THE USE OF cannabis-based CBD products for medicinal reasons is no longer a taboo or unreported subject in Ireland.

From high-profile campaigns like Vera Twomey’s to numerous other personal stories, like those of Noreen O’Neill and Brendan Flynn, the push for greater access to cannabis-based medical products is a visible one.

Also clear to see is that cannabis-based products are legally being sold in health food and specialised stores more and more across the country.

But while access to the products is becoming easier, there is still confusion among the public about their legality and dispute among doctors about their effectiveness.

There is also a lack of oversight on the products that are on sale leading to doubts about their reliability.

So what is the story?

CBD, or cannabidiol, is a chemical constituent of the cannabis plant and products based on it can be legally sold in Ireland.

CBD does not produce the same psychoactive effects that THC produces, so it does not get users high in the manner associated with the recreational use of cannabis.

CBD-based products have been used by patients suffering from a range of conditions including epilepsy, chronic pain, spasticity, insomnia and anxiety.

There is increasing clinical evidence about its success as a treatment but CBD is not currently authorised as a medicinal product by the Health Products Regulatory Authority (HPRA) in Ireland.

This means that it is not considered as a treatment option and CBD products can not be prescribed by doctors.

A recent decision in the United States, however, could point towards future changes here.

In June, a CBD-based drug called Epidiolex was approved by the Food and Drug Administration for use as a treatment for childhood epilepsy.

Clinical trials published in the New England Journal of Medicine showed that children using the drug had nearly 40% fewer seizures per month.

That trial was conducted on 120 children with Dravet Syndrome, the same condition Ava Twomey’s daughter Ava suffers from.

CBD products in tablet form. Niall Carson / PA Images Niall Carson / PA Images / PA Images

CBD for sale

But while similar approval may take some time from the HPRA, CBD products will continue to be sold in Ireland, even if they are not being prescribed by doctors.

For Professor David Finn of NUI Galway, this does present some issues.

Finn is a professor of pharmacology and co-director of the Centre for Pain Research at NUIG.

He supports greater research into the use of medical cannabis and points to the positive evidence on childhood epilepsy in particular.

But he does have concerns about both the effectiveness of CBD as a treatment and how it is being marketed.

“People are kind of treating CBD as type of nutritional supplement or a health food, and it’s a drug,” he explains.

Cannabidiol is a drug that we’ve know about since the 1960s and like all other drugs it is going to have effects on the body and some of those effects may be beneficial, and there’s evidence for that.Some of the published evidence is strongest for epilepsy, particularly for childhood epilepsy, and for inflammatory pain and maybe anxiety as well. But there may also be side effects.

“It seems to be fairly well tolerated overall, so there isn’t any  strong evidence for severe side-effects, but there is some evidence for mild to moderate adverse effects like nausea, vomiting, diarrhoea and some fatigue and dizziness. As well as potential interactions with other drugs the patient may be taking.”

Finn also shares some concerns about the unregulated CBD products that are currently on sale in Ireland and a lack of oversight.

“It’s very hard to know exactly what the composition of some of the products is.”

Some of them aren’t tested rigorously for quality control. So there can be batch to batch differences. There will be some cannabidiol in there but how much is in there is an open question.

“Some of these preparations are referred to as CBD oil or cannabis oil, which usually means it’s an oil extracted from the plant. But the cannabis plant is extremely complex, it has over 700 constituents in it, about 114 of these are cannabinoids.”

So that’s the issue. It’s very hard to guarantee to patients that they’re taking the same thing each time they go and buy these preparations. What they buy from a pharmacy in Cork might be different to what they get from a health food store in Dublin.

Among the concerns would be that the products have trace elements of THC from the extraction process. Products with THC at levels greater than 0.2% would be illegal.

Finn stresses that he is not saying CBD products on sale here contain THC, only that there is often no testing to show otherwise.

Vera Twomey (centre) protesting outside the Dáil. PA Images PA Images

Demand

But the owners of a new store in Dublin are confident that its products are sufficiently tested and are what they purport to be.

CBD Relieve Ireland in St. Stephen’s Green Shopping Centre opened last week and claims to be “Ireland’s first dedicated CBD store”.

Marketing manager at the new venture Joe Dunne says that the store sells CBD in a variety of forms such as vaping liquids, droplets, body oils and body creams.

The store sources all of its products from CBD Relieve in the UK, a business that Dunne says has been working with Britain’s medicines regulator.

“They’re working closely with the MHRA in relation to the proper wording and terminology that can be used on the stands and on the fliers and leaflets.”

All their products are independently lab tested as well to ensure product quality and to ensure that there is no THC, or under the level of THC that is allowable by EU regulations.

“The majority of the products don’t have any THC but they’re definitely always within the limits.”

Dunne says that CBD Relieve Ireland is separate from the UK company which shares its name and that they met with five or six CBD companies before settling on a supplier.

“It’s not like just selling an iPhone cover or another retail product, we had to be 100% sure that who we’re dealing with knows what they’re doing, knows where they’re going and has all the evidence to back up their products.”

[image alt="IMG_0535" src="http://cdn.thejournal.ie/media/2018/07/img_0535-3-630x348.jpg" width="630" height="348" title="" class="alignleft" /end]

The store does not sell its products to under 18s and Dunne adds that people who come in are encouraged to consult with their doctors before they buy.

He adds that staff in the store do not give medical advice and that any advice they do give is based on feedback from customers of the products in the UK.

“We have to be very careful with the advice we give because we’re not doctors, we’re not pharmacists, it’s not sold as a medical product either, it’s basically sold as a food supplement. So it’s a supplement that will either help or assist someone’s normal day-today well-being.

What you do is you work with the information you have with relation to customers, so we would work based upon what CBD Relieve UK’s feedback has been from their customers, and they have a lot because they’ve been operating two to three years.

Despite doctors not being able to prescribe CBD, Dunne claims that customers to the Irish store have been coming in and saying that their doctors have been advising them to explore it as an option.

“Since we’ve opened last week we’ve had huge amounts of customers in inquiring, having a look.”

“Feedback from in there is that people are telling the staff that their doctors have recommended that it can help with x, y and z. So there are a hell of a lot of doctors referring them to come in and have a look and try it out.”