Ireland to legalise cannabis for specific medical conditions

Ireland is set to legalise the use of cannabis for treating specific medical conditions, after a report commissioned by the government said the drug could be given to some patients with certain illnesses.

The Irish health minister, Simon Harris, said he would support the use of medical cannabis “where patients have not responded to other treatments and there is some evidence that cannabis may be effective”.

The report said cannabis could be given to patients with a range of illnesses including multiple sclerosis and severe epilepsy, and to offset the effects of chemotherapy.

“I believe this report marks a significant milestone in developing policy in this area,” Harris said. “This is something I am eager to progress but I am also obligated to proceed on the basis of the best clinical advice.”

Last November, Harris asked Ireland’s Health Products Regulatory Authority (HPRA) to examine the latest evidence on cannabis for medical use and how schemes to facilitate this operate in other countries.

The study found “an absence of scientific data demonstrating the effectiveness of cannabis products” and warned of “insufficient information on [the drug’s] safety during long-term use for the treatment of chronic medical conditions”.

“The scientific evidence supporting the effectiveness of cannabis across a large range of medical conditions is in general poor, and often conflicting,” it added.

However, it added that any decision on legalising use of cannabis was ultimately for society and the government to make.

Harris said he wanted to set up a “a compassionate access programme for cannabis-based treatments” and was now considering any changes in the law needed for its operation.

The new medical cannabis scheme will run for five years and will be constantly monitored by Irish health service experts.

The big policy shift came in the same week that the Fine Gael-led coalition in Dublin backed the idea of a “safe injection” room for heroin addicts in Ireland’s capital.

The Temple Bar Company, which represents bars, clubs, restaurants and other businesses in the cultural-entertainment quarter on the south bank of the Liffey in Dublin, expressed opposition to locating any of the injection centres in or close to the tourist district.

The Temple Bar chief executive, Martin Harte, said businesses in the tourist centre collected 1,500 syringes from the streets around the area every year.

“We are bracing ourselves for an increase in the level of syringe disposals and related antisocial behaviour,” he said.

“Addiction centres make no provision for what happens outside of opening hours … The Temple Bar Company is not opposed to tackling issues with drugs in Ireland, but we are opposed to proposals that exacerbate and fuel an injecting epidemic in Dublin city.”

Last year, Aodhán Ó Ríordáin, the former Irish Labour party junior health minister, became the first politician to call publically for a safe injection centre for the more than 20,000 registered heroin addicts in Dublin alone.

Ó Ríordáin also said he favoured making the possession of heroin, cocaine or other opiates for personal use no longer an arrestable offence.

Although he is no longer in government, after last year’s election, Ó Ríordáin’s suggestion of partial decriminalisation of drugs among users won the backing of rank-and-file police officers in Ireland, who said it would free up resources.

Ireland to legalise cannabis for specific medical conditions

German MPs vote to legalise cannabis for medicinal purposes

Germany’s lower house of parliament has passed a law legalising the use of cannabis for medicinal purposes.

People with serious illnesses such as multiple sclerosis and chronic pain, or a lack of appetite or nausea, could be offered marijuana under the law.

Patients will only have the right to be treated with cannabis “in very limited exceptional cases” and they will not be allowed to grow their own cannabis, according to the bill.

The health minister, Hermann Gröhe, said: “Those who are severely ill need to get the best possible treatment and that includes health insurance funds paying for cannabis as a medicine for those who are chronically ill if they can’t be effectively treated any other way.”

A health ministry spokeswoman said cannabis would only be used as a last resort. She said a scientific study would simultaneously be carried out to assess the effects of cannabis use in such cases.

Until now, patients had only been able to access cannabis for medicinal purposes by special authorisation –which had made it complicated. Now they will be able to get a prescription from their doctor and a refund for the upfront cost from their health insurance, she said.

The spokeswoman said the law was likely to take effect in March after a procedural reading by the upper house of parliament.

Until state-supervised cannabis plantations are set up in Germany cannabis will be imported.

Other countries that allow cannabis to be used for medical purposes include Italy and the Czech Republic.

German MPs vote to legalise cannabis for medicinal purposes

We must legalise access to medical cannabis as a matter of urgency | Mike Barnes

You’re effectively using the essential ingredients of cannabis right now. You and everyone else. That’s because our brains, and other parts of the body, have a natural endocannabinoid system that is now known to assist with how we deal with pain, the control of movement, the protection of the brain after damage and a host of other functions. Our increasing knowledge of this natural endocannabinoid system now gives a solid scientific rationale for why cannabis has so many positive medicinal effects. And as well as this recently understood scientific rationale, there is a substantial body of clinical evidence that medical cannabis works. My review of that evidence is published today by the UK all-party parliamentary group on drug reform as part of their inquiry into medical cannabis.

My challenge to the government is to have the political courage to accept the scientific rationale, accept the evidence and move to legalise access to medical cannabis under prescription here in the UK as a matter of urgency.

Cannabis has been a useful medicine for centuries, with known use dating back to 4000BC in ancient China

Currently, the government has cannabis classified as a Schedule 1 drug, a classification for substances judged to have no medicinal value. This is irrational and incoherent. The evidence is plain to see and has been compelling enough for a large number of countries to legalise access to medical cannabis including the Netherlands, Germany, Spain and 25 US states.

My report shows that there is strong evidence that medical cannabis helps with chronic pain; spasticity (common, disabling and painful after stroke or brain injury and common in those suffering from multiple sclerosis, as examples); for nausea and vomiting, especially during chemotherapy; and for the management of anxiety. There is also evidence of usefulness in sleep disorders, for appetite stimulation (in HIV, for example), fibromyalgia, post-traumatic stress disorder, severe childhood epilepsies, bladder problems and even for control of some cancers. The list goes on.

And this issue matters to a lot of people. Estimates by the campaign group End Our Pain put the number of people in the UK taking cannabis primarily for medical reasons at one million. Many have found that “regular” prescription medicines just don’t work for them, or have debilitating side-effects. As access to cannabis in the UK is illegal, all these people are at risk of prosecution. These people would be regarded as patients in those countries with a more enlightened approach, but here they risk being treated as criminals.

The usefulness of medical cannabis is unquestionable; but is it safe? Certainly there are some potential short-term effects such as dizziness, drowsiness, dry mouth, balance problems and sometimes confusion. These effects, however, are largely induced by the psychoactive component – tetrahydrocannabinol (THC). This is the chemical that causes the “high” sought by recreational users. The other main chemical is cannabidiol (CBD), which is neither illegal nor psychoactive and indeed counters the effects of THC. That’s why medical cannabis will be produced in controlled conditions to ensure the right balance between CBD and THC.

Much more powerful and potentially dangerous prescription medicines are prescribed routinely by doctors. Every drug prescribed has positive and negative effects and the doctor’s job is to weigh those risks and benefits, explain that balance to the patient and allow an informed choice. It would be no different in the case of medical cannabis.

What about the threat of long-term problems, such as triggering schizophrenia? The evidence is conflicting but nevertheless some cannabis products (mainly those high in THC) can induce transient symptoms similar to the symptoms of schizophrenia and exacerbate symptoms in individuals already suffering from psychosis. I would expect a doctor not to prescribe medical cannabis in such cases.

Cannabis has been a useful medicine for centuries, with known use dating back to 4000BC in ancient China. It was also widely used in ancient Indian, Greek and Roman cultures. Medicinal use was first properly documented by Dioscorides in the first century AD. It has certainly gone through periods of being in and out of fashion. A particular period of enthusiasm was during the 19th century when, for example, Sir John Russell Reynolds recommended it for period pain suffered by Queen Victoria.

The government now has the scientific rationale and the evidence. And through the campaigning efforts of End Our Pain and others, we have the powerful personal testimonies of those that are suffering. Let’s act. Let’s legalise access to medical cannabis now.

We must legalise access to medical cannabis as a matter of urgency | Mike Barnes

Legalise assisted suicide simply because "choice" the most critical principle in medicine - says BMJ

It difficulties MPs and peers to back the bill, describing them as “our timid lawmakers”.

Supporters of the bill welcomed the intervention, saying it was recognition that a “growing number” of medical doctors and other healthcare personnel support a adjust in the law.

But the BMA insisted that the journal did not represent its views or people of the wider healthcare occupation.

In just over two weeks Lord Falconer’s bill, which would allow medical professionals to prescribe lethal doses of drugs to terminally sick patients with a “settled intention” to finish their lives, will have its initial complete parliamentary airing with a second reading debate in the Residence of Lords.

Members of each houses are to be given a free vote on the concern and ministers, including Norman Lamb, the care minister, have presently signalled they would assistance it.

Last week the President of the Supreme Court, Lord Neuberger, publicly challenged Parliament to review the law on assisted suicide or encounter intervention by the courts.

The court turned down a challenge involving the loved ones of Tony Nicklinson, the “locked-in syndrome” sufferer who fought a lengthy campaign for assisted suicide, but signalled it could be prepared to declare the ban on assisting an individual to take their very own existence as “incompatible” with human rights if Parliament did not act.

“Let us hope that our timid lawmakers will rise to the [court’s] challenge,” the editorial remarks.

It goes on: Folks must be capable to workout decision in excess of their very own lives which must include how and when they die, when death is imminent.

“In current decades, respect for autonomy has emerged as the cardinal principle in health care ethics and underpins developments in informed consent, patient confidentiality, and advance directives.”

“Recognition of an individual’s appropriate to establish his or her best interests lies at the heart of this journal’s method to advance the patient revolution in wellness care.

“It would be perverse to suspend our advocacy at the second a person’s days have been numbered.”

Dr Peter Saunders, campaign director of the Care Not Killing Alliance, explained: “While autonomy is important it has to be balanced against other principles such as public security.

“None of us believes autonomy is absolute, if we did we would have to say that there was no location for law because every single law restricts personal autonomy.”

Sarah Wootton, Chief Executive of Dignity in Dying explained: “We are delighted that the British Health care Journal has backed Lord Falconer’s Assisted Dying Bill.

“The recognition by the leading healthcare journal of the importance of safeguarded patient choice in finish of daily life care is to be welcomed, and comes at a time when a developing amount of foremost wellness care experts are supporting this kind of decision.”

Dr Mark Porter, chair of the BMA Council, stated: “There are strongly held views inside of the medical profession on the two sides of this complex and emotive issue.

“The BMA remains firmly opposed to legalising assisted dying.

“This problem has been often debated at the BMA’s policy forming yearly conference and latest calls for a adjust in the law have persistently been rejected.

“The BMJ is a wholly owned subsidiary of the BMA, and quite rightly has editorial independence.

“Its position on assisted dying is an editorial decision and does not reflect the views of the BMA or the health care occupation.

“Our concentrate have to be on creating sure every single patient can accessibility the really best of palliative care, which empowers individuals to make selections in excess of their care.”

Legalise assisted suicide simply because "choice" the most critical principle in medicine - says BMJ

This plea to legalise assisted dying have to not be ignored | Raymond Tallis

‘If assisted dying were legalised, a physician or nurse would be present when the patient took the daily life-ending prescription.’ Photograph: Burger/Phanie/Rex Attributes

Prof John Ashton’s courageous and humane stance on the want to alter our attitudes towards death and dying could not be more timely, given that Lord Falconer’s assisted dying bill is to attain its crucial second studying in the Residence of Lords on 18 July.

Ashton’s phone for “midwives for the finish of life” is a response to a severe problem in the way the healthcare profession approaches the care of dying individuals. In element, as Ashton factors out, this is driven by the false expectation that there is a health-related answer to each and every problem and an unwillingness to recognise when health care interventions are futile, or worse, compounding the patient’s suffering.

The development of palliative care, in whifch Britain has led the way, is partly a corrective to this unthinking perspective. It begins with the acknowledgement that there is a time to move away from aggressive treatments and the illusion of remedy to a concentrate on symptom handle. But we require to recognise that even though this serves the demands of the bulk of individuals, many nonetheless suffer terribly.

A current survey has located that even in hospices (which provide the best attainable care) 2% of people – at least 6,000 adults – have no relief in the course of the final 3 months of daily life. We can anticipate that this proportion rises for the final days and hrs.

No civilised society can ignore this degree of struggling. On grounds of compassion alone, the Falconer bill have to command our assistance. If it is passed into law it would be feasible for terminally sick, mentally competent adults with a settled want to die to be given a life-ending prescription by a doctor.

Numerous oppose this on religious grounds, even though the majority of people with religious beliefs (60-70%) are in favour of assisted dying. Individuals who oppose the bill have to recognise that in performing so they are riding roughshod above a fundamental principle of medicine and healthcare ethics – respect for patient decision. And they must also remember the options to medically assisted dying: botched suicide attempts, death by voluntary starvation and dehydration, pilgrimages to Switzerland and assist from one-off amateurs who have the threat of prosecution hanging more than them.

The 17-12 months encounter of the Death with Dignity Act in Oregon has shown that a law similar to the a single proposed by Falconer (although the latter has much more safeguards) can be administered securely. The worries expressed by opponents that it may well have adverse consequences for health care care and society have not been realised. The Oregon Hospice Association at first opposed assisted dying. It withdrew its opposition following eight years of the law, finding that there was “no proof that assisted dying undermined Oregon’s finish-of-lifestyle care or harmed the interests of vulnerable individuals”.

Ashton’s intervention is notably critical because numerous supposedly representative health care bodies have a stance of opposition to assisted dying. This is despite the see of the bulk of physicians (some 61% in a recent poll) that organisations this kind of as the British Medical Association should continue to be neutral, as this is a matter for society, not the medical occupation, to decide.

If assisted dying had been legalised, a medical doctor or nurse would be current when the patient took the life-ending prescription. This would not correspond fully to Ashton’s thought of the equivalent of a midwife at the end of life. But it would be a wonderful improvement on the current scenario, where healthcare employees are obliged to deny aid to some sufferers at the time of their biggest require. In quick, to abandon them.

This plea to legalise assisted dying have to not be ignored | Raymond Tallis

Belgium to legalise euthanasia for kids

“There is no demand from the population or from the health-related community for the likelihood of euthanasia for minors,” explained Professor Stefaan Van Gool, a medical doctor specialising in the treatment of young children with cancer at Leuven’s university hospital. “There is no acute require for the law to catch up so rapidly.”

Mia De Schamphelaere, a Christian Democrat senator whose celebration is opposed to the new law, accused MPs of ignoring medical and ethical considerations due to the fact of a “disturbing ideological stubbornness”. “There is also a lot haste and too small fundamental debate on a topic that is quite actually a matter of life and death,” she mentioned.

A fortnight in the past, a motion signed by 58 representatives in the Council of Europe’s parliamentary assembly accused supporters of the legislation of selling “the unacceptable belief that a life can be unworthy which issues the quite basis of civilised society”.

In an unprecedented joint statement final year, Belgium’s Christians, Muslims and Jews expressed “disappointment and sadness” at the proposed law, and suggested children’s suffering could alternatively be eased by palliative care.

“The fear and impotence of mothers and fathers who see a child endure and die as well early touches us. Young children have to not be allowed to endure and medicine possesses the required implies,” said the statement.

Jean-Jacques De Gucht, a Flemish liberal MP and prominent supporter of the new law, has dismissed the calls for higher reflection and more time for debate.

“The proposal is also important to delay,” he said. “This debate has been carried out in a extremely serene and appropriate way. The healthcare reality is that there is no age limit for struggling and we want to provide an response.

“Everyone is totally free to decide on the way they themselves deal with that.”

Dr Gerland van Berlaer, a paediatrician at University Hospital Brussels, argued that the law is so tightly drafted that it will only apply to a handful of teens who are in innovative phases of cancer or other terminal illnesses.

“We are speaking about children that are truly at the finish of their life.

“It’s not that they have months or many years to go. Their daily life will end anyway,” he explained.

“The query they inquire us is: ’Don’t make me go in a horrible, horrifying way, let me go now although I am nonetheless a human currently being and whilst I nevertheless have my dignity.”

Concerns surrounding what constitutes proper grounds and consent for euthanasia have come underneath increasing scrutiny in recent years.

There was worldwide controversy final year after Nathan, born Nancy, Verhelst, 44, was killed by health care euthanasia after pleading for death because a botched intercourse change operation to turn her into a guy had resulted in “a monster”.

At the end of 2012, Marc and Eddy Verbessem, deaf twins aged 45, chose euthanasia by lethal injections following discovering that they would also quickly go blind.

Euthanasia carried out by physicians is only legal in 3 European nations, the Netherlands, Belgium and Luxembourg. Only the Dutch at present allow euthanasia to be administered to kids.

Figures realised on Tuesday showed that 42 Dutch psychiatric individuals have been assisted to die final year, a “marked increase” from 14 situations in 2012 that has raised issues above the extension of “mercy killings” to individuals who may well not be able to entirely consent.

Belgium to legalise euthanasia for kids

Belgium expected to legalise euthanasia for young children

Protesters from the Yellow Security Jacket group voice their opposition to the amendment legalising the euthanasia of younger kids. Photograph: Julien Warnand/EPA

Belgium, one particular of the number of nations in which euthanasia is legal, is expected to abolish age restrictions this week on who can inquire to be place to death – extending the proper to youngsters for the first time.

The legislation appears to have broad help in the largely liberal country. But it has also aroused extreme opposition – such as from a checklist of paediatricians – and men and women have staged noisy street protests, fearing that vulnerable children will be talked into producing an irreversible choice.

Backers this kind of as Dr Gerland van Berlaer, a prominent Brussels paediatrician, think that it is the merciful factor to do. The law will be distinct ample that it will apply only to the handful of teenage boys and ladies who are in sophisticated phases of cancer or other terminal illnesses and suffering unbearable pain, he explained.

Below existing law, they should let nature consider its course or wait until they flip 18 and can request euthanasia.

“We are talking about children that are actually at the end of their lifestyle. It really is not that they have months or many years to go. Their life will finish anyway,” mentioned van Berlaer, chief of clinic in the paediatric critical care unit of University Hospital Brussels. “The question they request us is: ‘Don’t make me go in a terrible, horrifying way, allow me go now while I am nevertheless a human currently being and even though I nevertheless have my dignity.’”

The Belgian Senate voted 50-17 on twelve December to amend the country’s 2002 law on euthanasia so that it would apply to minors, but only underneath specific additional circumstances. These contain parental consent and a necessity that any minor desiring euthanasia demonstrate a “capability for discernment” to a psychiatrist and psychologist.

The House of Representatives, the other chamber of parliament, is scheduled to debate on Wednesday regardless of whether to agree to the changes, and vote on them on Thursday. Passage is widely expected.

King Philippe, Belgium’s constitutional head of state, should signal the legislation for it to go into effect. So far, the 53-year-old monarch and father of 4 has not taken a public position, but spokesman Pierre De Bauw stated that is not unusual. “We never give any comment on any piece of legislation getting talked about in parliament,” De Bauw explained Tuesday.

Although a single viewpoint poll found 75% of Belgians in favour, there has been vocal opposition.

This week, an “open letter” from 160 Belgian paediatricians argued against the new law, claiming that there is no urgent require for it and that contemporary medicine is capable of soothing the discomfort of even the sickest young children.

The medical professionals also mentioned there was no aim way of supplying that youngsters possess the “discernment” to know what euthanasia means.

In addition to Belgium, the only other countries to have legalised euthanasia are the Netherlands and Luxembourg, said Kenneth Chambaere, a sociologist and member of the Finish-of-Life Care study group at the Free University Brussels and University of Ghent.

In Luxembourg, a patient should be 18. In the Netherlands, young children in between 12 and 15 might be given euthanasia with parents’ permission, whilst those who are sixteen or 17 should notify their dad and mom beforehand.

Belgium expected to legalise euthanasia for young children