Medicalization without legalization: the European policy for medical and recreational cannabis use

Abstract Aim Cannabis, unlike other illicit drugs, possesses medical properties. This unique characteristic necessitates a distinction between its clinical and legal status, prompting an inquiry into the nature of the relationship between these two dimensions. Countries are adopting one of three clinical policies regarding medical use (opposition, pharmaceuticalization, and medicalization) and one of three legal regimes regarding recreational use (prohibition, decriminalization, and legalization). This study examines the correlation between the clinical policy and the legal regime for cannabis in European countries. Subject and methods We used data from 39 European countries to classify every country’s clinical policy and legal regime. Then, we employed chi-squared and Spearman correlation tests to assess the relationships between the clinical and legal dimensions. Results The chi-squared test results indicate a strong and statistically significant relationship between the clinical policy for cannabis and the legal regime for recreational cannabis ( p < 0.01). Spearman correlation test results also reveal a positive, strong, and significant relationship ( p < 0.001). We found that medicalization as a clinical policy is associated with decriminalization as a legal regime (68% of medicalization countries decriminalize recreational use). Conclusion This study proposes a novel perspective that separates the concepts of medicalization and legalization, challenging previous assumptions about their interconnectedness. We argue that medicalization and decriminalization of cannabis are closely associated, likely because decriminalization facilitates patient access and fosters a medical cannabis market while avoiding the extremes of prohibition or full-scale legalization. These findings contribute to a more nuanced understanding of cannabis policy development in Europe and suggest that policymakers should consider the complex interplay between clinical and legal approaches when formulating cannabis policies. This research provides valuable insights for future policy discussions and highlights the need for further investigation into the long-term implications of these policy choices.