In the US, medical cannabis is now legal in 40 states. It has been 30 years since the first regulation was passed in California in 1996, and today most of the country provides access to a variety of cannabis-based treatment options. But what about the other side of the Atlantic? How is it going in Europe?
As in most parts of the world, the legal situation of medical cannabis has changed significantly in Europe over the last decade. Today, around a dozen countries have established legal frameworks for medical cannabis access, resulting in a wide variety of scenarios for patients. Some countries offer more treatment options than others, but in general, cannabis is prescribed for chronic and neuropathic pain, spasticity associated with multiple sclerosis, chemotherapy-induced nausea, certain types of epilepsy and cachexia or anorexia syndromes. It is not officially approved for anxiety or other mental health conditions, including sleep disorders. Consolidated Regulations The Netherlands has the oldest cannabis regulation in Europe. Its generally open approach to cannabis led to the introduction of the medical cannabis law in 2003. With more than 20 years of experience, the Dutch system is the most consolidated in the region. For patients, this means broad access: all doctors in the country are authorized to prescribe medical cannabis, and patients can obtain pharmaceutical-grade standardized products in pharmacies, either as buds or oils. Other countries, like the Czech Republic and Italy, have had regulations for over a decade. Their legal frameworks have been updated in recent years to address limited patient access and supply issues. Currently, patients in these countries can access both buds and standardized cannabis extracts, and most health insurance providers cover a significant portion of the costs. Recent Regulations Countries such as Germany, Poland, Portugal, and Switzerland have legalized medical cannabis more recently, allowing the dispensation of buds and extracts through medical prescriptions, providing relief to thousands of patients. In Greece, the medical system currently offers only one strain of cannabis buds, and only certain specialist doctors can issue the initial prescription. In other countries, options remain more limited. In Belgium, regulations only allow the purchase of pharmaceutical products such as Sativex; no part of the plant or extracts are legal for medical use. In the UK, the NHS only prescribes pharmaceutical products like Sativex or Nabilone, though private clinics provide access to buds and oil extractions. Regulations in Progress France and Spain are the only ones in Eastern Europe without a legal framework for medical cannabis. Both are currently working to implement regulations, and it is expected that in the coming months both countries will approve frameworks to allow patient access. In North and Western Europe other countries, including Denmark, Slovenia, and Ukraine, are also in the process of passing legislation or implementing regulated access to medical cannabis. Future regulation in the European Union Several initiatives are underway in the European Union to harmonize medical cannabis. Except for the UK and Switzerland, the mentioned countries are EU members, so a standardized framework could emerge in the future. For now, the European Pharmacopoeia has set uniform quality standards for cannabis buds, while a European Citizens’ Initiative, along with parliamentary groups and associations, promotes cross-border access, research, and a common regulatory framework.

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