The Ethics and Cancer Committee was seized by a patient in oncology, inviting him to pronounce on the use of therapeutic cannabis in France.
Is allowing therapeutic cannabis an ethical choice? Examined in all its forms for several months by the politico-medico-intello community, the issue of cannabis use in a context of care has recently been addressed by the Ethics and Cancer Committee.
Ms. A, a 27-year-old cancer patient"many interventions (lumpectomy, radiotherapy, double prophylactic mastectomy) or treatments (chemotherapy, hormone therapy)" and "faced with intense and chronic pain that the health care team could not contain in good conditions", improved its quality of life by using cannabis "in different forms". According to her, prohibiting therapeutic cannabis to patients who can not be relieved is akin to "refusal of care".
Supported by most of her medical staff, but wondering about the ethics of this treatment, she asked the Ethics and Cancer Committee. Because if many patients in the world praise its therapeutic virtues to relieve pain and nausea, its social representation in France and the few scientific studies conducted on its benefits slow down its legalization for medical purposes. Leaving legal and ethical frameworks, this question was for the first time touched by medical and paramedical personnel, philosophers, sociologists, psychologists, lawyers, associations, patients and their families or loved ones.
Favorable to non-smoked cannabis use
Recognizing that "the scientific literature on the effects of cannabis suffers from methodological problems", most of the studies being only observational, the Committee considers in its opinion No. 35 that it "can not identify any reason to oppose cannabis use by patients who claim to benefit from it, even if this benefit is not demonstrated according to the most rigorous scientific methodologies ".
Nevertheless, the Committee considers that it would be safer for patients if these active substances could be consumed "in a form that would enable them to avoid smoking, so as not to be exposed to the deleterious effects of this type of consumption. It should also be possible for this access to be supervised by the health authorities, in order to provide sick people with the necessary guarantees as to the quality, the concentrations and the optimal use of cannabis or its active substances ".
And the advice to continue: "Such a framework would furthermore allow patients to avoid the use of parallel circuits to obtain the product they benefit from.It would also avoid them to risk criminal prosecution because of their consumption".
What do we really know about the therapeutic virtues of cannabis?
In the United States, where cannabis is permitted in some states, nearly half of oncologists talk about therapeutic marijuana use for their patients without being adequately informed about the subject, according to a study published in the United States. Journal of Clinical Oncology.
"The scientific evidence supporting the use of medical marijuana in oncology is still very thin, which puts physicians in a very uncomfortable position," says Dr. Ilana Braun of the Dana-Farber Institute of Adult Psychosocial Oncology. So far, no randomized clinical trial has looked at the effects of medical marijuana in cancer patients, apart from its effects on nausea, so that oncologists rely on research on the use of cannabis for medical purposes in the treatment of diseases other than cancer.
An effective supplement to the standard treatment of pain
Two-thirds of the oncologists interviewed believe that medical marijuana is an effective supplement to standard pain management. In their experience, therapeutic cannabis is just as good as, or better than, conventional treatments for the side effects of chemotherapy such as nausea or lack of appetite.
A study published in The European Journal of Internal Medicine has shown that therapeutic cannabis would actually be effective in treating pain in the elderly. 901 patients over 65 years old participated in this research. All suffered from pain related to cancer, Parkinson's disease, post-traumatic stress, ulcerative colitis (inflammatory bowel disease), or Crohn's disease.
After six months of therapeutic cannabis treatment, over 93% of participants reported that their pain decreased by 4 to 8 points on a scale of 1 to 10. More than 70% of patients said they felt an overall improvement of their condition.