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          Medical Cannabis in Europe

          European countries have enacted cannabis reform in recent years. Cannabis is now legal for medical use in 30 European countries.[1] However, because of the fragmented nature of the market, approaches taken have varied in terms of types of products allowed and the regulatory frameworks governing their provision. Legalisation nonetheless has been a pan European story. Today, the biggest markets for medical use are France, Italy, Germany and the UK.



          Germany stands out as an example of Europe’s most mature market. With more than 16,000 registered patients, the country saw a strong response from patients when medical cannabis was legalised on March 10th, 2017, a distinguishing characteristic compared to other countries whose patient numbers dwindled for the first several years of legalisation due to constrictive regulations.[2] In Germany, patients with physician prescriptions can access medical cannabis through pharmacies.[3] While the pharmaceutical model is common in many legalised medical markets across Europe, Germany’s high patient participation rate may be attributable to its position as the first country to offer medical insurance coverage for medical cannabis through its universal health care system and through private insurers. Germany has now been joined by Italy, Denmark, Israel and Spain (with pharmaceutical forms only) in offering insurance coverage for cannabis-based treatments.[4]

          “In Europe, many counties have taken a pharmaceutical approach to regulating the plant, with a few big players, like Germany, covering the costs of medical cannabis under their health insurance systems.” – New Frontier Data


          The British government changed the law on medical cannabis on November 1st, 2018 making it a legal treatment for select conditions including rare forms of epilepsy and symptoms of multiple sclerosis. This change to the Misuse of Drugs Regulations 2001 is a move that many saw as inevitable. This move was partly in response to a review by the UK’s Chief Medical Officer that concluded that some medical cannabis products were effective for some medical conditions.[5] Campaigners widely celebrated this victory while scientists and researchers also welcomed the decision. An added impetus was a response to a number of high-profile cases of children who needed medical cannabis products to survive – such as Alfie Dingley and Billy Caldwell.[6] After a strong fight, these families were finally granted exceptions by the UK Home Office to access specific products via the NHS, such as Epidiolex from GW Pharmaceuticals.[7]

          More recently, on March 3rd, 2020, the UK government also lifted import restrictions on medical cannabis to ensure that people with prescriptions for cannabis-based products for medical use do not have their treatment delayed or interrupted.[8] Until now, patients have been faced with long waits, sometimes up to three months, for their prescriptions. Dr Andy Yates, Pharmacy Lead at the Centre for Medical Cannabis, responded to this development say the: “…announcement will be warmly welcomed by patients, carers and clinicians alike. It’s crucial as we build the evidence required to realise the potential of cannabis-based medicinal products that there are no unnecessary impediments to accessing prescriptions. We are grateful that the government has listened to the valid concerns expressed by our members and responded with measures that will immediately improve access to these novel medicines and accelerate clinical understanding of their use.”[9] While these changes came 18 months after the legalisation of medical cannabis, they represent a tremendous step towards improving the supply of cannabis-based medicinal products in the UK.


          Italy has 19 regions and two autonomous provinces, each of which hold local legislative power and maintain their own health systems (health services and insurance) for their respective residents.[10] Each region has authority to adopt medical cannabis laws and decide the terms of availability and reimbursement.[11] While all of the local governments have legalised medical cannabis, the availability of cannabis-derived pharmaceutical products, the lists of conditions eligible for treatment, and the levels of governmental subsidies, each differ across health systems.

          Since 2017, Italy’s Department of Defense has been producing medical cannabis with the goal of providing free cannabis-based medicines to 100% of patients in need through a heavily regulated environment.[12] Italy’s stands as one of the few regulatory models around the world where the government took complete control of cultivation, yet the program has been plagued with supply issues, and patients have been forced to rely either on the illicit market or importation of expensive products through one of seven licensed importers. The Italian parliament is reviewing a bill to create a uniform medical cannabis framework, as well as draft legislations for full legalisation.[13]


          Though the Netherlands is often mistakenly thought to have fully legalised adult-use cannabis, the cultivation and purchase of personal amounts from licensed coffee shops are only decriminalised.[14] Its medical market has been legal since 2000, and the Dutch Office of Medical Cannabis (BMC) through the Ministry of Health oversees the supply of medical cannabis to the country’s estimated 50,000+ patients.[15] In medical transactions, patients may obtain up to 16 grams of cannabis with a prescription, while coffee shops limit consumers to five grams per transaction, however limits are generally difficult to monitor and enforce.[16]


          Related ETF

          FLWR: The Rize Medical Cannabis and Life Sciences UCITS ETF



          1. New Frontier Data, “The US Cannabis Report: 2019 Industry Outlook”, Page 48, September 2019. Available at:
          2. IBID
          3. IBID
          4. New Frontier Data, “The US Cannabis Report: 2019 Industry Outlook”, Page 49, September 2019. Available at:
          5. Daze Digital, “The Pain of Trying to Get Medical Cannabis to Ease Chronic Illness”, March 2020. Available at:
          6. IBID
          7. IBID
          8. Health Europa, “Medical Cannabis Import Restrictions Lifted for UK patients”, March 2020. Available at:
          9. IBID
          10. New Frontier Data, “The US Cannabis Report: 2019 Industry Outlook”, Page 49, September 2019. Available at:
          11. IBID
          12. IBID
          13. IBID
          14. New Frontier Data, “The US Cannabis Report: 2019 Industry Outlook”, Page 50, September 2019. Available at:
          15. IBID
          16. IBID

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