Portugal’s Medical Weed Leaves by the Ton

Filed Under: Exported Access

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Portugal ships medical cannabis at industrial scale. At home, strict prescribing rules and unreimbursed preparations can push lawful treatment beyond a patient’s budget.

Portugal exported 66,305 kilograms of cannabis for medicinal purposes in the first half of 2026, according to INFARMED’s first-half activity report. The total already represented about 83 percent of the 79,883 kilograms reported for all of 2025.

Inside Portugal, INFARMED recorded 5,413 domestic prescriptions for authorized cannabis preparations and substances during the same six months.

Portugal has built a medical cannabis export sector measured in tens of thousands of kilograms. Domestic access still depends on strict prescribing rules, limited indications and, for the unreimbursed preparations described by OPCM, the patient’s ability to pay.

The export boom is official, not industry fog. INFARMED, Portugal’s National Authority of Medicines and Health Products, regulates cannabis activity for medicinal purposes. Germany was the largest reported destination at 37,442 kilograms during the first half of 2026. Spain received 11,386 kilograms, followed by Denmark at 8,968.

Those destinations need careful reading. INFARMED tracks export destinations, not final patient use. The report also says some European Union exports are partly associated with manufacturing operations involving raw materials. A kilogram shipped to Germany, Spain, or Denmark does not automatically prove where a finished product was consumed.

Portugal exported 9,271 kilograms in 2022, 11,973 kilograms in 2023, 31,188 kilograms in 2024, and 79,883 kilograms in 2025. The jump from 2024 to 2025 alone was roughly 156 percent. Six months of 2026 nearly matched the prior full year. Annualizing the first-half pace would put Portugal above 132 metric tons for 2026. That calculation illustrates the export surge but is not an official forecast.

INFARMED describes the shift in its own words:

“fase de escala industrial e de expansão internacional”

PCM translation: “a phase of industrial scale and international expansion.”

Portugal’s regulator traces the medical cannabis framework partly to commercial interest. INFARMED says the regulatory process followed interest expressed by international companies seeking to establish cultivation and manufacturing operations in Portugal during 2016 and 2017. The later licensing system covered cultivation, manufacturing, wholesale trade, transport, circulation, import and export. Economic relevance and export impact were part of the official review structure.

Portugal built the framework in stages. Law No. 33/2018 established Portugal’s specific medical cannabis framework in 2018, Decree-Law No. 8/2019 implemented the system, and Portaria No. 83/2021 established authorization requirements for cultivation, manufacturing, wholesale trade, transportation, circulation, import and export. By 2026, INFARMED could describe the commercial system through detailed licensing and export tables.

Portugal has built substantial regulatory infrastructure around medical cannabis exports. The 2026 report describes product-quality rules, site security, traceability and customer qualification. It also describes coordination among health, police, agriculture, economic and local authorities. INFARMED can show how cannabis moves through licensed business channels with unusual detail. The domestic patient table is much thinner.

Recorded prescriptions have increased sharply since 2021. INFARMED reported 460 prescriptions for authorized cannabis preparations and substances in 2021, 929 in 2022, 1,157 in 2023, 4,143 in 2024, 7,023 in 2025, and 5,413 in the first half of 2026. The acceleration is recent, and the table counts prescriptions, not unique patients. One patient may receive more than one prescription.

INFARMED does not report how many unique patients received cannabis or whether prescriptions were filled without delay. Its tables also omit treatment interruptions linked to cost, shortages, or prescribing difficulties.

By the end of the first half of 2026, INFARMED listed 16 cannabis preparations and substances with market authorization. The same report listed zero new authorizations during those six months. The holders named were Ferraz Lynce, Portocanna, SOMAÍ Pharmaceuticals and Tilray Portugal.

That figure of 16 market authorizations cannot be read as proof of 16 products sitting in pharmacies. In March 2025, OPCM discussed nine cannabis preparations then sold through community pharmacies. The later INFARMED report lists authorizations, not confirmed pharmacy stock, and it does not identify which authorized products had entered commercial supply or remained available to patients at midyear.

INFARMED’s public guidance explains the gap between authorization and real-world access. After authorization, holders must communicate the start of commercialization through the regulator’s SiATS portal. Holders must also report supply interruptions to INFARMED, according to INFARMED’s medical cannabis guidance. A product can be authorized before commercial sales begin, and supply can stop after it starts.

In a March 2025 Sábado interview republished by the Portuguese Observatory of Medicinal Cannabis, OPCM president Carla Dias said the nine cannabis preparations then sold through community pharmacies received no public reimbursement. She said private insurance also failed to cover them.

The Sábado headline stated the patient consequence plainly:

“Os doentes interrompem o tratamento porque é caro. Mas não têm outra opção.”

PCM translation: “Patients interrupt treatment because it is expensive, but they have no other option.”

Dias gave prices. She said vaporized flower preparations cost about 150 euros, and a patient using 1 gram per day would have enough for 15 days. Based on those figures, two 15-day flower supplies would cost about 300 euros per month, after an upfront vaporizer expense of roughly 300 euros. Oral preparations, depending on product and dose, ran around 90 euros per bottle.

At that dosage, flower alone would cost approximately 3,600 euros over a year, before the vaporizer. That is a calculation based on Dias’s example, not a national average.

OPCM described patients rationing doses, discontinuing treatment after experiencing relief and returning to conventional medicines that had already failed them. Price is not a side note when the lawful route sends patients back to treatments they had already exhausted.

Dias described a patient with a rare disease, chronic pain, severe muscle rigidity and rheumatological crises that sometimes left him unable to write. Cannabis eased his symptoms, but the cost repeatedly threatened the treatment. The same case exposed the prescribing barrier: Dias said she had to help the patient’s doctor write the first prescription because the physician lacked adequate training.

OPCM was also conducting its own patient survey because Portugal lacked a reliable national count. That gap remained visible in INFARMED’s 2026 report, which counted prescriptions and authorizations without identifying individual patients or measuring whether they could continue treatment.

The interview distinguished cannabis preparations from authorized cannabis-based medicines. Dias identified Sativex, classified as a cannabis-based medicine rather than one of the nine preparations, as reimbursed. Epidiolex required INFARMED authorization and hospital-pharmacy dispensing.

Dias said extending Sativex’s 37 percent reimbursement rate to cannabis preparations would give patients meaningful help. She argued that their third-line status blocked stronger reimbursement even though patients reach cannabis only after conventional medicines have failed or caused unacceptable side effects. The law makes people exhaust other options, then leaves the remaining treatment financially exposed.

Portugal’s patient-access problem exists inside the medical cannabis law, not because lawmakers failed to create one.

Portugal’s Law No. 33/2018, published on July 18, 2018, created the framework for medicines, preparations, and substances derived from the cannabis plant for medicinal purposes. It covers prescription, pharmacy dispensing, possession, and transport by the patient. It did not create adult-use legalization or a broad retail market.

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Portugal limits prescriptions to cases in which conventional authorized medicines have failed or caused significant adverse effects. The law also requires a special medical prescription. Pharmacies may dispense the products only after receiving that prescription and verifying the buyer’s identity.

INFARMED’s public guidance follows the same controlled route. INFARMED permits doctors to prescribe cannabis medicines, preparations and substances only after evaluating the patient and confirming an approved therapeutic indication. INFARMED restricts sales to pharmacies and requires a medical prescription.

INFARMED’s 2019 list covers spasticity associated with multiple sclerosis or spinal-cord injury, as well as nausea and vomiting caused by chemotherapy, radiotherapy or combination HIV/hepatitis C treatment. Qualifying uses also include appetite stimulation in palliative oncology or AIDS care; certain chronic pain; Tourette syndrome; treatment-resistant epilepsy; severe childhood seizure disorders; and treatment-resistant glaucoma.

A patient outside that frame may live in one of Europe’s major medical cannabis export countries and still find no ordinary legal route to a prescription.

The framework protects patients through medical supervision and traceable products, but it also restricts access by condition, prescription, and pharmacy availability. For unreimbursed preparations, the patient’s wallet becomes another gatekeeper.

The report details the industrial permissions. INFARMED reported 43 authorized entities in the first half of 2026, down from 49 in 2025, but that figure does not mean every operator held identical permissions. The categories overlap. The report lists 27 cultivation authorizations, 24 manufacturing authorizations, 38 import-export authorizations, and 15 wholesale-distribution authorizations.

The operator base narrowed while export volume surged. Cultivation authorizations fell from 38 in 2025 to 27 as of June 2, 2026. Manufacturing authorizations fell from 28 to 24. Import-export authorizations fell from 49 to 38, while wholesale-distribution authorizations fell from 16 to 15. INFARMED does not explain why the authorization counts declined, leaving no basis to attribute the change to enforcement alone.

INFARMED reported 32 inspections of cultivation and manufacturing activity in the first half of 2026, after 57 inspections in 2025 and 38 in 2024. The first-half total included 27 cultivation inspections and five manufacturing inspections. The regulator said supervision covers traceability, reliable records and proper qualification of customers and suppliers.

INFARMED warned that transactions without adequate scrutiny of counterparties can seriously violate legal obligations tied to controlled substances. The agency also said it strengthened procedures in 2025 and 2026. Those measures included suspending, revoking, and declining to renew authorizations when operators failed to meet legal requirements.

INFARMED tightly supervises the export industry, which makes the narrow domestic channel harder to dismiss as a question of regulatory capacity. Portugal tracks cannabis material, inspects operators, and authorizes exports large enough to supply major European markets. Portugal’s regulatory capacity works at industrial scale for exporters while domestic access remains narrow.

The Sábado interview documented treatment costs and described at least one physician who needed help writing a cannabis prescription. Dias blamed the difficulty on inadequate physician training.

Her explanation was direct:

“Os nossos médicos já deviam ter formação para o fazer mas, como ninguém a faz, nós fizemos um bocadinho esse papel.”

PCM translation: “Our doctors should already have training to do it, but because nobody provides it, we ended up doing a little bit of that role.”

The legal route depends on a doctor who knows how to prescribe, a pharmacy that can supply the product, and a patient who can keep paying. When any piece fails, medical cannabis exists in law but not in the life of the person who needs it.

Portugal’s growing prescription count cannot erase the evidence that high prices interrupt treatment or that some physicians still need help navigating the prescribing process. Portugal built serious export infrastructure inside a functioning legal framework, yet domestic patients still encounter a system far narrower than the tonnage suggests.

Portugal built its medical cannabis program around pharmaceutical control. INFARMED says the framework aims to make cannabis-based medicines, preparations and substances available while ensuring quality, safety and misuse prevention. Patients need products with verified quality, consistent labeling and traceable supply.

Strict control can protect patients from inconsistent products, weak labeling, and supply chains that no medical authority can inspect. It can also leave qualified patients inside a system where the legal product is approved, prescribed, and still too expensive to continue. Portugal has proven it can supervise cannabis as an export commodity, with a regulator overseeing cultivation, manufacturing, import, export, and wholesale distribution. Domestic access has not developed with the same force.

By midyear, recorded domestic prescriptions had reached roughly 77 percent of the 2025 total. The public table does not explain whether the increase came from new patients, repeat prescriptions, improved availability, or changing physician behavior.

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Portugal also had 16 authorized cannabis preparations and substances at midyear, no new authorizations in the first half, and domestic use limited to approved therapeutic indications. OPCM described high costs, unreimbursed preparations, and patients abandoning treatment because they could no longer afford it.

Portugal gave exporters an industrial system while domestic patients entered a medical bottleneck shaped by narrow indications, pharmacy availability, and unreimbursed costs.

Exports are not the offense, and a kilogram shipped abroad is not automatically denied to a Portuguese patient. The failure lies in building industrial scale for foreign commerce while qualified patients abandon treatment because they cannot afford to continue it.

Portugal’s records expose the imbalance. Export reports identify destination countries and kilogram totals while tracking license categories and inspections. Domestic tables stop at prescription transactions. The regulator counts cultivation inspections but not cost-driven treatment interruptions. Portugal knows how much cannabis leaves and where it is shipped, but not how many patients stayed in treatment.

In six months, Portugal recorded 66,305 kilograms of medicinal cannabis exports and 5,413 domestic prescriptions for authorized cannabis preparations and substances. Kilograms and prescriptions cannot produce a patient-access rate, but they expose where Portugal achieved scale first: the country built a cannabis system whose widest path leads abroad.

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