Referred to as the ‘green wave’ – the cannabis sector is undeniably on the rise across Europe, with policy changes in both medicinal and recreational contexts. BSDA predicts that global cannabis sales will increase by 22 percent in 2022, surpassing $61 billion by 2026.
With this in mind, cannabis legalisation both recreational and medical could yet have a huge role to play in driving post-pandemic economic recovery across the continent. Let’s take a look at the state of play of medical cannabis across Europe as it stands in 2022.
🇬🇧United Kingdom: Three patients prescribed in three years
Medical cannabis was legalised in 2018, yet barriers to patient access have been considerable, with only three patients being prescribed on the NHS in three years, despite production increasing by 700 percent. Key NHS concerns revolve around the potentially damaging impact of high THC levels on mental health, particularly when used long-term, along with regulatory barriers from NICE. Almost four years on from legalisation, the UK medical cannabis model is failing and in dire need of reform.
The International Narcotics Control Board (INCB) estimated that the UK was stockpiling 190 tonnes of medical cannabis, which equates to 92 percent of legal global supply. Parents and carers of epilepsy patients seeking cannabis prescriptions cited the adverse effects of current antiepileptic treatments, echoing concerns from patients globally.
🇩🇪Germany: 400 tonnes of cannabis demanded: significant scale-ups needed
Currently, the German cannabis market is highly import-reliant. Small-scale production occurs in “bunker-like buildings under high-security guidelines”, whose output of 2.6 tonnes for medical purposes would be insufficient. In 2019, Germany imported the largest quantity of medicinal cannabis in EU history from Portugal and Australia. The German Minister of Agriculture wants to involve German farmers to scale up, which would be complemented by imports.
🇪🇸Spain: Spain to legalise medical cannabis by end of 2022
In May 2022, a bill was introduced by the Spanish Socialist Workers’ Party (PSOE) to legalise medical cannabis. Four cannabis cultivation companies exist in Spain, where this legislation would enable them to supply domestic demand. The use of medical cannabis flowers would be prohibited, and prescriptions would be limited to three conditions: MS, some forms of epilepsy, and chronic cancer pain.
These proposals were based on findings in a special health report examined in March–May 2022 which analysed experiences in other countries. Congress requested the Health Department to authorise the commercialisation process. Dispensing guidelines are currently being created, in the hope that medical cannabis is available via Spanish hospital pharmacies as early as the end of 2022. Unidas Podemos – part of the Spanish government coalition – considered this the necessary opportunity to revive public health services, reduce the cost of medical cannabis, and increase its accessibility.
🇫🇷France: 2022 is the year of reform… or is it?
Since 2013, cannabis derivatives can legally be used in France for the manufacture of medicinal products. These products can only be obtained with a prescription and are only be prescribed when all alternatives have failed to effectively relieve suffering.
The pharmaceutical establishments and any establishments authorized by the French Health Agency (ANSM) to manufacture, import, and distribute active substances may be allowed to perform the above-mentioned acts, including, since 1st March 2022, the culture and production of cannabis. The legislation only specifies the conditions and procedures for the cultivation and production of cannabis for medical use.
Currently, it is unclear whether cannabis flowers will be used as the final product for patients. You can read an interesting piece about the colonial history of France’s relationship with cannabis, here.
🇱🇺Luxembourg: High-value, high-quantity interactions in the medical market
Medical cannabis was legalised in 2018 and Luxembourg has since been relying on imports. 140 kilograms was prescribed in 2020, for example for targeting treatment side effects such as nausea from chemotherapy. In comparison to other countries where medical cannabis is legal, this is an extensive quantity and indicates that their system is one to be modelled. Let us not forget the total of three prescriptions given to British patients in three years of legalisation.
However, it is far from perfect in its current form, with a reported purchase of an extortionate €3 million for 30 kilograms of medical cannabis – yes, €100 per gram – in 2021 by Luxembourg’s Ministry of Health. Average street prices are €13.75, meaning almost a ten-fold inflation of price.
This demarcates a ‘growing pain’ of what is yet to be an established global sector, or in other people’s views: wasteful expenditure of public resources. Bertrand Rambaud, representative of the Francophone Union for cannabinoids confirmed the abnormality of pricing: “Typically, wholesale purchase prices range from $2 to $3 per gram. Then on resale, it is around 7 euros.”
🇳🇱Netherlands: Only 1/10 of medical cannabis patients source via prescription
Medical cannabis was legalised in 2003 in the Netherlands, with Bedrocan receiving exclusive authorisation to cultivate. Between 2003 and 2016, “cannabis has been prescribed a total of about 170,000 times to over 15,000 patients” via pharmacies, which is what Spain is trialling. A Lifestyle Monitor survey conducted by the Dutch government demonstrated that one in ten medical cannabis patients obtained cannabis by prescription, with patients instead sourcing from “coffee shops, street dealers, and home cultivation”.
🇮🇹Italy: Severe medical cannabis shortages for patients
Despite legalising medical cannabis in 2007, patients today suffer from severe supply shortages. Prohibition Partners stated that “if you’re a patient in Italy, it means you can’t rely on a single product being available to you throughout the year”.
This is far from ideal, particularly as prescription changes and disruptions can significantly alter a patient’s quality of life, particularly those with chronic pain. Dr Viola Brugnatelli, Scientific Director of Cannabiscienza, raised concerns that Italy is facing a medical cannabis deficit of 1,000 kilos annually.
The medical use of cannabis was legalised in 2017, effective 2018. Data suggests that Poland is home to over 9,261 patients legally accessing medical cannabis, making it one of the largest such populations in Europe. Poland does not allow the growing of cannabis that contains more than 0.3% THC in flowering plants from which the resin has not been removed.
Cannabis for medical use is distributed to patients by pharmacies as a prescription medicine, i.e. a medicinal product prepared in a pharmacy on the basis of a medical prescription issued by a doctor. All products are covered under statutory health insurance.
Legislative changes enacted earlier this year were designed to make medicinal cannabis cheaper and more accessible for patients, by allowing the possibility of manufacturing the pharmaceutical raw material in Poland, thus not having to rely on imports.
According to Sensi Seeds, “The law was passed as a result of heated public debate, which intensified after the dismissal of a Warsaw doctor in 2015. It was found that the doctor had experimentally administered cannabis to young patients with epilepsy, without gaining the correct authorisation to do so. Medicinal cannabis was brought back into the spotlight the following year, when Tomasz Kalita campaigned for it to be legalised as a treatment for terminally ill patients. He died the following year of a brain tumour.”
🇨🇭Switzerland: Medical cannabis legalised in 2021, but remains strictly regulated
The Swiss Narcotics Act was amended in 2021, legalising medical cannabis. Once authorised by the Federal Office for Public Health, growing, selling, and importing cannabis for medical use is allowed solely if the THC figure is below 1 percent. Penalties for breaking this are extensive, with sentences up to twenty years and a fine. Exports are permitted for commercial purposes upon authorisation by Swissmedic, creating untapped opportunities to become a core European exporter.
🇵🇹Portugal: A booming medical cannabis market: 566% increase in exports 2021
Medical cannabis was legalised in 2018, and since then it has boomed. According to German TV network ProSieben, a shipment made in September 2019 from Portugal totalling 500 kilograms of cannabis flower was valued at €5 million. This was the largest shipment of medical cannabis in EU history. Cannabis exports increased by 600 percent in 2021 from the previous year, with 18 companies authorised to manufacture. Almost all of it is exported, placing it alongside exporters such as Canada, Israel, and Australia.
As of 2021, only Sativex is sold on the Portuguese market at a relatively high price, subsidised in part by the State. Its selling price is €475.27 with the state covering 37 percent, making this a highly inaccessible treatment option cost-wise.
🇩🇰Denmark: 200,000 square metres of space ready for cannabis cultivation
Similarly to the Netherlands and Switzerland, a 4-year pilot programme for medical cannabis was initiated in 2018 predominantly involving patients, doctors, and cultivators. In this pilot, cannabis products prescribed were unauthorised medicines, shifting all liability onto the doctors prescribing them. It was an immensely successful trial and was extended from 2021, leading to a unanimous vote in the Danish parliament for it to become a permanent industry.
Although the Danish Medicines Agency (DMA) issued a guideline for prescribers, they – perhaps controversially – said that “[prescribing doctors] can neither consult a package leaflet nor a summary of product characteristics to assess what beneficial effects or side effects the individual patient is likely to expect”. The treatment is exclusively for patients with specific conditions: MS, spinal cord damage, nausea after chemotherapy, and neuropathic pain – practically the same targeted indications as the UK, Spain, and others. It is only prescribed when authorised medicines have proven to be insufficient.
The Danish Ministry of Foreign Affairs cited 200,000 square metres of space across the country for cannabis cultivation. If this potential is developed efficiently, that would make it one of the world’s largest cannabis producers. There were 36 companies at the end of 2021 covering the entire value chain, with 65 percent of these attracting capital investment in the three years running up to that. Invest in Odense noted the “unique strength” of the Danish market, with its “regulatory framework permanently allowing companies to cultivate and produce medical cannabis without any limits on production capacity”.
🇦🇱Albania: Medical cannabis to be legalised for export only by the end of 2023
Albania is set to join the European green wave by the end of 2023: medical cannabis cultivation companies are likely to be able to apply for licences, valid for 15 years. According to Balkan Insight, a “draft law published […] on the public consultation website states that the government aims to license the production of cannabis for up to 150 hectares of land starting from 2023.” It is important to note that this would be for export only, leaving questions as to when Albanian patients will be able to access treatments.