The Irish government has appointed a public health academic to chair a formal review of its now five-year-old Medical Cannabis Access Programme (MCAP) following months of parliamentary pressure.
Despite launching in 2021, a recent (March 18, 2026) written ministerial answer reveals that less than 100 patients have been approved for medical cannabis treatment under the MCAP scheme.
Now, Health Minister Jennifer Carroll MacNeill has announced that Professor Shane Allwright, a retired Trinity College Dublin epidemiologist, will lead the Review of Access to Cannabis for Medical Use, set to examine the current operation of both the MCAP and the ministerial licence pathway, and assess whether the programme’s narrow eligibility criteria should be expanded.
This review has been in the works since January 2024, when the HRB published the evidence assessment commissioned to inform it.
According to MacNeill, the review is now expected to commence officially in Q2 2025 and publish its full report within 12 months.
From protest to programme
Following a grassroots campaign led by Vera Twomey in 2017, whose daughter Ava had a rare, drug-resistant form of epilepsy known as Dravet syndrome, work on the programme began in March 2017.
An expert reference group was established to develop clinical guidelines, and legislation was signed by Minister Simon Harris in June 2019, establishing the MCAP on a five-year pilot basis, before the first patient received treatment in 2021.
From the outset, the programme was confined to three qualifying conditions: spasticity associated with multiple sclerosis, intractable nausea and vomiting from chemotherapy, and severe treatment-resistant epilepsy.
Furthermore, prescribing rights were restricted to medical consultants, with patients needing to have exhausted all standard treatments before cannabis could be considered.
Even at that early stage, advocates warned the programme was structurally limited. Natalie O’Regan, a legal researcher and drug policy advocate, noted at the time that no patients were being supervised or monitored under the scheme, leaving ‘no raw data to inform the next steps.’
Gino Kenny, the People Before Profit TD who had been central to pushing for the programme, called it ‘far too restrictive,’ adding that it needed to include other conditions to ‘fulfil its potential.’
In a written answer to Deputy John Paul O’Shea on 18 March 2026, Caroll MacNeill confirmed that since the programme’s inception, 74 patients have been approved, with just 22 consultants submitting applications on behalf of their patients.
A parallel route, the ministerial licence, predates MCAP and allows patients to access cannabis products for conditions outside the programme’s eligibility criteria, subject to approval from the Minister for Health. That pathway has been described in multiple parliamentary answers as lengthy and bureaucratic, supplying patients with products sourced from a pharmacy in the Netherlands, with importation managed monthly by the HSE.
A written answer to Deputy Pádraig Rice in January 2026 confirmed that the ministerial licence scheme will also fall within the scope of the 2026 review.
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The evidence base
The review will be informed by a report published by the Health Research Board (HRB) in January 2024, which examined evidence from 47 systematic reviews covering more than three decades of research on prescribed medicinal cannabis across a range of conditions.
The HRB found evidence supporting its use for nausea and vomiting associated with cancer and spasticity in MS, both current MCAP qualifying conditions, as well as promising evidence of significant benefit for neuropathic pain. For most other conditions, including anxiety and pain in cancer, rheumatic diseases and fibromyalgia, the review found no conclusive evidence of efficacy.
The report described the overall body of research as ‘fragmented,’ with a ‘low degree of certainty in the evidence for most outcomes,’ and called for further high-quality clinical trials.
Dr Kathryn Lambe, Research Officer at the HRB and lead author, said the review would ‘help inform decision making in relation to future policy on the use of prescribed medicinal cannabis along with input from patient groups, clinicians, and service planners.’
This assessment, according to O’Regan, ‘failed to engage with any current MCAP patients, and missed the opportunity to gather real-world data that is available on their doorstep.’
“In 2024 we are still hearing ‘the need for more research’ as a reason to not expand access,” she added. “At the end of the day, it is patients who will suffer the consequences of limited access to a medicine that they may find invaluable.”
The HRB report was published in January 2024. The chair of the review it was intended to inform was not appointed until April 2026.
Ava’s Protocol
Among the issues the review is expected to address is the absence of any national policy on the administration of Schedule 1 cannabis products in hospital settings, a gap brought into sharp focus by the death of Cork girl Ava Barry in May 2023.
Ava, who had Dravet syndrome, had been granted a ministerial licence in 2017 allowing her to receive medicinal cannabis, which her mother, Vera Twomey, said reduced her seizures by 50 to 70 per cent.
During a hospital admission at Cork University Hospital, Twomey was required to remain on the ward for several weeks as the only licensed person permitted to administer Ava’s medication. An inquest in December 2024 heard that no local or national policy existed for administering medicines granted under special licence in hospital settings, and a jury recommended that a national policy be developed.
That recommendation has since become known as Ava’s Protocol. In a written answer to Deputy Rice in January 2026, Carroll MacNeill stated that administration of Schedule 1 cannabis-based products would be ‘one of the key considerations’ of the 2026 review, with recommendations expected within a year of the review’s commencement.
Barrister Doireann O’Mahony, representing Ava’s family, said the family had been “led to believe that Ava’s Protocol would be implemented, yet we are now being told there will be another review process.”
The review also arrives against a backdrop of documented cases of patients unable to travel to Ireland with legally prescribed cannabis medication. In December 2024, Jason Pickering, a UK patient prescribed medical cannabis flower for anxiety, had his medication confiscated at Dublin Airport despite carrying a valid prescription in its original packaging.
The Irish government treats unlicensed cannabis medicines, the majority of those prescribed in the UK, as Schedule 1 controlled drugs, and does not permit visitors to bring them into the country.
Professor Allwright
Professor Allwright’s appointment has drawn attention for her background in tobacco and public health policy rather than cannabis medicine.
She previously chaired the report on the health effects of environmental tobacco smoke that was critical to the introduction of Ireland’s smokefree workplace legislation in 2004, and led research into the impact of the smoking ban on bar workers’ respiratory health.
She is a Fellow emerita of Trinity College Dublin and an honorary fellow of both the Faculty of Public Health Medicine at the Royal College of Physicians of Ireland and the UK Faculty of Public Health.
Carroll MacNeill said she was ‘confident that Professor Allwright’s extensive experience will ensure that the work of the Group is thorough, balanced, and evidence-based’, while Allwright described the review as ‘important and challenging’, adding that she looked forward to ‘bringing my national experience in public health policy to the role.’
The review group’s full membership has not yet been announced. The Department of Health has not published terms of reference beyond those set out in the 1 April press release.
As its European neighbours are experiencing unprecedented growth in their respective medical cannabis industries, Ireland remains an outlier in its near inanimate pace of reform.
For Irish patients and advocates who have spent years navigating one of the continent’s most restrictive programmes, questions remain over whether this review will finally deliver the changes needed.
