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The global cannabis universe continues to expand rapidly after the United States Department of Health and Human Services (HHS) report, Germany’s removal of the narcotics label from cannabis, and the likely re-scheduling of cannabis in the U.S. to Schedule III. 

Even more is happening around the globe as countries implement updated, well-defined cannabis regulations to improve access. A tsunami of parliamentary and health regulatory discussions push for cannabis reform in almost every country within the European Union. 

In the coming months and years, there will undoubtedly be a global tectonic shift in cannabis that will usher in stronger EU and international cannabis markets.

The Top 10 Largest Legal Cannabis Markets in 2023
 

A handful of players dominate the global cannabis market. These countries are expected to continue to drive growth, even as other markets open and begin to catch up.
 

1. The United States 

The U.S. is the heavyweight champion of cannabis, with over $30 billion in legal sales in 2023: $10 billion in medical and $20 billion in recreational sales. 

Despite the size of the market and the apparent demand, the United States still does not recognize cannabis on a federal level. However, lawmakers are expected to shift cannabis to Schedule III in the relatively near future. This shift should reduce taxation for cannabis companies and hopefully provide a gateway to federal acceptance and the Secure And Fair Enforcement Regulation Banking Act (SAFER Banking Act) since Schedule III acceptance will render many arguments against cannabis moot.
 

2. Canada 

Canada was the first country to federally legalize recreational cannabis. In 2023, the country sold roughly CAD 5 billion ($4.35 billion) in regulated cannabis, including approximately CAD 250 million in medical cannabis sales. 

After the boom-bust of 2018, mainly due to overbuilding, the market remains wobbly, and recent regulatory changes came up short of creating a clear path to success. One of the key problems is high taxation, which is driving companies to insolvency in local markets. Significant amounts of products are being exported without tax, and Canadian flower has been dominating the scene in global medical markets.
 

3. The Netherlands 

In 2023, The Netherlands sold an estimated 285 to 570 million euros of cannabis through the country’s 570 coffee shops and the government-run Bedrocan medical cannabis distribution model. 

Bedrocan is the oldest medical cannabis company and is headquartered in the Netherlands. It cultivates within the country and sells its medical cannabis through the Danish government.

For years in the Netherlands, it was legal to sell cannabis recreationally but illegal to grow. Four years after legalization, the country has just started to produce legal cannabis through ten new internal use-only recreational grow licenses. However, extracts are still not permitted. 
 

4. Germany

Germany, which recently decriminalized cannabis and removed the plant’s narcotic classification, imported 33 metric tons of cannabis flower in 2023, according to the newest data from the country's Federal Institute for Drugs and Medical Devices (BfArM). The overall market is estimated to annually conduct 390 million euros in medical cannabis sales. 

The future of cannabis in Germany will likely be massive, as any doctor can prescribe cannabis for almost any reason. Clinics are popping up everywhere to drive prescriptions and product sales. 

Germany has paved the way for the EU to become more accepting of cannabis legislation, and more will soon follow.
 

5. Israel
 

In 2023, Israel sold approximately 315 million euros of cannabis. 

Israel is one of the older global medical cannabis markets and only permits the sale of flower. Recent regulations have made access to cannabis much simpler for patients, but there is still limited clinical-only access to extracts. Allowing patients access to extracts would open up more avenues of therapy. 

Additionally, Israel’s internal cultivation has come under pressure as Canadian imports continue to make up the vast majority of sales and are priced well below the production costs of local Israeli companies.
 

6. Australia

In 2023, Australia’s estimated legal cannabis sales were $165 million. 

Australia has the most diverse medical cannabis products of the truly medical-only markets, with roughly 800+ choices of extracts and flower. Its robust network of clinics and distributors throughout the large country makes it incredibly easy for patients to receive their prescriptions. The patient experience in Australia is one of the most modern, with U.S.-style dispensaries, pharmacies, and same-day prescription services.
 

7. The United Kingdom

With a reported 30,000-patient population, the U.K. has struggled with patient access. However, the reported higher-than-average cannabis consumption of the average U.K. patient implies a total market of 114 million euros. 

The regulated cannabis market in the U.K. is surging, with no stimulus to explain the sudden upward movement in medical cannabis sales. Although there is little political or regulatory will to loosen up archaic restraints on medical cannabis, experts forecast exponential market growth as citizens realize they have legal alternatives.
 

8. Italy

Italy is one of the more secretive medical cannabis markets, with market sales estimated at $42 million in 2023 and just 1.4 metric tons of cannabis flower imports.

Italy controls the cannabis market through the army and health regulators, which significantly limits competition, but doctors and specialty compounding pharmacies continue to provide access to Italian patients.
 

9. Jamaica

Jamaica has always been a cannabis tourism hub, but with recent legalization, the country sold $37.44 million of regulated cannabis in 2023. Jamaican cannabis is expected to be a significant export crop for the country as it capitalizes on name recognition.
 

10. Poland

Poland has become one of the fastest-growing young medical cannabis markets. In 2023, the country sold 4.6 metric tons of cannabis and experts expect revenue to reach $134.80m in 2024. Predictions indicate that sales will certainly increase expoentiually as more products move through their lengthy yearlong registration process.

Progress Toward Medical Cannabis in Europe

Europe is already home to several of the world’s largest global cannabis markets, and countless more countries are in talks to move toward regulated cannabis access for their citizens. 
 

Albania
In 2023, Albania approved the cultivation and manufacturing of medical cannabis. 
 

Czechia

Czechia is currently debating two proposals that closely resemble Germany and other medical cannabis markets. Even though cannabidiol (CBD) dominates the market, registered vendors can also sell tetrahydrocannabinol (THC) products. Further new regulations are expected to raise the bar in the EU.
 

France

France is moving from its trial program to medical-insured market access. The registrations will begin in late 2024, and the program is predicted to go into action in early 2025. France may well be one of the most unique models insofar as it will exclusively consist of insured medical cannabis sales and will require a government-approved tender offer.
 

Georgia

Georgia decriminalized the use and possession of cannabis in 2018. The current debate over medical cannabis cultivation continues.
 

Greece

Greece has been open to medical cannabis cultivation and production since 2018. However, actual cultivation for export and internal use began only in 2023. Greece is the only EU country that will not allow medical cannabis imports and will only allow domestically grown cannabis to be sold in the country and exported. Seemingly, medical cannabis not being allowed for importation maybe against EU free trade rules for pharmaceuticals, since this is not a recreational program like Netherlands or Switzerland...
 

Luxembourg

Luxembourg was one of the first EU countries to legalize cannabis. However, since 2021, there has been no progress toward medical cannabis imports for patient access or internal cultivation to supply an internal recreational market. 
 

Malta

Malta was also ahead of the curve, legalizing cannabis in late 2021. Since then, social clubs for recreational purposes have been established, and a few medical cannabis facilities are operating. However, the numbers are low, and access seems stalled. 
 

Portugal

Portugal is the number one EU medical cannabis export-producing country but has a tiny cannabis patient base, estimated at 500 to 1,000 people. 

Despite decriminalizing all drugs, they have not prioritized cannabis as a medicine and require an arduous registration process to register cannabis products for sale inside the country. Additionally, there is no current guidance or encouragement for internal use. However, this is expected to change.
 

Spain

Spain is debating a magistral, extract-only medical market despite having three times as many recreational social clubs as McDonald's restaurants. Similar to the Netherlands, it is legal for the social clubs to sell cannabis, but it is illegal to buy and produce cannabis products in the country. However, Spain shows significant promise medically; it is potentially one of the largest cannabis markets per capita and may soon establish medical access in 2024.
 

Switzerland

Switzerland has both medical and recreational cannabis. Social clubs, dispensaries, and pharmacies may all sell cannabis. Recreational cannabis must be organically grown in Switzerland, while pharmacies may import cannabis for medical use only.
 

Ukraine

Ukraine began 2024 with regulations allowing access to cannabis for medical cannabis patients and allowing internal cultivation of medical cannabis. 
 

Medical Cannabis in Central and South America
 

Countries in the Americas also show promise in terms of medical cannabis. Many countries have established regulated cannabis markets, and many more are pushing for greater access. 
 

Argentina

Medical cannabis has been legal in Argentina since 2017. The laws have become more liberal over time, but debate has surfaced over the widespread recreational consumption of cannabis in the country. 
 

Brazil

Until recently, Brazil only allowed CBD-only products. However, the country has now shifted to allow CBD-dominant products; medical cannabis products may now contain THC as long as CBD is the most prevalent cannabinoid. Although cannabis is easy to buy in Brazil, it is not regulated recreationally nor grown or manufactured locally...
 

Chile

Since 2015, Chile has allowed private consumption of cannabis for medical usage. The country has also decriminalized cannabis.
 

Colombia

Colombia is a major producer of medical cannabis for export and has a strict medical use-only policy inside the country.
 

Costa Rica

Costa Rica has plans to become a medical cannabis exporter. Though the laws surrounding recreational consumption within the country are relatively lax, cannabis is yet to be legalized.
 

Ecuador

Ecuador has only decriminalized small amounts of cannabis, but the country is expected to approve medical use and cultivation in the future.
 

Mexico

Medical cannabis laws in Mexico have continued to stall due to politics. Despite the significant unlicensed cultivation of cannabis for decades, legalization has yet to happen. It is doubtful legal medical cannabis will change in the future.
 

Uruguay
Uruguay has long wanted to be the South American hub for international cannabis. As of mid-2023, the country had sold 10.7 tons of cannabis, potentially valued at around $4.1 million in sales to pharmacies. In 2023, exports doubled from the prior year, and the market's domestic cultivation side is even larger.

Asia and Africa

Though not typically thought of as major players in the global cannabis market, many countries throughout Africa and Asia are becoming more accepting of cannabis and making moves toward legalization. 
 

Japan

After nearly 75 years, Japan is taking its first steps toward cannabis legalization. The country’s regulations will allow for CBD products as novel foods so long as they have almost undetectable THC limits. 
 

Lesotho 

The little mountainous country Lesotho inside South Africa borders is home to some of the larger medical cannabis farms and one of their largest farming exports. Although not legal for internal use, mountain people have been growing cannabis for decades. Lesotho is also expected to allow other pharmaceutical API production like Psilocybin.
 

Morocco

After decades of allowing cultivation but not sales, Morocco has begun allowing mountain cultivators to partner with pharmaceutical manufacturers to sell medical products in the mountains. Though the country has excellent name recognition, issues surrounding non-GACP mountain-grown products continue to swirl for medical usage. 
 

South Africa

South Africa recently decriminalized cannabis. The country is home to some of the most prominent legal medical cannabis cultivation farmers and will continue to be a significant export hub for medical cannabis. 
 

Thailand

Over the course of just a couple of years, Thailand went from zero legal sales to one of the biggest recreational-style cannabis infrastructures in modern history. 

Although it was intended to be a medical cannabis market, the cannabis industry in Thailand much more closely resembles a recreational framework. The country is home to over 8,000 legal cultivation licenses and as of November 2023, 1.1 million people had registered to cultivate cannabis. Thailand has an additional 12,000 regulated dispensaries, and it is estimated that double these numbers exist in the unregulated market. Thailand's politicians are debating how to rein in this explosion with stricter medical laws. With strict neighbors like China and Singapore, something must happen. 
 

Worldwide, Countries Are Debating Cannabis Access

With an estimated $200 to $400 billion unregulated cannabis market, it’s evident that much more needs to be done to provide consumers with safe access to high-quality cannabis products without fear of persecution. This list alone indicates a need for standardized global cannabis policies. 

Almost every EU country is debating cannabis regulations. When the U.S. reschedules, it should encourage countries in the EU and globally to stop arguing and start hammering out policy. There is still much more progress for both country-wide and global cannabis markets, but I am hopeful for significant progress throughout the rest of 2024.

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