Legal medicinal cannabis markets are expanding around the world
The number of people worldwide living in countries or states with legal access to medicinal cannabis has surged dramatically—from just 100 million in 2012 to an astonishing 1.5 billion in 2024. This monumental growth reflects a global shift in understanding cannabis not as an outlaw substance, but as a medicine.
The US States are dominant in legal cannabis
Rua’s focus is on high value, key markets outside of the US States.
While the United States stands as the largest market in the world for legal cannabis trade, this status is confined strictly to the state level. At the federal level, cannabis trade remains illegal, meaning each state independently crafts its own regulations. Currently, 43 out of 50 states have some form of legalization, whether for adult use or medicinal purposes. Despite this complex regulatory patchwork, the US continues to dominate the global legal cannabis market.
For Rua, we can not trade with the USA because of federal regulations. However, opportunity lies ahead - if and when cannabis becomes federally legal, it will be a possibility.
Key international markets are Germany, Australia and the UK
Germany and Australia stand as the largest markets globally for medicinal cannabis, commanding significant attention from industry. However, to truly grasp the potential for future growth, one must consider the relative population sizes of these nations as a crucial metric.
Germany, with a population exceeding 83 million, represents a vast and mature market with established regulatory frameworks and growing patient adoption. Australia, while smaller with approximately 26 million people, has demonstrated rapid market expansion and increasing acceptance of medicinal cannabis, fueled by progressive legislation and rising patient demand.
With a population of 68 million, the UK market presents a substantial opportunity for growth in health care and medicinal cannabis products. The increasing acceptance and awareness among patients and clinicians alike, combined with progressive regulatory changes, position the UK as a market with significant growth.
As we know, our home market of Aotearoa New Zealand's population of about 5 million offers a limited market size, constraining the scalability and potential return on investment for companies like Rua Bioscience.
Understanding these population dynamics is essential—not only to measure current market penetration but also to forecast the journey ahead.
Growth curves in key markets
All of the key markets that Rua Bioscience is focused on are undergoing significant growth. Each market records data according to their own regulations, however all available data suggests very large growth in uptake of legal medicinal cannabis.
Growth will continue as patients move to the legal framework
The data reveals a striking disparity between the number of cannabis consumers operating in illicit markets and the estimated numbre of legal medicinal cannabis patients across key markets. This gap underscores a substantial untapped population willing to engage within a regulated, legal framework - if barriers are addressed effectively.
Several critical factors contribute to this dynamic:
Cost and subsidisation: The price point of legal medicinal cannabis remains a significant barrier. Without subsidies, many patients opt for cheaper, illicit sources, prioritizing affordability over legality.
Stigma and healthcare interaction: The cultural and social stigma attached to discussing cannabis use with healthcare professionals deters many from seeking a legal diagnosis or prescription. Fear of judgment or misunderstanding keeps patients isolated from the medical system.
Doctor education: A pervasive lack of training and education among doctors regarding medicinal cannabis leads to hesitancy in prescribing and advising patients. This knowledge gap fosters patient mistrust and clinician reluctance.
Accessibility: The convenience and immediate availability of black-market cannabis starkly contrast with legal supply chains that may involve lengthy processes, limiting patients’ willingness to navigate complex regulatory environments.
Sources
Cannabis use in Australia
Australian Criminal Intelligence Commission (ACIC). (2021). National Wastewater Drug Monitoring Program: Report 12. Canberra, ACT: Australian Criminal Intelligence Commission. https://www.acic.gov.au/publications/national-wastewater-drug-monitoring-program
Australian Institute of Criminology (AIC). (n.d.). Research on Drug Law Enforcement. Canberra, ACT: Australian Institute of Criminology. https://www.aic.gov.au
Australian Institute of Health and Welfare (AIHW). (2020). National Drug Strategy Household Survey 2019. Canberra, ACT: AIHW. https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019
Australian Institute of Health and Welfare (AIHW). (2023). National Drug Strategy Household Survey 2022: Key Findings. Canberra, ACT: AIHW. https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2022
National Drug and Alcohol Research Centre (NDARC). (2016). Quantifying the Social Costs of Cannabis Use to Australia in 2015–16 (Whetton, S., Tait, R. J., Chrzanowska, A., Donnelly, N., McEntee, A., & Puljevic, C.). Sydney, NSW: NDARC, University of New South Wales. https://ndarc.med.unsw.edu.au/resource/quantifying-social-costs-cannabis-use-australia-201516
Penington Institute. (n.d.). Policy Briefs and Research Reports. Melbourne, VIC: Penington Institute. https://www.penington.org.au
Therapeutic Goods Administration (TGA). (n.d.). Medicinal Cannabis Information & Special Access Scheme. Canberra, ACT: Australian Government, Department of Health and Aged Care. https://www.tga.gov.au/medicinal-cannabis
Victorian Inquiry into Cannabis Use. (2021–2022). Legal and Social Issues Committee (Legislative Council) – Inquiry Documents & Submissions. Parliament of Victoria. https://www.parliament.vic.gov.au/lsic-lc/article/4309
Victorian Parliamentary Budget Office (PBO). (n.d.). Costing and Revenue Estimates – Cannabis-Related Publications. Melbourne, VIC: PBO. https://www.pbo.vic.gov.au/
Cannabis use in New Zealand
Ministry of Health, New Zealand. (2015). Cannabis Use 2012/13: New Zealand Health Survey. Retrieved from https://www.health.govt.nz/system/files/2015-05/cannabis-use-2012-13-nzhs-may15-v2.pdf
New Zealand Herald. (2023). The regions, age groups, and ethnicities using the most medicinal cannabis. Retrieved from https://www.nzherald.co.nz/nz/the-regions-age-groups-and-ethnicities-using-the-most-medicinal-cannabis/LNG7NHEDI5GYJMG6SCER7B3HKQ
New Zealand Drug Foundation. (2022). More than 250,000 Kiwis still accessing medicinal cannabis through the black market. Retrieved from https://drugfoundation.org.nz/articles/more-than-250000-kiwis-still-accessing-medicinal-cannabis-through-black-market.
Minstry of Health, New Zealand. Data on the supply of unapproved medicinal cannabis products in New Zealand https://www.health.govt.nz/regulation-legislation/medicinal-cannabis/information-for-industry/data-on-the-supply-of-unapproved-medicinal-cannabis-products
Cannabis use in the UK
Office for National Statistics (ONS). (2022). Drug misuse in England and Wales: year ending June 2022. https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice
Snowdon, C. (Institute of Economic Affairs). (2018). Joint Venture: Estimating the Size and Potential of the UK Cannabis Market. https://iea.org.uk/publications/joint-venture
Prohibition Partners. (2022). The European Cannabis Report (7th Edition). https://prohibitionpartners.com/reports
Parliamentary Office of Science and Technology (POST). (2019). POSTnote 593: Medical Cannabis. https://researchbriefings.files.parliament.uk/documents/POST-PN-0593/POST-PN-0593.pdf
NHS England / NHS Digital. (Various years). Freedom of Information (FOI) Data on Medical Cannabis Prescriptions. https://digital.nhs.uk/
House of Commons Library. (2020). Medical use of cannabis. Research Briefing [CBP 8357]. https://commonslibrary.parliament.uk/research-briefings/cbp-8357/
Cannabis use in Germany
GKV-Spitzenverband. (2023). Statutory health insurance reports on reimbursement of cannabis-based medicines (2022–2023). https://www.gkv-spitzenverband.de/english/english.jsp
Prohibition Partners. (2023). The European Cannabis Report: 8th Edition (Q2 2023). https://prohibitionpartners.com/reports
German Pharmacists Association (ABDA). (2022). Data & Statistics on Dispensed Prescriptions (including Cannabis). https://www.abda.de/en
Deutsches Arzneiprüfungsinstitut (DAPI). (2022). Prescription Monitoring and Reimbursement Data. https://www.dapi.de
Bundesverband Cannabiswirtschaft (BvCW). (2023). Press Releases and Market Analyses on Medical Cannabis in Germany. https://cannabiswirtschaft.de
Bundeskriminalamt (BKA). (2023). Jahresbericht Rauschgiftkriminalität [Annual Drug Crime Report]. https://www.bka.de/DE/AktuelleInformationen/StatistikenLagebilder/Rauschgift/rauschgift_node.html
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). (2021). Germany Country Drug Report 2021. https://www.emcdda.europa.eu/publications/country-drug-reports/2021/germany_en
Epidemiological Survey of Substance Abuse (ESA). (2021). Consumption of Psychoactive Substances in Germany: Key Findings. Conducted by the IFT Institute for Therapy Research. https://www.ift.de/en/home/
Deutscher Hanfverband (DHV). (2019–2022). Estimates of the German Cannabis Market (Illicit and Legal). https://hanfverband.de
University of Bremen, Centre for Social Policy Research (ZeS). (2020). Research Publications on Drug Policy and Cannabis Consumption. https://www.uni-bremen.de/en/zes
Institute for Therapy Research (IFT), Munich. (2022). Surveys and Studies on Substance Abuse (Cannabis Section). https://www.ift.de/en/home/
New Frontier Data. (2022). Global Cannabis Market: Focus on Europe. https://newfrontierdata.com
Cannabis use in the USA and Canada
National Conference of State Legislatures (NCSL) https://ncsl.org
Marijuana Policy Project (MPP) https://mpp.org/states
Grandview Research https://www.grandviewresearch.com/industry-analysis/us-cannabis-market