To which patients could it be prescribed? In what form? What would be the risks? We take stock of cannabis for medical use.
The therapeutic cannabis, which has just obtained a first green light from experts gathered by the National Agency for Drug Safety (ANSM), helps relieve suffering patients, especially for multiple sclerosis.
1. Therapeutic cannabis, what is it?
Cannabis is used for its antalgic, antispasmodic and anti-inflammatory qualities for thousands of years in China, India and the Middle East. It owes its effects to molecules called cannabinoids, including THC (tetrahydrocannabinol), a psychoactive agent (which modifies perception), and CBD (cannabidiol) with a relaxing action.
Synthetic THC (dronabinol) is marketed under the name Marinol in France, but his prescription is subject to a temporary use authorization (ATU) registered a procedure that limits significantly the use (a few hundred twenty patients’ years).
The CBD useful to treat convulsions, anxiety and nausea, is present next to the THC Sativex spray to relieve patients suffering from multiple sclerosis who received his authorization on the market (AMM ) in France in 2014 but which has not been marketed because of a lack of price agreement.
2. What are the indications for therapeutic cannabis?
Cannabis relieves patients whose pain does not yield with traditional analgesics, including multiple sclerosis (reflex muscle contractions), the cluster headaches, sleep disturbances, nausea due to chemotherapy treatments…
Studies have suggested possible efficacy for neurodegenerative diseases like Alzheimer’s but need to be confirmed. A report from the EU Drugs Agency noted “significant gaps in scientific data”. The patients who could benefit are estimated between 300,000 – the most common estimate – and 1 million.
3. In what form would it be prescribed?
The “smoke route”, especially the seal, “cannot be recommended”, according to Professor Nicolas Authier, chairman of the Scientific Committee set up last September to decide on access to therapeutic cannabis. In fact, inhaled smoke is just as dangerous – and carcinogenic – as smoking.
In addition, the effect is fast and not long lasting if it is smoked. Spraying allows better control of doses. It may be envisaged administration in the form of spray, inhalation, capsules, suppositories, drops under the tongue, oils or patches.
4. What might be the risks associated with the use of therapeutic cannabis?
As with any substance, there are risks: decreased alertness (road safety), cardiac risks, risk of decompensation (delusional puffs, destructuration) among psychotics. “You need supervision, with contraindications, standardization of products and medical follow-up,” says Dr. Authier. The European report notes that “serious side effects are rare”.
The LREM deputy and neurologist Oliver Veran, who seized the Minister of Health Agnes Buzyn on medical marijuana, said that currently “we prescribed morphine which is addictive, codeine and opium derivatives” that are often very poorly tolerated. In the absence of sufficient studies, however, it is unlikely that therapeutic cannabis will be prescribed as first-line: more likely, it may be prescribed when other pain treatments fail.
5. Will therapeutic cannabis be allowed in France?
The Temporary Scientific Committee appointed by the ANSM at the request of the Minister of Health must deliver its opinion in two stages. Having established the relevance of the authorization of medicinal cannabis and advanced several therapeutic indications (multiple sclerosis, severe epilepsy, nausea, cancer care, palliative care) December 13, it will work for 6 months on the modalities of its implementation available.
Several points must be raised such as its mode of prescription and delivery, its possible reimbursement. So many questions to be decided before a possible provision, of which Dr. Authier “is not sure” that it can be done in 2019.