Therapeutic cannabis: in France (2023), for which diseases?

Authorized since October 2020, the use of therapeutic cannabis or medical cannabis is allowed until March 25, 2024 in Franceaccording to decree updated on March 25, 2023. The experiment was initially planned for 2 years (March 2021-March 2023). What sick can be cured legally with cannabis in France today? In what forms ? What are the names of medicinal products containing cannabis ? How to get them? Update on legalization in France.

Definition: what is medical or therapeutic cannabis?

“THE cannabis is a somewhat generic term which covers very different plants by their composition and contain many different moleculessome of which, alone or in combination, have therapeutic virtues, recalls Pr Nicolas Authier, psychiatrist, specializing in pharmacology and addictology, Head of the Medical Pharmacology Department and of the Pain Assessment and Treatment Center of the Clermont-Ferrand University Hospital. When we talk about medical cannabis, we are not talking about an isolated substance but a combination of molecules in a precise indication. We manufacture medications very different from each other in their composition. They have different therapeutic interests and profiles.“Among these molecules, the CBD : “CBD (cannabidiol) is a substance derived from cannabis with a interesting therapeutic effect for different indications: pain, epilepsy“, explains the specialist. Before emphasizing the importance of the qualifier “medical” to designate these cannabis-based medicines: “This allows us to talk about the purpose of use and not to affirm, perhaps sometimes abusively, the capacities of this cannabis to cure. This term makes it possible to oppose that of “non-medical cannabis” which has other purposes of use: festive use or self-therapeutic use.”

Is therapeutic cannabis legal in France? In 2023?

Yes since green light given by the National Assembly in December 2019 following the publication of the decree of October 2020, therapeutic cannabis can be legally prescribed to certain patients in France. This experiment launched in March 2021 for an initial term of two years (March 2023) been prolonged by decree until March 25, 2024. In February 2022, a decree authorizing the cultivation in France of cannabis for medical use was also published. In March 2022, the 1500th patient who have experimented with medical cannabis has been recorded.

Medical cannabis is authorized in Switzerland, Canada, Germany, the Netherlands and Norway.

For which diseases?

The 5 therapeutic indications selected for experimenting with the use of medical cannabis are:

• neuropathic pain refractory to accessible therapies (medicated or not);
• certain forms ofepilepsy severe and drug-resistant;
• certain stubborn symptoms in oncology related to cancer or its processing;
• palliative situations ;
• painful spasticity of the multiple sclerosis or others diseases of the central nervous system.

“It comes in addition to other treatments and not as a replacement.”

“For each indication, this comes in addition to other treatments and not as a replacement, specifies Professor Authier. These are adjuvant treatments that aim to improve the care and quality of life of the patient.“.

The initiation of treatment with medical cannabis is strictly reserved for doctors working in the structures selected for participate in the experiment. A patient who does not belong to these structures can talk about it to their attending physician who can then send them to the appropriate structure. If agreed with the doctor, a prescription is issued for a 28-day prescription maximum. The patient has a maximum of 3 days to present your prescription and collect your treatment :

• in the pharmacy of the reference structure
• in the city pharmacy chosen by the patient, subject to their agreement and the prior training of several of their pharmacists.

THE prescription renewal must be done at most every 28 days.

Medical cannabis: in what form is it sold?

“It is in no way a question of marketing joints for treatment“, answers Professor Authier straight away.ANSM To excluded the route of administration smoked for medical cannabis. It is allowed:

• Form inhalation by vaporization (dried flowers)
• Form oral (oil, compressed)

THE medicines contain THC and CBD.

What are the side effects of medical cannabis?

The side effects of medical cannabis are well known: they are mainly neuro-psychiatric and related to THC: drowsiness, anxiety attack, paranoid state but also for prolonged use a risk of dependence… There may also be cardiovascular side effects such as changes in blood pressure or heart rate… These side effects will of course depend on the composition of the specific drug.

What are the contraindications?

The contraindications depend on the composition of the products and the patient’s history.

► When the patient presents a risky cardiovascular environment or some history of cardiovascular or cerebrovascular disorders severe (heart failure, stroke for example)., it is contraindicated to prescribe drugs containing THC.

► Similarly, THC cannot be prescribed to patients who suffer or have suffered from psychotic disorders (schizophrenia) or severe anxiety disorders.

► Medical cannabis is also contraindicated in case ofsevere liver failure or predictive biological damage and severe renal failure.

►Cannabis for medical use is contraindicated in pregnant and breastfeeding women.

Thank you to Pr Nicolas Authier, Psychiatrist, specializing in pharmacology and addictology, Head of the Medical Pharmacology Department and of the Pain Assessment and Treatment Center of the Clermont-Ferrand University Hospital.