a long-standing party policy, decided by our membership, to support the legalisation of medicinal cannabis. It is through that prism that we looked at the legislation on Second Stage and that is why we supported its passage at that Stage.

Today cannot pass without me saying that there are parts of the legislation which we believe to be flawed and to hold it up as the final and complete answer to patients is unfair. There was a great deal of misunderstanding, some of which was bordering on misinformation, when it came to this Bill. It is irresponsible to say that the Bill, in its current form, will guarantee access to medicinal cannabis for all who need it. It is apparent, from the legal advice and the motion from the Joint Committee on Health, that it will not. While I agree with the legal advice, which is factually correct that amending the Bill would be an extremely onerous undertaking and require substantial redrafting to avoid any undesirable policy consequences, if the drafters can work with us, as they indicated to me that they would both outside this Chamber and on the record, and if they are willing to compromise on the sections of the Bill which have nothing to do with the legalisation of cannabis for medicinal use, then I believe that we can overcome these issues.

In the meantime, we await the launch of the medicinal cannabis compassionate access programme. I ask that the Minister consider placing the statutory instruments before the Joint Committee on Health so that we might be able to ensure they are devised in such a way that we get the maximum value for those people outside the House who are awaiting this legislation and the compassionate access programme.

Having met the drafters and having been assured that they understand that there are elements which are problematic for my party, they are willing to work with others who support these objectives. They are prepared to compromise on the sections which go beyond the objectives of the Bill.

We will oppose the motion as outlined by the Joint Committee on Health. We will give conditional support to the medicinal cannabis Bill provided it is sufficiently amended, in line with our party policy.

Mick Barry (Cork North Central, Solidarity)
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I want to put on the record what I believe is happening in this debate. There was a recommendation from all parties on the Joint Committee on Health, bar Solidarity-PBP, to stop the progress of this Bill, or to effectively kill it. In the past week, U-turns have been performed by the Fianna Fáil Party and by the Sinn Féin Party.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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That is not true.

Mick Barry (Cork North Central, Solidarity)
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That is a fact.

Jonathan O'Brien (Cork North Central, Sinn Fein)
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That is disingenuous now.

Mick Barry (Cork North Central, Solidarity)
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Sinn Féin has changed its position.

Pat Gallagher (Donegal, Fianna Fail)
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Deputies.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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Deputy Barry should speak to his colleague.

Mick Barry (Cork North Central, Solidarity)
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I believe that those changes were made in the face of public opinion-----

Jonathan O'Brien (Cork North Central, Sinn Fein)
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Deputy Barry is wrong.

Mick Barry (Cork North Central, Solidarity)
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-----on this issue, which is in favour of change.

I note the comments of the Fianna Fáil representative, in particular, asking Solidarity-PBP to accept that the Bill is deeply flawed. I do not accept that this Bill is deeply flawed nor do I believe it is perfect. I believe amendments could improve it. It is fundamentally sound and it is not deeply flawed. If that is a signal on the part of the Fianna Fáil Party that it intends to gut this Bill on Committee Stage and achieve on Committee Stage what the party was unable to do today, we will fight it all the way on that.

A more accurate assessment of the Bill and its so-called flaws was published in the Irish Examinerby Fergus Finlay, who wrote that this is "an excellent piece of work which needs to be tightened up in some respects". That is fair and balanced. He wrote that "what happened to Mr Kenny's Bill on medicinal cannabis was another example of extremely poor parliamentary work [he was not referring to Deputy Gino Kenny here], that actually failed to protect the public interest." That was a criticism, by the way, of the Joint Committee on Health, and Mr. Finlay was correct in that regard.

The Minister talks about having an approach based on medical opinion and not that based on politicians' opinion. I am all for that. The proposal the Minister puts forward of having a regulatory system which allows for the prescription of medicinal cannabis for those with epilepsy, MS and suffering nausea post-chemotherapy is far too limited. The most wide-ranging, authoritative and comprehensive study into this was the study conducted around the Barnes report in the UK. Barnes's recommendation was medicinal cannabis for the management of chronic pain. That is far broader than the three limited examples given by the Minister.

At its annual conference, the Irish Medical Organisation representing GPs showed itself to be open to the idea that in the event of legalisation, one would have prescription by GPs, and that is the way it should be. It is GPs who have the relationship with the patients who are suffering - a far more progressive approach than the approach of the Government.

I would say to the people in the Public Gallery to keep the pressure up on this issue. Do not place any trust-----

Pat Gallagher (Donegal, Fianna Fail)
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I ask the Deputy to address the Chair. It is customary.

Mick Barry (Cork North Central, Solidarity)
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I would advise them not to place trust their in the majority of the parties on this issue. They have conducted U-turns in the face of pressure on this issue. People should keep the pressure up and, if necessary, protest for the progress that is needed in the interests-----

Dessie Ellis (Dublin North West, Sinn Fein)
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That is nonsense.

Mick Barry (Cork North Central, Solidarity)
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-----of tens of thousands of people in this country who need this change and who are suffering on a daily basis.

Jonathan O'Brien (Cork North Central, Sinn Fein)
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The only people who did not do a U-turn was Solidarity-PBP; it compromised.

Mick Barry (Cork North Central, Solidarity)
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Deputy Jonathan O'Brien does not like being called out on it.

Jonathan O'Brien (Cork North Central, Sinn Fein)
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What, compromisation?

Dessie Ellis (Dublin North West, Sinn Fein)
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I will call it out.

Jonathan O'Brien (Cork North Central, Sinn Fein)
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I will call a halt to it now in a minute.

Kate O'Connell (Dublin Bay South, Fine Gael)
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I recognise that cannabis has been used for medicinal effects for centuries. I fully accept and appreciate that cannabis has properties which some people find to be effective in the treatment of many conditions, including pain, nausea and seizures.

There is a shortage of peer reviewed evidence for the efficacy and safety of cannabinoid treatment. Peer reviewed evidence is usually the cornerstone of clinical best practice in medicine, not anecdotal evidence and not the sort of talk-to-Joe pressure that is being applied here. Bypassing the approach to regulation exposes the public to incomplete and unpredictable medical treatments.

I am very concerned that comprehensive legal advice that we, on the Joint Committee on Health, received is basically being ignored by Members in this House.

3 o’clock

We have heard today that the HPRA has no experience of dealing with cannabis regulation, but we dealt with that issue at the Joint Committee on Health. That is true for any new drug coming up for regulation. If a new drug is produced tomorrow, of course the HPRA will have had no experience because it did not exist. In that sense, Deputy Richard Boyd Barrett's point is void.

The flaws have been highlighted. Someone brought up the Dutch situation. I want to clarify for the House that in Holland medicinal cannabis is available through pharmacies, but it is not reimbursed by health insurance companies because the body of evidence is not strong enough for them to take the hit. Deputy Gino Kenny has said someone goes in and pays his or her money, that that is essentially what one does. It is very important that we do not misrepresent some of the stuff out there. I feel very strongly about this issue because we are elected to represent - I would appreciate it if I was not sneered at across the Chamber-----

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I was not sneering.

Kate O'Connell (Dublin Bay South, Fine Gael)
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We are elected-----

Pat Gallagher (Donegal, Fianna Fail)
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Deputy Kate O'Connell to continue, without interruption from the Chamber or the Visitors Gallery.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I did not do anything.

Kate O'Connell (Dublin Bay South, Fine Gael)
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We have cameras here and can see the Deputy sneering.

Pat Gallagher (Donegal, Fianna Fail)
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The Deputy has a right to be heard. Let there be no interruptions.

Kate O'Connell (Dublin Bay South, Fine Gael)
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Some in this House might feel it is okay to proceed with this measure, but I believe I have a responsibility, as an elected Member, to proceed with caution. There are other Members of the House who are very well qualified in this field, medical professionals in all parties, who know that the Bill is flawed and would call out the Deputies here as being populist on the issue.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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That is not true.

Kate O'Connell (Dublin Bay South, Fine Gael)
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I am all for having a new Bill. I am all for working through the issue, but the Bill put before the Joint Committee on Health was so deeply flawed. It is very disturbing that we would set a precedent by ignoring the volume of legal advice we have received and that we would do anything in this House to disrupt those mechanisms that have been put in place to safeguard public health.

I am mindful of the fact that earlier during Leaders' Questions Deputies spoke about robust regulatory processes for sodium valproate use by women who were intending to or who might become pregnant. About two hours ago we had Deputies talking about strict regulatory processes and making available information to safeguard public health, but now they are saying, "Don't mind those regulations; it will be fine."

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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I want to respond to what Deputy Kate O'Connell has just said. I am a member of the Joint Committee on the Eighth Amendment of the Constitution alongside the Deputy. We are dealing with a situation where women, including me and others in the House, are being exiled from the country to obtain a medical procedure. Now we are looking at a Bill that tries to deal with a situation where children are being exiled from the country to obtain certain medicines. Anyone's heart would have been gladdened by seeing Ava Barry on Facebook and the difference made to her life by being able to access medicinal cannabis while residing in Holland. I share the concerns everybody here has expressed for her mother, Vera Twomey, who has been totally stressed out in the battle she has had to fight with the State to have the right thing done by her daughter.

It is completely disingenuous for Deputy Kate O'Connell and others to say they cannot ignore the volume of evidence brought before them because they are ignoring another volume of evidence. They refused to have Professor Barnes come before the Joint Committee on Health. They also refused to call the Irish Medical Organisation, IMO, which passed a motion at its conference recently calling for doctors to be allowed to prescribe medicinal cannabis. These Deputies have refused to listen to a body of evidence that is stronger than that of the HPRA. They also say we do not have experience of prescribing cannabis here. We do not have experience of performing abortions here either, but we are fighting to be able to provide for them. This is a disingenuous position for a professional such as Deputy Kate O'Connell and other medical professionals in this House to take.

International experience shows that Ireland is out of step with other countries in Europe. As others said, in Germany, Italy, Spain, France, Poland, Greece and the Baltic countries medicinal cannabis is legal. Are we such a great, plucky little race that we can stand alone and say it is not going to happen here, just as we stand alone and say there will be no access to abortion in this country? Can we not be on the right side of history, science and justice and listen to what is being said?

I wish to make a conciliatory remark to the parties that have indicated that they are generally supportive. We are willing to consider changing the Bill in a big way. I urge them to come along to hear the evidence of Professor Mike Barnes in the audiovisual room next Tuesday at 5.30 p.m.

Ruth Coppinger (Dublin West, Solidarity)
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I also want to know what is going on. We have a family in exile. While there are many families in exile, Vera Twomey and her family's experience have been centre stage. Vera would have been present for this debate but for the fact that she has suffered a stress related hospitalisation. She and her husband have been forced to take turns to care for their daughter in another country. One would have to have a heart of stone not to want to sort out their situation. How come it is fine to have medicinal cannabis available in Holland, Australia, Chile, Germany, Greece and Mexico but not Ireland? It is down to the fact that the establishment has adopted an extremely conservative and backward position on this issue, as it does on so many other issues, including abortion. It is ironic that Deputy Kate O'Connell has talked about the lack of health care and medicine for women but does not recognise that the same is happening in this case purely because of the nature of cannabis. It must also have something to do with the pressure exerted by the pharmaceutical industry.

It is welcome that Fianna Fáil and Sinn Féin have stated they will not block the Bill. That is great, but I put it down to the fact that the response on this issue on social media has been massive. I have never witnessed such support on an issue from both young and old and all layers of society. It defies belief this Parliament is so conservative that it would block something that is so clearly needed.

The last point I will make is in response to comments made on leakage. Some Deputies have said there would be a leak into recreational use, but all legally prescribed drugs leak into recreational use. On what planet are Deputies living? The biggest addiction is to legally prescribed drugs, but that should not be used as a reason not to progress the Bill. We should let it progress and stop blocking it.

Pat Gallagher (Donegal, Fianna Fail)
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I was doing some mathematics during the course of the debate and found a few half minutes here and there. To remove any doubt, we will now have three minute contributions by Deputies Michael Collins, Eamon Ryan, Seamus Healy, Joan Collins, Thomas P. Broughan, John Curran, John Brassil, Dessie Ellis, Pat Buckley, Jonathan O'Brien, Aindrias Moynihan and Clare Daly. If there is any time left, I will call others, but I ask all Deputies to stick to the three minute time limit.

Michael Collins (Cork South West, Independent)
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I am delighted to have the opportunity to speak about this extremely important issue which has been brought to light in the last year by a very brave Cork woman, Vera Twomey. She highlighted the problems facing her young daughter, Ava Barry, who was suffering from a severe form of epilepsy, Dravet syndrome. She has seizures numerous times a day, but these seizures can be reduced significantly by the administration of medicinal cannabis. She is now living in the Netherlands where she is able to receive the appropriate medical help and her seizures have stopped. Vera has described this as "life-saving". However, Ava is unable to return home as she cannot legally obtain the necessary cannabis based treatment here. This is yet another failure on the part of the health system. Why are we, as a nation, shamefully shipping people out of the country in pursuit of simple cures which could easily be available here? Ava's case is but one example. Another is that of John Patrick Harrington who had to travel abroad to undergo a simple cataract operation. Why can we not deal with our own health issues here rather than exporting them?

I am aware that certain provisions of the Cannabis for Medicinal Use Regulation Bill 2016 are unclear and that there are numerous technical issues with the legislation, including unintended legal implications, as highlighted by the Joint Committee on Health. I note the findings of the report on the scrutiny of the legislation. The report's authors are fearful that the Bill which proposes the removal of cannabis from the list of controlled substances under the Misuse of Drugs Act 1977 could have major unintended policy consequences such as decriminalising cannabis for recreational use, of which I am not in favour.

However, I do not accept the committee report outcome that the Bill should not advance to the next Stage because there are too many technicalities and problems facing the legislation in its current form. I seek that the Bill would go forward to Committee Stage and any relevant issues and amendments be addressed at that point, and Deputy Kenny has said he accepts this. The issue at hand is far too important, not only for young Ava Barry and her mother, Vera, who have faced this nightmare for years, but for all the people affected by this type of epilepsy, severe migraines and many other illnesses. I am sure all the relevant changes to the legislation to allow only sick patients obtain the necessary CBD can be addressed on Committee Stage.

Eamon Ryan (Dublin Bay South, Green Party)
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I am very glad we seem to have a changed situation. This morning my understanding was that the Bill would not be moving on to Committee Stage and I do not know what changed in that regard. I listened to what Deputy Harty said. I know there was a fairly extensive discussion at the committee and there can be different views on how what went through. However, there was not an absence of debate, and Deputy O'Connell can refer to that as well. For whatever reason, I welcome that Sinn Féin and Fianna Fáil seem to have changed their view on the merits of the Bill going to Committee Stage. I am glad it will. Whatever one's view, it is a very complex, technical and difficult issue and the parties need to present their detailed alternatives and to have an open legislative process. As Deputy Gino Kenny acknowledges, there are flaws in the Bill and he is not clinging on to the structure or any particular wording. In some ways, it provides the House with the opportunity to do something innovative, and while it is complex, difficult and challenging, I believe it is something we should aim to do. We would support that step, as we have at each stage.

I want to refer to two issues. We have heard the evidence on one side while Professor Michael Barnes is on the other side, and I am glad he is coming here next week to address the medical case. I refer to the inquiry report from the all-party parliamentary group for drug policy reform in the House of Commons which was published recently. I refer to it because my Green Party colleague, Caroline Lucas, was one of the main authors of this significant report. To give some context, the report by Professor Michael Barnes and Dr. Jennifer Barnes was based on a literature search producing over 20,000 references and the evidence was graded according to the system used by the American Academy of Neurology. While I do not dispute that Deputy Harty and others have medical views, this is the sort of thing we need to tease out on Committee Stage, given this report suggests there are 20,000 references to medical cannabis having effects in regard to pain management and moderate evidence in regard to its use in treating sleep disorders, appetite stimulation and in cases of chemotherapy, fibromyalgia and so on. That was the report that influenced me, partly because it comes from my Green Party colleagues.

As I understand it from listening to Deputy Harty, the other argument is there is a concern this would lead to the effective decriminalisation by the back door. That probably will not come into this Bill, which is specific in its intention around medicinal use. From our party's perspective, however, that is also a debate we should be having. Our current system, which is based on a criminalisation process in regard to the possession or use of cannabis, is not effective, is not working and, in fact, is forcing people into the criminal system. It would be far better to have a health-centred approach which does not look to criminalise someone if they are using but looks to help them. Where that has been introduced in countries like Portugal and Australia, it seems to have resulted in lower use, although the evidence on this needs to be teased out. It may be able to protect the vulnerable who we do not want using it, such as younger people, but we may be able to get away from this incredibly expensive and punitive criminal system which is not stopping supply but is just letting the criminal underworld run it. It is far better for us to do that in a safe, medically tested way rather than through the current system.

Séamus Healy (Tipperary, Workers and Unemployed Action Group)
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I welcome Vera to the Visitors Gallery and hope she is fine again. I spoke to her earlier this morning and she was absolutely over the moon. Her daughter Ava has been responding very well to the treatment she is receiving in the Netherlands. Obviously, she wants Ava back at home, particularly once the three-month monitoring period is completed on 28 November.

I welcome what appears now to be a general consensus that this Bill should go to Committee Stage for consideration and for whatever amendments are necessary. We all know there are thousands of individuals out there, including thousands of children, who would benefit from medicinal cannabis prescribed in a proper way. That is what this Bill is all about. It is to ensure there is a regime in place whereby medical cannabis can be available to the very many people who are suffering and to people whom it would benefit where there is good medical and scientific evidence that it can alleviate suffering. We know that it can. The evidence is out there and has been given by various experts and specialists over a long number of years.

The bottom line is that other jurisdictions have dealt with this matter. They have introduced legislation and introduced programmes whereby patients can be prescribed cannabis to their benefit. If other jurisdictions have done it, I do not see why the Oireachtas cannot do it. I certainly support this legislation. As Deputy Kenny said, amendments need to be made to the Bill. Many are very straightforward, such as changing the word "consumer" to "patient", changing the word "certificate" to "prescription" and simply deleting the reference to "smoking cannabis". Many of the matters raised by the committee can be dealt with in a very straightforward and simple way. Now is the time. We must grasp the nettle and put in place a proper, regulated, medically based system to allow people who suffer chronic pain, seizures and a number of other illnesses to have proper treatment through medicinal cannabis.

Joan Collins (Dublin South Central, Independent)
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I welcome those in the Visitors Gallery. On 1 December 2016, when the Bill came before the Dáil, there was great hope among thousands of people that we were going to see change and people would have proper access to medicinal cannabis. People were crying out for it. That expectation has risen in the recent period. When Vera Twomey marched from Cork to the Dáil gates, I remember the support she had all along the way. That reflected not just those who needed medicinal cannabis for medical purposes but the support for access for her daughter to CBD.

While there was a lot of technical detail at the committee that I would not be au faitwith, I wish to make one point. Professor Barnes, who is an eminent expert, was not invited to the committee. The IMO was not invited to the committee and it has passed a motion stating that it should not be just consultants who are able to dispense medicinal cannabis.

I am absolutely opposed to anybody trying to kill this Bill but I am also opposed to people trying to use it against others in here when people want to work together to try to make sure it happens and that people see change. I support Deputy Kenny's motion that this goes on to Committee Stage but we should be working together to make sure it happens, not for me or for anybody in Sinn Féin, Fianna Fáil or Solidarity-People Before Profit, but because we represent people out there who need this Bill to go through. I appeal to everybody to start working together on this. There has been a change.

I was going to read from an email that I received, but I am sure that all of us have received many emails about people going through a dire situation with chronic pain and so on, so I will leave it at that. I support Deputy Gino Kenny's Bill.

Tommy Broughan (Dublin Bay North, Independent)
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I support the outstanding work of Deputy Gino Kenny and People Before Profit in producing the Cannabis for Medicinal Use Regulation Bill and having it passed through Second Stage. Despite the caveats and reservations in the report on the scrutiny of the Bill - I listened carefully to Deputy Harty on that matter - and coming from the Department of Health and the Minister, the Bill should proceed straight to Committee Stage and any reasonable and necessary amendment should be tabled then or on Report Stage.

In his introductory speech on the Bill last December, Deputy Gino Kenny made a powerful case for its passage into law. In particular, he recalled the extraordinary campaign of Vera Twomey on behalf of her daughter Ava. I welcome Vera to the Public Gallery. The Deputy was heavily involved in that campaign. He also drew our attention to other harrowing medical situations, such as those of Marie Fleming and her husband Tom and of Mark Gaynor and his son Ronan. I recall Deputy Bríd Smith discussing the difficulty involved in treating Dravet syndrome during a later part of the debate.

Like many Deputies, I was struck by a report, entitled Cannabis: The Evidence for Medical Use, which was produced by Professor Michael Barnes and Dr. Jennifer Barnes in May 2016. It presented good evidence for one or more cannabis products or natural cannabis in the management of chronic pain, including neuropathic pain, spasticity, nausea and vomiting, particularly in the context of chemotherapy, and the management of anxiety. The report also outlined a graduated list of the successful use of medicinal cannabis for many other conditions.

I listened to Deputy Harty's caveats and reservations and his statement that the Bill should not proceed to Committee Stage, but the issues raised could be addressed. These are said to be "technical issues and implementation difficulties". I have read some of the committee's work. The claim that there is a "shortage of peer-reviewed evidence for the efficacy and safety of cannabinoid treatment for many conditions" does not seem to have a basis in fact, given the wide international experience and research to which I have alluded. The point that the committee makes about the cannabis regulatory authority has relevance. This House is always reluctant to create yet another quango or agency, but the remit of the Health Products Regulatory Authority, HPRA, could simply be extended, as Deputy Gino Kenny has argued in line with the German model, to include the regulation and research of medicinal cannabis treatment.

The scrutiny report also had difficulties with the proposed framework of the avenue to cannabis, but the Misuse of Drugs Regulations 2017 clearly enunciate the responsibility of a registered medical practitioner in prescribing drugs that, in the future, could include medical cannabis.

I again wish to convey my support to Deputy Gino Kenny and his colleagues in People Before Profit for producing the Cannabis for Medicinal Use Regulation Bill. The Bill should proceed to Committee Stage and I am heartened by some of the comments that have been made during this debate. Any reasonable amendments on, for example, the caveats to which I have referred could be dealt with then or later in the House.

John Curran (Dublin Mid West, Fianna Fail)
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I welcome the opportunity to contribute on this debate. None of us can contribute without being conscious of and touched by the story of Vera Twomey and her daughter. For many of us, it has dominated and been at the forefront of these proceedings. From personal experience, I know what she is going through and the challenges she is facing, particularly when traditional and conventional drugs no longer operate as they should. While the legislation before us will have a major impact for Vera, it is also important to realise that it will be further reaching than that.

I acknowledge the work of the committee. I read its report. The committee found significant challenges in the Bill. According to the concluding remark on the last page of the recommendations to the Dáil, it would be onerous to address those issues. The Bill's proposers have stated that they are willing to challenge and address these. My colleague, Deputy Kelleher, indicated that he was prepared to work on this and give an opportunity for the issues to be addressed.

Speaking as a former Minister of State with responsibility for drugs, one of my main issues relates to a specific concern of the committee, namely, the Bill's proposal to remove cannabis from the Misuse of Drugs Act and what that would entail. Apart from being a psychoactive drug, considerable research and reports refer to cannabis as being a gateway drug and so on. However, I do not want to have that debate today. The types of issue that were highlighted need to be addressed.

Deputy O'Reilly spoke. I have the greatest of respect for the members of the committee. It was an all-party report and they conducted their work in a fair manner. The issues that they highlighted need to be addressed. We are prepared to work with colleagues to do so.

In that regard, I am appalled by Deputy Barry's comments.

Mick Barry (Cork North Central, Solidarity)
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I am sure Deputy Curran is.

John Curran (Dublin Mid West, Fianna Fail)
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He tried to turn this into nothing but a political game. He wanted the politics of opposition. He wanted the politics of protest. When Members of all parties in this House-----

Mick Barry (Cork North Central, Solidarity)
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Deputy Curran is the one who-----

Pat Gallagher (Donegal, Fianna Fail)
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Please, Deputy Barry.

John Curran (Dublin Mid West, Fianna Fail)
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Members on all sides of this House were faced with a choice between rejecting the Bill completely and killing it off and-----

Mick Barry (Cork North Central, Solidarity)
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Deputy Curran should look at himself in the mirror.

John Curran (Dublin Mid West, Fianna Fail)
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-----affording an opportunity to address the issues identified by the committee and making the substantial changes required to render the Bill fit for purpose and capable of delivering the effects that Deputy Gino Kenny intended it to have. That is the challenge. We have stated that we are prepared to do it. Of all Deputies who have spoken today, Deputy Barry was the one who turned around and said, "Protest and turn this into an issue". Members on all sides of the House agreed to work to try to deliver-----

Mick Barry (Cork North Central, Solidarity)
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I will say it again.

John Curran (Dublin Mid West, Fianna Fail)
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-----the outcome that Deputy Gino Kenny's Bill was intended to have.

Ruth Coppinger (Dublin West, Solidarity)
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He said: "Keep up public pressure."

Jonathan O'Brien (Cork North Central, Sinn Fein)
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Not true.

Pat Gallagher (Donegal, Fianna Fail)
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I call Deputy Brassil, who has three minutes.

Ruth Coppinger (Dublin West, Solidarity)
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That is what he said: "Keep up public pressure."

Jonathan O'Brien (Cork North Central, Sinn Fein)
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Not at all.

Ruth Coppinger (Dublin West, Solidarity)
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It is very potent.

John Brassil (Kerry, Fianna Fail)
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I welcome the opportunity to contribute on this debate.

Ruth Coppinger (Dublin West, Solidarity)
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It has a habit of changing Sinn Féin's minds.

Pat Gallagher (Donegal, Fianna Fail)
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Please, ciúnas.

Jonathan O'Brien (Cork North Central, Sinn Fein)
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No. The email that I got from Deputy Coppinger's colleague changed our minds, not public pressure.

Ruth Coppinger (Dublin West, Solidarity)
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It took just one email to change Sinn Féin's minds.

Pat Gallagher (Donegal, Fianna Fail)
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Please, Deputies. You all got opportunities to speak.

Jonathan O'Brien (Cork North Central, Sinn Fein)
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It took one email and a couple of conversations that Deputy Coppinger's group was not ready to have.

Mick Barry (Cork North Central, Solidarity)
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You are very sensitive, Jonathan. Very-----

Pat Gallagher (Donegal, Fianna Fail)
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There will be no meetings within the House. I call Deputy Brassil.

John Brassil (Kerry, Fianna Fail)
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I welcome the opportunity to contribute on this debate. I have severe reservations about the Bill. My background is in pharmacy. I have had the opportunity through my working career to encounter issues such as those raised by Deputy O'Reilly, for example, teratogenic problems among mothers who are on Epilim, people becoming chronically addicted to benzodiazepines, and people who have been using selective serotonin reuptake inhibitors, SSRIs, for depression and either cannot get off them or, if they try, the side effects are worse than the original depressive effects.

As legislators, we are considering politically based treatment and prescribing, but I am not sure that we are fully qualified to do that. I have no issue with debating medicinal cannabis in the Chamber and getting its use, given that it can be of great benefit, but the way to do so is through compassionate access programmes. When we are fully satisfied on the safety of any drug, I am happy to have it used. When I say "safety", I am referring to standard procedures. It is through double-blind randomised trials that one finds out whether a drug is useful and safe. Any amount of testing must be done before it gets into the public domain. That is as it should be. The reason for this is that, in the 1960s, a drug called thalidomide was taken by women for morning sickness, but it had untold consequences. That is why this whole area has tightened up significantly.

Pat Gallagher (Donegal, Fianna Fail)
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Please.

John Brassil (Kerry, Fianna Fail)
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That is why it should be-----

Pat Gallagher (Donegal, Fianna Fail)
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There will be no interruptions from the Public Gallery.

John Brassil (Kerry, Fianna Fail)
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That is why the use of any drug-----

Pat Gallagher (Donegal, Fianna Fail)
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I want the debate to continue, but if we are going to have interruptions from the Public Gallery, we may not be able to continue. Whatever people's opinions are, I ask that they not express them.

John Brassil (Kerry, Fianna Fail)
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I thank the Leas-Cheann Comhairle. That is why the use of any drug should be done in line with the strictest safety regulations, including medicinal cannabis. I have no issue with its use as long as it is proven to be safe and goes through the correct channels.

Deputy Barry said the Bill is not flawed and he will not be changing it. If it is not flawed-----

Mick Barry (Cork North Central, Solidarity)
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I did not say that. I said it was not deeply flawed.

John Brassil (Kerry, Fianna Fail)
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-----do not change it. If he does not want to change it and does not believe it is flawed, that is fine. We will see where it goes.

Dessie Ellis (Dublin North West, Sinn Fein)
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I would like to acknowledge the family, friends and supporters in the Gallery. I am glad to see Vera there. I wish her and her daughter all the best. We are not dealing with the legalisation of cannabis. However, we should make medicinal cannabis available to those who require it for medicinal purposes where it is deemed medically necessary and is prescribed by a medical practitioner in consultation with the patient, parents and family members. We have to be compassionate in our approach to this sensitive issue. We understand this is a very emotive issue, but we have always been upfront with families and listened to their concerns.

We have also been straight in outlining where we stand on these matters. We cannot mislead or give false promises to those who are suffering and continue to suffer. We await the launch of the compassionate access programme for medicinal cannabis which the Minister for Health, Deputy Simon Harris, has indicated will be available later this year. We will monitor its delivery and hope it is fit for purpose. We shall see.

However, there is much work left to be done on the Bill. It is flawed and the Joint Committee on Health was of the same opinion as us. The Bill requires amending. This debate concerns a motion on the scrutiny of the report and, as my colleagues stated, we will oppose the motion in order to allow the legislative process to continue, given the assurances from the drafters of the Bill who are willing to compromise on aspects of the Bill which many legislators have indicated they have a problem with.

We support the Cannabis for Medicinal Use Regulation Bill, but it will require amendment in those areas which are contrary to party policy as decided by our Ard-Fheis. There is an onus on us all to support and help anyone who is suffering or has a disease which can be alleviated in some way by the use of medicinal cannabis. We need to get this over the line.

Jonathan O'Brien (Cork North Central, Sinn Fein)
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The reason we have decided to support the amendment to the motion to allow the Bill to go to Committee Stage is because we sat down with Deputies Kenny and Boyd Barrett last week. In fairness to both, we had a very frank conversation around some of the issues we had with the Bill. Deputy Kenny has always known that we have concerns about certain aspects of the Bill which have prevented us from supporting its passage at the final stage.

Deputy Kenny has always said that he is willing to work with others within the House to address these concerns. Last Tuesday week, we put four particular concerns to Deputies Kenny and Boyd Barrett. In fairness to both, not only did they take those concerns on board, they came back with draft amendments they were willing to allow on Committee Stage which addressed our concerns. On that basis, we decided it was in everyone's interests to allow the Bill to go forward to Committee Stage.

The sponsors of the Bill showed a willingness to work on the aspects which we felt fell outside its purpose, that is, to provide medicinal cannabis. Some of the issues we raised concerned Parts 2 and 3 of the Bill and some of the functions which would be given to the cannabis authority. Some of those functions went way beyond medicinal use. I will list some of them for the information of Deputy Barry, who said the Bill is not deeply flawed.

One asked employers to review current drug-free workplace policies. A second considered research for recreational use. A third referred to patients as consumers. A fourth referred to methods of consumption. A fifth related to the descheduling of cannabis as a Schedule 1 drug. In fairness, Deputies Kenny and Boyd Barrett came back with an amendment to reschedule it. It will not be descheduled, as is the current proposal. Rather, the amendment will reschedule the drug as a Schedule 4 drug along with other medicines which can be classified as drugs, such as benzodiazepines. That is a very responsible attitude to take.

Another unintended consequence of the Bill which we wish to highlight is that as it is currently drafted, somebody who has a criminal conviction for the sale and supply of cannabis could obtain a licence. A convicted drug dealer could obtain a licence. That has been addressed by the sponsors of the Bill. On that basis, we are willing to support its passage. This is nothing to do with public pressure or U-turns. Rather, it is Members coming together with a willingness to work together to pass legislation. We are willing to do that.

Aindrias Moynihan (Cork North West, Fianna Fail)
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It is almost a year since we debated Second Stage of the Bill. There was widespread support across parties at that time. I am glad that the support has continued. People recognised that medicinal cannabis can make a difference to people and that efforts need to be made to make it accessible to those whom it will help. It may help conditions such as multiple sclerosis, MS, epilepsy and others.

A number of issues were highlighted on Second Stage. Since then, issues such as the cannabis board and the possible availability of cannabis well beyond medicinal use have arisen. They need to be dealt with if the Bill is to progress. I understand the sponsor is willing to make significant changes and deal with those issues in the Bill. I would be keen to support him and move the process along if that is possible.

There was widespread cross-party support for the Bill. I would like that to continue rather than there being efforts to divide and cause aggravation. This goes beyond politics. It is about making something available to ease people's conditions.

Cannabis needs to be controlled and the Bill is not about the wholesale availability of medicinal cannabis. The substance needs to be controlled through the proper channels, and that needs to be facilitated if the Bill is to progress. I would like the Bill to progress to Committee Stage where the necessary changes and improvements can be made.

The committee report referred to a compassionate access programme. Secondary legislation should be a faster and more accessible route. Over the past year, we have seen that things are very restrictive and change is not happening as quickly as should be the case with primary legislation.

If the Minister is serious, he needs to get that moving and make it realistically accessible. In the meantime I would like to see the Bill advance to Committee Stage, where all the larger matters that have been identified could be dealt with. I note the willingness of the sponsors to do that.

Clare Daly (Dublin Fingal, Independent)
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The fact that we have had so many Deputies competing to contribute to the discussion is reflective of the fact that everybody takes the matter incredibly seriously. There is a large inherent contradiction in this with the silence surrounding legalised opioids, which make billions of euro for pharmaceutical companies, and drugs like Lariam, which are legal but do enormous damage, held against the queasiness that exists around the legalisation of cannabis, which is safe and non-addictive. It has been proven to have huge medicinal benefits.

I do not need to be convinced of the hypocrisy that surrounds this issue and there are arguments that I have made many times before. As one of only eight Deputies who supported a Bill from a former Deputy, Luke "Ming" Flanagan, to legalise cannabis in all circumstances, I clearly support the use of cannabis in medical circumstances. We must be honest as that is not what today's debate is about. This is about how to make cannabis available as quickly as possible to our citizens who so desperately need it. I am mindful that we sat here almost a year ago and people desperate for that treatment were led to believe it could be granted with a wave of a hand; it was implied that if the Bill went through Second Stage, it would be sorted within a few weeks. That did not happen. If, as a result of some games being played today, we have another year of being in the same position, it will amount to a scandalous betrayal of people who need this treatment.

I reject some of the analysis of the health committee on the Bill. I have read its report and the reply from Solidarity-People Before Profit. There are qualms among the committee members about the potential side-effects and the need for more peer-reviewed research and so on but those are not reasons not to advance the Bill. There are plenty of ways in which the committee could have advanced the issues. I also accept the points made that this legislation is deeply flawed. It is a fact, although I wish it were not so. It is in the way it has been drafted and there are fundamental problems with the Bill in its current form. They need to be addressed or else we would be lying to people in the Gallery and outside. The Bill has not been delayed because of some plot to delay the legalisation of medicinal cannabis but maybe civil servants who are slow at responding to issues have used poor drafting to delay it. That should not happen.

Today's debate seeks to move this forward. The health committee debated making access more readily available through secondary legislation and so on. In order to force whatever mechanism is required for delivery - I do not care if it is secondary legislation - this Bill should remain on the Order Paper. It should go to Committee Stage and keep the pressure on so we will not be here in a year's time in the same position.

David Stanton (Cork East, Fine Gael)
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Having listened to speakers this afternoon, on behalf of the Minister for Health I am left in no doubt that this is clearly a very important matter for Deputies and many members of the public as well. I thank Deputies for the work that has gone into this and for taking part in today's debate. We must all remember that the fundamental issue we are discussing is whether the Bill will progress to Committee Stage rather than the general issue of cannabis usage. There seems to be consensus among colleagues that this should happen.

Some of us are around here long enough to know if there is very flawed legislation, it might not be possible to amend it and sometimes it is better to start from scratch, redraft the legislation and resubmit it. Most colleagues I have listened to have said there are serious flaws in the legislation so the committee will have a challenge in addressing them. It may well be the case that the committee might have to start again and redraft the legislation. It might be considered if a Bill is so fundamentally flawed, and the easiest thing might be start again. However, we are where we are.

The Bill has been carefully examined by the committee and the report indicates the Bill has fundamental flaws that could lead to many undesirable and unintended consequences for patients and wider society. I know the committee put much time and work into this and took the matter very seriously. Deputy Harty chaired those discussions. There are medical professionals in the House who have also expressed their opinions, and Deputy Brassill spoke very strongly from his experience. We must listen to that too.

The Bill places the regulation and oversight of medicinal cannabis under a completely different and separate legislative and regulatory framework to all other held products. This appears to be an attempt to bypass the existing well-established rules in place for the protection of public health and safety. We are on new ground and we must proceed carefully. The legal advice obtained by the committee refers to major legal issues with the contents of the Bill. Currently, there is very little clinical evidence on the safety and effectiveness of many cannabis products and we must proceed cautiously as a result. After all, we agree that cannabis is not a normal medicine and it has not gone through the normal assessment procedures and clinical trials for medicines, which are designed to protect patients. Therefore, we must take great care in making such products available for patients.

It is my view and that of the Minister for Health that a system of accessing cannabis for medicinal use must be introduced on a gradual basis under appropriate clinical supervision, and only for those patients recommended for such treatment by their treating consultant. These consultants are experts in their patients' medical conditions and they are best placed to monitor carefully a patient's response to cannabis treatment, including improvements or deterioration in a patient's medical condition. This level of clinical involvement limits the level of risk to a patient's overall health.

As I said, the expert reference group established by the Minister for Health, Deputy Harris, to develop the operational, clinical and practice guidelines for the access programme has made great progress in finalising the clinical guidelines for prescribing cannabis for medicinal purposes under the programme. It is also important to note it remains open to consultants to prescribe cannabis treatment for a patient if granted a licence to do so by the Minister for Health. In such cases, it is the decision of the patient's consultant to prescribe cannabis for a patient under his or her care. It is also the decision of the prescriber to make an application to the Minister for Health for such a licence. I advise any consultant considering this option to consult the Department of Health directly for more information.

I thank the Chairman and members of the health committee for their thorough examination of this Bill and their work in preparing this report of scrutiny of the Private Members' Bill. It appears the majority want the Bill to proceed to Committee Stage and the Government will not oppose it at this time. We have listened very carefully to the debate. I wish the committee the very best in amending this legislation, as it will be a major challenge. Like Deputy Kelleher and some others, I have been around this House for quite a while dealing with very complex legislation and I know this will not be easy. One must be very careful not to have unintended consequences at the end of the process that could result in much damage. The Government will not oppose the amendment to the motion and it will not support the motion.

Michael Harty (Clare, Independent)
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I am in a very difficult position, as I was when the debate was conducted on 1 December last year. At the time I saw fundamental flaws in the Bill and I was the only person in the Chamber that night to speak against it. I spoke on it from a position of genuinely held medical views, which I still hold. I am also here as the Chairman of the health committee, which is proposing the motion that the Bill should not proceed to Committee Stage. On that committee there were three Fianna Fáil members, three Fine Gael members, a member of the Labour Party, a member of Sinn Féin and three Independents. The recommendation that the Bill should not proceed to Committee Stage was reached without dissent.

It would appear today that is not the case and I find it very difficult to speak on a motion when those who did not dissent are now dissenting. Such is politics. I have learned much about politics from working on this cannabis Bill.

I believe the committee had fair hearings. I do not believe that anybody was badly treated at the committee. Many Members, who were not members of the committee, contributed. I do not accept that there was any bias. I chaired the meetings in a fair and unbiased manner. There were some robust exchanges and asked particular questions. By analysing the contributions of all those who spoke at the meetings, and we had four meetings on medicinal cannabis, we came to our unanimous conclusion.

It was the intention of the committee, and it is my intention as chair, to see medicinal cannabis products being available to patients. I met Ms Vera Twomey in the audiovisual, AV, room in June 2016 and promised her that I would bring the issue before the Joint Committee on Health, which I did on 24 November last. I know that she was bitterly disappointed in me when I told her on 1 December that I was going to oppose this Bill. It upset her greatly. However, my intention, and the intention of the committee, is to provide medicinal grade cannabinoid products to treat people who have conditions which will respond to it. That is still the intention of the committee. The committee rejected the Bill because we found that it was substantially flawed and was not going to progress the provision of medical grade cannabinoids for patients. I would love it if that was possible in the future, but we had to deal with the Bill, and our conclusion was that it should not proceed to Committee Stage.

The Bill was very poorly worded. It is telling that many sections of the Bill were taken from the Luke 'Ming' Flanagan Bill of 2013, which proposed the introduction of recreational cannabis as well as medicinal cannabis. Many of the sections of the Bill were taken from that previous Bill and were not cleaned up properly. Both the committee and I found many references unacceptable. It referred to recreational use, it referred to consumers rather than patients, it referred to selling cannabis rather than dispensing it and it referred to certification by a doctor rather than prescribing by a doctor, and there is a fundamental difference between a doctor issuing a certificate and a doctor writing a prescription because a prescription has a legal status whereas a certificate has no status, or certainly substantially less status. The Bill proposes making available whole plant cannabis products. Included in that is a provision to sell cannabis by weight, which of course implies that cannabis is for smoking. It also proposes that cannabis should be sold in plain packaging so that it would not be advertised. A further proposal is for a ban on smoking cannabis in the workplace, which I found quite extraordinary. It implies that cannabis could be smoked legally outside the workplace. Indeed, in section 44 of the Bill it defined cannabis as something that could be smoked.

Those were the flaws that I could see. The more one reads the Bill the more flaws become apparent. That was the substantial reason the committee did not recommend that this Bill should proceed. It certainly did not want to indicate that it did not support the provision of medicinal cannabinoid products, either on their own or in combination, which would treat illness. That is the aim of the committee.

The study conducted by Mr. Mike Barnes was referenced widely in the Bill. One of the issues that the proposers of the Bill had was that the HPRA did not reference pain as an illness or a condition for which medicinal cannabis should be produced. There are only four studies in the study from Mr. Barnes which deal with smoking cannabis. None of those four studies reached a level that Mr. Barnes had set for good evidence that medicinal cannabis dealt with pain. Those studies were class two and three studies, and the bar Mr. Barnes set for good evidence was not reached by those four studies. That is not to say that smoking cannabis could not relieve pain, but in his own investigations the studies on smoked cannabis did not reach the level at which it could be called good evidence. The products that Mr. Barnes referenced as having good evidence for pain relief were pure cannaboid products, and he named those four products which he accepted relieved pain. However, smoking cannabis did not reach that level.

The content of this Bill relates to smoking cannabis, and that was the main objection the committee had on the Bill. Smoking cannabis has serious health effects. It can precipitate psychosis, particularly if smoked by young adolescents or young adults. It can trigger a psychotic illness. I have patients who have had psychosis triggered by smoking cannabis. I have come across patients who have been demotivated, and their lives changed completely, by smoking cannabis. There is a 9% dependency rate if one smokes cannabis on a regular basis. They are the issues that I feel are unacceptable in this Bill.

I have to reiterate that the committee is committed to providing medicinal cannabis that is safe and effective and has data to back it up. We could not accept the Bill in the manner in which it was drafted. The Government made the excellent suggestion that this Bill be redrafted rather than amended. The committee felt that it would be so difficult to amend this Bill that it would be practically impossible. We are now going to be given the task of amending the Bill, and I feel it is going to be very difficult to amend it. I suggest that redrafting may be a better course of action than amending.

I thank the Leas-Cheann Comhairle for the opportunity to contribute to this debate. I am standing alone on this side of the House again. It is a very uncomfortable position to be in. I hope people understand that as Chairman of this committee I cannot go against its recommendation, so I will be voting that the Bill should not proceed to Committee Stage.

Pat Gallagher (Donegal, Fianna Fail)
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A genuine and sincere thanks to all the Members present for their co-operation. When we started at 2 o'clock it looked as if very few would get a chance to speak, but because of their co-operation and my recommendations everyone has had his or her say. I thank the Members for that. I also thank those in the Public Gallery for their restraint.