Medical cannabis could soon get the green light in France after unprecedented trial

Patience is a virtue. But when faced with indescribable pain on a daily basis, being virtuous is not the priority. At least it isn’t for Valérie Vedere, who was diagnosed with HIV in 1992 and then throat cancer in 2012.

“To appease the burning sensation I get from radiotherapy, I use cannabis therapeutically,” the 58-year-old living in Bordeaux says. “But I also experience pain from antiretroviral treatments for HIV.”

“It’s as if my hands and feet are being squeezed in a vice, which can lead to extreme burning and tingling sensations. I also have muscle spasms that generally take place at the end of the day,” Vedere explains. Her chronic pain is something that can’t be treated with painkillers like tramadol or other opioids. “It’s not suitable for the long-term,” she says.

When France launched a nationwide experiment to test the use of medical cannabis for patients with serious illnesses three years ago, Vedere was determined to participate.

“I had already been using cannabis to ease my symptoms illegally. Now, I would be able to use it legally and have consistent follow-ups with my doctor,” she says. After persuading her doctor that she was a perfect candidate for the trial, she finally became a participant in May 2021 – two months after the experiment was launched.

A leap in the direction of legal medical cannabis

The first results of the trial came trickling in two years later, in 2023. Patients felt their symptoms had improved significantly, with no unexpected side effects. No cases of substance abuse or addiction had been reported.

“Our evaluations show that between 30 and 40 percent of symptoms like pain, spasms, quality of life or epileptic seizures for example, have improved significantly,” says Nicolas Authier, a doctor specialised in pharmacology, addiction and pain who is also the president of the scientific committee tasked with monitoring the medical cannabis trial.

Preparations to make prescribed cannabis-based medicines more readily available, including in pharmacies, are now under way for 2025.

Read moreFrance launches public consultation on legalising cannabis

“Cannabis-based medicines are currently dispensed in hospitals or in hospital pharmacies, but in the long-run, most of them will become available in regular pharmacies much like any other drug,” says Authier.

The French National Agency for the Safety of Medicines and Health Products (ANSM) has until the end of the year to authorise approved cannabis-based products for medicinal use. Those products will then be granted temporary approval for five years – with scope for them be renewed indefinitely – pending a decision by European authorities to market the drugs.

Until then, the patients who were part of the trial will continue to have access to cannabis-based medicines. But as of Wednesday March 27, no new participants are able to join the trial.  

A total of 3,035 people took part in the unprecedented experiment and 1,842 are still receiving treatment today.

An unprecedented experiment

Before the trial was first launched across 275 health facilities in the country, a committee of interdisciplinary scientists – consisting mostly of healthcare professionals and patients – was set up. Together, they defined the conditions under which the experiment would be rolled out, what medicines would be used, the training pharmacists and doctors would receive, how patients would be monitored and the information they would receive.

Health authorities then allowed limited prescriptions for people suffering from five specific conditions: neuropathic pain, some drug-resistant forms of epilepsy, intense oncology symptoms related to cancer or cancer treatment, palliative situations and pathologies that affect the nervous system, like multiple sclerosis.

Patients were only prescribed cannabis-based medicines if available treatment was found to be insufficient, or if they presented an aversion to existing drugs.

Mylène, who is 26 and lives in Paris, has tried a cocktail of medications to combat her cephalgia – a condition that results in recurring and extremely painful headaches. “They are brutal. The pain is permanent, seven days a week. I haven’t had a break since they started in 2014,” she says. “And sometimes I get a particularly painful attack, and it’s as if two cinder blocks are being pressed against my head.”

“I tried all kinds of treatment. Paracetamol, ibuprofen, opioids like tramadol and even morphine. Either the medicine wouldn’t have an effect on me or the side effects were too intense,” the young radiologist explains. “I joined the trial in late December 2023 and started taking medical cannabis droplets morning and night. It’s almost been three months and I am already starting to feel relief. I feel a change that’s really starting to take effect.”

Depending on their condition, patients were given medical cannabis either in oil or dried flower form. Oil droplets were generally taken orally, while dried flowers were inhaled in vaporisers to prevent the potential health risks from burning the plant.

Cannabis-based medicines can have varying degrees of THC and CBD, the two main compounds unique to the cannabis plant, known as cannabinoids. While THC is its primary psychoactive compound, responsible for the typical weed high consumers can feel, it is most efficient in tackling pain. CBD, the second most prevalent compound in cannabis or cannabinoid, is still psychoactive but doesn’t have the same intoxicating effect as THC.

“The majority of patients were given cannabis-based medicines in oil form, which is the treatment that has the longest lasting effect,” Authier explains. “But oil droplets don’t prevent peaks of severe pain that can only be relieved by fast-acting medication … so sometimes we added dried cannabis flowers that patients could inhale using a vape. The effects don’t last very long but are very rapid.”  

However, in February 2024 the ANSM decided to stop prescribing medical cannabis in flower form.

“I wasn’t at the mediation meeting when the decision was taken so I can’t say for certain why,” says Authier. “It seems that the medical cannabis flower looks too similar to the illicit cannabis flower consumed for [recreational] purposes. So that could cause confusion and perhaps spark fears of a potential black market.”

“It’s all very debatable,” Authier adds, unconvinced.

For Vedere, both the oils and flowers are “indispensable”. Angered with the decision to stop prescribing medical cannabis in this form, she wrote an open letter to the French health ministry demanding an explanation.

“I don’t want to take opioids. And when I have sudden attacks of pain, the flowers are the only thing that relieve me,” says Vedere. “So I will just have to continue using the oil that I’m prescribed. As for the flowers, I’ll buy them illegally.”

Based on the five medical conditions that warrant this type of treatment, Authier estimates that between 150,000 and 300,000 people in France could be prescribed cannabis-based medicines, meaning that an entire industry has been holding its breath for the roll-out of the drugs.

While suppliers of the cannabis-based medicines used in the years-long trial were Israeli, Australian and German companies – those tasked with distribution were French.

Along with Germany, France could become the biggest market for medical cannabis in Europe, according to French daily Le Monde.

But despite the promise of a booming market, introducing these drugs to the French market and even getting the trial off the ground has been anything but a bed of roses.

The bad rep of cannabis in France

A few days ago, while attending a Senate hearing on the impact of drug trafficking in France, Finance Minister Bruno le Maire reiterated his position that the decriminalisation of cannabis was a no-go.

“Cannabis is cool and cocaine is chic. That is the social representation of drugs,” he said. “But in reality, the two are poisons. They are both destructive and contribute to the undermining of French society as a whole.”

Despite France being one of the biggest cannabis consumers in Europe, it also has some of the toughest laws against the drug. THC is still classified as a narcotic in France, with the maximum level permitted in any cannabis plant limited to 0.3 percent. CBD is legal as long as the cannabis plant does not exceed the permitted levels of THC.

There is still a lot of stigma around cannabis in France, even though public opinion on its medical use is hugely encouraging. According to a 2019 survey by the national Observatory for Drugs and Addictive Tendencies, 91 percent of French people say they are in favour of doctors prescribing cannabis-based medicines “for certain serious or chronic illnesses”.

Read moreCannabis in France: Weeding out the facts from the fiction

Still, attitudes around the plant are difficult to shift. “It’s impossible to completely shake off the stigma attached to the word cannabis, which is associated with narcotics. So we had to make a real effort to reassure [the medical community] throughout the experiment,” says Authier.

When it comes to medicinal cannabis, politicians and public health officials in France have expressed their concerns through two key arguments. First, that the roll-out of these medicines would be too expensive. And second, that the legalisation of medicinal cannabis will inevitably lead to the legalisation of its recreational use.

“Our objective has always been accessibility. Ensuring that patients have access to these medicines and that doctors prescribe them,” Authier counters. “It was never, as some like to believe, a Trojan horse move to then legalise recreational cannabis. That has absolutely nothing to do with our trial. Opium-based medicines exist without heroin being legalised.”

“We had to deal with some rather dogmatic opinions and deconstruct a lot of beliefs or language to be taken seriously,” he confesses.

The first place to ever legalise medical cannabis was California, in 1996. Colorado followed suit four years later in 2000, then Canada in 2001, the Netherlands in 2003, Israel in 2006, Italy in 2013 and Germany in 2017. To date, around 20 countries in Europe have joined the list, each with their own set of rules and restrictions.

In France, it wasn’t until 2018 that serious discussions around medical cannabis emerged in the public sphere. And it took another three years before the trial began, in 2021.

Now that it looks like medical cannabis is here to stay in France, at least for the next five years, Mylène feels relieved.

“When I was accepted as a participant a few months ago, I thought ‘finally’,” she sighs. “I can see a real step forward and I hope it continues. I hope that it can become more readily available so that as many people as possible can be treated.”