ANALYSIS: Why France’s history means it could be a world leader in medical cannabis

As the French government approves the first medical trials on cannabis for over 60 years, Professor David A Guber looks back at the long history of cannabis 'cures' in France.

ANALYSIS: Why France's history means it could be a world leader in medical cannabis
Yohan Paulvé, a hemp farmer based in southern France. Photo: AFP

This past summer the French food and drug office, the Agence Nationale de Sécurité du Médicament, greenlighted limited medical cannabis trials inside France, something that’s been illegal since 1953.

Many have applauded the move as an important first step toward rational, public health-oriented cannabis regulation in France. The Agence Nationale de Sécurité du Médicament similarly praised the trial for its groundbreaking efforts to produce “the first French data on the efficiency and safety” of cannabis for medical therapies.

This is all well and good. However, when it comes to cannabis, a peculiar historical amnesia seems to be gripping French medicine. These trials are not the nation’s first efforts to produce scientific data on medicinal cannabis products. Far from it.

READ ALSO Is France about to legalise cannabis?

Eric Grange inspects his crop of hemp, grown for industrial purposes, in France. Photo: AFP

During my research into the history of intoxicants in modern France, I found that in the middle 19th century Paris functioned as the epicenter of an international movement to medicalise hashish, an intoxicant made from the pressed resin of cannabis plants.

Many pharmacists and physicians then working in France believed hashish was a dangerous and exotic intoxicant from the “Orient” – the Arabo-Muslim world – that could be tamed by pharmaceutical science and rendered safe and useful against the era’s most frightening diseases.

Starting in the late 1830s they prepared and sold hashish-infused edibles, lozenges and later tinctures – hashish-infused alcohol – and even “medicinal cigarettes” for asthma in pharmacies across the country.

Throughout the 1840s and 1850s dozens of French pharmacists staked their careers on hashish, publishing dissertations, monographs and peer-review articles on its medicinal and scientific benefits.

French epidemiologist Louis-Rémy Aubert-Roche published a treatise in 1840 in which he argued hashish, administered as a small edible called “dawamesk” taken with coffee, successfully cured plague in seven of 11 patients he treated in the hospitals of Alexandria and Cairo during the epidemic of 1834-35.

An anti-contagionist in a pre-germ theory era, Aubert-Roche, as most physicians then, believed the plague an untransmittable disease of the central nervous system spread to humans via “miasma,” or bad air, in unhygienic and poorly ventilated areas.

Aubert-Roche thus believed, mistaking symptom relief and luck for a cure, that hashish intoxication excited the central nervous system and counteracted the effects of the plague.

“The plague,” he wrote, “is a disease of the nerves. Hashish, a substance that acts upon the nervous system, has given me the best results. I thus believe it is a drug not to be neglected.”

Cannabis has a long history of medical usage in France. Photo: AFP

Physician Jacques-Joseph Moreau de Tours, organiser of the infamous Club des Hachichins in Paris during the 1840s, likewise heralded dawamesk as a homeopathic wonder drug for treating mental illness. Moreau believed insanity was caused by lesions on the brain. And also believed that hashish counteracted the effects.

Moreau reported in his 1845 work, “Du Hachisch et l’aliénation mentale,” that between 1840 and 1843 he cured seven patients suffering mental illness at Hôpital Bicêtre in central Paris with hashish. Moreau wasn’t totally off-base; today cannabis-based medicines are prescribed for depression, anxiety, PTSD and bipolar disorders.

Despite the small sample size, doctors from the U.S., the U.K.Germany and Italy published favorable reviews of Moreau’s work with hashish during the late 1840s and across the 1850s. One praised it as a “discovery of much importance for the civilized world.”

Though physicians in France and abroad touted dawamesk as a miracle cure, they also complained about the inability to standardise doses due to the variation in the potency of different cannabis plants. They also wrote about the challenges posed by the common adulteration of dawamesk, which was exported from North Africa and often laced with other psychoactive plant extracts.

In the early 1830s several physicians and pharmacists in the British Empire attempted to solve these problems by dissolving hashish in alcohol to produce a tincture. By the middle of the decade, French practitioners followed suit. They developed and marketed their own hashish tinctures for French patients. One pharmacist in Paris, Edmond de Courtive, branded his concoction “Hachischine” after the infamous Muslim assassins often associated with hashish in French culture.

The popularity of hashish tincture grew rapidly in France during the late 1840s, peaking in 1848.

That was when pharmacist Joseph-Bernard Gastinel and the aforementioned De Courtive engaged in a legal battle over the patent – then known as the “right to priority” – for tincture manufactured though a particular distillation method.

“L'Affaire Gastinel,” as the press termed it, caused an uproar in French medical circles and occupied the pages of journals and newspapers in Paris for much of that fall.

To defend his patent, Gastinel sent two colleagues to argue his case to the Academy of Medicine in October 1848. One, a physician called Willemin, claimed that not only did Gastinel devise the tincture distillation method in question but that his tincture provided a cure for cholera, also thought to be a disease of the nerves.

Though Willemin was unable to convince the Academy of Gastinel’s right to priority, he did convince doctors in Paris to adopt hashish tincture as a treatment against cholera.

The use of cannabis for recreational purposes in France remains illegal. Photo: AFP

Physicians in Paris didn’t have to wait long to test Willemin’s theory. A cholera epidemic erupted in the city’s outskirts just months later. But when hashish tincture failed to cure the nearly 7,000 Parisians killed by the “blue death,” doctors increasingly lost faith in the wonder drug.

In the following decades hashish tincture fell into disrepute as the medical theories of anti-contagionism that underpinned the drug’s use against the plague and cholera gave way to the germ theory and thus a new understanding of epidemic diseases and their treatment.

During the same period, physicians in French Algeria increasingly pointed to hashish use as a key cause of insanity and criminality among indigenous Muslims, a diagnosis they termed folie haschischique or hashish-induced psychosis. Heralded as a wonder drug only decades before, by the end of 19th century the drug was rebranded as an “Oriental poison.”

These earlier efforts to medicalise hashish in 19th-century France offer doctors, public health officials and policymakers today several important insights as they work to return cannabis-based medications to the French market.

First, they must work to dissociate cannabis intoxicants and medicines from colonial notions of “Oriental” otherness and Muslim violence that ironically underpinned both the rise and fall of hashish as medicine in France during the 19th century. As scholar Dorothy Roberts astutely argued in her 2015 TED talk, “race medicine is bad medicine, poor science and a false interpretation of humanity.”

Doctors and patients also must be measured in their expectations of the benefits of medicalised cannabis and not over-promise and then deliver lacklustre results, as happened with hachichine during the cholera outbreak of 1848-49.

And they must remain mindful that medical knowledge unfolds historically and that staking the new career of cannabis as medicine on contested theories could hitch the drug’s success to the wrong horse, as happened with hashish after the obsolescence of anti-contagionism in the 1860s.

But if France were to engage its colonial past, reform its prohibitionist policies and continue to open up legal room for medical cannabis trials, perhaps it could again become a global leader in this new medical marijuana movement.

David A Guber Jr is a faculty member in the history department at Bard Early College Baltimore, USA, where he has published on the history of alcohol and drugs. This article first appeared on The Conversation.

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OPINION: France’s ‘slow train’ revolution may just be the future for travel

Famous for its high-speed TGV trains, France is now seeing the launch of a new rail revolution - slow trains. John Lichfield looks at the ambitious plan to reconnect some of France's forgotten areas through a rail co-operative and a new philosophy of rail travel.

OPINION: France's 'slow train' revolution may just be the future for travel
The slow trains would better connect rural France. Photo: Eric Cabanis/AFP

France, the home of the Very Fast Train, is about to rediscover the Slow Train.

From the end of this year, a new railway company, actually a cooperative, will offer affordable, long-distance travel between provincial towns and cities. The new trains – Trains à Grande Lenteur (TGL)?– will wander for hours along unused, or under-used, secondary lines.

The first service will be from Bordeaux to Lyon, zig-zagging across the broad waist of France through Libourne, Périgueux, Limoges, Guéret, Montluçon and Roanne. Journey time: seven hours and 30 minutes.

Other itineraries will eventually include: Caen to Toulouse, via Limoges in nine hours and 43 minutes and Le Croisic, in Brittany, to Basel in Switzerland, with 25 intermediate stops  in 11 hours and 13 minutes.

To a railway lover like me such meandering journeys through La France Profonde sound marvellous. Can they possibly be a commercial proposition?

Some of the services, like Bordeaux-Lyon, were abandoned by the state railway company, the SNCF, several years ago. Others will be unbroken train journeys avoiding Paris which have never existed before – not even at the height of French railway boom at the end of the 19th century.

The venture has been made possible by the EU-inspired scrapping of SNCF’s monopoly on French rail passenger services. The Italian rail company Trenitalia is already competing on the high-speed TGV line between Lyon and Paris.

The low-speed trains also grow from an initiative by President Emmanuel Macron and his government to rescue some of France’s under-used, 19th century, local railways – a reversal of the policy adopted in Britain under Dr Richard Beeching from 1963.

The cross-country, slow train idea was formally approved by the rail regulator before Christmas. It has been developed by French public interest company called Railcoop (pronounced Rye-cope), which has already started its own freight service in south west France.

Ticket prices are still being calculated but they are forecast to be similar to the cost of “ride-sharing” on apps like BlaBla Car.

A little research shows that a Caen-Toulouse ticket might therefore be circa €30 for an almost ten-hour journey. SNCF currently demands between €50 and €90 for a seven-and-a-half-hour trip, including crossing Paris by Metro between Gares Saint Lazare and Montparnasse.

Maybe Railcoop is onto something after all.

The company/cooperative has over 11,000 members or “share-holders”, ranging from local authorities, businesses, pressure groups, railwaymen and women to future passengers. The minimum contribution for an individual is  €100.

The plan is to reconnect towns ignored, or poorly served, by the Train à Grande Vitesse (TGV) high speed train revolution in France of the last 40 years. Parts of the Bordeaux-Lyon route are already covered by local passenger trains; other parts are now freight only.

In the longer term, Railcoop foresees long-distance night trains; local trains on abandoned routes; and more freight trains.  It promises “new technological” solutions, such as “clean” hydrogen-powered trains.

MAP France’s planned new night trains

For the time being it plans to lease and rebuild eight three carriage, diesel trains which have been made redundant in the Auvergne-Rhône-Alpes region.

There will be no space for a buffet or restaurant car. Restaurants and shops along the route will be invited to prepare local specialities which will be sold during station stops and eaten on board.

What a wonderful idea: French provincial meals on wheels; traiteurs on trains.

Olivia Wolanin of Railcoop told me: “We want to be part of the transition to a greener future, which is inevitably going to mean more train travel.

“We also want to offer journeys at a reasonable price to people who live in or want to visit parts of France where train services have all but vanished. We see ourselves as a service for people who have no cars – but also for people who DO have cars.”

Full disclosure. I am a fan of railways. I spent much of my childhood at Crewe station in Cheshire closely observing trains.

Three years ago I wrote a column for The Local on the dilemma facing SNCF and the French government on the 9,000 kilometres of underused and under-maintained local railway lines in France. Something like half had been reduced to low speeds because the track was so unreliable. Several dozen lines had been “suspended” but not yet officially axed.

The government commissioned senior civil servant, and rail-lover, François Philizot to study the problem. After many delays, he reported that much of the French rail network was in a state of “collapse”. Far from turning out to be a French Beeching, he recommended that a few lines might have to close but most could and should be saved – either by national government or by regional governments.

Since then the Emmanuel Macron-Jean Castex government has promised a big new chunk of spending on “small lines” as part of its €100 billion three year Covid-recovery plan. Even more spending is needed but, for the first time since the TGV revolution began in 1981, big sums are to be spent on old lines in France as well as new ones.

The Railcoop cross-country network, to be completed by 2024-5, will run (at an average of 90 kph) partly on those tracks. Can it succeed where a similar German scheme  failed?

François Philizot suggested in a recent interview with Le Monde that a revival of slow trains might work – so long as we accept that a greener future will also be a less frenetic future.

“When you’re not shooting across the country like an arrow at 300 kph, you can see much more and you can think for much longer,” Philizot said.

Amen to that.