Science

Medical cannabis: “We are far from the miracle cure”

For these few patients with chronic pain, the disappointment is immense. Selected to experiment with cannabis for therapeutic purposes in a trial started three months ago, they were to be followed for two years. But they finally left the program long before the end. The reason ? The benefits they derived from this experimental treatment were zero or close to zero, while the side effects (increased heart rate, vomiting, panic episodes, etc.) manifested themselves too strongly.

These few failures were expected. “Scientific studies, when done well – and there are not many of them – show that a sometimes significant portion of patients do not benefit from this type of treatment. Moreover, if cannabis was so effective that that, one would prescribe it in first intention whereas there, one tests it after other existing drugs which are themselves already partially effective “, recalls Nicolas Authier, head of the medical pharmacology department at the CHU of Clermont-Ferrand and Chairman of the Scientific Committee on Cannabis for Medical Use.

But this lucid observation does not prevent the doctors from continuing the trial. Because some patients suffering from certain forms of epilepsy, neuropathic pain, side effects of chemotherapy or multiple sclerosis could see their lives significantly improved. In what proportion? Impossible to say. Most of the 400 patients recruited so far – out of a total target of 3,000 – the experiment is continuing.

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Exploratory medicine

“Faced with the same treatment, patients’ response varies. We therefore strive to make the medicine as personalized as possible. We start with very low dosages and very gradually increase the dosage to achieve an effective result without adverse effects or with consequences that are well tolerated. It is exploratory medicine “, recognizes Nicolas Authier.

One of the challenges of the experiment is to test several combinations of CBD and THC, two substances contained in cannabis. These do not have the same effects and can be complementary. CBD, for example, helps reduce the frequency of seizures in some forms of epilepsy. But when we seek to fight against pain, in the case of cancer or multiple sclerosis for example, THC is more useful because it will act on neural receptors transmitting painful messages.

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Doctors are interested in both the direct and indirect effects of this psychotropic ingredient. “When you suffer from chronic pain, you only think about it. Your whole life revolves around it. The risk is then to fall into a vicious circle which reinforces the pain and its complications like anxiety, sleep disorders or a depressive state. In this case, cannabis can help patients to get out of this deleterious chain by helping them to divert their attention to something else “, assures Nicolas Authier. Of course, the idea is not to put the patient to sleep: “There is a dosage to be found and we do not yet master it well enough, he admits. But some patients already feel the difference.” We can guess it. through their testimonies. Some tell us they sleep better. Others seem less preoccupied with their suffering, they become more mobile, leave their homes and allow themselves to think of something other than the pain. We are not revolutionizing medicine. Cannabis is not a miracle cure. But it is a therapeutic tool which sometimes makes it possible to change the course of care “, assures Nicolas Authier. It remains to be seen whether in the long term, many patients will have access to it. Indeed, beyond the necessary authorizations, the treatment has a cost. and not all doctors are necessarily in favor of it.


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