Portugal: the medical cannabis market is legal but non-existent

The Legalization of Medical Cannabis in Portugal has been in effect for two months now but the National Authority for Medicines and Health Products (Infarmed) has not yet approved any cannabis-based medicine. And for good reason: no pharmaceutical company has filed an application for marketing authorization, despite the seven medical conditions that legally justify the use of medical cannabis.

The Portuguese medical cannabis market is nonexistent

The situation in Portugal is such that doctors have nothing to prescribe to patients who request medical cannabis, despite its legal status. Since February 1, pharmaceutical companies have been able to submit applications for marketing authorization for medical cannabis products, but None of them did. As a result, patients do not have access to cannabis-based medications, and the Portuguese medical cannabis market is currently nonexistent.

The list of medical conditions The conditions for which medical cannabis is approved include: nausea and vomiting associated with chemotherapy, chronic pain, spasticity associated with multiple sclerosis, and severe epilepsy associated with Dravet and Lennox-Gastaut syndromes. It also includes glaucoma, Tourette syndrome, and appetite stimulation in palliative care and among AIDS patients—conditions for which the College of Physicians had pointed out in 2017 that the scientific evidence was weak.

The only drug currently approved in Portugal is Sativex for the treatment of spasticity in multiple sclerosis. It had undergone a centralized authorization procedure at the European level in 2012. As in France, this product is legal but not available; it is not sold in the country. To obtain it, one must apply for a special authorization. According to figures from the Ministry of Health, only 21 authorizations were issued between 2016 and 2017. Yet it is partly in Portugal that the cannabis used to produce Sativex—which is formulated by British laboratories—is grown. GW Pharmaceuticals.

A market with little appeal?

The Portuguese legalization law specifies that medical cannabis may only be prescribed as a last resort when conventional treatments have failed. This is the same is true in the United Kingdom. This regulation mechanically restricts patients' access to medical cannabis. Furthermore, Portugal has chosen to, like other countries, to authorize medical cannabis only in the form of pharmaceutical products. The plant is therefore not available in its natural form, which automatically eliminates a segment of the market that is effectively reserved for the pharmaceutical industry. However, the Portuguese market is not necessarily attractive to this industry.

In fact, beyond political and regulatory considerations, economic factors also play a decisive role. Portugal has low public health care spending (16.6 billion euros) by European standards. By comparison, public health care spending in France and Germany amounts to 251 and 352 billion euros, respectively. In the report on Europe by Prohibition Partners, the Portuguese medical cannabis market is estimated to be worth only 500 million euros in 2028, compared with 9.5 and 7.7 billion euros for the French and German markets, respectively.

Portugal is, however, attractive in terms of production costs, and several companies have already set up operations there. This is the case for GW Pharmaceuticals but also of Tilray, which owns facilities worth 25 million euros north of Lisbon, as well as several other companies that plan to use their production and export licenses to serve the German market. Thus, Portugal functions more as a gateway to the European market than as a market in its own right. The Left Bloc party had denounced this as a form of hypocrisy regarding the patients’ situation.