For a group of activists in Paris, France, the upcoming medical cannabis experiment is only the beginning. It’s the first step in changing the way the country thinks about drugs, addiction and healthcare. And the French government’s cannabis trial is just one piece of a much larger vision.

Related: European Commission to Unify Stance on Cannabis in March 2020

It just so happens that cannabis is currently gaining the most traction — but it certainly isn’t the only front runner.

It’s bigger than just cannabis

On 28 January 2020, patients, doctors, lawyers, advocates and onlookers came together in a conference hall in Paris.

Governing the event was Jacques Boutault, the mayor of the second arrondissement in the city. Members from various collectives and the ANSM, France’s health and safety agency for medicine, waited in the aisles around the audience.

Each member sat anxiously, waiting to hear about one thing: How was the medical cannabis experiment going to turn out?

For the uninitiated, the trial is likely one of Europe’s most anticipated. Over the course of 18 months, beginning in September 2020, an association of medical professionals will administer medical cannabis to 3,000 relevant patients.

Each patient will be followed from prescription to treatment, and any feedback will be closely recorded throughout the trial. If successful, it would be a huge step in helping patients gain access to critical medicines.

If it fails, however, it could spell disaster for the cannabis movement in France and the rest of Europe.

The first speaker to take the podium at Espace Jean Dame was Deputy of Isère and General Secretary of the Commission for Social Affairs Olivier Véran. More importantly, Véran was also a hospital neurologist at the Grenoble University Hospital (CHU). ‘When I was working as a neurologist, I had so many patients coming to me and telling me about how they were self-dosing with cannabis,’ he said. ‘Eventually, I got myself licensed and trained in prescribing cannabis products.’

Getting this licence meant that his office soon became inundated with patients seeking cannabis-based treatment. ‘I couldn’t wait to stop giving anti-depressants, morphine and opioids,’ he said. It’s also for this reason that he has been one of the most vocal advocates of the cannabis trial in France.

In October 2019, he helped secure funding for the experiment after submitting an amendment to the Social Security Financing Bill. He justified the decision in an October 2019 interview with the French radio station RTL by stating:

‘There are thousands of patients who are without a solution to neuropathic suffering, pain caused by neurological damage, pain tied to cancers, and psychiatric disorders. [And] cannabis derivatives can work as a supplemental treatment to these issues.’

He concluded his brief introduction last week by adding that he hopes the first results of the experiment are successful. This way, France can quickly onboard the next batch of patients seeking medical treatment. The number of patients participating in the first round was quickly a point of contention in the round table.

Nathalie Richard of the ANSM, Alexandre Maciuk of the University of South Paris and Bertrand Rambaud, member of the ACT Collective, discussed the details of how Richard and her team would be pursuing the cannabis trial.

For the uninitiated, the ACT Collective is one of the most outspoken advocate groups for cannabis reform in France. By platforming patients and medical workers, ACT hopes to make clear to regulators the therapeutic benefits of cannabis. Events like the one last week in Paris are just one example of its activism.

Richard of the ANSM made clear that the experiment would be focused primarily on how cannabis could be safely distributed to a body of patients.

🗓️ Nathalie Richard, Directrice adjointe des médicaments en neurologie, interviendra à la table ronde: "le pharmacien face aux addictions" dimanche 10 février à 14h30 aux rencontres de l'officine#Rencoff ➕ d'information: https://t.co/dk4yU3oBGc pic.twitter.com/xpf2bASEy8 — ANSM (@ansm) February 6, 2019

‘We are less focused on how cannabis works. We know much of this already, and the committee has confirmed this,’ she said. ‘Instead, we want to focus on training the community, distribution channels, and how we can follow patients in the trial.’

This is in part why the number of patients is so small.

For some, like Rambaud, the number is too small, however.

Rambaud is also the founder of the UFCM, an organisation promoting the use of cannabis as a medicine. Perhaps his most important credential is the fact that he is first and foremost a patient. For over 30 years, he has been battling with French authorities and his condition. For him, the experiment is a good start, but not enough.

‘I don’t see this as a “glass-half-full” or “glass-half-empty” situation,’ he said. ‘I’m just happy that we now have a glass.’

He critiqued the fact that the ANSM would only be following 3,000 patients for five specific maladies. This group of illnesses includes treating painful spasticity tied to sclerosis, supplemental treatment in oncology, helping soothe refractory pain, treating severe cases of epilepsy and also helping in cases of palliative care.

As for specifics, there were few on offer. Rambaud, for instance, indicated that the program had few concrete plans for what would happen to patients after they left the experiment.

Richard did rebut, however, adding that more details would be released in the middle of February. She confirmed that patients would be inducted by September of this year. The nature of the conversation in Paris last week and the demographic participating therein also points to how serious the country is taking the issue.

After the medical professionals, legal experts added their two cents. Yann Bisiou, the president of advocacy group L630 and law professor at the University of Montpellier, optimistically described a few grey areas in current French law that could make room for cannabis. Others, like Ingrid Metton, another member of L630, expressed their frustration that ‘sick people were being prosecuted for treating themselves with cannabis.’

Like ACT Collective, L630 is a group fighting for change within the wider drug landscape. Cannabis, as well as psychedelics, is merely an aspect of this grander objective.

The group has also been active in relieving the opioid crisis in France via its advocacy of an overdose drug called Naloxone. Hospitals and emergency centres around the country supply the product in a nasal spray.

Indeed the breadth, focus and clarity with which members of all the panels outlined the medical trial’s objective are striking. And, if one is to consider France’s history with drug use, such a discourse is critical for taking on cannabis.

How France kicked its opioid addiction

Not long ago, France had a serious crisis that resembled much of what’s going in the United States at current. In the 1980s and 90s, the country’s authorities were dealing with heroin and opioid epidemics.

To curb the issue, the government legalised and made available the use of a particular drug called buprenorphine.

Buprenorphine is also an opioid but doesn’t make addicts out of consumers. More importantly, it curbs many of the symptoms associated with withdrawal for recovering patients. But this was just one aspect of the resolution. Because of France’s socialised healthcare system, doctors were able to freely prescribe the medicine to those in need.

Within just a few years of this policy shift, ‘about 10 times as many addicted patients began receiving medication-assisted treatment, and half the country’s heroin users were being treated. Within four years, overdose deaths had declined by 79 percent’, reported Vox.

These figures would likely be higher too if not for the stigma around addiction.

What one can gather from the above example is very simple. Cannabis can be discussed at high levels within legal and medical communities. This is because there are real, quantifiable benefits for patients who are treated with relevant illnesses. The project now, in France as well as abroad, is ensuring that this particular discourse is preserved.

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It is a multi-layered discussion that involves educating the public, doctors, legal specialists and local politicians. Only when all of these agents are up to speed as to the nature of cannabis and how it should be implemented will patients begin receiving important, opioid-free care.

Previously, Strain Insider reported on how many of the discussions surrounding cannabis are business-oriented. This isn’t necessarily a bad thing, but it has no place in advocacy. Changing public policy, serving patients and informing the public about incoming medicines should not be the subject of speculation or shareholders’ interests.

From the meeting in the second arrondissement last week, French leaders appear to be pursuing this goal in good faith.