Emigration: “I would tell people if they are thinking about it, relocate because you will get better access”

In a new series, Cannabis Health News talks to women who have experienced emigration in search of safe, legal cannabis access.

Imagine packing your entire life into boxes and emigrating with your family to a new country just to be able to easily access your medication.

Emigration is sadly nothing new to Ireland. Over the years, thousands have left to access a better life abroad in places such as England, Canada and America. The numbers are staggering with the highest year of emigration recorded as over 54,000 in 2012 at the height of the recession.

While those figures are slowing down due to the growth in the Irish economy post-recession, there remains a steady flow out of the country. Adding to the broad range of reasons for leaving is the state of the Irish medical cannabis system.

There are currently two systems in place: the ministerial license which allows patients to receive their medication from the Netherlands and the Medical Cannabis Access Programme (MCAP). The MCAP only considers epilepsy, cancer nausea and multiple sclerosis. There has been widespread criticism that this does not go far enough to recognise the broad spectrum of patients who use cannabis especially chronic pain patients.

Alicia’s Story

Alicia Maher is one of the most high profile cannabis patients in Ireland. She emigrated from Cork to live in Spain for a few months during lockdown but now cannot travel home.

“I went into hospital to have my tonsils removed and there were complications. I ended up having three operations and was in the hospital for three months. While I was in there, I started to bleed from the bowel then they said I had ulcerative colitis or Crohn’s disease. They couldn’t figure out at the time what it was because my colon was so badly damaged.”

“One night when I was in the hospital, my large intestine broke and I had emergency surgery to remove my entire colon. I woke up with a bag on my stomach. When I went to have this removed a few years later, they discovered precancerous cells in my rectum. They needed to remove my rectum immediately which meant the bag on my stomach became permanent.”

Sadly the surgery meant more complications as Alicia developed Methicillin-resistant Staphylococcus aureus (MRSA) which took years for the wounds to heal. MRSA is a type of bacteria that’s resistant to several widely used antibiotics and is often referred to as a superbug. It can be extremely difficult to treat.

“I had to heal from the inside out but it took years. It was the first time I’d ever had pain like that. I eventually found out that my coccyx bone was actually broken. I had to give up work because the pain was just too much. My doctor started me on medication like Tramadol with injections every three months. I developed sciatica where you get pain down your leg and I couldn’t walk at all. They upped the pain medication I was on and added Lyrica and Amitriptyline. I had to wear patches all the time. The side effects were atrocious.”

Alicia found she was sleeping most of the time as a result of the tablets. A fall on her broken coccyx bone sent her to hospital in 2018. The staff treated her as if she was looking for medication rather than being in pain. They refused to even X-ray saying there was no point as they knew it was already broken.

Read more: CBD may reduce side effects associated with anti-seizure medications.

It was then that Alicia decided to try cannabis.

A family friend in America sent over a vape for her to try. Despite never trying cannabis before, she was surprised that it worked from the very first time. She was determined to reduce the 30 different opioid tablets she was on which took about 6 months. As she detoxed from the pain medication, it was then that she started to think about the issues surrounding access in Ireland.

“I needed to speak to my GP to tell him I had come off half my medication. I was so worried thinking he was going to give out to me but looked at me and said he had seen a difference straight away when I walked in.

He said he would apply for the ministerial licence. However, I needed a pain consultant which I didn’t have as mine had left the HSE. They said they weren’t denying the license but because its chronic pain, they couldn’t do it until I had a consultant.”

This started a series of appeals to get the ministerial license granted. Alicia was eventually given an appointment with a consultant who agreed with her doctor that the cannabis was working for her. It finally came through in May 2020 but there was one huge problem, the COVID crisis had begun.

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Emigration to Spain

By this time, Alicia had moved to Spain and lockdown had begun. Spain had one of the toughest lockdowns in Europe among spiralling cases of COVID. Alicia and her husband had decided to move after a few bad experiences with accessing cannabis illegally in Ireland. They decided to leave their PhDs, families and life at the University of Limerick to move. They initially moved out in November with a view to returning in March.

She had begun to look into the cost of cannabis through her license in Ireland but it was then she discovered that it would EUR€2,500 every three months for her medication.

In Ireland, medical cards can be granted to certain patients to cover the cost of their medication. The cards are means-tested and cover the cost of a patient’s medications. Alicia discovered that there was no coverage on the medical card because it was for chronic pain.

“How was I supposed to pay €10,000 a year for the cannabis prescription because there is no coverage on the medical card? They said if I suffered from epilepsy, multiple sclerosis or vomiting associated with chemotherapy then I would get refunded. The only reason they won’t refund it is because its chronic pain which feels like discrimination based on the condition you have.”

Alicia chose Spain because of the access to the cannabis clubs. The cannabis social clubs are private, non-profit organisations where users can register to access their medication safely. However, during Covid, all the clubs suddenly closed for lockdown.

“It was perfect at the start due to the cannabis clubs but then they closed for three months. I got in touch with a clinic in Madrid and sent them my prescription so they took me on. They knew I was stuck here and had a prescription at home so it was on a discretionary basis. They posted my order down to me every month at a fifth of the price of back home.”

Returning home

One of the hardest parts of emigration is the difficulty in returning home once you have established a life in a new city. Each passing year means more roots, connections and ties to your new home. Prescriptions not being recognised and spiralling costs add another layer of difficulty into the mix. The threat of something happening to a loved one during lockdown has been especially difficult for those away from home.

“It’s hard not being able to go home when I want to especially during covid. I was afraid something would happen to someone at home. I contacted the International Narcotics Control Board who are the regulatory people for medicines across the EU for controlled drugs. I said I had an import license to bring cannabis into Ireland and a prescription from my doctor too. I asked if I needed to, could I bring my medication with me? They referred me to the HSE who said absolutely not.”

“I’ve emailed the Minister for Health, Stephen Donnelly and Frank Feighan over twenty times. I only got a response last week which was identical copy and paste responses from the internet. I was disgusted when I saw the emails. Two different departments and identical emails, that felt insulting. I emailed a five-page letter about my medical history and my family back home. They sent back information which was freely available on the internet.”

So what would Alicia say to anyone thinking about emigration for medical cannabis?

“If someone was waiting in Ireland until pain is added as a qualifying condition, I would tell them not to waste time. I got a call from Gino Kenny, a politician from People Before Profit who said he thinks they may not add it until the end of the pilot scheme for MCAP which isn’t even up and running yet. It could take about five years. He doesn’t think reimbursement is going to happen either.”

“I would just tell people if they are thinking about it, relocate because you will get better access somewhere like here with the cannabis clubs. If it’s for quality of life purposes then there is no question whatsoever.”

Read more: New patients network aims to fix issues with access and safety