Doctors are slowly enrolling patients in France’s first medical cannabis experiment three months after it began. Many are eager to access the drug to treat a range of conditions, including chronic pain, but participating in the experiment is arduous – and the chances of success are slim for most.
“Patients are really eager to get these products. They know they are available in other countries and some of them have been abroad to get them, ”says neurologist Didier Bouhassira.
He is a pain specialist in one of the largest pain centers in France at the Ambroise Paré hospital in Boulogne, west of Paris, and is involved in an experiment testing the prescription and distribution of medical cannabis in France.
Although the rules are changing and CBD, one of the constituents of cannabis, is becoming increasingly available in France, THC, the plant’s main psychoactive element, remains illegal and the use of marijuana is a criminal offense.
“Many patients ask about cannabis. They are impatient for this experiment, ”says Bouhassira. “But unfortunately very few will be involved.”
3,000 people will take part in the two-year experiment – 700 of whom will suffer from chronic pain. Only three or four of Bouhassira’s patients will be involved, which means he had to make difficult decisions.
Listen to a report on one of Bouhassira’s first participants in the cannabis experiment on the Spotlight on France podcast:
France in the Spotlight, episode 56 © RFI
In order to participate in the experiment, patients must have severe neuropathic pain that does not respond to other drugs.
“Many neurological diseases are associated with very severe neuropathic pain,” explains Bouhassira. “Even opioids don’t work very well with these patients. So we use antidepressants or anticonvulsants that normally have nothing to do with pain. “
A few dozen of his patients qualify for the experiment, but the requirements are so high that only a handful will actually sign up.
“If you take part in this experiment, you are not allowed to drive, so that’s an exclusion criterion,” he says, adding that participation is not easy with monthly appointments and a lot of paperwork.
“If we explain all the restrictions, many of them reject them because it’s too complicated.”
Johanne Seneco really wanted to take part. Bouhassira had her come from her home in Amiens to enroll.
She arrives at the office with her husband and walks with a stick.
“I feel like I’m on fire, I burn from head to toe all the time,” she says, her face pinched behind a surgical mask.
Seneco has been using Bouhassira for pain management since 2015 after severing a botched knee surgery the previous year, leaving her with severe leg pain that has since spread throughout her body, causing a disorder called complex regional pain syndrome.
She is in constant pain, 24 hours a day. She cannot move well on her own and cannot work. She had to quit her job as a middle school assistant and spends most of her time in bed with pillows.
“I’ve lost everything,” she says, and her eyes swell. “The hardest part is the effect it had on my daughter. She is now 18 but has not had a mother for seven years. “
Bouhassira has Seneco fill out forms and questionnaires asking about her pain level and state of mind. She has to fill this out at monthly doctor visits during the two-year experiment.
She doesn’t mind this work if it gives her access to something that could relieve her pain. She has tried many drugs and treatments, such as hypnosis and acupuncture, none of which worked. Some made the pain worse.
Unlike many who suffer from chronic pain, Seneco has never tried cannabis.
“The doctors told me to smoke a joint,” she says. “But I never dared because I was worried about what else could be in it.”
Many other Bouhassira patients are not so hesitant.
“We discuss it openly with them and ask whether they tried smoking or took it in another form,” he explains. “It is important for us to know.”
When cannabis works, Bouhassira doesn’t stop them from continuing, but warns of the risk of using unregulated products.
“The problem is, there are no controls on these products that you buy online or on the street,” he says.
Trial and error
After half an hour of paperwork, Bouhassira Seneco finally presents what it came for: the recipe for sublingual drops of cannabis oil with an equal amount of CBD and THC.
The recipe takes up a whole page because you want her to start with a small amount and increase every few days until she either feels her pain ease or starts to show negative effects.
“They will increase very progressively depending on the effect,” explains Bouhassira. “There is no fixed dose. We adapt to every patient. “
Prescription in hand, Seneco then goes down to the pharmacy in the basement of the hospitals, where a pharmacist spends half an hour going through the prescription.
Pharmacists are the key
The experiment is not a drug test, but a test of the logistics of prescribing and distributing cannabis for which general practitioners and pharmacists are trained.
“I was interested because everything to do with pain is close to my heart,” explains a pharmacist in the southwest who completed his training but did not want to be identified because cannabis is still a sensitive subject in France. “I want to enable efficient pain treatment.”
The one day online course focused on dosages.
“It should help us feel comfortable with what’s on the prescription,” she says, although she has still put it into practice as few patients were included in the experiment that was slowed down by Covid.
“The role of a pharmacist is to give the right drug, with the right dosage and the right information,” she continues. “This is about supporting people.”
On the way to legalization
This experiment is “quite unique” for a drug in France, says Nicolas Authier, doctor and pharmacologist and president of the scientific committee for medical cannabis.
Such an experiment is necessary because of the legal status of cannabis, which continues to face strong opponents in the government, even though a growing majority of French support its legalization.
The experiment is a step towards advancing the subject.
“It is likely that in the end it will be difficult to say no,” says Authier. “Once you’ve started the experiment, you usually take the time to organize what’s next and rarely stop everything after that.”
Seneco leaves the hospital pharmacy with a paper bag with a small bottle of cannabis oil from the Israeli company Panaxia. It’s enough for a month before she comes back for her next doctor’s appointment for a new prescription.
She is eager to get home and start treatment.
“What I am looking for is relief because I have no more life,” she says. “I don’t expect to be out of pain. But if I can cut it in half, that would be wonderful. “
“It’s not a silver bullet,” says Bouhassira, warning patients that cannabis may not work. “Usually it offers partial relief.”
Authier says cannabis will not work for most of the patients who participated in the experiment, and it is unclear who it will work for: “Until now, international research has not been able to tell which patient profile is most likely to respond to these drugs.” . “
But some will have a good answer with “a marked improvement in their quality of life”.
“That’s something. We’ll have done our job as doctors,” he says.
Hear the story of Bouhassira’s meeting with Seneco on the Spotlight on France podcast, episode 56.