Each of these stories are about people who are suffering from serious pain, yet their doctors have not prescribed adequate painkillers (or they have, but the pills they prescribe are too addictive). The healthcare system is complex, and there is no one-size-fits-all treatment. But that doesn’t mean there isn’t hope.
When you’re living with multiple sclerosis, it’s hard to believe that you’re not in constant pain, but for one French woman, all she had to do was move to the south of France. Last year, she moved from Paris to Marseille and started using medical cannabis to treat her symptoms. After a few months of using cannabis, she experienced a dramatic change. Her pain was less severe, and she could even go for a long walk without feeling exhausted. Her husband was even happier because he no longer had to play the role of the family caregiver.
Three months after the experiment began, doctors are gradually enrolling patients in the first experiment with medical cannabis in France. Many people want access to a drug to treat a range of conditions, including chronic pain, but participating in the trial is expensive and the chances of success are low for most. Patients are only too happy to have these products. They know these drugs are available in other countries, and some of them have gone abroad to get them, says Didier Buchassira, a neurologist. He is a pain specialist at one of France’s largest pain centers, the Ambroise Paré Hospital in Boulogne, west of Paris, and is involved in an experiment to test the prescription and distribution of medical cannabis in France. Although regulations are changing and CBD, one of the components of cannabis, is increasingly available in France, THC, the main psychoactive component of the plant, remains illegal and the use of marijuana is a criminal offence.
Difficult selection
Many patients ask for cannabis. They are looking forward to it, Buhassira said. But sadly few will attend. The two-year experiment will involve 3,000 people, 700 of whom suffer from chronic pain. Only three or four of Mr. Buchassir’s patients will be involved in this project, which means he had to make some tough decisions. Listen to a report on one of the first participants in the cannabis experiment, Buchassir, on the Spotlight on France podcast: Focus on France, episode 56 © RFI To participate in the trial, patients must have severe neuropathic pain that does not respond to other medications. Many neurological diseases are accompanied by very severe neuropathic pain, Buchassira says. Even opioids don’t work well for these patients. So we use antidepressants or anticonvulsants, which usually have nothing to do with pain. Several dozen of his patients can participate in the experiment, but the requirements are so high that few will actually sign up. If you participate in this experiment, you are not allowed to drive, so that is the disqualifying criterion, he said, adding that participating in the experiment is not easy, with monthly meetings and a lot of paperwork. When we explain all the restrictions, many of them refuse because it is too complicated.
Persistent pain
Johanna Seneco volunteered. Buchassira asked him to leave his home in Amiens to go to school. She enters the office with her husband walking with a cane. I feel like I’m on fire, I’m burned from head to toe, all the time, she says, her face pulled tight behind a surgical mask. Seneco has been going to Buhassira for pain management since 2015, after a botched knee surgery the year before severed her nerves and left her with severe pain in her leg, which then spread throughout her body, causing a condition called complex regional pain syndrome. She suffers constantly and severely, 24 hours a day. She can’t move or work on her own. She has had to quit her job as a high school assistant and spends most of her days in bed with her head propped up on pillows. I lost everything, she said, her eyes bloodshot. The hardest part is the impact it had on my daughter. She is now 18 years old, but has not had a mother for the last seven years. The accountant has Seneco fill out forms and questionnaires about pain symptoms and state of mind. She will need to fill them out at her monthly doctor’s appointments during the two years of the experiment. It’s a job she doesn’t mind, as long as it gives her access to something that can ease her pain. She tried many medications, as well as treatments like hypnosis and acupuncture, but nothing helped. Some made the pain worse.
Self-treatment
Unlike many chronic pain sufferers, Seneco never tried cannabis. The doctors advised me to smoke a joint, she says. But I never dared because I was afraid of what else might be in there. Many of Bukassir’s other patients are not so indecisive. We talk to them openly and ask them if they smoke or have tried other forms of drugs, he says. It’s important for us to know. While cannabis is beneficial, Buhassira does not advise against its use, but warns of the risks of using unregulated products. The problem is that there is no control over these products, whether they are bought online or on the street, he says.
Tests and errors
After half an hour of paperwork, Buhassira finally hands Seneco what she came for: a recipe for sublingual cannabis oil drops containing equal amounts of CBD and THC. The prescription takes up a whole page because she has to start with a small amount and increase it every few days until she feels less pain or a negative effect. They will increase very gradually, depending on the effect, Buchassira explains. There is no fixed dose. We adapt to each patient. Seneco goes to the pharmacy in the basement of the hospital, prescription in hand, where the pharmacist checks the prescription for half an hour.
Pharmacists play a key role
This is not a drug trial, but a test of the logistics of prescribing and dispensing cannabis, and GPs and pharmacists are trained to do so. I was interested because I’m interested in everything to do with pain, explains a pharmacist from the southwest who has undergone training but didn’t want to make himself known because cannabis remains a sensitive subject in France. I want to promote effective pain management. The one-day online course focused on dosage. This was done so we could be sure of what was on the prescription, she says, although she hasn’t put it into practice yet because few of the patients in the experiment were slowed down by the drug Covid. It’s the pharmacist’s job to give the right medicine, with the right dosage and the right information to support them, she says. It’s about supporting people.
Towards legalisation
This experience is quite unique for a medicine in France, says Nicolas Autier, physician and pharmacologist, chairman of the scientific committee for medicinal cannabis. Such an experiment is necessary because of the legal status of cannabis, which still has strong opponents within the government, although a growing majority of French people support its legalization. The experiment is a step in the right direction. It will probably be hard to say no in the end, Avtier says. Once you start an experiment, you usually need time to organize the rest, and rarely to tear it down afterwards.
High Expectations
Seneco leaves the hospital pharmacy with a paper bag containing a small bottle of cannabis oil produced by the Israeli company Panaxia. That’s enough for a month, until she goes to her next doctor’s appointment to get a new prescription. She is eager to go home and begin her treatment. I seek relief because I have no life left, she says. I don’t expect to get zero pain. But if I can cut it in half, that would be great. It’s not a quick fix, says Buchassira, who warns patients that cannabis may not work. It usually gives partial relief. Authier says cannabis won’t work for most patients in the experiment, and it’s unclear for whom it will work: At this stage, it is not possible to tell from international studies which profile of patients is most likely to respond to these drugs. But some people will respond well, with a marked improvement in their quality of life. That’s something. We’re going to do our job as doctors, he says.
