74 patients in 5 years: why is Ireland's medical cannabis programme a failure?

Five years after Ireland’s implementation of of its Medical Cannabis Access Program (MCAP), the government has decided to conduct an official review of this system, which has been widely criticized for being too restrictive and slow.

Minister of Health, Jennifer Carroll MacNeill, confirmed that the professor Shane Allwright, a retired epidemiologist from the Trinity College, Dublin, will chair the Review of Access to Medical Cannabis. This review will examine both the MCAP framework and the parallel procedure for ministerial license in Ireland, while assessing whether the eligibility criteria should be expanded.

This announcement comes amid growing political pressure and a renewed review of the program's performance since its launch in 2021.

Only 74 patients approved in five years

Although it was presented as a major milestone for the Irish healthcare system, official figures show that the MCAP has benefited only a remarkably small number of people. In a written parliamentary response dated March 18, 2026, Minister Carroll MacNeill confirmed that only 74 patients have been approved under the program since its inception.

Only 22 consulting physicians have submitted applications on behalf of patients, highlighting the low participation rate among prescribers and raising new questions about the program’s actual accessibility.

The Irish MCAP was launched as a five-year pilot project and remains limited to three eligible conditions: spasticity associated with multiple sclerosis, refractory nausea and vomiting associated with chemotherapy, and severe, treatment-resistant epilepsy. Access is further restricted by the requirement that prescriptions be issued by medical specialists and only after all conventional treatments have been exhausted.

For many advocates, these restrictions have prevented the MCAP from becoming a fully operational national access channel.

A system shaped by activism, but limited by its design

The program was initially launched thanks to a citizen-led campaign organized by Vera Twomey, whose daughter Ava had Dravet syndrome, a rare form of drug-resistant epilepsy. The public campaign began in 2017 and prompted the government to develop a regulatory framework for medical cannabis.

Work on the program officially began in March of that year, with a group of experts developing clinical guidelines. The legislation was then signed into law in June 2019, establishing the MCAP as a pilot project.

However, concerns about its structure soon arose. The drug policy activist Natalie O’Regan argued that the program lacked follow-up and concrete data collection. The representative from People Before Profit Gino Kenny, a key political supporter of the MCAP, also described the program as «far too restrictive.».

Ministerial licenses are also in the spotlight

Alongside the MCAP, Ireland continues to offer patients a separate option: the system of ministerial authorizations. This program predates the MCAP and allows patients to access cannabis-based treatments for conditions that do not meet the program’s official criteria, but only with the minister’s direct approval.

This system has been described on several occasions in parliamentary responses as bureaucratic and slow. The products are supplied by a pharmacy in the Netherlands, with imports handled each month by the Health Service Executive (HSE) Irish.

Carroll MacNeill confirmed in January 2026 that the ministerial licensing system would also be reviewed as part of the 2026 process.

A review of the scientific data highlights the potential for treating neuropathic pain

This review should be based on a major assessment of scientific data published in January 2024 by the Health Research Board (HRB). This report reviewed 47 systematic reviews covering more than 30 years of research.

The HRB found evidence supporting the prescription of cannabis for chemotherapy-related nausea and vomiting and spasticity associated with multiple sclerosis, two conditions already covered by the MCAP. It also identified promising evidence regarding the neuropathic pain, suggesting that this could become a central focus of discussions on expanding the eligibility criteria.

However, for many other conditions frequently cited by patients—such as anxiety, cancer-related pain, fibromyalgia, and rheumatic diseases—the HRB concluded that the data were inconclusive and fragmented.

The Ava Protocol and Gaps in Hospital Access

One of the most politically sensitive issues that is likely to be addressed is the lack of a national policy authorizing hospital staff to administer Schedule 1 cannabis-based medications.

This issue came to light during the case of Ava Barry, who died in May 2023. An investigation subsequently revealed that there was no official policy regarding the administration of cannabis-based medications under special licenses in hospitals, which forced her mother to remain in the ward as the only person legally authorized to administer her treatment.

The recommendation that followed is now known as Ava Protocol, and Carroll MacNeill confirmed that this would be a key point to be examined during the review.

Ireland Lags Behind in the Expansion of Medical Cannabis in Europe

While many European countries have expanded their regulatory frameworks regarding medical marijuana and attracted commercial investment, Ireland has lagged behind, with one of the most restrictive and slowest access systems on the continent.

The exam is scheduled to begin on second quarter of 2026 and publish its findings within 12 months. For patients and advocates, the key question is whether this long-awaited process will finally lead to concrete reforms or whether it will merely prolong a system that has has already deprived most patients access to treatment.