When France began its first large-scale experiment with medical marijuana, the expectation was that it could lead to legalisation. But three years on the experiment is ending with no clear path forward, leaving hundreds of patients who took part in the study in limbo.
In 2021, Nadine Attal was on the scientific committee that was putting in place France’s first large-scale experiment with medical marijuana, recruiting patients, doctors and pharmacists to see how it could be prescribed and used in the health system.
Three years later, when it was becoming clear that the experiment would end without a legalisationof the use of medical marijuana, Attal had to break the news to her patients.
“I wanted them to receive the information from me, because I did not want them to learn it through the media,” she said.
“So we sent them letters, to inform them. And they are extremely unhappy. They're extremely emotional. They are going to pharmacies, weeping, crying. Some say: ‘What are we going to do?’”
Listen to an interview with Nathalie Attal in the Spotlight on France podcast, here:
Attal is a neurologist and the director of the pain clinic in the Ambroise-Paré hospital in Boulogne, west of Paris. About 25 patients were enrolled in the experiment which was supervised by the National agency for the safety of medicines and health products (ANSM).
The experiment recruited 3,200 patients across the country with disorders ranging from cancer, to epilepsy, to multiple sclerosis that could benefit from medical cannabis.
Some 1,800 ended up taking part in the experiment, 700 of them for chronic, neuropathic pain that was not responding to any other treatments, including opioids.
Pain relief
Many of the patients found relief from taking oils with varying ratios of CBD and THC, the psychotrophic component in marijuana.
“In general, it relieved their spontaneous pain, and it particularly had an effect on their pain paroxysm, so on the acute episodes of pain,” said Attal.
Some patients who had previously been smoking marijuana – illegally – stopped, when they had access to the medical-grade cannabis products prescribed through the study.
And overall, the logistics worked, too. With the exception of overworked Paris-area GPs, doctors and pharmacists joined the experiment, and learned how to prescribe cannabis, and treat patients
Successful experiment
“It was more successful among pharmacists than among primary care physicians in the Paris area, but on the whole, if you look at the general results, it was generally positive. And I think the ANSM is pleased about the results,” said Attal.
Indeed, in 2023 after a green light from the agency, the health minister at the time wrote an extension of the experiment into the 2024 social security budget.
Most everyone involved in the experiment assumed that medical marijuana would be authorised by the end of 2024, but it has stalled, likely falling by the wayside in the wake of France's political instability – eight health ministers have been appointed since the start of the study in 2021.
And as focus turns to budget cuts and a breakdown of the health system, medical cannabis is not a top priority.
Patients left in the lurch
“There are not many politicians who are very interested in it, because there are things that are more urgent, which I understand. It’s not urgent, from an economic perspective. But it is an emergency for these patients,” said Attal.
The 1,200 patients currently using medical marijuana in the experiment will have to stop.
“I want to find solutions for these patients. Medical marijuana was one potential solution," stresses Attal, who is angry that these patients, who got a taste of something that helps, will be left with nothing.
“Apparently the politicians are not ready. OK, they're not ready. They should be ready, but they're not. But we have these patients now. What are we going to do with them? You cannot forget these patients,” she said.
“This is no longer about research, it’s about medicine. We do have to do something for them. We're dealing with human beings."
The study enrolled "very, very fragile patients. Some of them have spinal cord injury, post-stroke pain, they are handicapped, they are disabled. They need help," said Attal.
"So you cannot just say you're going to stop. You have to think of the consequences.”
Waiting for a political decision
The study was given a six-month extension, through the end of June 2025, to wean patients.
There is hope that the current health minister, Yannick Neuder, a cardiologist turned lawmaker, who took up his position in December 2024, could convince the government to consider the issue.
On a visit to a Paris hospital at the start of January, in his first public comments as minister, he said that medical cannabis should be studied “because it covers a range of intractable pain that is often not relieved by other medicine".
But until a political decision is taken to allow medical cannabis to be prescribed in France, some patients will turn back to their previous habits, buying and smoking marijuana illegally.
“One of my patients wrote to everybody I know. He said: 'OK, I'm going to go back to smoking', which isn’t ideal," cautions Attal.
“He has pulmonary problems. It's very deleterious for him to smoke, for many reasons, including psychiatric reasons."
She is angry that patients like these are being left in limbo, but is holding out hope for a solution.
“It was very good for these patients. And I do hope we can find a solution for them - for this tiny group of patients, without even thinking of a legalisation.”
Find an interview with Nadine Attal in the Spotlight on France podcast, episode 123, listen here.
