“If they make a change in the drinks, then this is something we will have to look at in January…putting a framework around specifically the drinks.”

By Rebecca Rivas, Missouri Independent

When Joshua Grigaitis founded the Mighty Kind Company in St. Louis in 2019, his team started by producing flavored sparkling water infused with CBD, a non-intoxicating compound found in cannabis.

The company has since become a major player in the market for intoxicating hemp-THC beverages. But with a federal ban looming, Grigaitis said he is prepared to return to the company’s roots.

The ban is now set to take effect December 11, after President Donald Trump signed a bill last week delaying its implementation by one month.

“Big picture is we’re gonna sell a variety of products, and we’re gonna stay diversified,” Grigaitis said. “We were originally a CBD company. We’ve never had the thought: we’re not going to have anything to do if we can’t sell THC drinks. We’ll just do something else.”

Hemp companies across Missouri and the nation are rethinking their business plans in anticipation of the ban. While Grigaitis is confident Mighty Kind can adapt through new products, companies built around low-dose, full-spectrum cannabis products—those created specifically for people seeking relief from chronic pain or health ailments—could face a far more difficult path forward.

Dr. Ethan Russo, a neurologist in Washington and founder of the medical cannabis research and drug development company Credo Science, said the medical side of the industry is in “chaos.”

“There are just many, many companies going out of business, some of whom have produced very good products that have been helpful to people with medical conditions that haven’t had relief otherwise,” Russo said. “It’s a very bad time for the industry.”

Russo said these products focus on the therapeutic compounds found in cannabis, such as CBD and CGB, and the small amount of THC, such as 3 mg or less, in them activates those non-intoxicating compounds and makes them more effective.

While Congress may end up allowing and regulating these products, particularly considering Trump’s support for them, there is no wiggle room in the legislation Missouri lawmakers passed this spring.

When Missouri’s law goes into effect on November 12, intoxicating hemp products will be “put under the purview of the department’s existing regulations for cannabis products,” said Lisa Cox, spokeswoman for the Missouri Department Health and Senior Services, which oversees the state’s cannabis program.

On November 12, everything that comes from cannabis and is intoxicating—or has more than 0.4 milligrams of THC per container—will be considered marijuana and can only be sold in licensed dispensaries. The cannabis also has to be grown and manufactured in licensed Missouri facilities.

For now, beverages will stay on store shelves until December 11, and there will be no other regulation of these items except that people now must be 21 to buy them until then.

Missourians won’t be able to purchase hemp-derived THC products online after November 12, even though it’d be federally still legal. There are currently a few low-dose full-spectrum products available in dispensaries.

Dr. Patricia Hurford, a physical medicine and rehabilitation specialist in Chesterfield, said she anticipates she’ll hear more concern from her patients when their full-spectrum products are no longer available in November. Like Russo, Hurford commends Missouri’s legislation for protecting children and regulating the quality of cannabis products, but she worries about access to medicinal products.

“Patients require protection,” Hurford said, “and sometimes protecting those patients means we have to take dangerous products off the shelf. Sometimes it just means we’re offering and preserving access to safer and lower-dose alternatives.”

Hemp vs marijuana

This wave of complicated, confusing policymaking around cannabis is pushing a necessary conversation about having two different laws for hemp and marijuana, Russo said.

That conversation should be, “legalize it and regulate it. That’s the only way that this can work,” he said.

Hemp and marijuana are essentially terms the government uses to distinguish between the part of the cannabis plant that has high amounts of THC.

Hemp has previously been defined as any part of the plant containing 0.3 percent or less delta-9 THC by dry weight.

Last November, a provision in the federal spending bill amended the definition of hemp, changing the limit to a total THC concentration of less than .3 percent on a dry weight basis, rather than only delta-9 THC. It also prohibits products from containing more than 0.4 milligrams of THC per container.

Missouri’s law was aimed at getting unregulated intoxicating cannabis products, particularly those that are attractive to children, off the shelves.

Republican state Rep. Dave Hinman of O’Fallon, who sponsored the ban, believes the state will send out communication directly to retailers to make sure they understand the nuisance of the law.

Hinman anticipates Missouri’s upcoming legislative session to be filled with much more work to be done on this issue, and he said he’s been asked by state leaders to continue taking the lead on cannabis-related legislation.

If Congress allows full-spectrum products, Missouri will have to approve that use through a bill. And if there is further delay of the federal ban, then lawmakers will have to pass regulations on beverages.

“If they make a change in the drinks, then this is something we will have to look at in January…putting a framework around specifically the drinks,” Hinman said. “If we need to make changes and adjustments, I will absolutely be involved in this.”

Panic for patients

Hurford said the marijuana industry was born out of creating medicinal, therapeutic products. However, now dispensaries are often more focused on recreational products, she said, and offer an environment that might be intimidating for patients to enter and find what they need.

“Let’s get back to promoting the medicinal aspects in those products,” she said.

Healer is an example of a company that has helped her patients, and she believes its co-founder, Dr. Dustin Sulak, is a “well-respected, knowledgeable clinician.” But its products will be banned in November, and company owners say they won’t pursue trying to work within the marijuana regulations.

Healer’s co-founder and CEO, Brad Feuer, said marijuana cultivation facilities nationwide focus on growing cannabis with high THC and low CBD content, which doesn’t work with their formula. And secondly, it wouldn’t be cost effective for the company or patients.

Katherine Golden is a nurse who seven years ago founded an independent cannabinoid health hotline called Leaf411. She said while more medicinal products with only one or two milligrams of THC were available in dispensaries when her hotline first started, many of them have been pulled off the shelves.

“That to me is the heartbreak of what’s happening with our legislation because you’re taking access away from a product that is not being abused,” Golden said. “The hemp market—those who are the responsible players—are providing this product that the retailers aren’t carrying because it doesn’t sell enough for them.”

Part of the reason is because these customers need it delivered to their homes, particularly those caring for people with dementia or those struggling with ailments, she said. Her hotline has already gotten a taste of the panic patients may feel in November after California’s ban was put in place in July.

“I can only guess when we see another state like Missouri ban on Nov. 12, we’re going to hear from Missourians calling us saying, ‘What do I do? I just found this out,’” she said. “Because a lot of patients are so involved in what they’re doing in their lives, they’re not following what’s happening.”

Andrew Mullins, executive director of the Missouri Cannabis Trade Association that represents the state’s marijuana businesses, said for patients to be protected, their medical products must be “tested, taxed, age-gated and responsibly packaged, which simply isn’t happening with intoxicating hemp.”

“Many dispensaries already carry low-dose THC products,” Mullins said, “and we expect there will be more emphasis on medicinal uses of their products and development of additional products to meet patient demand, as online and unregulated channels diminish.”

Adrian Holguin, a California-based cannabis consultant under his business CannaShark, said Missouri’s regulatory framework ties the hands and potential profits of businesses working in intoxicating hemp and low-dose, full-spectrum. Like Healer, most of these businesses will choose to not to find a place in Missouri’s market.

“They have to take their operations and either leave the state and find the last remaining states,” he said, “or they have to be ready to pivot in a direction that’s going to make sense and that follows the legislation that’s coming.”

Business owners could try to work with a licensed Missouri marijuana manufacturer or cultivator to make their products under the new law. However, even for marijuana companies, Missouri is “a tough state to crack,” he said, partly due to the consolidation of facility licenses. Other states are going to be more accommodating.

“When you decide on business,” he said, “where to play is one of the main questions you ask yourself.”

Grigaitis believes this moment is going to produce challenges, but it’s also going to push innovation. Mighty Kind is looking to launch a new seltzer with Lion’s Mane mushroom concentration, he said, which promotes relaxation, focus and brain support.

“I see it as all very positive,” Grigaitis said, “you know, evolution of moving from alcohol to something less harmful for everybody and plant magic of all kinds.”

This story was first published by Missouri Independent.

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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.

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.

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