Medicinal cannabis: what diseases can it treat?

Why use medical cannabis?

The term “medical cannabis” or “medical cannabis” actually refers to different medicines that contain cannabinoids, that is, molecules derived from cannabis. the plant, the hempwould contain a hundred different cannabinoids.

Two of these compounds are of particular interest to medicine for their analgesic and relaxing properties: cannabidiol (CBD) and the tetrahydrocannabinol (THC). In therapeutic cannabis there is one or the other, or a mixture of the two, with variable doses depending on the patient’s profile. “THC is the compound sought after by cannabis smokers for its high and relaxing effect, but it is also the molecule responsible for the risk of addiction. CBD, on the other hand, has relaxing and sedative effects. It has no known addictive potential. explains the Pr Nicolas Simon, pharmacologist and addict at the University Hospital of Marseille.

Various cannabinoid medicines already authorized

In France, several cannabinoid-based medicines already have marketing authorization (AMM). However, their access is extremely restricted:

– Marinol (dronabinol): in the form of soft capsules, it contains synthetic THC and can be prescribed as part of a temporary use authorization (only in pain centers) in case of non-neuropathic pain relieved by conventional treatments.

– Sativex: authorized since 2014 (but not yet marketed in France), it comes in the form of an oral spray. It contains equal parts of THC and CBD. It can be used in multiple sclerosis (MS) against muscle spasms.

– Epidyolex, based on CBD, has been authorized since 2019 in certain rare childhood epilepsies.

Therapeutic cannabis: for what diseases?

Since March 2021, cannabis for medical use is experienced in France under the aegis of the National Drug Safety Agency (ANSM). It is about testing cannabis derivatives in people who conventional treatments fail to relieve, and therefore in a therapeutic dead end. The trial will last two years, that is, until 2023.

Total, 3000 patients you will benefit from it. They are all carefully selected and correspond to very specific criteria. In fact, the indications retained by the Ansm for this experiment are strictly defined:

– Certain forms of severe epilepsy.

– Rebellious chronic neuropathic pain (fibromyalgia is not one of them).

– Muscle spasms (spasticity) in multiple sclerosis (MS) and other diseases of the central nervous system.

– Refractory symptoms in cancer patients, as part of supportive care. In this area, experimentation with therapeutic cannabis has been extended in April 2022 people treated with hormone therapy after breast or prostate cancer.

– End of life situations.

Can therapeutic cannabis be prescribed in Parkinson’s disease?

Parkinson’s disease is not one of the indications retained in the context of the French experiment, due to lack of scientific validation. In principle, therefore, patients cannot benefit from it, except in special cases, as explained by Professor Nicolas Authier, president of the temporary scientific committee for monitoring the experimentation of cannabis for medical use: “A patient suffering from this disease may be included to treat, for example, refractory neuropathic pain or painful spasticity associated or concomitant with Parkinson’s disease. »

Without waiting for changes in regulations and scientific knowledge, some patients with Parkinson’s disease do not hesitate to use cannabidiol (CBD) to alleviate symptoms such as anxiety Y the Depression where the muscle tremors. the French Federation of Deparkinsonian Groups remember, however, that CBD does not cure Parkinson’s disease and advises people who are tempted by the experiment to consult their doctor before taking it.

Medical cannabis: how effective?

Currently, therapeutic cannabis -and more specifically cannabidiol (CBD)- has demonstrated its effectiveness in certain rare forms of childhood epilepsy. This is the reason why a drug l‘Epidyolex received marketing authorization in 2019.

Apart from this indication, evidence is still lacking. It seems that the effect is quite variable from one person to another, especially in the treatment of chronic pain. medical cannabis “It probably has very important therapeutic potential, but at this time we do not know if it is due to a molecule (CBD and/or THC), to a mixture of cannabinoids and in what proportions. Its effects have been demonstrated in certain childhood epilepsies. Probably may alleviate some type of chronic pain, but not all studies conclude in the same way. It’s hard to summarize.” explains Professor Simon.

Therapeutic cannabis: what side effects?

Each patient who is prescribed therapeutic cannabis goes through a “titration phase”, that is, a period during which the doctor adapts the dose of THC and/or CBD to achieve the best efficacy while limiting the risk of side effects. Since monthly consultations will allow you to make the necessary adjustments.

In general, the main side effect induced by medical cannabis is drowsinesstherefore, it is not recommended that the patients included in the experiment drive a vehicle.

Other side effects have been observed: diarrhoea, palpitations, anxiety…

Medical cannabis: a risk of addiction?

Medical cannabis (specifically drugs containing THC) can, in some people, be addictive. In the experiment that is currently being carried out, the dose of the product is adapted to limit this risk of addiction. Secure prescriptions are only issued for 28 days in order to better control side effects and, if necessary, modify the dose.

Possible interactions with other medications

Finally, you should know that medical cannabis can interfere with other medications (including anti-epileptics, anticoagulants and immunosuppressants) and modify their effectiveness. Here again, caution is required.

The occurrence of adverse effects and drug interactions is also monitored by specialized pharmacovigilance centers. All facts relating to patients included in therapeutic cannabis experimentation are recorded in a register. The benefit and risk assessment of therapeutic cannabis will be produced in 2023.

Therapeutic cannabis: what contraindications?

As a precautionary measure, the National Medicines Agency excluded from the experiment pregnant and lactating women, patients with heart, kidney or liver failure, as well as people with a history of psychotic disorders (eg schizophrenia).

The therapeutic cannabis tested in France is presented in two different ways. Form oil, is ingested orally. usually it is about drops deposited under the tongue for better absorption of the product. Another possibility: inhalation after vaporization of dried flowers.

The drug cannot, under any circumstances, be smoked. This is a deliberate choice by health authorities to ensure patient safety, as burning a cannabis joint releases carcinogens in the same way as a tobacco cigarette.

Therapeutic cannabis: which doctors can prescribe it?

Therapeutic cannabis can only be prescribed by a doctor who has followed a specific trainingorganized by the National Drug Safety Agency.

The first medication prescription is signed by a doctor who practices in a specialized hospital service (more than 200 reference structures are authorized by the Ansm). The relay can be taken by the treating doctor, provided that he has also received training.

Where to get medical cannabis?

Currently in France, access to therapeutic cannabis is reserved for patients included in the experiment piloted by the Ansm or as part of a clinical trial and always under the authority of the Medicines Agency.

To participate in medical cannabis experimentation, patients must make a request to their doctor, knowing that the final decision to accept or reject the person rests with a specialized hospital service.

Medical cannabis: some pharmacies are authorized to deliver it

Patients included in the experiment can, with a secure prescription valid for a maximum of 28 days, obtain their therapeutic cannabis at a hospital pharmacy or in the city at one of the authorized pharmacies to deliver this type of product. The pharmacist must meet two conditions: be a volunteer to participate in this experiment and have received training in therapeutic cannabis.

Medical cannabis – not to be confused with over-the-counter CBD

People looking to sleep better, relax, ease anxiety, or soothe muscle aches are increasingly turning to over-the-counter CBD products that can be purchased without a prescription online. pharmacyin specialized stores or in some large surfaces. These are low-dose products, containing mainly CBD. Only traces of THC (0.3% maximum) are allowed. These over-the-counter products cannot, strictly speaking, be considered medical cannabis.

Therapeutic cannabis: the results after a year of experimentation

In mid-March 2022, that is, one year after the start of the experiment, the National Drug Safety Agency (Ansm) took stock. At this stage, 1,500 patients out of the expected 3,000 had been able to benefit from a medical cannabis prescription. However, a quarter of these patients had withdrawn from the experiment, either due to adverse effects or lack of efficacy.

In total, the Ansm indicates that 1,522 health professionals actively participate in experimentation with therapeutic cannabis: specialist or general doctors, as well as pharmacists who work in hospitals or pharmacies.

Also, a decree of February 17, 2022 authorizes the cultivation of therapeutic hemp on French territory, which was previously strictly prohibited.

Medical cannabis: the states that authorize it

If France plans to generalize the use of therapeutic cannabis at the end of the experiment, in 2023, other countries have already taken the step: Israel, Canada, the Netherlands, Germany, the United Kingdom, the United States, Portugal, Luxembourg, Lithuania, Chile, Colombia, Switzerland, 33 US states…

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