Keywords: cannabis, therapeutic, consumption, adults, interpretative phenomenological analysis, qualitative methods

Levels of cannabis use are high during adolescence, but the proportion of cannabis users among adults is also progressing, often for medical reasons. This study describes the reasons and motivations for using medical cannabis among adults over 30 years old in France. This qualitative study was performed using an interpretative phenomenological analysis. People with a history of cannabis use or current cannabis users were recruited from the TEMPO cohort. Homogeneous purposive sampling was applied among those using medical cannabis. Twelve participants, among 36 who reported using cannabis for medical reasons, were selected and interviewed. Five superordinate themes were identified in the analysis: 1-Soothing a traumatic experience through cannabis use; 2-An ambivalent relationship with the user and cannabis and with the user and close relatives; 3-Cannabis, a known soft drug comparable to alcohol or tobacco, leading to an illogical demonization; 4-Recreational use in the context of experimentation; and 5-A paradoxical desire for exemplary parenting. In this first recent study to describe the reasons and views adults have to continue using cannabis after 30 years of age, we identified ways to explain this consumption. The internal appeasement provoked by cannabis stems from a struggle to appease a violent external situation.

Introduction

As in other countries, cannabis is the most experienced and used illicit drug among the French population [START_REF]Observatoire européen des drogues et des toxicomanies (OEDT)[END_REF]. In 2021, 47.3% of 18-64 year-olds had already experimented with cannabis (32.9% in 2010), with 10.6% continuing to use it in the following year (8.0% in 2010), in a ratio of 1 woman for every 2 men [START_REF] Nézet | Les usages de cannabis en population adulte en 2021[END_REF]. Problematic use can be deduced from the overall number of patients admitted to treatment for the first time for cannabis-related problems, which increased by 76% between 2006 and 2017 in Europe [START_REF]Observatoire européen des drogues et des toxicomanies (OEDT)[END_REF]. Nevertheless, while France has one of the most repressive illegal drug legislations in Europe, it is also the European countries with the highest levels of cannabis use (44.8% of lifetime users aged 15-64 vs. 37.5% in Spain or 22.6% in Belgium, even 6.1% in Hungary; 21.8% of past-year users aged 15-34 vs. [START_REF]Comment prendre en compte la situation sociale des patients en médecine Générale ?[END_REF].1% in Spain or 13.6% in Belgium, even 3.4% in Hungary) [START_REF]Observatoire européen des drogues et des toxicomanies (OEDT)[END_REF]. Different legislation in European countries could lead to different cannabis use [START_REF] Barata | Non-medical cannabis use: international policies and outcomes overview. An outline for Portugal[END_REF]. A recent study showed that older adults experienced recreational cannabis for medicinal purposes following legalization [START_REF] Baumbusch | Older adults experiences of using recreational cannabis for medicinal purposes following legalization[END_REF].

However, there was no evidence that reasons to use cannabis for medicinal purposes changed according to cannabis legislation.

If the levels of cannabis use are high during adolescence, the proportion of cannabis users among adults is progressing even more, reflecting both the aging of the generations that experimented this product during a period of high popularity, alongside a decreasing rate of cannabis initiation among younger generations [START_REF]Drogues et des Toxicomanies (OFDT). Drogues et addictions, données essentielles [Drugs and addictions[END_REF]. In France, daily use is increasing among older generations: from 1.4% in 2014 to 2.0% in 2017 for 35-44 year-olds and from 0.6% to 1.2% for 45-54 year-olds [START_REF] Spilka | Les niveaux d'usage des drogues illicites en France en 2017 [Levels of illicit drug use in France in 2017[END_REF]. Over the past 30 years, observation of cannabis use in the adult population has revealed a trend: an aging of users with experimenters mostly aged over 30 and "use during the year" increasingly linked to people in their thirties and forties. This trend clearly suggests that some of the first generations of users did not give up their cannabis use as they got older. This increase in use throughout the French population therefore significantly alters the demographic distribution of cannabis consumers [START_REF] Nézet | Premiers résultats du Baromètre santé de Santé Publique France 2020 relatifs à l'usage de cannabis en population générale [Cannabis use levels in France in 2020. First results of the Santé publique France 2020 health barometer on cannabis use in the general population[END_REF].

Otherwise, the high risk of "problematic" use peaks at 28% for users aged between 26 and 44 years old [START_REF] Spilka | Les niveaux d'usage des drogues illicites en France en 2017 [Levels of illicit drug use in France in 2017[END_REF]. However, this level varies depending on age: between 45 and 64, more than one out of five users also have an increased risk of problematic use [START_REF] Spilka | Les niveaux d'usage des drogues illicites en France en 2017 [Levels of illicit drug use in France in 2017[END_REF]. Thus, among people seeking help from healthcare centers, the percentage of cannabis users over the age of 40 increased from 5.4% in 2007 to 9.6% in 2017 [START_REF]Observatoire Français des Drogues et des Toxicomanies (OFDT). RECAP[END_REF][START_REF]Observatoire Français des Drogues et des Toxicomanies (OFDT). RECAP[END_REF].

The reasons for cannabis use among adults are unclear. In particular, during adulthood, cannabis may be used by people with emotional and/or psychological difficulties, in addition to, or instead of, psychotropic drugs. Indeed, 52% of people aged 50 and over use cannabis for medical purposes and 18% recreationally, compared to 18% and 50%, respectively, among 18-29 year-olds [START_REF] Sexton | A survey of cannabis acute effects and withdrawal symptoms: differential responses across user types and age[END_REF]. Other studies show that the main reason for using medical cannabis is pain (52.5% of people) with a higher percentage among those aged 45 and over (60.9%) compared to those aged 25-44 (45.4%) [START_REF] Rotermann | Prevalence and correlates of non-medical only compared to self-defined medical and non-medical cannabis use, Canada[END_REF]. Other medical reasons for using cannabis include anxiety, nervousness and depression for 18.8% of the subjects and insomnia for 18.3% [START_REF]Observatoire Français des Drogues et des Toxicomanies (OFDT). RECAP[END_REF].

A recent qualitative study conducted in the US state of Colorado aimed to identify reasons for medical and recreational cannabis use and perceptions of cannabis among people over 60. The study showed that the primary reason of using cannabis was pain management [START_REF] Bobitt | Qualitative analysis of cannabis use among older adults in Colorado[END_REF]. Some used it as an alternative of other treatments, such as opioids [START_REF] Wendelboe | Is there less opioid abuse in states where marijuana has been decriminalized, either for medicinal or recreational use? A Clin-IQ[END_REF].

Between 2014 and 2017, the French Observatory of Drugs and Addictive Tendencies ("Observatoire français des drogues et des tendances addictives", OFDT) conducted a qualitative study called ARAMIS to better understand the motivations of young people to experiment and consume psychoactive substances while retracing their consumption trajectories [START_REF] Obradovic | Motivations et trajectoires d'usage de drogues à l'adolescence [Attitudes, Representations, Motivations and trajectories of drug use in adolescence[END_REF]. Experimentation with cannabis, unlike cigarettes, gave rise to positive impressions and, very often, benefited from the image of being less addictive and less "dangerous" [START_REF] Obradovic | Motivations et trajectoires d'usage de drogues à l'adolescence [Attitudes, Representations, Motivations and trajectories of drug use in adolescence[END_REF]. Nevertheless, the trajectories of cannabis consumption from adolescence to adulthood remain poorly understood and the perceptions and views of this drug among adults have not yet been documented in France. Recreational cannabis has often been perceived more negatively than medical cannabis, with views of cannabis being influenced by the way the substance is consumed [START_REF] Bobitt | Qualitative analysis of cannabis use among older adults in Colorado[END_REF].

Our aim was to determine the reasons and motivations for using medical cannabis among adults over 30 years of age in France.

Materials and Methods

In part of a mixed-methods research study, we carried out a qualitative investigation using an interpretative phenomenological analysis (IPA). This type of analysis was used to offer insight into the individual experience and the participants' views in order to identify a phenomenon common to all [START_REF] Smith | Interpretative phenomenological analysis: theory, method and research[END_REF]. We used COREQ-32 criteria to ensure the validity of our study [START_REF] Coreq | COnsolidated criteria for REporting Qualitative research) Checklist[END_REF].

Sampling

The study was based on data from the TEMPO cohort, a cohort of young adults aged 25 to 47 (40 on average in 2020), followed longitudinally since 1991 with successive data collection interviews in 1999, 2009, 2011, 2015, 2018, and 2020-2021, during the COVID-19 pandemic [START_REF] Mary-Krause | Cohort Profile: The Tempo Cohort study[END_REF]. In 2021, the TEMPO cohort included 659 participants.

Among them, 58% used cannabis at least once in their lifetime. Detailed reasons were available for 91% of them.

Homogeneous purposive sampling was applied among participants who reported using cannabis for medical reasons. The definition of medical use of cannabis in the qualitative study was based on participants' answers in the quantitative study: selfmedication to manage stress, anxiety, headaches or migraines, chronic pain, depression, muscle spasms, nausea, loss of appetite, muscle stiffness, epileptic seizures, tremors, or to prevent vomiting. We sought to ensure that participant's characteristics were as diverse as possible.

Sample

One third of the 36 participants who used cannabis for medical reasons were interviewed. Between January and May 2022, we carried out 12 in-depth, individual interviews in French, each lasting around two hours.

During these interviews, we collected information concerning their social-emotional life, professional life, housing, and access to healthcare [START_REF]Comment prendre en compte la situation sociale des patients en médecine Générale ?[END_REF].

Data collection

After written consent was given by the participants, comprehensive, in-depth, individual video interviews were recorded, anonymized and transcribed. These interviews were conducted freely following the annotations of an interview guide drafted by researchers with clinical and cannabis-related expertise (see Appendix A).

It included questions about participants' cannabis consumption, e.g. quantity and frequency, motivations for consumption, and also questions about how they their consumption impacts their daily life.

All the researchers kept a log book throughout data collection, to record their feelings and preconceptions (supplementary material). The main preconceptions were: adults consuming cannabis to treat physical illnesses if/when they had tried all the treatments available. Specifically, we hypothesized that people who use cannabis over the age of 30 do so mainly for medical reasons.

Data analysis

Three phases of analysis were carried out as part of the IPA method [START_REF] Smith | Interpretative phenomenological analysis: theory, method and research[END_REF]. We first analyzed the interviews one by one, coding the verbatim line by line. We assigned codes to groups of words, sentences or paragraphs. From there, 1500 characteristics emerged. Then, we created specific categories in each interview and we finalized 13 specific categories. Once each transcript had been analyzed, a table of superordinate themes was constructed. We obtained 5 superordinate themes. Triangulation between the researchers was done at each step of the analysis and after each interview, in dedicated sessions. The researchers discussed these codes and reached consensus.

Data sufficiency was sought and obtained with conclusive categories identified from the coded data and new categories emerging from new interviews were similar to the previous ones.

Ethics

The Sorbonne University Ethics Committee approved the qualitative study (n° CER-2021-069). All participants gave their written consent.

Results

Twelve individuals participated in the present study. Participants had a median age of 41.1 years. Seven were women and three had chronic diseases. Participant characteristics are presented in Table 1.

Soothing a traumatic experience through cannabis use

The people interviewed felt uncomfortable and unhappy during their adolescence.

They felt bad about themselves and used cannabis to feel better.

For example, for participant 9 (P9), "There was an awkwardness. Adolescence was a difficult time for me, with a lot of emotional difficulties. And that allowed me to.... To bring down the level, and then put me in a certain state of stability."

Many of the participants were unable to cope with violent, traumatic external events in their lives. They smoked joints to escape their victim status, a status they were aware of. This traumatic event could be their parents' divorce, like for P1 who said: Participants were affected by these events and continued to suffer from them. During their interviews, P2, P4 (who had both experienced breakups and depression) and P8 cried.

"
Thus, cannabis was used by many of the participants to treat depression. For them, life was and is a series of continuous struggles. Cannabis relieved them. Smoking cannabis via joints was done for self-medication and was even considered "better" than the so-called classical treatments. They tried other treatments and didn't want to use them, instead identifying the benefits of cannabis use through their personal experience.

Antidepressant treatment was considered to be more addictive.

An ambivalent relationship with the user and cannabis and with the user and close relatives

When discussing cannabis use, participants explained they knew and understood the risks, but at the same time regretted their consumption and were ashamed of it.

Moreover, they may have felt judged for their use: P1 said that she did not appreciate the way others looked at her: "Because of the people. In fact, I'm the one who's panicking [...] I say to myself, 'Oh, there are people around you. My God, there are people around, they'll see me, they'll understand."

In a similar way, they devalued themselves but also affirmed their strength and their ability to fight their addiction. An addiction that was difficult to fight according to P6:

"In Saint Denis, it's hard to get out of it (cannabis)."

Furthermore, the interviewees both liked and hated cannabis at the same time. They liked the taste and smell but they "didn't advocate cannabis" (P1, P2, P8). They did not want to be cannabis users as said by P2: "I'm not in favor of cannabis. The consumption I had I don't want it". Nevertheless, they had simultaneously negative and positive perceptions of cannabis, as explained by P8: "Because I really like the taste of weed, I love all that. I'm a gourmet."

Cannabis was also a way to socialize. It allowed participants to belong to a group. It was the thread that kept them attached to each other, as expressed by: "Cannabis is a golden thread"

It was both a solution to an unease but also a constraint. They felt appeased but it was in fact a "false" appeasement.

P6: "Cannabis as a smokescreen"

This ambivalence was found in participants relationships with their loved ones: they felt supported and supported others, but also highlighted complicated relationships.

For example, for P6, his wife is his "salvation". She was the one that helped him stop a consumption that was killing him. However, P1's daughter had a critical regard on her mother: "Well, afterwards, it's silly little thoughts of teenage girls that you... but it's just to sting... in fact… she's trying to hurt (laughs)".

Loneliness, unspoken words and misunderstandings were recurrent feelings when speaking about their families.

P5: "In... our family there were, as in any family..

. things left unsaid"

This ambivalence was also found in their relationship with doctors. They could trust their doctor but might also be suspicious of him or her, such as P1: "Of course, he's a doctor... You know what I mean? He's not going to tell me to smoke ".

Cannabis, a known soft drug comparable to alcohol or tobacco, leading to an illogical demonization

All 12 participants displayed knowledge surrounding cannabis. They discussed the forms of consumption, dosage and ways to obtain the drug. They knew the difference between cannabidiol (CBD) and tetrahydrocannabinol (THC).

P8: "I think that if there was for example CBD in vapes or things like that, like they do in other countries, the risk is almost zero."

Some held an activist attitude. They insisted on the awareness they had about the importance of providing education about cannabis.

P8: "I think that legalizing and raising awareness much earlier, you know, in a... in a collective intelligence way. Not in a judgmental way."

Cannabis was seen as a "natural" soft drug, unlike other so-called "chemical" drugs.

One participant even spoke of an "organic" product.

P11: "I mean is it (cannabis) organic... Mainly (laughs) yeah is it organic or has there been chemical input?"

P12: "Cannabis is also natural."

P12: "A drug or coke, you are necessarily addicted to it much faster than a natural product (cannabis) in quotation marks."

Cannabis was also distinguished from tobacco or alcohol. It was even considered sometimes less addictive, and participants preferred it to the negative effects of alcohol or tobacco. This comparison with drinking alcohol and smoking tobacco was omnipresent. They didn't understand why tobacco or alcohol were legal when cannabis was not.

P9: "Alcohol can cause delirium tremens, you can have very, very violent things actually when you stop drinking and when you have a regular consumption/use of cannabis, it doesn't do that at all."

According to them, cannabis was demonized. They did not understand why cannabis was judged so harshly. They considered this demonization illogical, a demonization advocated by their parents, who grew up in the 60s, a period of high drug diffusion.

P6: "Cannabis was something that didn't speak to them very much, even though they were part of the sixties."

Recreational use in the context of experimentation

Most of the participants were seeking fun and enjoyment, a feeling of well-being and pleasure. They enjoyed their experience of consumption. For them, cannabis was a symbol of transgression.

P9: "Initially, it's a... an experience of discovery, a little transgressive research where we are in something where we experiment, let's say."

The interviewees had a common desire to experiment with different drugs, but preferred cannabis.

P5: "I dipped into circles that were a bit ... one thing leading to another with other narcotics that I didn't really get hooked on [...] 'ecstasy, methamphetamine, I tried a little MDMA. But that was purely festive ... In particular situations ... related to either rave parties or private student parties."

While discussing their use, participants distinguished the difference between using cannabis when they were young vs. when they were older. Most of them said that "it was different" now that they were older. They no longer bought it to use recreationally but used it to manage conditions and symptoms, for both physical and mental illness.

Some of the participants, mainly the men, linked their consumption with violence.

Their relationship with cannabis was tainted with violence, previously dealing cannabis in the past. They changed as they became parents, leading to our last theme.

A paradoxical desire for exemplary parenting

Most of the participants had children and wanted to be good parents. They tried to combine their cannabis use with their role as parents. P1 stressed that she was a good mother and didn't smoke around her children.

P1: "I only smoke in the evening. During the day with my children, it's forbidden [...] I'm telling you, I only smoke when my daughters are in bed because it allows me to get high and not have to say to myself, 'Oh, the little ones, what if one gets up?"

This was not only a maternal reaction but also a paternal one. P3 had stopped using cannabis to support his wife: "as soon as I knew my partner was pregnant [...] I wanted to have clear ideas of how to accompany her during her pregnancy and [...] to handle my child."

Participants were responsible parents and their children became their priority.

Parenthood was difficult and they recognized the difficulty of their role.

P9: "Something very strong happens when you become a mother and [...] Everything is put back in its place, I don't know how to say it, but the accessory becomes accessory again and is

no longer in the foreground. On the other hand, the essential is finally recognized as being the essential."

They refused that their children would go on to repeat their mistakes. They wanted to be better at parenting than their parents had been, to be more open but paradoxically resemble their parents whom they admire. The theme of ambivalence was also seen again.

For P6, "Parenthood replaces a lot of drugs."

Discussion

Main findings

To our knowledge, this was the first recent study to describe the reasons and views of adults for continuing their cannabis consumption, as medical cannabis, from age 30years onwards. Earlier studies, most of them in the early 2000s, did not specifically study medical cannabis, but rather the perception of cannabis in all age groups, specifically among adults [START_REF] Dany | L'étude des représentations sociales de la drogue et du cannabis : un enjeu pour la prévention. [The study of social representations of drugs and cannabis: a challenge for prevention[END_REF][START_REF] Govarthnapany | Motives and Perceptions of Cannabis Use among a Sample of Employed Graduates in Malaysia: A Qualitative Study[END_REF]. In our study, in-depth interviews were conducted on the feelings and emotions of the participants, allowing them to describe their personal stories and experiences. All of the reasons found for using "medical" cannabis in adulthood were experienced by most of the participants.

The use of cannabis to sooth traumatic experiences has been previously detailed in the literature. Indeed, a systematic review and meta-analysis showed that sexual and physical abuse during childhood were factors affecting vulnerability to cannabis use in adolescence, whilst also associating with substance use in adulthood [START_REF] Huang | The Long-term Effects of Childhood Maltreatment Experiences on Subsequent Illicit Drug Use and Drug-related Problems in Young Adulthood[END_REF]. As it is impossible to appease certain violent external triggers, cannabis is often used to provoke an internal appeasement, as being a form of resignation beyond a certain resilience.

In these situations, cannabis is used as an antidepressant. Nevertheless, this role of cannabis as an antidepressant is controversial in the literature [START_REF] Feingold | Cannabis and depression[END_REF][START_REF] García-Gutiérrez | Cannabidiol: A Potential New Alternative for the Treatment of Anxiety, Depression, and Psychotic Disorders[END_REF][START_REF] Martin | Antidepressant and Anxiolytic Effects of Medicinal Cannabis Use in an Observational Trial[END_REF]. A recent, randomized trial showed that cannabis improved insomnia but had no effect on anxiety or depression [START_REF] Gilman | Effect of medical Marijuana Card Ownership on pain, insomnia, and affective disorders symptoms in adults, a randomized clinical trial[END_REF]. Cannabis is said to have euphoric and anxiolytic effects, but low symptom and quality of life improvement [START_REF] Spechler | Attenuated reward activations associated with cannabis use in anxious/ depressed individuals[END_REF]. Anxious and depressed people and cannabis users don't have the same level of activation of brain areas [START_REF] Spechler | Attenuated reward activations associated with cannabis use in anxious/ depressed individuals[END_REF] which could explain the lack of effect of cannabis.

Cannabis is also seen as a natural, organic product, a notion found in the ARAMIS qualitative study [START_REF] Obradovic | Motivations et trajectoires d'usage de drogues à l'adolescence [Attitudes, Representations, Motivations and trajectories of drug use in adolescence[END_REF]. However, our interviews did not only reveal a more or less regular consumption of cannabis, but also the concept of addiction, which may or may not have been present among the interviewees. Addiction is a normal reaction to an abnormal situation. This notion of addiction, far from being recent, was defined as "the repetition of acts likely to provoke pleasure but marked by dependence on a material object or a situation sought and consumed with 'greed' " [START_REF] Pedinielli | Psychopathologie des addictions[END_REF]. Furthermore, the notion of psychological trauma is found in "the question of considering the emotional deficiencies that lead the addict to pay with his or her body for the unfulfilled commitments contracted elsewhere" [START_REF] Bergeret | Le psychanalyste à l'écoute du toxicomane[END_REF]. This definition reflects a traumatic reality underpinned by early deficiencies in one's childhood. The idea of a situation originating in childhood is found, as an addicted person is defined as a slave to a single solution to escape mental pain [START_REF] Dougall | L'économie psychique de l'addiction[END_REF]. This element was observed in some participants in our study.

There are works, recommendations and labelled diagnostic and therapeutic tools to help in the detection of unhappiness in general medical practice [START_REF] Binder | Detection of adolescent suicidality in primary care: an international utility study of the bullying-insomnia-tobacco-stress test[END_REF][START_REF]Guidelines on mental health promotive and preventive interventions for adolescents: helping adolescents thrive[END_REF]. It is a way to alleviate addictions and the possible suicidal thoughts or self-harm of the patient, in order to care for teenagers at risk.

Participants' ambivalent relationship with close family and friends could be conceptualized by the Karpman drama triangle [START_REF] Karpman | The definition book on the Drama Triangle and Compassion triangle by the originator and author. The new transactional analysis of intimacy, openness, and happiness[END_REF] which identifies three roles: the rescuer, the persecutor and the victim. A parallel with cannabis users can be drawn for users who could be considered as victims. In this context, cannabis would be both a savior, that makes one feel better and more relieved, and a persecutor, because it created an addiction one fights against. The same drama triangle could be observed in participants' relationships with their loved ones. Parents, brothers or sisters and even friends could act as both rescuers, in the role of supporters, and persecutors, because they may judge participants about their cannabis consumption. They sometimes even assumed the role of the tormentor, and participants' reason for their ill-being (parents' divorce, criticism of their weight, rejection because of their difference). This dramatic triangle helps to explain the situations of inner conflict in which the participants found themselves.

To get out of this triangle, different approaches have been described. The Empowerment Dynamic (TED), published in 2009 [START_REF] Emerald | The Power of TED[END_REF], suggests that the victim may adopt the role of "creator" and consider the persecutor as a "challenger," calling upon a "coach" rather than a rescuer. The "coach" would then help the person to make informed choices. This person could be their wife, like P6 who said his wife was his "salvation", the one who enabled him to get over his addiction. Similarly, P9, a psychologist, stopped her use at the same time she started her psychotherapy sessions.

Her psychotherapist can thus be seen as her "coach."

They deal with their use, their entourage's opinion of their use, but also their role as parents which is very important for them. Thus, we find, in their discourse, the notion of parenthood oriented around several axes including: the experience of parenthood and the feeling of parenthood clearly explained by the interviewees. They put a certain amount of pressure on themselves to be good parents, which is a contemporary injunction [START_REF] Houzel | Un autre regard sur la parentalité. [Another perspective on parenthood[END_REF][START_REF] Martin | Être un bon parent[END_REF].

Limitations and future research

Our study had some limitations. The first is the small number of subjects.

Nevertheless, the size of the sample was sufficient enough for deep analysis and was close to a classic sample in IPA [START_REF] Smith | Interpretative phenomenological analysis: theory, method and research[END_REF]. Second, we interviewed "medical" cannabis users according to a specific definition. The definition of medical cannabis was taken from the literature [START_REF] Houzel | Un autre regard sur la parentalité. [Another perspective on parenthood[END_REF][START_REF] Martin | Être un bon parent[END_REF][START_REF] Haug | Cannabis use patterns and motives: A comparison of younger, middle-aged, and older medical cannabis dispensary patients[END_REF]. But, as the interviews progressed, answers such as "to forget life's problems", "to fit in with a group", "to do what others do", "to fill a void" could be interpreted as medical reasons and not only "recreational" cannabis use. So, the line between medical and recreational cannabis is thin and difficult to formally define.

Nevertheless, the definition used corresponds unambiguously to medical problems.

Only one interviewee, among the 36 "medical" users, consumed cannabis as CBD oil to relieve muscle pain related to multiple sclerosis, instead of smoking joints as all the other participants did. It would be interesting to investigate more participants using CBD alone. It would also be interesting to interview people with a defined "recreational" use of cannabis to compare their reasons with those using cannabis for "medical" reasons. Third, our sample was not completely representative of the general population. Participants were of a high socio-economic level. This is the case for the entire TEMPO cohort. Indeed, populations with a low socio-economic status are generally underrepresented in health studies [START_REF]Interdepartmental action plan 2017-2021 : government health prevention policy[END_REF][START_REF] Rolnitsky | The representation of vulnerable populations in quality improvement studies[END_REF]. Moreover, there were no statistical associations between socio-economic status and cannabis use [START_REF] Shackleton | Socioeconomic Inequalities in Adolescent Substance Use: Evidence From Twenty-Four European Countries[END_REF] and there is no literature indicating that specific reasons for medical cannabis use may be different according to the socio-economic status. Fourth, the interviews were mainly conducted by video call, which may have hindered the relationship between the participant and the interviewer, but the richness of the interviews suggests this was not a significant limitation.

Our study also has several noteworthy strengths. First, we used a logbook to deconstruct the researchers' subjectivity. Secondly, we checked that our study design conformed to 30 out of the 32 criteria of the COREQ checklist for reporting qualitative research [START_REF] Coreq | COnsolidated criteria for REporting Qualitative research) Checklist[END_REF]. The two not-validated criteria concerned the feedback to participants on the transcripts and the use of video calls. The feedback to participants could not be done for ethical reasons. We felt that it would be difficult to show participants that their traumatic experiences could have an influence on their use of cannabis. Because of the COVID-19 pandemic, the interviews were mainly conducted via video call, which could be thought to have hindered the relationship between the informants and the interviewer, but the interviews were in-depth enough for analysis. Moreover, a recent article showed that online focus groups could be a good opportunity for studying addictive online behaviors [START_REF] Flayelle | The advantages and downsides of online focus groups for conducting research on addictive online behaviours[END_REF]. It might be the same for individual online interviews. Thirdly, the duration of the interviews made it possible to extract very rich information, allowing for better understanding the reasons for the medical use of cannabis by adults. Moreover, the comprehensive interviews helped to limit the desirability bias. Fourthly, our population had a high level of education that allows them to have a high level of literacy and to take a step back from what medical cannabis is [START_REF] Park | Literacy Gaps by Educational Attainment: A Cross-National Analysis[END_REF].

Conclusions

Amongst participants, there were various reasons for the continued use of cannabis into adulthood, with the need for internal appeasement from cannabis stemming from difficulties in processing previous violent, external events. Knowledge of the reasons for the consumption of cannabis in adulthood allows us to better target prevention campaigns. Moreover, it seems important to raise awareness among caregivers, so that they may know how to recognize the suffering of adolescents to prevent subsequent psychoactive substance use.

Table 1 .

 1 Characteristics of the study participants.

	Participants	Sex	Age Diploma	Socio-	Marital	Employment	Place of	Residential
				professional	status	status	residence	area
				category
	1	Female	General	Jewelry sales	Married Unemployed	House	Urban
			Certificate	advisor
			of
			Secondary
			Education
	2	Female	Bachelor's	Employee in a	Married Unemployed	Family	Urban
			Degree	social support			house
				service
	3	Male	Master's	Employee in a	Married	Active	Apartment	Urban
			Degree	digital agency
	4	Female	Master's	Executive in	Single	Active	Apartment	Urban
			Degree	the
				pharmaceutical
				industry
	5	Male	Master's	Information	Married	Off work	Apartment	Urban
			Degree	systems
				consultant
	6	Male	Bachelor's	Railway	Married	Active	House	Urban
			Degree	worker -runs a
				maintenance
				workshop
	7	Female	Bachelor's	Nurse	Married	Active	House	Urban
			Degree
	8	Female	Bachelor's	Executive in a	Married	Active	Apartment	Urban
			Degree	technical
				cooperation
				agency
	9	Female	Master's	Psychologist	Married	Active	Apartment	Rural
			Degree
	10	Male	Master's	Computer	Married	Active	House	Urban
			Degree	scientist
	11	Male	Bachelor's	IT Consultant Married	Active	House	Rural
			Degree
	12	Female	Bachelor's	Bank executive Married	Active	House	Urban
			Degree

We identified 13 categories from which five superordinate themes emerged (Table

2

): Soothing a traumatic experience through cannabis use; An ambivalent relationship with the user and cannabis and with the user and close relatives; Cannabis, a known soft drug comparable to alcohol or tobacco, leading to an illogical demonization;

Table 2 .

 2 Superordinate themes and categories.

	Superordinate themes	Categories
		Unhappiness during adolescence
	Soothing a traumatic experience through cannabis use	Traumatic events
		Cannabis as an antidepressant
	An ambivalent relationship with the user and cannabis and with the user and close relatives	An ambivalent relationship with cannabis A "false" appeasement? An ambivalent relationship with closest relatives
	Cannabis, a known soft drug comparable to alcohol or tobacco, leading to an illogical demonization	Being knowledgeable Cannabis, a soft drug A demonization deemed illogical
	Recreational use in the context of experimentation	Recreational use Experimenting with other drugs
	A paradoxical desire for exemplary parenting	Being good parents An essential role, difficult to assume

  P8: "But on the other hand, I prefer that to taking antidepressants [...] Clearly. My therapist told me, frankly, in your case... It's not worth going into depression... And it's not worth taking antidepressants either. So, if you have something (cannabis) that makes you feel good at the time, it allows you to come down, breathe and relativize..."

This research was supported by the French Institute for Public Health Research (IReSP) and Aviesan Alliance within the call for research projects to fight against psychoactive substance addictions, project number IRESP-19-ADDICTIONS-13. The TEMPO cohort is supported by the French National Research Agency (ANR), the French Institute for Public Health Research-IReSP (TGIR Cohortes), the French Inter-departmental Mission for the Fight against Drugs and Drug Addiction (MILDeCA), the French Cancer Institute (INCa) and the Pfizer Foundation.


Prof. dr. Hab Anna Geppert

Keynote speach for the Conference Putting the Territorial Agenda 2030 into practice Local and regional pilot activities and their supporting framework conditions 6 May 2021 -German Association for Housing, Urban & Spatial Development Spatial planning in the implementation of the Territorial Agenda of the European Union 2030

Over the last 20 years, spatial planning has been progressively overshadowed by the EU's economic and environmental objectives: climate change, energy transition, digital economy. The EU's Territorial Agenda 2030 is a further illustration of this. However, it is the national and local actors who, in the concrete choices they make, develop their territory. The pandemic should make us think. It is time to question the paradigm of happy globalisation, to invest in our cities, our countryside and our regions away from the big cities.

From this point of view, the proposals of the Latvian Presidency (Riga Declaration on small and medium-sized towns, 2015) and the Portuguese Presidency (for the development of rural areas, 2021) are welcome. Let's get back to spatial planning!

Spatial planning; European spatial planning; Territorial Agenda of the European Union; European Spatial Development Perspective; climate change; energy transition; digital economy; small and medium-sized towns; development of rural territories. * I would like to express my sincere thanks to the organisers of this conference for inviting me to reflect on the relationship between the Territorial Agenda of the European Union, which is already in its second revision, and its raison d'être: European spatial planning, or at least spatial planning in Europe.

I am particularly grateful to Dr. Jonas Scholtze, who addressed three very pertinent questions to me concerning the Territorial Agenda 2030 and its implementation in relation to spatial planning: I will follow their order.

The present speech, reworked, will be the subject of a later scientific publication.

1-Will the EU Territorial Agenda 2030 strengthen spatial planning in Europe?

To answer this question, I will start with a brief historical review -not for the sake of history, but because it helps to understand the present situation. Originally, the European Economic Community was building a common market and had no competence in spatial planning. However, from 1975 onwards, the European Economic Community set up a regional policy in order to support the regions that were suffering from the very liberal economic model that it established -in other words, the least wealthy, least developed regions. Is this spatial planning under a different name?

For a French person, the answer is yes. In its early days, French regional planning policy aimed to rebalance the national territory, reducing the disparities between industrialised and less industrialised regions, and between Paris and the rest of the country. It is therefore not surprising that it was a Frenchman, Jacques Delors, who gave a major boost to regional policy when he was President of the European Commission (1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995). However, in other EU member states, spatial planning is based on other traditions. Even today, there is no consensus on what spatial planning is, what its objectives are, what its instruments are or who is -and should be -involved.

At the European level, history shows the difficulty, if not the impossibility, of getting the Member States to agree on a European spatial planning policy. It took ten years of negotiations (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999) to produce the ESDP. The informal Council of Ministers responsible for spatial planning adopted not a European-scale master plan, visible on a map, but a set of principles that each state could interpret and implement according to its own circumstances.

With the ESDP, the European level adopted a method that is still relevant to the territorial agenda of the European Union: governing by discourse. The last twenty years have shown the success of certain concepts disseminated by the ESDP, such as polycentrism, which has been taken up in many national and regional documents, and the rural-urban partnership. Thus, a certain convergence of vocabulary and thought has taken place between nations. Spatial planning policies have been influenced, particularly by the rules for the allocation of structural funds. Spatial planning has been strengthened, particularly in countries where it was not of great importance.

The Territorial Agenda 2020 has added a method for its implementation: this regular consultation of stakeholders, coordinated by the troikas of the states holding the EU Council Presidency. In this way, the policies implemented are better known, followed, and "peer pressure" can play a role in promoting them. However, the priorities added over the last twenty years have profoundly changed this policy -in parallel with the evolution of the EU's overall objectives.

While we are on the subject of government by discourse, let us take a look at the adjectives that qualify the vision of the European territory pursued in successive documents: in the ESDP (1999) it is balanced and sustainable. In the first version of the Territorial Agenda 2020 (2007), Europe becomes competitive and sustainable. In the 2011 update, we find an inclusive, smart and sustainable Europe, which is fully in line with the Europe 2020 strategy of the European Council. Along the way, the issue of regional disparities has lost its importance. In other words, economic policy has taken precedence over spatial planning.

The 2030 Territorial Agenda continues in this direction. Its subtitle, "A future for all places", is a catch-all. Its two main objectives, a Just Europe and a Green Europe, relate to sectoral policies, economic, social and environmental. They are broken down into "territorial priorities", in which the spatial dimension is finally mentioned. In this strategic framework, the spatial planning dimension itself is weak.

However, fortunately, implementation will depend on national and local actors. Research that we have carried out on integrated territorial investments (ITI) in the Île-de-France region has shown that it is in the concrete local choices that the balance between sectoral injunctions and the territorialisation of public policies takes shape. It is therefore more important than ever that nations, cities and regions take hold of their territorial development and act.Therefore, while remaining very reserved, and even critical, about the evolution of the strategic framework of the territorial agenda, I see more hope in the pilot projects carried out in concrete action, in particular in the subject of the regions lagging behind carried by our German friends.

The next question invites me to enter the debate by proposing guidelines for action.

Developing the European territory outside globalisation.

Allow me to offer a personal reflection. Which regions are "lagging behind"? Today, they are the losers of globalisation. They are the regions far from the metropolises, where small and medium-sized towns -the bulk of European towns!are struggling to keep up with global economic competition.

We believed that we had to connect these regions and cities to globalisation. The pandemic should make us reconsider. We do not know the cause of the virus, but we have seen its spread: Corona is a virus of globalisation. It has flourished in places where people from all over the world gather, airports, ski resorts, large demonstrations. It hit the big cities hard, those cities that are, par excellence, the places of globalisation: Milan, New York, London, Paris... In France, with each new announcement of lockdown, we are witnessing a real urban exodus. In Île-de-France, one million people, or 10% of the population, are moving to the provinces. On the property market, medium-sized towns and suburban locations are becoming more attractive. The pandemic acted as a catalyst, but in reality the movement had already begun among the most affluent populations because, despite their performance on the world market, our megacities have become unliveable.

In the anonymity of our big cities, we no longer see people but masses, and the slogans of tolerance, justice and fraternity ring hollow. In science fiction films, faceless figures inhabit dystopian metropolises: anonymous, athletic workers in Fritz Lang's Metropolis, policemen and criminal gangs in Gotham City, android replicants in Ridley Scott's Blade Runner. The latter is set in Los Angeles in... 2019. Have we come this far? Through artificial intelligence and eugenics, we are trying to produce androids. And our society is becoming increasingly harsh. On my daily commute in the heart of Paris, I come across people screaming in the metro, aggressive behaviour, homeless people sleeping on the pavement, rats running in the streets in broad daylight. Only five years ago, it was not like this. This is what the elites have already started to run away from.

It is time to question globalisation, to develop cities and regions that can function locally. When we talk about polycentrism, let us not forget that! Because today, even with our functional regions, our circular economy and our short circuits, we are far from it. It is time to reduce our dependence on global trade, which turns our territories into giants with feet of clay, and to renew our approach to the regional economy.

It is now time to build cities on a human scale, where people can live and work. Cities with short distances, with streets that invite you to wander, with welcoming gardens; cities free from shrill billboards, blaring loudspeakers and the Internet; cities in harmony with their hinterland; cities rich in history; cities built around a church, not a factory, a bank, a tourist attraction or a shopping centre.

This brings me to the last question: the contemporary debate.

Reconnecting with the foundations of spatial planning

In France, the priorities of planning policies are driven by international organisations, the European Union and the United Nations: adaptation to climate change, energy transition and digitalisation. This trio carries a major internal contradiction. If the Internet were a country, it would be the third largest consumer of electricity in the world with 1500 TWH per year, behind China and the United States. In total, digital technology consumes 10 to 15% of the world's electricity. This consumption doubles every 4 years. The energy savings made in other sectors will not be sufficient to offset the disastrous effects of this headlong rush.

While our public policies are accelerating the digital transition, we are abandoning traditional sectors of regional development. In France, rail networks are in decline and regional lines are being abandoned: we have lost 30% of our lines compared to the 1950s. The road network is deteriorating due to a lack of maintenance. According to an audit conducted in 2018, without a major change in infrastructure policy in the next few years, more than 60% of roadways will be severely deteriorated by 2037, not counting engineering structures. The most disadvantaged areas will be the first victims, and being equipped with Internet will not help them.

At European level, in 2015, the Latvian Presidency promoted the Riga Declaration, which called for a policy of revitalisation of small and medium-sized towns. However, it is clear that there has been no follow-up. The Portuguese Presidency's proposal concerning support for rural areas is particularly welcome and relevant. These two aspects, small and medium-sized towns and rural areas, could be the subject of joint reflection and coordinated, even integrated, actions.

It is urgent to rethink our priorities by taking these elements into account. As on the eve of the fall of the Roman Empire, we are at a turning point. Without a deliberate planning policy, in terms of employment, infrastructure and support for services, many small and medium-sized towns will decline -and yet they still exist today. We have a unique network of towns and cities that is a territorial substratum for a harmonious development of the territory. Let us not wait until it is too late!

Conference paper