The French medical cannabis market is now in the very final stage of decision-making before being implemented nationally, as the HAS presented its draft for the pricing and reimbursement strategy earlier this week.

Since the launch of its pilot project in 2021, efforts to expand access beyond the 3000 patients the programme saw at its peak have been a slow and often frustrating battle.

Over the last few months, thanks to a more stable political situation and a willing regulator, that pace has shifted gears and nationalisation is now likely just months away.

Yet, as we race towards the finish line, questions are now being raised by industry stakeholders, clinicians and patient communities over whether the system is being built for patients, or for the institutions that govern them?

During yesterday’s Cannabis Europa Paris 2026, this issue dominated the afternoon’s sessions, with panellists ranging from patients-turned-entrepreneurs, US industry leaders, pharmaceutical scientists and vaping specialists all weighing in to provide a forensic analysis.

A good start that was never designed to last

The pilot programme was always considered a precursor to the national framework, but was only ever designed as a proof of concept set to last two years. Over multiple extensions, issues with available products and formats began to surface, and the permanent framework has largely carried these over.

A primary concern was the severely limited product range, primarily oils, which fell short of what a mature market requires. Patients need both slow-release and fast-acting formats, and the absence of the latter is not a minor inconvenience. For conditions requiring rapid onset, like acute cancer pain, PTSD, and severe spasticity, waiting 40 minutes for an oil to take effect is clinically unacceptable.

There is no universally superior format, the panel argued. Each delivers a different pharmacokinetic profile suited to different conditions. For instance, sublingual tablets for chronic pain and neurological conditions, inhalation extracts for acute needs, suppositories for IBD. Clinicians need half-life data, Tmax and Cmax profiles for each format to prescribe appropriately.

Later in the day, Helene Klein, who represented a main pilot programme stakeholder throughout the experimentation, offered a revealing assessment of the delays. The officials responsible were not from the pharmaceutical world and were learning as they went.

Their core ambition, she recalled from a private conversation with a DGS official, was to generate data and become the first country to build a proper evidence base for a reimbursed medical cannabis market. This ambition ultimately shaped the entire market, but also led to the multi-year delays.

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Flower’s omission remains controversial

As we’ve reported recently, France’s omission of traditional flower products from its market will likely help clear hurdles from a regulatory perspective, but there is a good reason the format dominates almost every medical market in which it’s available.

One panel argued flower served a necessary transitional purpose where inhalation extracts are unavailable, but should not be the long-term solution, only 20-30% of flower is active substance, the remainder carrying respiratory unknowns that are unacceptable in a pharmaceutical-grade product.

Inhalation extracts change the calculus. They offer flower’s rapid onset without its risks, but counterintuitively a vape cartridge at 85% THC delivers less THC to the bloodstream than an oil at 2.5%.

VAPESafer Chairman Arnaud Dumas de Rauly stressed that devices and oils must be registered and tested as a combined system, as testing components in isolation tells you nothing about what the patient actually inhales.

The commercial reality remains that France does not yet have these extracts available. As Cantourage CEO Philip Schetter argued, without both inhalation extracts and telemedicine, France risks leaving a significant portion of its potential patient population outside the regulated system. Markets that fail to offer the formats patients demand do not eliminate demand but simply push it underground.

The education deficit

Physician training was identified as the most urgent unresolved issue. France’s RECAN registry gathered useful data in the pilot’s first two years then fell away during the transition period, meaning that despite running three years longer than intended, the evidence base is now thinner than it should be.

Panellists agreed that training needs to be integrated into existing clinical pathways and extended beyond just doctors to nurses, pharmacists, and medical students.

Dr David Tang went further, arguing the entire system needs educating. In the UK, police were treating patients with legal prescriptions as criminals at roadside stops until recently, simply because they had never been briefed on the regulatory change.