Regulation
Why Legal Medical Cannabis Does Not Guarantee Access
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Brazil and Colombia have both opened legal routes to medical cannabis. They have also shown why changing the law is only the beginning. A patient needs a prescription, an available product, and a way to pay. A grower needs authorization, production capacity, and someone willing to buy the harvest. Legal permission connects these steps only when the surrounding system works.
A new study, “Selective legalization: How medical cannabis regulation constitutes markets in Brazil and Colombia,” examines how those systems developed.1 Published in the International Journal of Drug Policy, it compares reforms from 2014 through August 1, 2026, showing how countries pursuing medical access authorized different activities in different sequences.
The practical opportunity is substantial. Understanding where permission stops and participation begins gives policymakers a clearer target: build rules that help patients obtain treatment and allow qualified producers to operate sustainably.
How Medical Cannabis Rules Shape the Market
Author Paulo José dos Reis Pereira calls the process “selective legalization.” Governments recognize certain uses, products, and activities while leaving others prohibited or more narrowly permitted.
That distinction matters because cannabis is not a single commercial activity. Growing plants, extracting cannabinoids, manufacturing medicines, importing products, and dispensing prescriptions involve separate permissions. Opening one part of the chain does not automatically open the others.
The study uses document analysis and a structured comparison of the two countries. It examines authorized activities, participation routes, required resources, and connections to international markets. It does not measure whether a particular reform caused lower prices or better health outcomes.
Its central lesson is nevertheless concrete: the order in which governments authorize activities helps shape the businesses and access routes that develop around them.
Colombia Built Production Before Broadening Patient Options
Colombia established relatively early routes for cultivation, processing, and foreign trade. That gave businesses opportunities to develop production infrastructure and pursue overseas buyers. Domestic patient access followed pharmaceutical and health-regulatory requirements.
The study reports that approximately 76% of cannabis received for manufacturing derivatives between 2017 and July 2025 was declared as intended for export. That figure describes its intended destination, not the quantity ultimately shipped overseas.
Similarly, administrative records showed 1,342 licenses classified as active, extended, or renewed in June 2026, held by 877 individuals or organizations after the researcher standardized holder names. Those records did not establish how many license holders were producing or selling.
For readers following Colombia’s medical cannabis framework, the distinction is essential. A country can authorize substantial cultivation capacity while still developing the channels through which domestic patients obtain products.
Colombia’s 2025 recognition of cannabis flower as a finished medicinal product widened the legal possibilities. However, the paper could not assess the effects of implementation on patient access or smaller growers.
Brazil Expanded Access Through Imports and Pharmacies
Brazil followed a different sequence. Individual imports and pharmacy products expanded while general administrative authorization for domestic cultivation remained unavailable during much of the period examined.
Under the earlier pharmacy framework, businesses could manufacture authorized products in Brazil but depended on imported cannabis-derived inputs. Patients and associations also pursued court protection for domestic cultivation, creating additional access routes with different requirements and degrees of legal certainty.
The scale of administrative activity was considerable. Anvisa, Brazil’s health regulator, granted more than 600,000 import authorizations between 2015 and 2025, including over 190,000 in 2025. These were not necessarily distinct patients or completed purchases.
As MyCannabis explains in its updated guide to Brazil’s cannabis laws, medical access involves different regulatory categories. An exceptional personal import and a product authorized for pharmacy sale should not be treated as interchangeable approvals.
Brazil’s associations also matter to the economic picture. The study describes organizations that combined production with care networks, medical support, and legal assistance. Evaluating their role solely by product volume would miss some of the services supporting access.
What the Study Establishes About Cannabis Access
The comparison below draws entirely from the paper and reflects its study period, rather than a complete account of subsequent implementation.
| Dimension | Colombia | Brazil |
|---|---|---|
| Regulatory sequence | Early authorization of cultivation, processing, and foreign trade | Expansion of individual imports and pharmacy products before general cultivation rules took effect |
| International connection | Production linked to foreign markets and firms | Administrative access routes relied on foreign products or inputs |
| Participation requirements | Capital, infrastructure, compliance, and access to buyers | Purchasing resources, regulatory compliance, or judicial protection, depending on the route |
| Evidence limitation | Licenses did not establish actual production or sales | Import authorizations did not establish unique patients or purchases |
Brazil’s August Reforms Change the Starting Point
The paper’s August 1 cutoff is important. Brazil’s principal cultivation resolutions took effect on August 4, 2026. Its historical finding about the absence of an operative general cultivation route should therefore not be presented as the country’s unchanged position today.
Anvisa’s subsequent cultivation implementation guidance explains the requirements for legal entities undertaking authorized medicinal, pharmaceutical, and research activities. Cultivation requires prior Special Authorization and compliance with other applicable requirements. The medicinal production framework covers varieties containing no more than 0.3% THC.
Separately, Anvisa’s updated cannabis product guidance addresses the manufacturing and import framework that took effect in May.
These changes create opportunities for a more developed domestic supply chain. Whether they deliver lower costs, dependable supply, or broader participation requires operating evidence that the study does not provide.
Why Small Growers Need More Than a License
A hypothetical small producer illustrates the gap. Receiving a cultivation license may resolve the first legal obstacle. The business still needs financing, testing, suitable facilities, processing arrangements, and a buyer. If those pieces arrive at different times, authorization can generate expenses before it generates revenue.
This suggests a practical policy question beyond license counts: are support measures aligned with the stage at which producers actually get stuck?
Shared testing services, clearer application guidance, and credible purchasing arrangements are possibilities worth evaluating. Their value would depend on whether they reduce costs without weakening product standards. The paper does not test these interventions, but its distinction between permission and participation explains why they deserve attention.
Colombia’s government acknowledged implementation challenges in its March 2026 update on small-grower participation in northern Cauca. Officials described dialogue and proposed regulatory adjustments intended to support smaller producers and their transition into regulated markets. That documents an implementation effort, not proof that inclusion has already been achieved.
Measure the Patient’s Whole Access Journey
The same logic applies to patients. A product’s listed price is only one component of access. Consultations, administrative steps, delivery, travel, and repeat prescriptions can also require money and time.
A useful extension of the study would therefore measure the entire journey from seeking treatment to obtaining a repeat supply. Two systems might offer similarly priced products while imposing very different practical burdens.
Continuity deserves particular attention. A first purchase shows that access happened once. Reliable repeat dispensing provides stronger evidence that a route can support ongoing care. Neither establishes clinical effectiveness, which requires separate evidence.
Domestic production could help diversify supply, but local cultivation alone cannot guarantee affordability. Processing, testing, distribution, and commercial margins still influence the final price. Imports can also contribute useful options. The policy objective should be dependable, quality-controlled access, with evidence showing which arrangements deliver it.
Three Developments to Watch in Medical Cannabis Reform
The study gives regulators, businesses, and patient organizations a more useful scorecard than simply counting new permissions. Three developments will show whether the next phase is working:
- Whether new cultivation authorizations become sustained production and completed sales, including for smaller growers.
- Whether patients obtain reliable repeat supplies with manageable total costs and fewer administrative delays.
- Whether public reporting distinguishes licenses, purchases, unique patients, and actual production.
Brazil and Colombia demonstrate that medical cannabis reform can keep improving after its first legal breakthrough. The next advance will be easier to recognize when governments measure what people can actually obtain and accomplish through the systems they create.
References:
1 Pereira, P. J. dos R. (2026). Selective legalization: How medical cannabis regulation constitutes markets in Brazil and Colombia. International Journal of Drug Policy, 158, 105574. https://doi.org/10.1016/j.drugpo.2026.105574
