[Psychedelics in the field of chronic pain. A path to explore?] / Psychédéliques dans le domaine de la douleur chronique. Une piste à explorer?

Psychedelics are emerging as a therapeutic innovation in psychiatry and their use in chronic pain is worth exploring. In fact, they can modulate the serotonergic system, affecting central pain sensitization mechanisms. Ketamine, used for chronic analgesia, can lead to pain reduction, but additional studies are needed to assess its longterm effectiveness. "Classic" psychedelics are recently attracting renewed interest for their potential effects on chronic pain. Despite limited studies, evidence suggests analgesic benefits, an effect on inflammation, and potential impacts on certain functional disorders. These results pave the way for further research in this ever-evolving field.

Les psychédéliques émergent comme une innovation thérapeutique en psychiatrie et leur utilisation dans la douleur chronique mérite d'être explorée. En effet, ils peuvent moduler le système sérotoninergique, influençant les mécanismes de sensibilisation centrale à la douleur. La kétamine, utilisée en antalgie chronique, peut aboutir à une réduction de la douleur, mais des études supplémentaires sont nécessaires pour évaluer son efficacité à long terme. Les psychédéliques «classiques¼ suscitent un regain d'intérêt récent pour leurs effets potentiels sur la douleur chronique. Malgré des études limitées, des indices suggèrent des bénéfices analgésiques, une influence sur l'inflammation et des impacts potentiels sur certains troubles fonctionnels. Ces résultats ouvrent la voie à de nouvelles recherches dans ce domaine en constante évolution.

[Ethics in the practice of psychedelic-assisted psychotherapy]. / Déontologie de la pratique de la psychothérapie assistée par psychédéliques.

This article proposes 10 points considered essential on the ethics associated with the practice of psychotherapy assisted by psychedelics (PAP) : 1) respect of the legal framework (LStup) of the use of psychotropic drugs ; 2) adequately manage psychedelics (storage, production and safety) ; 3) announce adverse effects to the competent authority ; 4) guarantee a psychotherapeutic follow-up ; 5) guarantee the safety of the patients during the treatment ; 6) establish indications on the basis of scientific evidence ; 7) do not confuse personal recreational use and strict medical use ; 8) avoid proselytizing or bad medical practices ; 9) do not to consider the personal consumption of psychedelics as a competency in care and 10) ensure that access to care is equitable and reasonable.

Cet article propose 10 points jugés essentiels au sujet de la déontologie associée à la pratique de la psychothérapie assistée par psychédéliques (PAP) : 1) Respecter le cadre légal (LStup) de l'utilisation des psychotropes ; 2) gérer les psychédéliques de manière adéquate (stockage, production et sécurité) ; 3) annoncer les effets indésirables à la pharmacovigilance ; 4) garantir un suivi psychothérapeutique ; 5) garantir la sécurité des patients lors du traitement ; 6) poser les indications sur la base des évidences scientifiques ; 7) ne pas confondre l'usage récréatif personnel et un usage médical strict ; 8) éviter le prosélytisme ou les mauvaises pratiques médicales ; 9) ne pas considérer la consommation personnelle de psychédéliques comme faisant office de compétence en matière de soins et 10) veiller à rendre l'accès aux soins équitables et raisonnables.

Psilocybin-assisted therapy for depression: A systematic review and dose-response meta-analysis of human studies.

Psilocybin is increasingly studied for its antidepressant effect, but its optimal dosage for depression remains unclear. We conducted a systematic review and a dose-response meta-analysis to find the optimal dosage of psilocybin to reduce depression scores. Following our protocol (CRD 42022220190) multiple electronic databases were searched from their inception until February 2023, to identify double-blind randomized placebo-controlled (RCTs) fixed-dose trials evaluating the use of psilocybin for adult patients with primary or secondary depression. A one-stage dose-response meta-analysis with restricted cubic splines was used. Cochrane risk of bias was used to assess risk of bias. Our analysis included seven studies with a total of 489 participants. Among these, four studies focused on primary depression (N = 366), including one study with patients suffering from treatment-resistant depression. The remaining three studies examined secondary depression (N = 123). The determined 95% effective doses per day (ED95) were 8.92, 24.68, and 36.08 mg/70 kg for patients with secondary depression, primary depression, and both subgroups, respectively. We observed significant dose-response associations for all curves, each plateauing at different levels, except for the bell-shaped curve observed in the case of secondary depression. Additionally, we found significant dose-response associations for various side effects, including physical discomfort, blood pressure increase, nausea/vomiting, headache/migraine, and the risk of prolonged psychosis. In conclusion, we discovered specific ED95 values for different populations, indicating higher ED95 values for treatment-resistant depression, primary depression, and secondary depression groups. Further RCTs are necessary for each population to determine the optimal dosage, allowing for maximum efficacy while minimizing side effects.

Cannabis Consumers' View of Regulated Access to Recreational Cannabis: A Multisite Survey in Switzerland.

INTRODUCTION: There is considerable effort in legalizing recreational use of cannabis globally. The successful implementation of a program of regulated access to recreational cannabis (PRAC) depends on the consumers' engagement. The aim of this study was to examine the acceptability of twelve different regulatory aspects by cannabis users including those obtaining cannabis from the illicit market and vulnerable populations such as young adults and problematic users. METHODS: The current study is a multisite online survey conducted in Switzerland. A total of 3,132 adult Swiss residents who consumed cannabis within the previous 30 days represented the studied population. Mean age was 30.5 years, 80.5% were men, and 64.2% of the participants stated that they always or often obtain cannabis from the illicit market. We described consumers' acceptability of twelve regulatory aspects concerning THC content control, disclosure of sensitive personal data, security aspects, and follow-up procedures by applying descriptive statistics and multiple regression models. RESULTS: THC content regulation showed most discrepancy with 89.4% of the participants stating to engage in a PRAC if five different THC contents were available as compared to 54% if only 12% THC was available. The least accepted regulatory aspect was disposal of contact details with an acceptability rate of 18.1%. Consumers mainly obtaining cannabis from the illicit market, young adults, and problematic users showed similar acceptability patterns. Participants obtaining cannabis from the illicit market were more likely to engage in a PRAC if five different THC contents were available as compared to participants obtaining cannabis from other sources (OR 1.94, 95% CI: 1.53-2.46). CONCLUSION: A carefully designed PRAC that takes into account the consumers' perspective is likely to transfer them to the regulated market and to engage vulnerable populations. We cannot recommend the distribution of cannabis with only 12% THC content as this is unlikely to engage the target population.

[Artificial intelligence and psychiatry: questions from psychiatrists to ChatGPT]. / Intelligence artificielle et psychiatrie : questions de psychiatres à ChatGPT.

Psychiatrists and psychotherapists specialising in the fields of addiction, personality disorders, ADHD and suicidal crisis, we questioned the ChatGPT artificial intelligence program in order to form an opinion on the quality of its answers to questions on these subjects. Our aim is to satisfy our curiosity about these emerging tools. On the other hand, we want to assess the relevance of the answers in order to know whether relatives and patients can use them safely. In this article, we comment on the question-and-answer dialogue with the artificial intelligence program in the light of the literature.

Psychiatres et psychothérapeutes spécialisés dans les domaines de l'addiction, les troubles de la personnalité, le TDAH et la crise suicidaire, nous avons questionné le programme d'intelligence artificielle ChatGPT dans le but de nous faire une opinion sur la qualité de ses réponses à des questions sur ces sujets. Notre objectif est, d'une part, de satisfaire notre curiosité face à ces outils émergents. Nous voulons également évaluer la pertinence des réponses pour savoir si proches et patients peuvent les utiliser en sécurité. Dans cet article, nous commentons le dialogue de questions-réponses avec le programme d'intelligence artificielle à la lumière de la littérature spécialisée.

[Addiction: what's new in 2022]. / Addictions : ce qui a changé en 2022.

Addictions appear everywhere, mutate, transform with new products and behaviors, playing on our painstaking efforts to try to control them. Drawn into this current, the impression that dominates invites more to understand and to coax rather than to fight. Addictions are our condition, let's deal with it, rather than fight against them. It is therefore a question of knowing the products, that everyone can identify their level of risk, and of giving as many tools as possible, at any age, whatever the behavior or the product. This article shows us that there is a lot to do, from school benches to liver transplantation. There is also a lot to discover, in the recognition of the therapeutic virtues, of cannabinoids for example or even in their prescription, of pharmaceutical heroin for example, sometimes by far the best option.

Les addictions émergent de partout, mutent, se transforment avec des nouveaux produits et comportements, se jouant de nos efforts laborieux pour tenter de les contrôler. Entraînés dans ce courant, l'impression qui domine invite davantage à comprendre et à amadouer plutôt qu'à lutter. Les addictions sont notre condition, faisons avec, plutôt que contre. Il s'agit donc de connaître les produits, que chacun puisse identifier son niveau de risque, et de donner autant d'outils que possible, à tout âge, quel que soit le comportement ou le produit. Cet article nous montre qu'il y a beaucoup à faire, des bancs de l'école à la transplantation hépatique. Il y a aussi beaucoup à découvrir, dans la reconnaissance des vertus thérapeutiques, des cannabinoïdes par exemple, ou encore dans leur prescription, de l'héroïne pharmaceutique, parfois de loin la meilleure option.

Does slow release oral morphine have impact on craving and impulsivity in heroin dependent individuals?

Craving and impulsivity are addiction components which explain why heroin-dependant individuals (HDI), continue using heroin despite not wanting to do so. Opioid maintenance treatment (OMT), such as slow-release oral morphine (SROM), is the most effective treatment for opioid dependence. However, the impact of SROM on craving and impulsivity remains unclear. In this observational study, 23 HDI receiving SROM, their usual OMT, took part in the experiment. Each of the participants filled in the perceived level of craving with a visual analog scale. Their impulsivity was assessed via three laboratory tasks, the stop-signal reaction time, the Balloon Analogue Risk Task and delay discounting. Each evaluation was performed before and after SROM administration. Craving was significantly reduced after administration of SROM (difference 2.83; P = 0.0010), whereas there were no significant differences in performance in the three laboratory tasks. In the long term, we observed an improvement on delay discounting correlated with the duration and dosage of SROM. The acute impact of SROM appears to significantly reduce craving, without impacting impulsivity. Observation of the correlation between delay discounting and the duration and dosage of OMT is of great interest and should be studied further.

A century of research on psychedelics: A scientometric analysis on trends and knowledge maps of hallucinogens, entactogens, entheogens and dissociative drugs.

A scientometric analysis was realized to outline clinical research on psychedelics over the last century. Web of Science Core Collection was searched up to March 18, 2022, for publications on psychedelics. Network analyses and bibliometrics were combined, to identify research themes and trends with Bibliometrix and CiteSpace. The primary aim was to measure research trends evolution over time, and the secondary aims were to identify bibliometric performance and influence networks of publications, authors, institutions, and countries. Sensitivity analyses were conducted for 2016-2022, and 2021 time periods. We included 31,687 documents (591,329 references), which aggregated into a well-structured network with credible clustering. Research productivity was split into an early less productive period mainly focusing on safety issues, and a "psychedelic renaissance" after the 1990s. Major trends were identified for hallucinogens/entheogens, entactogens, novel psychoactive substances (NPS), and on dissociative substances. There was a translational evolution from the bench to the bedside, with phase 2 and 3 trials and/or evidence synthesis in particular. The most recent trends concerned NPS, ketamine-associated brain changes, and ayahuasca-assisted psychotherapy. The USA and Canada were the most productive settings for the research overall, and more recently this geographical distribution became more prominent, reflecting legislative context/policy making. A translational evolution of psychedelics has been occurring, that has brought approval of esketamine for depression and will likely lead to approval of additional psychedelics across mental and physical conditions. Toxicology screening tools for NPS are urgently needed, which in turn might follow the same translational evolution of psychedelics in the future.

[Mobile phone applications for addiction treatment]. / Applications sur smartphone pour le traitement des addictions.

This literature review focuses on mobile phone applications for addiction treatment. Only applications used in combination with a standard treatment were considered. Eleven studies met inclusion criteria. The applications offered information, monitoring, motivational, and relapse prevention tools. Two applications offered more specific psychotherapeutic support. A majority of the studies showed a reduction in consumption following treatment, and this reduction was greater in patients who used an application. The use of smartphone applications in combination with the usual treatment therefore seems to increase the effectiveness of addiction treatment in reducing consumption.

Cette revue de littérature porte sur les applications de traitement des addictions disponibles sur téléphones portables. Seules les applications utilisées en parallèle avec un traitement habituel ont été prises en considération. Onze études ont été retenues. Les applications offraient des aides concernant l'information, le monitorage, des outils motivationnels et de prévention de rechute. Deux applications proposaient une aide psychothérapeutique plus spécifique. Une majorité d'études a mis en évidence une diminution des consommations suite aux traitements plus importante chez les patients qui utilisaient une application. L'emploi d'applications sur smartphone en combinaison avec le traitement habituel représente donc un potentiel gain d'efficacité sur la réduction des consommations.

Electrophysiological and behavioral correlates of cannabis use disorder.

Current research indicates deficits in cognitive function together with widespread changes in brain activity following long-term cannabis use. In particular, cannabis use has been associated with excessive spectral power of the alpha rhythm (8-12 Hz), which is also known to be modulated during attentional states. Recent neuroimaging studies have linked heavy cannabis use with structural and metabolic changes in the brain; however, the functional consequences of these changes are still not fully characterized. This study investigated the electrophysiological and behavioral correlates of cannabis dependence by comparing patients with a cannabis use disorder (CUD; N = 24) with cannabis nonuser controls (N = 24), using resting state electroencephalogram (EEG) source-imaging. In addition to evaluating mean differences between groups, we also explored whether particular EEG patterns were associated with individual cognitive-behavioral measures. First, we replicated historical findings of elevated levels of (relative) alpha rhythm in CUD patients compared with controls and located these abnormalities to mainly prefrontal cortical regions. Importantly, we observed a significant negative correlation between alpha spectral power in several cortical regions and individual attentional performance in the Go/NoGo task. Because such relationship was absent in the nonuser control group, our results suggest that reduced prefrontal cortical activation (indexed by increased relative alpha power) could be partly responsible for the reported cognitive impairments in CUD. Our findings support the use of electroencephalography as a noninvasive and cost-effective tool for biomarker discovery in substance abuse and have the potential of directly informing future intervention strategies.

[Microdosing LSD: practices and risks]. / Microdosage de LSD : pratiques et risques.

The practice of microdosing, which consists of ingesting a hallucinogen at 5-10% of a dose that would induce a psychedelic effect, has recently been the subject of growing interest by the media. The craze for microdosing has been relayed by the supposed effects of increased performance and creativity reported by professionals, especially in Silicon Valley. Despite this strong public interest, the evidence supporting this practice remains preliminary. Available studies are mostly based on single doses, leaving open the question of a possible stronger effect with regular doses. LSD's main effect is on the serotonin system, in particular on 5-HT2A receptors, a receptor involved in neurobiological processes underlying learning.

La pratique du microdosage, qui consiste à ingérer un hallucinogène à 5-10 % d'une dose qui induirait un effet psychédélique, a récemment fait l'objet d'un intérêt croissant par les médias. L'engouement constaté pour le microdosage a été relayé par des effets d'augmentation de performance et de créativité rapportés par les milieux professionnels, notamment de la Silicon Valley. Malgré ce vif intérêt public, les évidences soutenant cette pratique restent préliminaires. Les études disponibles sont pour la plupart basées sur des prises uniques, laissant ouverte la question d'un effet éventuel plus marqué avec la prise de doses régulières. Le LSD exerce ses principaux effets sur le système sérotoninergique, en particulier sur les récepteurs 5-HT2A, impliqués dans des processus neurobiologiques sous-tendant l'apprentissage.

[What's new in addiction medicine]. / Addictions.

The development of research, clinical practice and prevention in addiction medicine is, compared to other disciplines, more influenced by socio-political factors. Research on psychedelics has thus long been hampered by prohibitive policy but has recently been revived thanks to the relaxation of these political positions. The extensive prescription of baclofen for alcohol addiction is mainly the consequence of popular support and has so far not been clearly supported by specific research. The aim of the new Gambling Act was to harmonize the regulatory provisions for lotteries and betting on the one hand and casino gambling on the other, while at the same time opening up the market for online gambling.

Le développement de la recherche, de la pratique clinique et de la prévention en addictologie est davantage influencé par les circonstances sociopolitiques que dans de nombreuses autres disciplines. La recherche sur les psychédéliques a ainsi longtemps été entravée par une politique prohibitive mais a été relancée récemment grâce à l'assouplissement de ces positions politiques. La prescription importante du baclofène pour traiter l'addiction à l'alcool est principalement la conséquence d'un soutien populaire et n'est jusqu'à présent pas clairement appuyée par la recherche spécifique. Le but de la nouvelle loi sur les jeux d'argent était d'harmoniser les dispositifs de régulation concernant les loteries et paris d'une part et les jeux de casinos d'autre part, tout en ouvrant le marché des jeux en ligne.

[Psychotherapy assisted by psychedelics, intense and unusual exposures therapy]. / Psychothérapie assistée par des psychédéliques, un traitement par expositions intenses et inhabituelles.

There is a renewed interest in the use of psychedelics in the treatment of addictions. The mode of action of psychedelics could be explained by the addictolytic effect of the substance or by an amplifying effect a unique experience. If studies are lacking on the intrinsic addictolytic effects of psychedelics in humans, animals and in vitro experiences show an increase in neurogenesis. In humans, the effectiveness could be explained by the intensity of the lived experience. If the purely experiential aspect is the key to the effectiveness of treatment, it strengthens the idea that psychedelics act as reinforcers of the psychotherapeutic experience by exposure to intense and unusual internal stimuli.

Un regain d'intérêt est constaté pour l'usage des psychédéliques dans le traitement des addictions. Le mode d'action des psychédéliques pourrait être expliqué par l'effet addictolytique de la substance ou par un effet amplificateur d'un vécu d'une expérience unique. Si des études manquent sur les effets addictolytiques intrinsèques des psychédéliques, la recherche fondamentale met en évidence une augmentation de la neurogenèse dans le cortex préfrontal. Chez l'homme, l'efficacité pourrait être expliquée par l'intensité de l'expérience vécue. Si l'aspect purement expérientiel est la clé de l'efficacité du traitement, cela renforce l'idée que les psychédéliques agissent comme renforçateurs de l'expérience psychothérapeutique par une exposition à des stimuli internes intenses et inhabituels.

[The coaching, a posture of the caregiver in addictology]. / Le coaching, une posture du soignant en addictologie.

The change process in addictive behaviours can be long and cause caregivers and patients to question their competences. In this context, caregivers are invited to adopt a coaching approach. They can then use this expertise to support a partnership relationship, which encourages the sharing of power while at the same time lightening each other's "load".

[Addictions]. / Addictions.

This article describes a new form of administration of inhaled prescribed heroin currently under investigation. It underlines the particularity of opioid agonist prescription in jail and presents new perspectives in using psilocybin in addiction medicine treatment. A brief literature review about vaping confirms its interest in quitting cigarette, with a cost of addiction to vaping and recent worrisome reports of chemical pneumonia. Finally, the withdrawal of WHO guidelines on opiates use in pain management, in the context of a suspicion of conflict of interest, underlines the sensible balance between over- and under- prescription of opiates in analgesic treatment.

Cet article montre l'intérêt d'une nouvelle forme d'administration inhalée d'héroïne pharmaceutique actuellement à l'étude. Il sensibilise aux conditions particulières de la prescription d'agonistes opioïdes en milieu carcéral et ressuscite des souvenirs des seventies en reprenant l'exploration scientifique des vertus thérapeutiques de la psilocybine. Même si le vapotage semble être un bon moyen de lâcher la cigarette, les anciens fumeurs ont tendance à s'y accrocher et un risque de pneumonie chimique parfois mortelle vient d'être mis en évidence. Finalement, le retrait de l'OMS de deux directives relatives à l'usage d'opioïdes dans le traitement de la douleur, sur fond de suspicion de conflit d'intérêts, montre l'équilibre délicat entre sur- et sous-prescription des antalgiques opioïdes.

[The community as a place of intervention in the treatment of addictions]. / La communauté comme lieu d'intervention dans le traitement des addictions.

Mobility and shifting of treatment sites to the community is useful and necessary for some individuals with addictions who are unable to access traditional treatment programs. The article presents different treatment models : Assertive community treatment, Housing First and transition programs. The main effects of the programs presented are a reduction in days of hospitalization and the use of emergency services, as well as an improvement in adherence to outpatient care. These are encouraging results given the significant difficulties of a population which often presents the phenomenon of «â€…revolving doors ¼ with very high rates of readmissions and lack of treatment continuity.

La mobilité et le déplacement des lieux du traitement vers la communauté sont utiles et nécessaires pour certaines personnes souffrant d'addictions qui n'arrivent pas à adhérer aux programmes de soins traditionnels. L'article présente différentes modalités de soins : les soins dans le milieu (assertive community treatment), le Housing First et des programmes de transition. Les effets principaux des programmes présentés sont une réduction des jours d'hospitalisation et de l'utilisation des services d'urgences, ainsi qu'une amélioration de l'adhérence aux soins ambulatoires. Ce sont des résultats encourageants vu les difficultés importantes de cette population qui présente souvent le phénomène de «â€…porte-tournante ¼ avec des taux de réhospitalisation très importants et des prises en soins chaotiques.

Disentangling the role of users' preferences and impulsivity traits in problematic Facebook use.

The use of social network sites (SNSs) has grown dramatically. Numerous studies have shown that SNS users may suffer from excessive use, associated with addictive-like symptoms. With a focus on the popular SNS Facebook (FB), our aims in the current study were twofold: First, to explore the heterogeneity of FB usage and determine which kind of FB activity predicts problematic usage; second, to test whether specific impulsivity facets predict problematic use of FB. To this end, a sample of FB users (N = 676) completed an online survey assessing usage preferences (e.g., types of activities performed), symptoms of problematic FB use and impulsivity traits. Results indicated that specific usage preferences (updating one's status, gaming via FB, and using notifications) and impulsive traits (positive and negative urgency, lack of perseverance) are associated to problematic FB use. This study underscores that labels such as FB "addiction" are misleading and that focusing on the actual activities performed on SNSs is crucial when considering dysfunctional usage. Furthermore, this study clarified the role of impulsivity in problematic FB use by building on a theoretically driven model of impulsivity that assumes its multidimensional nature. The current findings have identifiable theoretical and public health implications.

Game Addiction Scale Assessment Through a Nationally Representative Sample of Young Adult Men: Item Response Theory Graded-Response Modeling.

BACKGROUND: The 7-item Game Addiction Scale (GAS) has been validated under standard confirmatory factor analysis and exhibits good psychometric properties. Whether this scale satisfies the necessary conditions for consideration by item response theory (IRT) modeling remains unknown. However, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) recently proposed criteria, in its section 3, to define internet gaming disorder (IGD) to promote research on this possible condition. OBJECTIVE: The objective of our study was to (1) analyze GAS in the context of IRT (graded-response) modeling; (2) investigate differential item functioning (DIF), a feature of IRT modeling, in 2 subsamples; and (3) contribute to the ongoing (IGD) debate related to the validity of the DSM-5 criteria using GAS items as a proxy. METHODS: We assessed 2 large representative samples of Swiss men (3320 French-speaking and 2670 German-speaking) with GAS. RESULTS: All items comprised high discrimination parameters. GAS items such as relapse, conflict, withdrawal, and problems (loss of interests) were endorsed more frequently in more severe IGD stages, whereas items related to tolerance, salience (preoccupation), and mood modification (escape) were endorsed more widely among participants (including in less severe IGD stages). Several DIF effects were found but were classified as negligible. CONCLUSIONS: The results of the analyses partly support the relevance of using IRT to further establish the psychometric properties of the GAS items. This study contributes to testing the validity of the IGD criteria, although cautious generalization of our findings is required with GAS being only a proxy of the IGD criteria.

[Can the cannabis-prohibition be supported by medical evidence ?] / La prohibition du cannabis se justifie-t-elle médicalement ?

Currently, important issues around laws on regulation of cannabis use lead to reflect on the prohibition, which is still in force in most countries. The present article attempts to demonstrate by explaining the concepts of the principle of harm, legal paternalism and the precautionary principle that prohibition of cannabis cannot be justified medically. One of the main elements highlighted is that the prohibition does not allow to avoid the consumption and the damages due to cannabis use and that these principles (people should restrain from using cannabis) cannot be applied.

Actuellement, des enjeux importants autour de la modification des lois sur la réglementation du cannabis amènent à reprendre la réflexion autour de la prohibition de ce produit encore en vigueur dans la majorité des pays du globe. Cet article tente de démontrer, en explicitant et en se basant sur les concepts de principe du tort, du paternalisme juridique et du principe de précaution, que la prohibition du cannabis ne se justifie pas médicalement. Un des éléments principaux mis en évidence actuellement est que la prohibition ne permet pas d'éviter la consommation et les dommages dus au cannabis et que de ce fait, ces principes (qui voudraient que l'on s'abstienne de consommer) n'ont pas lieu d'être.