Medical cannabis and treating epilepsy

Sir, – Epilepsy is a group of brain disorders characterized by the occurrence of recurring unprovoked seizures, and seizures can be difficult to control in a third of people with epilepsy. Some have very severe epilepsy, often due to an underlying genetic abnormality, and often have life-threatening seizures with devastating effects on the quality of life and the wider family.

There has been a long historical interest in the use of marijuana in the treatment of epilepsy. In recent years, controlled studies published in leading medical journals on a non-psychoactive cannabis ingredient, cannabidiol (CBD), have shown beneficial benefits in some people with certain types of severe epilepsy. Pharmaceutical grade CBD (Epidyolex) is the only European Medicines Agency (EMA) cannabinoid approved for the treatment of select patients with some forms of complex difficult epilepsy. Although it is the only medical cannabis product approved by the EMA, it is still not approved for reimbursement by the Health Services Executive (HSE) in Ireland. This process is ongoing and there is no definite end to the completion of the reimbursement decision in sight.

So now I could prescribe Epidyolex to my patients who I think might benefit, but it’s prohibitively expensive at around € 2,000 a month.

Meanwhile, then Health Minister Simon Harris announced in June 2019 the establishment of a Medical Cannabis Access Program (MCAP) to provide cannabis products in a range of situations, including those with certain complex epilepsy disorders. This program has still not been carried out satisfactorily, consists of cannabis-based products with tetrahydrocannabinol (THC), a psychoactive compound for which clinical trial data on efficacy in complex epilepsy are not available (despite anecdotal reports of beneficial effects in some cases), not included exclusively Preparations containing CBD, including the only EMA licensed product, and from an administrative point of view, the program is very time consuming and demanding for clinicians.

The saga of the adequate availability of medical cannabis for complex epilepsy has been going on in Ireland for several years, and neurologists, patients and families are deeply frustrated with the lack of networked thinking at the departmental and HSE level. On behalf of the neurological community and patients with severe epilepsy and their families, I advocate that eligible patients be provided with the only EMA licensed product for the treatment of some of the most serious life-threatening forms of epilepsy. In this case, the MCAP would largely be superfluous. – yours etc.

Prof. NORMAN DELANTY,

Specialist in neurology,

Beaumont Hospital,

School of Pharmacy

and biomolecular sciences,

and FutureNeuro

Research Center,

Royal College of Surgeons

In Ireland,

Dublin 2.