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Medical cannabis: an experimental programme in France in 2021

The medical use of Cannabis sativa L., also known as hemp or cannabis, appears to be an option in the treatment of certain types of pain, despite its limited evaluation.

France has announced the start of an experimental programme in 2021 involving medical use of cannabis. The programme is aimed at patients with chronic, neuropathic or cancer pain, or patients with multiple sclerosis who experience painful muscle spasms. The drugs authorised during this programme are Cannabis sativa L. extracts in oral or sublingual form, and preparations for inhalation supplied with a specific medical device to produce a spray.

There is no robust evidence in patients with chronic pain that cannabis derivatives reduce the intensity of neuropathic pain or cancer pain. But it is possible that the neuropsychological effects of cannabis produce a feeling of wellbeing in some patients. Adverse effects were common in these trials, and were the same as those known to occur with recreational cannabis use, primarily dizziness and psychological disturbances. Many drug interactions are foreseeable.

In patients with multiple sclerosis, an oromucosal spray containing a mixture of standardised Cannabis sativa L. extracts (Sativex°) relieved painful muscle spasms more effectively than placebo in about 10% of patients. In addition to the adverse effects of cannabis derivatives, this spray impairs the sense of taste and can cause discomfort at the site of application.

Herbal drugs generally contain dozens of different substances. Herbal preparations do not come with the same guarantees as does a substance isolated from a plant and which has been granted marketing authorisation: the composition of herbal preparations is more variable, their evaluation is generally less robust.

©Prescrire 1 May 2021

Source: "Medical cannabis in chronic pain. An option for some types of pain, while awaiting further evaluation" Prescrire International 2021; 30 (226): 128-132. Subscribers only.

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For more information:

"Multiple sclerosis:
a cannabis-based drug
for some patients"
(June 2014)

"Cannabidiol (Epidyolex°)
in certain severe forms
of childhood epilepsy: an option
to consider, but liver function
must be monitored"
(September 2020)

See also:

"Adverse effects of cannabis.
Inform psychologically vulnerable
patients of the risk of serious,
dose-dependent disorders"
Prescrire Int 2011;
20 (112): 18-23.
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