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Table 1 Current legal status of Cannabis and CBMs in selected countries

From: Cannabis-based medicines and the perioperative physician

ContinentCountryYear approvedNotes
North AmericaAmerica (United Nations Office on Drugs and Crime 2019; Mead 2017; US Food and Drug Administration 2016; Aguilar et al. 2018)1996-2017Cannabis 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)1999/2018Medical 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)2017Medical 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 AmericaUruguay (United Nations Office on Drugs and Crime 2019; Aguilar et al. 2018; Uruguay Government 2018)2013Medical 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)2015Medical use:
-Medical prescription required for medicinal cannabis
-CBM can be imported under special license
Brazil (Aguilar et al. 2018; Brazilian Government 2016)2014Medical 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)2017Medical use:
-Prescription and government authorisation required through ministry of health
-State produced pharmaceuticals for domestic market
-Cannabis oils legal for import
OceaniaAustralia (Aguilar et al. 2018; Australian Government Department of Health 2018; Therapeutic Goods Administration 2017)2016Medical 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)1977Medical 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
EuropeNetherlands (Aguilar et al. 2018; Office of Medicinal Cannabis 2018; Government of the Netherlands 2019; Office of Medicinal Cannabis Government of the Netherlands 2019)2000Medical 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
Germany (Aguilar et al. 2018; Broich 2018)2017Medical 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)2017Medical 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)2013Medical 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)2018Medical 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 EastIsrael (Aguilar et al. 2018)1992Medical 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
AsiaJapan (Aguilar et al. 2018) Prohibited
Pakistan (Aguilar et al. 2018) Prohibited
Philippines (Aguilar et al. 2018; Republic of Phillipines House of Representatives 2018)2016Medical 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
AfricaSouth Africa (Department of Agriculture, Forestry and Fisheries 2018; Constitutional Court of South Africa 2017; Medicines Control Council 2016)2018Medical 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