Medical use of cannabis and cannabinoids containing products – Regulations in Europe and North America

Published:January 10, 2018DOI:


      • Medical use of cannabis is still controversial and different between countries.
      • Herbal cannabis is not authorized by the main regulatory agencies.
      • 23 European countries authorize cannabinoid-based medicines.
      • Four countries and many states in the United States authorized herbal cannabis.


      In 1937, the United States of America criminalized the use of cannabis and as a result its use decreased rapidly. In recent decades, there is a growing interest in the wide range of medical uses of cannabis and its constituents; however, the laws and regulations are substantially different between countries. Laws differentiate between raw herbal cannabis, cannabis extracts, and cannabinoid-based medicines. Both the European Medicines Agency (EMA) and the United States Food and Drug Administration (FDA) do not approve the use of herbal cannabis or its extracts. The FDA approved several cannabinoid-based medicines, so did 23 European countries and Canada. However, only four of the reviewed countries have fully authorized the medical use of herbal cannabis – Canada, Germany, Israel and the Netherlands, together with more than 50% of the states in the United States. Most of the regulators allow the physicians to decide what specific indications they will prescribe cannabis for, but some regulators dictate only specific indications. The aim of this article is to review the current (as of November 2017) regulations of medical cannabis use in Europe and North America.


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        • Warf B.
        High points: an historical geography of Cannabis.
        Geogr. Rev. 2014; 104: 414-438
      1. Aggarwal SK, Carter GT, Sullivan MD, ZumBrunnen C, Morrill R, Mayer JD. Medicinal use of cannabis in the United States: historical perspectives, current trends, and future directions. J. Opioid Manag. n.d.;5:153–68.

      2. Rica C. Final Act of the United Nations Conference for the Adoption of a Single Convention on Narcotic Drugs n.d.

        • Bergmark A.
        EMCDDA Monographs. A cannabis reader: global issues and local experiences.
        (Available from:)
      3. United Nations. Final Act of the United Nations Conference for the Adoption of a Protocol on Psychotropic Substances, 1971. Available from: n.d.

        • EMCDDA
        Medicinal Cannabis and Derivatives - A Legal Analysis of the Options, Their Limitations, and Current Practice in the EU.
        Eur Leg Database Drugs, 2002: 1-35
        • Ashton C.H.
        Pharmacology and effects of cannabis: a brief review.
        Br. J. Psychiatry. 2001; 178: 101-106
        • Piomelli D.
        • Russo E.B.
        The Cannabis sativa versus Cannabis indica debate: an interview with Ethan Russo, MD.
        Cannabis Cannabinoid Res. 2016; 1: 44-46
        • Hillig K.W.
        • Mahlberg P.G.
        A chemotaxonomic analysis of cannabinoid variation in Cannabis (Cannabaceae).
        Am. J. Bot. 2004; 91: 966-975
        • Mechoulam R.
        • Hanuš L.O.
        • Pertwee R.
        • Howlett A.C.
        Early phytocannabinoid chemistry to endocannabinoids and beyond.
        Nat. Rev. Neurosci. 2014; 15: 757-764
        • Kiran Vemuri V.
        • Makriyannis A.
        Medicinal chemistry of cannabinoids.
        Clin. Pharmacol. Ther. 2015; 97: 553-558
        • Van Norman G.A.
        Drugs and devices: comparison of European and U.S. approval processes.
        JACC Basic Transl. Sci. 2016; 1: 399-412
      4. Jill Kieffer, European medicines agency representative (personal communication, October 2nd 2017). n.d.

      5. FDA. Public Health Focus - FDA and Marijuana: Questions and Answers n.d. (accessed October 4, 2017).

      6. FDA. Public Health Focus - FDA and Marijuana n.d. (accessed October 5, 2017).

        • FDA
        Cesamet FDA Approval.
        • FDA
        MARINOL® FDA Approval.
        • FDA
        SYNDROS FDA Approval.
        • U.S Congress
        Public Law: The Comprehensive Drug Abuse Prevention and Control Act of 1970.
        . 1970; 27 (Available from:)
        • Klieger S.B.
        • Gutman A.
        • Allen L.
        • Pacula R.L.
        • Ibrahim J.K.
        • Burris S.
        Mapping medical marijuana: state laws regulating patients, product safety, supply chains and dispensaries, 2017.
        Addiction. 2017; 112: 2206-2216
        • Hasin D.S.
        U.S. Epidemiology of Cannabis Use and Associated Problems.
        Neuropsychopharmacology. 2017; : npp2017198
      7. State of Florida. Constitutional amendment petition form. Available from: n.d.

      8. The Commonwealth of Massachusetts, Executive Office of Health and Human Services, Department of Public Health, Bureau of Health Care Safety and Quality, Medical Use of Marijuana Program. Guidance for Physicians Regarding the Medical Use of Marijuana n.d. (accessed November 20, 2017).

      9. State of New-York. Practitioner Information for the Medical Marijuana Program n.d. (accessed November 20, 2017).

        29 Legal medical marijuana states and DC.
        • Ablin J.
        • Ste-Marie P.A.
        • Schäfer M.
        • Häuser W.
        • Fitzcharles M.A.
        Medical use of cannabis products: lessons to be learned from Israel and Canada.
        Schmerz. 2016; 30: 3-13
      10. Canada Ministry of Justice - Access to Cannabis for Medical Purposes Regulations. Available from: n.d.

      11. Health Canada. Understanding the New Access to Cannabis for Medical Purposes Regulations - n.d. (accessed November 21, 2017).

      12. Health Canada. Fact Sheet - SATIVEX - n.d. (accessed November 21, 2017).

      13. Health Canada. Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the cannabinoids [Health Canada, 2013] - n.d. (accessed November 21, 2017).