The French are the EU's biggest pot smokers but public and political opinion is divided over what to do about this. Patrick Middleton reports.

A few months ago we talked to an exchange student from a US West Coast college who told us "I smelt it as I walked through the front door of the dorm." To start with, at least, Doug was not aware of the contradictions surrounding the role of cannabis in French society. Statistics are somewhat approximate, inevitably, but it's widely assumed that there are some 4 million fumeurs de H across the country with around half a million lighting up every day. Unsurprisingly, the biggest consumers are in the younger age groups. They are scarcely deterred by the law. Paradoxically, the Code Pénal spells out some of Europe's harshest penalties for the possession and use of cannabis – one year prison and a fine of €3750 for those convicted. In reality, these penalties are a dead letter and charges are very rarely brought. That's certainly true in this region.

To penalise a pot smoker is futile

As several commentators have put it, there has been an effective decriminalisation of cannabis at a personal level. It's important, though, to distinguish between two different processes. What's happened is an unofficial dépénalisation but (and some discussions blur this distinction) that's not the same as legalising the drug and consequently its open sale. The point was well made by Eric de Montgolfier, Nice's former chief prosecutor: "To penalise a pot smoker is as futile as taking to court someone who drinks alcohol. It's a social and medical issue, not one for criminal justice. Legalising production and sale would be a different matter altogether and I say a firm no to that." And yet tolerance is extended to most of those who "grow their own" in gardens or on balconies or even indoors under lamplight. In one recent case a local woman who was selling a significant part of her crop got off with a year suspended and a fine when she explained that she used the money to pay her son's fees at the CIV.

Public opinion, like that of politicians, is clearly divided. A lot of lefties and "liberals" offer the same predictable knee-jerk reactions to the pot issue as they do to gay marriage and anything said or done by the Palestinians. That doesn't mean they're necessarily always wrong but emotion rather than reason governs their reactions. Admittedly, some quite reasonable people have argued in favour of dépénalisation, including cabinet members Vincent Peillon and Cécile Duflot who, apart from anything else, like de Montgolfier, are aware of the futility (and high cost) of trying to discourage the use of cannabis by law. On the right, of course, there are parallel knee-jerk reactions. At the very mention of a relaxation of the formal sanctions, however ineffective they are, Jean-François Copé bares his teeth and launches into a rant about the perils of permissivity. What pollsters find is that 70% of the French population claim not to favour dépénalisation. The reality is that for a significant part of the population – as for 30 million Americans – pot is just part of life.

In adolescents ... serious and irreversible effects

So what do medical specialists have to say? To find out I talked to Dr Christian Carrère at the addictology unit at the l'Archet 2 Hospital in Nice: "The situation you've described is very worrying, especially as cannabis use is increasing. Above all, and this is what I want to emphasise, the effects of the drug are particularly damaging in the case of adolescents with some starting to use at age 11 or 12 or even earlier. In those years the brain is still developing and cannabis can have serious and irreversible effects on such functions as memory and concentration. Prolonged use can lead to a generalised social demotivation – "turn on, tune in and drop out" can be literally true – as well as inducing such cognitive dysfunctions as hallucinations and even triggering latent disorders such as schizophrenia. Cannabis can also be linked to physical disease, notably cancer. That's especially true where there's multiple substance abuse – of alcohol, tobacco and cannabis together."

Dr Carrère stresses that "cannabis" is a catchall word that needs to be glossed with care. “For one thing, much of what's consumed today is much more potent than the product used by the pioneer smokers back in the sixties. Now there's a wide range of ‘brands’ available. The most dangerous is what in French we call ‘shit’ – that's cannabis cut with all sorts of other ingredients from tire rubber to shoe polish. This produces a particularly noxious form of tar which can easily induce cancer. On the positive side, I'd mention the form of the drug used for medical purposes, not simply identical with its recreational variety, which is widely recognised as effective in pain control and without the disadvantages of morphine."

A couple of days after I spoke with Dr Carrère, the Ministry of Health announced that it was considering licensing Sativex, a cannabis-based product administered by nasal spray (and already available in the UK) for use in relieving pain and discomfort suffered by multiple sclerosis patients.

Treatment ... it's not easy

What sort of patients does the unit treat? “We deal with all forms of addiction, including alcohol and nicotine dependence as well as narcotics. With cannabis, it's very often worried parents who bring in their adolescent children whom they've discovered to be users. As I've explained, they've got reason to be worried. I've seen promising academic careers destroyed by cannabis and, remember, the effects can be irreversible. There are, though, some encouraging things I can say to parents. Most young users give up the drug in their early twenties, hopefully having avoided serious damage, though the risk is always there. I'd also stress that medical experience shows that it's not the case that cannabis users inevitably move on to ‘hard’ drugs, such as heroine. That's quite rare."

What sort of treatment is offered? "It's not easy. One problem is that there's no substitute product to offer during the period of withdrawal, as we have with nicotine and heroine. Patients are hospitalised for 14 days with no access to cannabis. They may be given medication to relieve the anxiety they often feel at this time. Then they get intensive personalised counselling – I’m both a physician and a psychiatrist. As with all forms of addiction, you get backsliding, that's to be expected, but a significant number emerge free of their dependence."

And Dr Carrère's final thoughts? "Two points. It's absolutely scandalous that persons of influence, politicians and others, seek to minimise the dangers of the drug and I urge any young person who's an habitual user of cannabis or the parents concerned to seek treatment." 

Service d'addictologie, Hôpital l'Archet 2 (Nice) - Tel. 04 92 03 94 61