The French are standing on the precipice of significant policy change. In the last year, France has made progressively confident legislative steps towards a medical cannabis program. In January 2020, the great French medical cannabis experiment kicked off and should pave the way to cautious but essential changes within the country.
True, compared with many progressive American states, the French are remaining quite careful about their initial foray into medical cannabis — but their approach remains in line with other European countries. The sentiment of the new experimental program is both curious and conservative. It may also be a stalling tactic until the European Union has a chance to clarify its official position on medical cannabis.
The Need for Medical Cannabis in France
According to some assessments, in France there may be as many as 1.5 million patients who could benefit from access to medical cannabis. These patients suffer from a variety of medical conditions, but many which are well-established within cannabis research, including epilepsy, cancer, HIV/AIDS, multiple sclerosis, and chronic pain. These are some of the most commonly accepted qualifying conditions in the US.
As French patient advocacy groups have argued, it’s unethical to prevent these patients from accessing any effective treatment, especially when conventional options may be failing them. Cannabis, as proven elsewhere, is a useful tool for combating some of the most challenging issues related to these diseases.
There are notably very few statistics available about the use or acceptance of medical cannabis among French citizens. Yet, despite strict punishment under French law for possession, the French are quite familiar with the plant, at least from numbers reported by the French Observatory for Drugs and Addiction (OFDT).
As per their assessment, 700,000 people in the country use cannabis daily, and double that number confirm they use the plant regularly. Additionally, the OFDT reports that roughly 17 million citizens have tried cannabis at some point in their lives. These numbers don’t differentiate between medical use and recreational, but we can, at the very least, assume a general societal acceptance and familiarity with the plant.
The Great French Experiment with Medical Cannabis
In the fall of 2019, France passed the Social Security budget for 2020, which included a few key approvals for a small experiment. The French Agency on the Security of Medicine and Health Products (ANSM) received permission to conduct a trial on medical cannabis for pain among 3,000 patients who were already undergoing treatment for the chronic condition.
Physicians will administer cannabis-based drugs to the selected pain patients through official medical channels in the country. Starting in January 2020, the two-year experiment will intake patients for six months, provide treatment for six months, then assess outcomes for another six months. Upon completion, a report will be submitted back to the ANSM for a final decision on the efficacy of cannabis as a therapeutic option.
All aspects of this government-run trial are under the strict control of the ANSM. They control which conditions qualify for participation within the study, which physicians are allowed to issue cannabis prescriptions, and which routes of administration are allowable. Although physician participation within this project is entirely voluntary, the ASNM requires stringent training and adherence protocols.
In 2018, the now-disbanded Specialized Committee on Cannabis (CSST) recommended the study of cannabis for “epilepsy, to relieve symptoms of nausea and anorexia among cancer patients, for patients with multiple sclerosis, or palliative care.” This new experiment only covers illness-related pain. Broadly speaking, that still includes a number of possible chronic conditions including chronic pain, epilepsy, spasticity in multiple sclerosis, and neuropathic disorders.
In contrast to other countries or regions with medical cannabis legislation, the French are allowing for only five types of prescriptions for medical cannabis based on different cannabinoid profiles. The official recommendation is for vaporizing dry leaves or edible oil preparations, including oil pills or drinks. Policymakers are strongly advising doctors to direct their patients to avoid smoking.
The Expectation in France and Abroad
What is the purpose of this extensive and exhaustive study of medical cannabis in France? As is the case in the UK and Germany, France is curious but extremely cautious about the potential of medical cannabis. Markets in all of these European countries haven’t launched in the same way as they have in the US. If the US market is the wild west of medical cannabis, the new French experiment is a markedly reserved comparison study.
The primary objective of the pilot medical cannabis project is to evaluate the efficacy of cannabis for therapeutic applications among real-world patients. It’s specifically quite restrictive in terms of participants, physicians, and dosing guidelines in the initial phases as a way to deliver quality data in 2021 when the pilot completes. Too many variables and it’s very challenging to analyze the results.
The secondary objective, even if program administrators haven’t publicly stated it, may be to see how global policy shifts regarding medical cannabis play out. While the Canadian and US markets have been picking up momentum over the last few years, EU countries are still taking it easy. There have been only tentative entries into the world of medical cannabis among EU member states.
Back in 2019, the Director General of the World Health Organization (WHO) wrote to the Secretary General of the United Nations requesting a rescheduling of cannabis under the international drug control framework. The recommendation to reschedule was to allow for easy international trade of cannabis for both therapeutic and scientific applications. Unfortunately, while the UN was poised to review the scheduling in March 2020, it seems as if the governing body has postponed the decision until further notice.
As James Walsh, the US representative and principal deputy assistant secretary for the Bureau of International Narcotics and Law Enforcement Affair, stated, “We do regret that the [UN Commission on Narcotic Drugs] was unable to take action on the WHO cannabis recommendations this week, given that Member States have been working hard since February 2019 to engage in an in-depth consultative process on the legal, administrative, social and economic impacts of the recommendations.” Members have proposed to revisit this topic in December.
Among the EU member states, there are significant disagreements about the legitimacy of medical cannabis. Even if there are medical cannabis programs in place within the most prominent economic players on the continent (Germany, France, and UK), there is still no consistency, supply channels, nor trade agreements facilitating these programs. France may be implementing this pilot project as a stalling tactic to await official changes to EU and international policy.
The EU Approach: Slow and Steady
The great French experiment is adopting a very European approach to medical cannabis, mimicking the program recently launched in Germany.
Unlike in the US, where medical cannabis programs operate outside of federal law, the French government is managing the program down to the most minute details like dosing and type of cannabis prescribed. Furthermore, the government is ensuring its physicians, not budtenders, who are working with patients to titrate to the proper dose.
Although this approach may seem overly cautious when compared to markets in the US, it’s necessary to ensure proper rollout within a government-run medical system. It also allows France space to await international policy changes, which in the end will make their national program easier to supply.