Medical cannabis regulation: Taking the best of the North American and European models

There is no consensus on how to optimally integrate cannabis within the health system. France is experimenting with a model of legal access for patients with treatment-resistant symptoms related to chronic diseases, following the European mode of regulation. Contrary to the North American model, this framework does not consider the intrinsic characteristics of herbal cannabis (HC), which is mostly chosen by patients outside of medical expertise.

We compare North American and European models systematically on these policy dimensions: form of cannabis available, eligibility criteria, distribution and reimbursement schemes. We then discuss the advantages and limitations of the models. The European model has the advantage of minimizing diversion and providing coverage to some of those treating severe diseases, but it limits the availability of HC and the eligible conditions. While the narrow existing evidence on efficacy of HC legitimates such restrictions, we point out the technical and economic barriers in demonstrating this efficacy, especially: (1) the potential existence of the entourage effect; (2) the heterogeneity in chemical composition across varieties and in treatment response; (3) the lack of economic incentives due to difficult in securing a patent; and (4) the impossibility to publicly fund research in a timely and cost-efficient manner. This calls for an innovative regulation framework.

A dual distribution system would retain the best of both approaches while avoiding their limitations. While the first channel would resemble the existing European model, a complementary distribution, such as Cannabis Social Clubs, could provide HC for patients who neither fulfil the criteria, nor are satisfied with standardized pharma-grade cannabis. If well-monitored, this dual system would shed light on the use patterns of patients as they choose between medical paradigms providing a real-world example of how plant medicine can be incorporated into the European health system.