Les médecins recrutent lentement des patients dans la première expérience française de cannabis médical, trois mois après son début. Beaucoup sont impatients d'accéder au médicament pour traiter une gamme de troubles, y compris la douleur chronique, mais la participation à l'expérience est onéreuse - et les chances de succès, pour la plupart, sont minces. </p><div> <p>« Les patients sont vraiment impatients d'obtenir ces produits. Ils savent qu'ils sont disponibles dans d'autres pays et certains d'entre eux sont allés à l'étranger pour les obtenir », explique le neurologue Didier Bouhassira.
He is a pain specialist in one of the largest pain centers in France at Ambroise Paré hospital in Boulogne, west of Paris, and is participating in an experiment that tests the prescription and distribution of medical cannabis in France.
Although the rules are changing and CBD, one of the components of cannabis, is increasingly available in France, THC, the plant’s main psychoactive element, remains illegal, and consuming marijuana is a crime.
“Many patients ask for cannabis. They are looking forward to this experience, ”says Bouhassira. “But unfortunately very few will be involved. “
The two-year experiment will involve 3,000 people, 700 of whom suffer from chronic pain. Only three or four of Bouhassira’s patients will be affected, which means he had to make some tough decisions.
Listen to a report on one of Bouhassira’s first participants in the cannabis experiment, in the Spotlight on France podcast:
To participate in the experiment, patients must have severe neuropathic pain that does not respond to other medications.
“Many neurological diseases are associated with very severe neuropathic pain,” explains Bouhassira. “Even opioids don’t work very well in these patients. So we use antidepressants, or anticonvulsants, which usually have nothing to do with pain.
A few dozen of his patients qualify for the experiment, but the demands are onerous enough that only a handful sign up.
“When you participate in this experiment, you cannot drive, so it is an exclusion criterion”, he specifies, adding that participation is not easy, with monthly meetings and a lot of paperwork.
“When you explain all the constraints, many of them decline, because it’s too complicated.
Johanne Seneco was eager to participate. Bouhassira had her come from her home in Amiens to register.
She arrives at the office with her husband, walking with a cane.
“I feel like I’m on fire, I get burns from head to toe, constantly,” she said, her face pinched behind a surgical mask.
Seneco has been seeing Bouhassira for pain management since 2015, after a failed knee surgery the previous year, which caused him severe pain in his leg that has since spread throughout his body, triggering a condition called pain syndrome. regional complex.
She is in constant and severe pain 24 hours a day. She cannot move well on her own and cannot work. She had to quit her job as a college assistant and spends most of her days in bed, propped up on pillows.
“I lost everything,” she said, her eyes cloudy. “The hardest part is the impact it had on my daughter. She is 18 now, but for the past seven years she has not had a mother.
Bouhassira asks Seneco to fill out forms and questionnaires about his pain levels and state of mind. She will need to complete them during monthly doctor visits throughout the two-year experience.
It’s a job she doesn’t hesitate to do, if it gives her access to something that could help ease her pain. She tried many drugs and treatments like hypnosis and acupuncture, but none worked. Some made the pain worse.
Unlike many people with chronic pain, Seneco has never tried cannabis.
“The doctors told me to smoke a joint,” she says. “But I never dared because I was worried about what else might be in it. “
Many other Bouhassira patients are not so hesitant.
“We discuss it openly with them and ask them if they have tried smoking or taking it in other forms,” he explains. “It’s important for us to know.
If the cannabis works, Bouhassira doesn’t discourage them from continuing, but warns of the risk of using unregulated products.
“The problem is, there is no control over what products they buy online or on the street,” he says.
<p> <iframe src="https://www.facebook.com/plugins/video.php?height=476&href=https%3A%2F%2Fwww.facebook.com%2FRFI.English%2Fvideos%2F801225507257950%2F&show_text=false&width=476&t=0" width="476" height="476" style="border:none;overflow:hidden" scrolling="no" frameborder="0" allowfullscreen="true" allow="autoplay; clipboard-write; encrypted-media; picture-in-picture; web-share"></iframe> <figcaption class="m-em-flash__legend"> <span class="a-media-legend"> </span> </figcaption> <h2><strong>Essai et erreur</strong></h2>Après une demi-heure de paperasse, Bouhassira présente enfin à Seneco ce pour quoi elle est venue : la prescription de gouttes sublinguales d'huile de cannabis, avec une quantité égale de CBD et de THC.
The prescription takes up an entire page, as she should start with a small amount and increase every few days until she feels her pain subsides or has a negative effect.
“You will increase very gradually, depending on the effects,” explains Bouhassira. “There is no fixed dose. We adapt to each patient.
With a prescription in hand, Seneco then goes to the pharmacy in the basement of the hospital, where a pharmacist spends half an hour reviewing the prescription.
Pharmacists are the key
The experiment is not a drug trial but a test of the logistics of prescribing and dispensing cannabis, and family physicians and pharmacists are trained to do so.
“I was interested because I care about everything related to pain,” says a pharmacist from the southwest who took the training, but did not want to be identified, because cannabis is still a touchy subject. in France. . “I want to facilitate effective pain treatment.
The one-day online course focused on dosages.
“It was to help us get comfortable with what’s on the prescription,” she says, although she still put it into practice, with few patients enrolled in the. experimentation, which was slowed down by the Covid.
“The role of a pharmacist is to give the right medication, with the right dosage and the right information to support them,” she continues. “It’s about supporting people. “
This experience is “rather unique” for a drug in France, specifies Nicolas Authier, doctor and pharmacologist, and chairman of the scientific committee on medicinal cannabis.
Such experimentation is necessary, due to the legal status of cannabis, which continues to have strong opponents of the government, even as a growing majority of French people support its legalization.
The experience is a step towards advancing the question.
“It is likely that it will be difficult to say no at the end,” said Authier. “Once you start the experiment, it’s usually to take the time to organize the rest, and rarely to stop everything afterwards. “
Seneco comes out of the hospital pharmacy with a paper bag containing a small bottle of cannabis oil, made by the Israeli company Panaxia. That’s enough for a month, until she comes back for her next doctor’s appointment for a new prescription.
She can’t wait to get home and start treatment.
“What I’m looking for is relief because I have no more life,” she says. “I don’t expect to achieve zero pain. But if I can halve it that would be wonderful.
“It’s not a quick fix,” says Bouhassira, who warns patients that cannabis may not work. “Usually that provides partial relief. “
Authier says cannabis will not work on most of the patients included in the experiment, and it is not known for whom it will work: “As of yet, international research has not been able to say which profile of patient is most likely to respond to these drugs. . “
But some will have a good answer, with “a marked improvement in their quality of life”.
“It’s already something. We will have done our job as a doctor, ”he says.
Hear the story of Bouhassira meeting Seneco on the Spotlight on France podcast, episode 56.