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How to get a medical cannabis prescription in France

How to get a medical cannabis prescription in France

In March 2021, LAUNCH OF THE EXPERIMENT AND INCLUSION OF THE 1st PATIENT, an experiment that authorizes doctors registered in the register of specialists to legally prescribe cannabis-based medicines when they accept that their patients can benefit from it as a means of treatment.

cannabis medical experiment infographic

Infographic-timeline-maj2022.pdf

Only 20% of people in France still think cannabis should be illegal, but despite huge support medical cannabis is still rarely prescribed.

Current guidelines indicate that except for a few conditions, there is a lack of evidence to support the prescription of cannabis-based medicines.

For the majority of people in France, the only way to access cannabis is through an experiment involving 3,000 patients. To be eligible, a patient must have an eligible condition and must have habitually tried two prior medications or prescription treatments for their condition.

Under what conditions can medical cannabis be prescribed in France?

There are a number of qualifying conditions or symptoms that can be treated with medical cannabis. In all cases, the symptoms can either be a primary problem or a problem caused by another condition. When going to a clinic, the specialist will ask you about your symptoms in order to assess whether medical cannabis is appropriate.

The main conditions for which medical cannabis is used are:

  • neuropathic pain refractory to accessible therapies (medicated or not);
  • certain forms of severe and drug-resistant epilepsy;
  • certain stubborn symptoms in oncology related to cancer or its treatments;
  • palliative situations;
  • painful spasticity of multiple sclerosis or other pathologies of the central nervous system.

Find a medical cannabis structure in France

It is only carried out by physicians from voluntary reference structures and taking charge of one of the 5 therapeutic indications selected.

The map of voluntary reference structures involved in the experiment can be consulted below.

Discover the map and the lists by region of the reference structures (04/04/2022)

Two possibilities: the doctors of these centers can propose to some of their patients to take part in the experiment and/or the patients followed within these structures can express to their doctor their wish to take part.

Patients who are not followed in one of the referral structures can discuss this with their attending physician so that he can refer them to one of them.

The doctor must have previously checked whether the patient falls within the inclusion criteria. The final decision whether or not to include a patient rests exclusively with the doctor of the voluntary referral structure.

Medical follow-up during the 24 months of the experiment can then be provided in part by a liberal doctor, general practitioner or specialist, who has received and validated the compulsory training made available by the ANSM.

Patient consent is required at the start of the experiment.

What happens during the appointment?

When you contact a facility, they will ask you for access to medical records to confirm that you have a condition that is suitable for prescription.

Map and lists by region of reference structures (04/04/2022)

This usually involves telling the GP that you need a copy of the summary health record and the clinic can help you with this.

After that, you will need to attend a consultation - in person. During the appointment, the consultant will perform an assessment and ask questions such as why previous treatments have not worked or caused problems, how the symptoms of the disease being treated have affected your life, your sleep, your mobility, etc. .

The doctor or counselor will also ask you about any previous use of cannabis as a means of treatment. If they feel that prescribing medical cannabis is appropriate, they will discuss the options with you.

Some facilities may first present your case to a multidisciplinary team before deciding if an order is appropriate, usually these meetings are held weekly, so you may have to wait to hear the decision.

Don't forget that the doctors and counselors are there to help you and also to answer your questions or your fears. You may find it helpful to take notes and you always have the right to request that anything discussed not be included in the clinical record.

Medical cannabis: 1 out of 5 French people ready to take it

Views on the use of medical cannabis vary greatly from country to country. According to Statista's Consumer Insight surveys, Germany and Poland are among the countries where people are the most open about this. As our chart shows, 39% and 46% respectively of German and Polish respondents are willing to use it as part of treatment.

In Germany , the topic has recently come to public attention, as the government is currently examining the possibility of allowing cannabis use for adults, including for recreational use. The country plans to draw up its cannabis legalization project by the end of 2023. As a reminder, medical cannabis has been legal in Germany since 2017 for seriously ill patients.

In Canada , where the use of cannabis has been legal since 2018, residents are also rather interested in this form of treatment: more than a third of respondents are willing to take it. By contrast, in Spain and France , only 22% and 23% of respondents said they were open to taking medical cannabis for treatment. In South Korea, they are even less numerous: only 13%.

Graph "populations open to medical cannabis"

What happens when medical cannabis is prescribed?

If your Doctor agrees to prescribe you medical cannabis, your prescription will be confirmed in writing and then filled by a specialized pharmacy.

It is likely that your establishment will recommend a specific pharmacy to you, but the choice is yours.

Pricing and Reimbursement Medical Cannabis

Medical or therapeutic cannabis will be fully covered for patients benefiting from the experiment during the 24 months.

Then, the reimbursement is not yet decided and its rate will be decided according to various parameters such as the cost and the advantages of the product.

Once you have started taking your medication, the dispensary will request a follow-up visit, usually within 4 weeks, to discuss how you are doing with your medical cannabis and to see if any changes need to be made. It is important that you attend this consultation to continue to receive repeat prescriptions.

How will I take my medical cannabis?

During the consultation, the doctor will ask you questions to learn more about you, your condition and how medical cannabis can help you. You may be prescribed cannabis flower or cannabis oil , depending on your symptoms.

Cannabis flowers

cannabis flowers

If you are prescribed cannabis flower, the doctor will tell you the initial and maximum daily dose you should take.

However, cannabis flower takes a bit of work to consume.

You will need a scale that is accurate to 0.01g to be able to accurately weigh each dose.

You will need to Grind the cannabis flower, a grinder can help with this process as it breaks down the cannabis into a finer and more cohesive form.

Cannabis can only be prescribed for consumption with a dry herb vaporizer. NO SMOKING . Dry herb vaporizers heat the cannabis to a temperature where the beneficial components, such as CBD and THC, vaporize. This vapor can be inhaled and is a healthier and more effective method of administration than combustion (smoking).



Cannabis Oil

If you are prescribed cannabis oil, the doctor will tell you the initial and maximum daily dose you should take.

Cannabis oils usually come with a dropper with a dose indicator on the pipette.

To consume cannabis oil, you will need to place the tip of the dropper under your tongue and squeeze the bulb of the dropper to release the oil. Hold the oil under your tongue for 30-60 seconds before swallowing. This will aid in the absorption of cannabinoids.

The Side Effects of Therapeutic Cannabis

The side effects of medical cannabis are known: they are mainly linked to THC, they can cause: drowsiness, anxiety attack, paranoid state but also for prolonged use a risk of dependence ...

other side effects of a cardiovascular type a drop or rise in blood pressure or heart rate… These side effects will of course depend on the level of THC and the person's biochemistry.

The Contraindications of Medical Cannabis

The contraindications are different depending on the composition of the products and the patient's history. When the patient has cardiovascular health problems or severe cardio or cerebrovascular disorders ( heart failure, stroke, etc. ),

it is contraindicated to prescribe drugs containing THC. Likewise, THC cannot be prescribed to patients who suffer or have suffered from psychotic disorders ( schizophrenia ) or severe anxiety disorders . Medical cannabis is also contraindicated in cases of severe hepatic insufficiency or predictive biological impairment and severe renal insufficiency .

Participating patients will not be required to drive while taking medical cannabis. Finally, THC or CBD cannabis is contraindicated in pregnant and breastfeeding women.

When will medical cannabis be available to more people?

Currently, only three cannabis-based medicines are authorized and available on prescription from the ANSM.

Sativex , THC, and CBD sprays may be prescribed to treat moderate to severe spasticity in adults with multiple sclerosis.

Epidiolex , a CBD isolate product, may be prescribed along with clobazam to treat seizures associated with Lennox-Gastaut syndrome and Dravet syndrome in children.

Nabilone , a synthetic THC product, can be used as an adjunct treatment for nausea and vomiting caused by chemotherapy.

It is currently estimated that around 200,000 people in France use home-grown cannabis to treat medical conditions. While these people are pushed into illegality, the issue of better access to medical cannabis continues to be a pressing issue and a hotly debated topic.

At this point, ANSM recommendations still suggest that cannabis-based medicines are appropriate for a small number of conditions.

FAQ: Medical Cannabis in France

Q: Can cannabis be grown in France for medical purposes?
A: Still not. Even during experimentation with cannabis for medical use, article R.5132-86 of the Public Health Code applies and maintains a principle of prohibition of the cultivation of cannabis, including for therapeutic purposes, insists the Medicines Agency.

Q: What are the indications for medical cannabis in France?
A: Medical cannabis is prescribed for five specific indications: neuropathic pain refractory to other therapies, severe epilepsy resistant to conventional drugs, certain stubborn symptoms in oncology such as pain, nausea, painful spasticity of multiple sclerosis or other pathologies of the central nervous system, as well as palliative situations.

Q: Can a patient ask to participate in the experiment?
A: Yes, by contacting a doctor working in one of the 324 hospital reference centers listed on the ANSM website.

Q: In what form is the treatment available?
A: Medical cannabis is available in the form of oil and dried flowers, and the dosage is inspired by experiences in other countries such as Canada or the Netherlands.

Q: Where do the products come from?
A: Products are imported from Australia, Canada, Portugal or Israel. However, a decree published in February 2021 now authorizes the cultivation of medical cannabis in France.

Q: What is the outcome after two years of experimentation?
A: The national electronic monitoring register (Recann) recorded 2,282 adverse effects, including 59 serious cases during the first twenty months of the experiment. Adverse effects are mainly central nervous system disorders, gastrointestinal problems and psychiatric repercussions. The risk of addiction is low.

Q: Is there a risk of drift?
A: The sale and consumption of cannabis for recreational purposes remains prohibited in France. Medical cannabis is strictly supervised by the ANSM and can only be prescribed by a doctor working in a hospital reference center.

In summary :

medical cannabis is still little prescribed in France despite growing support from the population. It is currently only available as part of a trial that aims to include 3,000 eligible patients.

These patients must have an eligible condition and have usually tried two prior medications or prescription treatments for that condition. The main conditions for which medical cannabis is used are neuropathic pain, certain forms of severe epilepsy, certain stubborn symptoms in oncology, palliative situations and the painful spasticity of multiple sclerosis.

Patients can contact a doctor from the voluntary reference structures who take care of one of the 5 therapeutic indications selected for the experiment. The consent of the patients is compulsory at the start of the experiment and the medical follow-up is provided in part by a liberal doctor, general practitioner or specialist who has received the compulsory training.

Sources:

Inclusion of the first patient in the experimentation with medical cannabis, ANSM, March 26, 2021

Decree No. 2020-1230 of October 7, 2020 relating to experimentation with the medical use of cannabis.

National Assembly. Regular session of 2019-2020. Full report. First session of Friday, October 25, 2019.


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