Table 1 Current legal status of Cannabis and CBMs in selected countries
From: Cannabis-based medicines and the perioperative physician
Continent | Country | Year approved | Notes |
|---|---|---|---|
North America | America (United Nations Office on Drugs and Crime 2019; Mead 2017; US Food and Drug Administration 2016; Aguilar et al. 2018) | 1996-2017 | Cannabis illegal under federal law, individual states have legalised to varying degrees Medical use: -Legalised by 33 states -FDA has approved dronabinol (Marinol ®, Syndros® ), nabilone (Cesamet ®,) and cannabidiol (Epidiolex ®) (CBMs) for specific indications, but cannabis plant not FDA approved Recreational use: -Legalised by 10 states (Alaska, California, Colorado, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont, Washington) and District of Colombia for recreational use -Illinois to be legalised January 1 2020 -Multiple states have bills in session to legalise recreational and medicinal cannabis and its products -“Decriminalised” in numerous states (ie avoid jail term) |
Canada (United Nations Office on Drugs and Crime 2019; Aguilar et al. 2018; Government of Canada 2018b; Health Canada 2018) | 1999/2018 | Medical use: -Regulated by federal government -Healthcare practitioner authorisation required -Patients can access cannabis through federally licensed seller, designate someone to produce, or grow their own. Recreational use: -Cannabis for recreation legalised October 2018 under Cannabis Act -Cannabis act permits sale of cannabis oil, fresh cannabis, dried cannabis, cannabis plants and seeds -Retailers must be authorised to sell cannabis | |
Mexico (Aguilar et al. 2018; Government of Mexico 2018a; Government of Mexico 2018b; Government of Mexico 2018c) | 2017 | Medical use: Cannabis use allowed for medical and scientific purposes Application required for import and use of cannabis and CBMs for medical purposes Products with < 1% THC recently marketed under Government authorisation with no prescription required | |
South America | Uruguay (United Nations Office on Drugs and Crime 2019; Aguilar et al. 2018; Uruguay Government 2018) | 2013 | Medical use: -Prescription required for CBM for medicinal use -Medicinal cannabis not authorised to be sold -CMs accessible via specialist prescription Recreational Use: -Cannabis legalised and market regulated from December 2013 with strict controls |
Chile (Aguilar et al. 2018) | 2015 | Medical use: -Medical prescription required for medicinal cannabis -CBM can be imported under special license | |
2014 | Medical use: -Imports of medications based on CBD oil for medical and therapeutic use for patients with prescription allowed -Nabiximols (Sativex ®) licensed for MS -Cannabis plant prescription prohibited | ||
Argentina (Aguilar et al. 2018; Argentinian government 2018; Government of Argentina 2019) | 2017 | Medical use: -Prescription and government authorisation required through ministry of health -State produced pharmaceuticals for domestic market -Cannabis oils legal for import | |
Oceania | Australia (Aguilar et al. 2018; Australian Government Department of Health 2018; Therapeutic Goods Administration 2017) | 2016 | Medical use: -cultivation, manufacture, prescribing and dispensing of medicinal cannabis products for patients now legal -Access via authorised prescriber program, or special access scheme on individual patient basis. Must be prescribed -Cannabis, THC, nabiximols (Sativex ®), dronabinol (Marinol ®), nabilone (Cesamet ®, Canemes ®) listed under schedule 8, require prescription -Cannabidiol listed under schedule 4, requires prescription |
New Zealand (Aguilar et al. 2018; New Zealand Parliament 2018; New Zealand Ministry of Health 2018) | 1977 | Medical use: -Prescription required for most cannabis-based products, some require ministerial approval -Nabiximols (Sativex ®)and CBD based products available without ministerial approval -Bill currently passing through NZ parliament to improve access | |
Europe | Netherlands (Aguilar et al. 2018; Office of Medicinal Cannabis 2018; Government of the Netherlands 2019; Office of Medicinal Cannabis Government of the Netherlands 2019) | 2000 | Medical use: -Medicinal use legalised in 2000 -Office of Medicinal Cannabis government agency responsible for supplying medicinal cannabis to pharmacies, prescription required -5 compositions produced, with varying strengths of THC and CBD Recreational use: -Illegal, but smoking cannabis under strict conditions allowed |
2017 | Medical use: -Medicinal cannabis products able to be prescribed by physician -CBMs included in range of medications covered by public and private health insurance | ||
Poland (Aguilar et al. 2018) | 2017 | Medical use: -Medicinal cannabis sold in registered pharmacies. -Patients need permission from pharmaceutical inspector and physician | |
France (Aguilar et al. 2018; National Agency for the Safety of Medicines and Health Products 2013) | 2013 | Medical use: -Law changed to allow marketing authorisation of products containing cannabis or its derivatives -Dronabinol (Marinol ®) approved and marketed -Nabiximols (Sativex ®) approved but not marketed due to price disagreements | |
Ireland (Aguilar et al. 2018; Department of Health Ireland 2018; Health Products Regualtory Authority 2017) | Medical use: -Cannabis for medical use access programme enables prescribing of Cannabis for medical use by Medical Consultant -Authorised CBMs (nabiximols (Sativex ®) , dronabinol (Marinol ®), nabilone (Cesamet ®, Canemes ®) should be used in first instance with prescription -Cannabis (plant or extracts not authorised as medicine) considered as treatment option -Cannabidiol (Epidiolex ®) not currently authorised | ||
UK (National Institute for Health and Care Excellence 2019; Dame Sally Davies 2018; National Health Service 2019) | 2018 | Medical use: -CBMs recently rescheduled, only available via prescription from doctor on the specialist register -Nabilone and Nabiximols (Sativex ®) currently licensed but the latter is not approved by NICE -Dronabinol not available as a licensed medicine -Cannabidiol not classed as CBM, and not controlled. Epidiolex® currently in licensing process. -NICE draft guidance for prescription of CBMs currently open for public consultation | |
Middle East | Israel (Aguilar et al. 2018) | 1992 | Medical use: -Medical Cannabis Unit established for the regulation of Cannabis -Specialist physicians apply for Medical Cannabis permit on behalf of patient - > 40,000 patients receiving medicinal cannabis |
Asia | Japan (Aguilar et al. 2018) | Prohibited | |
Pakistan (Aguilar et al. 2018) | Prohibited | ||
Philippines (Aguilar et al. 2018; Republic of Phillipines House of Representatives 2018) | 2016 | Medical use: -Cannabis allowed with prior authorisation from a doctor and treatment delivered in dedicated centres -Covers all forms of Cannabis, no specific mention CBMs | |
India (Aguilar et al. 2018; Indian Council of Medical Research 2018) | Medical use: -Legal provisions for medicinal use yet to be implemented -Council of Scientific and industrial research currently undertaking research into medical benefits | ||
Africa | South Africa (Department of Agriculture, Forestry and Fisheries 2018; Constitutional Court of South Africa 2017; Medicines Control Council 2016) | 2018 | Medical use: -Special authorisation from Medical Control Council by physician can be requested for prescription of medicinal cannabis products -Cannabidiol preparations excluded from Medicines and related substances act |