M. Nicolas Authier, ANSM’s Narcotic and Psychotropes Commission President spoke about therapeutic cannabis and its potential as a remedy for diseases. We will go further and deepen the subject with him in three questions. Cannabis has a bad press. We knew its effect on brain during recreative use, or in microdoses, to stimulate creativity and reflexion. Here we will talk about its therapeutic effect. Not to worry, no one took some before writing (or so few).
MyScienceWork: What resembles the future for therapeutic cannabis in France, for the upcoming years?
Nicolas Authier: First, a national experimentation conducted by ANSM, allowing 3000 patients to benefit from it. It should start in 2020. It aims to evaluate access modalities to this drug, as well as the adhesion of health professionals and patient to this system. First french data will then be collected. This experimentation does not aim to prove the relevance of medical cannabis use in the withold indications - which has before been approved on published scientific data and experimental feedback from patients and other countries. Beyond those two years of experimentation, the question of the sustainability of such access will be asked. Of course, depending on the progress of scientific breakthrough on the subject, other indications could be discussed (anxiety troubles, schizophrenia…). Question of repayment of those drugs used during treatment will be asked rapidly to ensure this therapy pursuit for patients that benefit from it. At last, those two years could allow the french sector to be structured in term of cannabis-based drug production.
MSW: What are the concerned diseases?
NA: Five situations are concerned by access to cannabis drug experimentations.
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Chronic neuropathic pain, which are consecutives to nerve malfunction or neural lesion, wherever could come from this painful dysfunction.
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Abnormal muscular contraction pain in central nervous system (brain, or spinal cord). It can happen for example in multiple sclerosis, following a vascular cerebral accident, or a medullary trauma (of spinal cord).
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Some epilepsies that are drug-resistant could as well benefit from those prescriptions.
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On complication related to cancer or anti-cancer chemotherapy (appetite loss, weight loss, pain …), cannabis can show an interest.
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At last, patients in palliative treatment, with or without cancer could be treated that way. For all these situations, cannabis could be given after failure of previous medication, or intolerance to therapeutic disposals that are available.
MSW: Why, despite a visible need of it, the use is still controversial ?
NA: Two main reasons can be identified. The first one is related to scientific proof levels which are extremely low concerning the benefit/risk ratio. Although many patients report a relief, especially in the five situations explained before, it is difficult to expose on a large population panel, with conventional clinical studies, the interest of therapeutic cannabis. For this reason prescriptions are specifically for patients whose pain is not relieved, and to whom medicine owes another therapeutic strategy. This strategy can be settled by creating guidelines, leading them, and have a better evaluation.
The second one is directly related to the illicit status of cannabis, and his non-medical use, largely widespread in France. It can be even more difficult to conceive that a plant considered as an illicit drug can also, with a therapeutic finality and a non-smoked consumption, be a treatment. Nevertheless, more than 90% French people are supportive to cannabis based drug access. During the settlement of french experimentation, it will be very important to set up a large public campaign of information allowing to differentiate, in term of path end and risks, the medical cannabis from the non-medical one.
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