Medical Cannabis in Europe: Which Countries Allow It?

Overview: Europe's Patchwork of Medical Access

Medical cannabis access in Europe is not governed by a single European Union framework. Each country regulates independently, under its own narcotics legislation, medicines law, and clinical guidance. The result is a patchwork of regimes ranging from Germany's open prescribing model — among the most accessible in the world — to countries where a single licensed medicine for one condition represents the entire legal framework.

What qualifies as "medical cannabis" also varies. Some countries permit only authorised pharmaceutical products (such as Sativex or Epidyolex). Others allow magistral preparations — cannabis-based products prepared by pharmacies to a prescription. Germany and the Netherlands permit both pharmaceutical products and pharmacy-prepared cannabis flower. The distinction matters commercially: pharmaceutical products carry formal marketing authorisations; magistral preparations operate in a more fragmented supply chain with fewer regulatory requirements but also less reimbursement certainty.

Country-by-Country Status

The table below reflects the position as of April 2026. Patient number estimates are indicative; official data collection standards vary significantly.

Germany: The Standard-Setter

Germany's medical cannabis framework underwent its most significant transformation in April 2024, when the Cannabis Act (CanG) came into force. Cannabis was removed from the Narcotics Act (BtMG) and reclassified under the Medicines Act (AMG), which had an immediate practical effect: any licensed physician can now prescribe cannabis-based medicines for any condition they consider appropriate, without requiring BfArM exceptional authorisation.

Critically, Germany's statutory health insurance (GKV) — which covers approximately 90% of the population — is obligated to reimburse cannabis prescriptions, subject to a cost-benefit assessment by the Federal Joint Committee (G-BA) for ongoing reimbursement decisions. In practice, this has created the most financially accessible medical cannabis framework in Europe. Patient numbers are estimated to have exceeded 100,000 active prescriptions in 2025 and are growing steadily as physician familiarity increases and cost barriers fall.

Germany imports the majority of its medical cannabis — from Canada, the Netherlands, Portugal, Denmark and Malta — though domestic cultivation capacity is developing under BfArM licences. EU-GMP certification is required for all products sold into the German market.

United Kingdom: Legal but Under-Prescribed

The UK legalised cannabis-based medicinal products (CBMPs) in November 2018 following high-profile cases involving children with treatment-resistant epilepsy. The reform allowed specialist doctors to prescribe Schedule 2 cannabis products. In practice, the NHS has been extremely cautious: fewer than 20,000 patients receive NHS cannabis prescriptions, almost exclusively for Epidyolex (CBD for epilepsy) and Sativex (nabiximols for MS).

The gap between legal access and practical access has been filled by private cannabis clinics. Operators including Curaleaf UK, Sapphire Medical, Lyphe Group and Mamedica have built significant patient bases — estimated at around 100,000 in aggregate — prescribing for conditions including chronic pain, PTSD, anxiety and sleep disorders. Patients pay out of pocket, typically £150–£300 per month for medicine and clinic fees.

This private market represents a significant commercial opportunity but also a vulnerability: it depends on specialist prescribing without NHS clinical guideline support, and pricing pressure is intensifying as the market grows. The UK's post-Brexit regulatory divergence — MHRA rather than EMA — creates both barriers and opportunities for companies developing novel CBMPs.

France: The Emerging Market

France's medical cannabis trajectory illustrates how quickly a market can scale when regulatory will aligns with clinical need. A time-limited experimentation programme launched in March 2021 demonstrated sufficient patient benefit that the ANSM (Agence nationale de sécurité du médicament et des produits de santé) recommended permanence. A decree published in March 2024 converted the experiment into a permanent programme.

Authorised products are prescribed by specialist physicians for five broad indications: neuropathic pain not responding to conventional therapies, certain forms of refractory epilepsy, spasticity-related symptoms from MS, nausea and vomiting from chemotherapy, and palliative care. The programme is structured to capture real-world evidence, and products must come from approved suppliers meeting EU-GMP standards.

Patient numbers reached an estimated 70,000 by late 2024 and are growing. France's large population, established medical infrastructure, and growing ANSM capacity make it the second-largest European medical cannabis market in development, behind Germany.

Market Size and Investment Outlook

The European medical cannabis market is at an inflection point. Analyst projections for 2028 market value range from €2 billion to €4 billion, with the range reflecting uncertainty about Germany's commercial retail trajectory, UK NHS adoption rates, and the speed at which France and Poland scale their programmes.

Several structural factors support the bull case: growing physician confidence driven by patient outcomes data; falling average selling prices as Canadian and Portuguese supply capacity increases; and the expanding base of conditions for which cannabis is being prescribed. The bear case centres on reimbursement risk — particularly if German GKV bodies restrict cannabis prescriptions for high-volume, lower-acuity conditions — and competition from synthetic cannabinoids and reformulated CBD medicines that may attract more straightforward marketing authorisations.

For investors, the medical cannabis market offers better risk-adjusted returns than adult-use speculation in most European markets: it operates within pharmaceutical frameworks, serves identified patient populations, and generates recurring revenue from chronic-condition patients. The operational challenge is achieving the scale and EU-GMP certification required to compete on price in the German market while maintaining margins in smaller-volume markets.

External reference: European Medicines Agency — Cannabis-Based Medicines Guidelines

External reference: German Federal Ministry of Health — Cannabis