The Rise of Medical Marijuana: Health Benefits and Changing Societal Attitudes

Just two decades ago, Indian hemp was associated in Poland solely with criminal law. Today, the same raw material, in the form of pharmaceutical flower, oil, or ready-made preparations, is kept in pharmacy safes under Rpw prescriptions. According to the report National Academies of Sciences, Engineering, and Medicine from 2017, for three clinical indications there is "decisive or substantive" evidence of the effectiveness of cannabinoids. This article explains why medical marijuana is gaining popularity, what the patient journey looks like in Poland in 2026, and what contemporary science says about it. What is medical marijuana – a guide to clinical indications

What exactly is medical marijuana?

Medical marijuana is a pharmaceutical flower or extract from Cannabis sativa L. with controlled THC and CBD content, dispensed by prescription. According to the definition adopted in the report NASEM (2017), the category includes over 100 cannabinoids and synthetic preparations. The key difference from recreational cannabis: standardization, GMP control, and physician oversight.

THC, CBD, and other cannabinoids

Over 100 cannabinoids have been identified in the plant, but two are clinically the most important. THC (delta-9-tetrahydrocannabinol) is responsible for psychoactive and analgesic effects. CBD (cannabidiol) does not produce a "high" but exhibits anticonvulsant, anxiolytic, and anti-inflammatory effects. Both molecules interact in the so-called entourage effect (entourage effect).

Dried flower, oil, extract – pharmaceutical forms

In Polish pharmacies, patients encounter three main forms: flower for vaporization (e.g., Aurora, Bedrocan, Tilray), oil from extract with standardized THC/CBD concentration, and registered medications (Sativex, Epidiolex). Each form has a different pharmacokinetic profile: vaporization takes effect after 5-15 minutes, oil after 30-90 minutes, but with a longer effect.

According to the report NASEM (2017) "The Health Effects of Cannabis and Cannabinoids", the plant Cannabis sativa contains over 100 cannabinoids, of which THC and CBD have the best-documented pharmacological effects. Standardization of the content of these two compounds is the basis of the pharmacy of medical marijuana.

What has been the history of medical marijuana legalization?

The first breakthrough was California in 1996, when Proposition 215 legalized the use of cannabis for medical purposes. Other milestones include Germany (March 2017), Poland (November 1, 2017), and Canada, which additionally legalized recreational use in 2018. Over 30 years, more than 50 jurisdictions worldwide have changed their laws.

California 1996: Proposition 215

The result of the referendum in California (55.6% in favor) opened the first legal path for cancer patients and people with AIDS. The state initiative preceded federal law in the U.S. by a quarter of a century. By 2024, medical cannabis was legal in 38 U.S. states. However, the federal classification of cannabis as Schedule I is still a subject of disputes.

Germany 2017 and the Polish amendment

March 2017 brought the German law "Cannabis als Medizin", which includes reimbursement for the NFZ equivalent for selected indications. In Poland, the Sejm passed an amendment to the Act on Counteracting Drug Addiction on July 7, 2017, and the regulations came into force on November 1, 2017. The first Rpw prescription was filled in January 2019, after the raw material was supplied by a producer from Canada.

Canada 2018: a step further

The Canadian Cannabis Act of October 2018 legalized cannabis not only for medical but also for recreational use. It is one of the largest regulatory experiments of the 21st century. Government statistics show that the percentage of adult Canadians using cannabis increased from 14% in 2018 to about 27% in 2023, without the catastrophic health effects predicted before the reform.

How many patients in Poland use medical marijuana?

The Polish medical marijuana market is growing exponentially. Available data indicates that the number of filled Rpw prescriptions for cannabis raw material increased from several thousand in 2019 to over 600,000 in 2023. According to industry reports monitoring the P1 system ZSMOPL, over 8 tons of pharmaceutical flower were issued in Poland in 2024.

Dynamics 2019-2025: a jump of two orders of magnitude

The first full year of distribution (2019) brought several hundred filled prescriptions. In 2020, this number exceeded 60,000, and in 2022 already 280,000. Data reported by industry services (Konopia Press, Cannabis News) indicate that in 2024, the Rpw prescription for cannabis was among the 25 most frequently issued prescriptions in Polish healthcare.

Who is the typical Polish patient?

Analysis of inquiries directed to Polish pharmacies specializing in filling Rpw prescriptions shows that two groups dominate: patients aged 35-55 with chronic pain (sciatica, fibromyalgia, neuropathies) and individuals aged 60+ undergoing oncology treatment. The third group consists of parents of children with drug-resistant epilepsy seeking complementary therapy.

The Polish medical marijuana market has increased by about two orders of magnitude between 2019 and 2024, from several hundred filled Rpw prescriptions annually to over 600,000. The year 2024 marked the import of over 8 tons of pharmaceutical hemp flower, according to industry data monitoring the P1 ZSMOPL system.

What are the main medical indications?

The strongest scientific evidence points to three therapeutic areas. According to the report NASEM (2017) there is conclusive evidence for the effectiveness of cannabinoids in treating chronic pain in adults, chemotherapy-induced nausea, and spasticity in multiple sclerosis. Other indications have weaker evidence bases, although a growing clinical foundation.

Chronic pain – the broadest application

Dr. Kevin Hill in a review published in JAMA (Hill, 2015) indicates that there is "moderate evidence" for the effectiveness of cannabis in treating neuropathic pain. Meta-analysis Whiting et al. (2015) involving 28 studies and 2454 patients showed that cannabis reduces pain intensity by ≥30% in 37% of patients compared to 31% in the placebo group.

Nausea after chemotherapy and cachexia

Nabilone (Cesamet) and dronabinol (Marinol) are synthetic cannabinoids registered in the U.S. as early as the 1980s for treating chemotherapy-induced nausea. According to Whiting et al. (2015), cannabinoids are also effective in treating weight loss in patients with HIV/AIDS. Dronabinol remains one of the few FDA-approved drugs for this indication.

Drug-resistant epilepsy – the breakthrough of Epidiolex

Study Devinsky et al. (2017) published in the "New England Journal of Medicine" showed that Epidiolex (pure CBD) reduced the frequency of seizures in children with Dravet syndrome from 12.4 to 5.9 per month (median reduction of 38.9% compared to 13.3% in the placebo group, p=0.01). The FDA registered the drug in 2018.

Multiple sclerosis – Sativex

Sativex (nabiximols), a sublingual spray containing THC and CBD in a 1:1 ratio, has been registered in the EU, among other things, for treating spasticity in MS. Clinical studies have shown that about 40% of patients achieve clinically significant reduction in spasticity when standard antispastic medications fail.

PTSD and anxiety disorders

This is an area with the weakest but growing evidence. The report NASEM (2017) classifies the evidence as "limited". However, Israeli and American programs for veterans provide increasingly more clinical observations. In 2024, the FDA approved a phase III study on MDMA + psychotherapy, thus opening the discussion on a broader approach to PTSD pharmacotherapy.

The report NASEM (2017) identifies three indications with the strongest evidence: chronic pain in adults, chemotherapy-induced nausea, and spasticity in multiple sclerosis. The meta-analysis Whiting et al. (2015) included 28 randomized controlled trials involving 2454 patients.

What is the endocannabinoid system?

The endocannabinoid system (ECS) is an internal network of receptors and lipid mediators, discovered in the 1990s by Raphael Mechoulam's team. It consists of two main receptors (CB1 and CB2), endogenous cannabinoids (anandamide, 2-AG), and enzymes. The ECS regulates pain, sleep, appetite, mood, and immune response. This is why cannabis exhibits such a wide range of effects.

CB1 and CB2 receptors – two pillars of pharmacology

CB1 receptors dominate in the brain (cortex, hippocampus, cerebellum), responsible for the psychoactivity of THC and its impact on memory and coordination. CB2 receptors are mainly found in immune system cells (B lymphocytes, macrophages). Hence, the anti-inflammatory action of CBD, which modulates signaling on CB2 without producing a psychoactive effect.

Anandamide and 2-AG – "endogenous cannabis";

Anandamide (from the Sanskrit „ananda” – bliss) and 2-arachidonoylglycerol are endogenous ligands of the ECS. The body produces them in response to pain, stress, and physical exertion (the so-called „runner’s high” is associated with anandamide, not just endorphins). A deficiency in endocannabinoid tone (CECD - Clinical Endocannabinoid Deficiency) is a hypothesis explaining, among other things, fibromyalgia and migraines.

The fact that the ECS was discovered only by studying the mechanism of THC action, and not the other way around, illustrates the paradox of cannabis pharmacology. Tens of thousands of years of traditional use preceded scientific understanding. The "drug" was "found" before the receptor, and the plant helped discover a fundamental regulatory system of mammals.

What cannabis-based medications are registered?

Four cannabinoid molecules have the status of registered drugs by the FDA, EMA, or in national jurisdictions. These are: nabilone (Cesamet, 1985), dronabinol (Marinol, 1985), nabiximols (Sativex, 2010 in the EU), and pharmaceutical cannabidiol (Epidiolex, 2018). Each has undergone a full registration path with phase III clinical trials.

Cesamet and Marinol – oncology classics

Nabilone (synthetic THC analog) and dronabinol (synthetic THC in sesame oil capsules) were registered by the FDA in 1985 for treating chemotherapy-induced nausea resistant to standard antiemetic medications. Marinol later received an indication for anorexia in AIDS patients. Dosing starts at 2.5 mg twice daily.

Sativex – the first „true” cannabis medicine in the EU

Sativex (GW Pharmaceuticals) is the first preparation containing standardized cannabis extract (THC and CBD in a 1:1 ratio) registered in the UK in 2010, and subsequently in other EU countries and Poland. Indication: symptomatic treatment of spasticity in adult patients with multiple sclerosis when other medications have failed. Form: sublingual spray.

Epidiolex – a breakthrough for childhood epilepsy

Epidiolex (pharmaceutical cannabidiol in oil solution) was registered by the FDA in June 2018 for treating epilepsy in Dravet and Lennox-Gastaut syndromes in patients aged ≥2 years. The EMA approved it in 2019 (as Epidyolex). The drug is an example of how an isolated cannabinoid goes through the normal registration path on par with other modern therapies.

What does the NASEM 2017 report say about health benefits?

The report „The Health Effects of Cannabis and Cannabinoids” (NASEM, 2017) is the most comprehensive review of the scientific literature, based on over 10,000 publications. The committee classified the evidence into five categories: conclusive/substantive, moderate, limited, insufficient, and none. Only three indications received the highest category.

Evidence „conclusive or substantive”

The NASEM committee identified three areas with the strongest evidence base: treatment of chronic pain in adults, chemotherapy-induced nausea (mainly oral synthetic cannabinoids), and spasticity in patients with multiple sclerosis (patient self-assessment). For these indications, cannabinoids were deemed „effective or probably effective”.

Evidence „moderate”

In this category, NASEM placed the effectiveness of cannabinoids in treating sleep disorders in patients with chronic pain, fibromyalgia, and MS. Moderate-quality evidence also pertains to short-term improvement of objectively measured symptoms of multiple sclerosis. For other indications (anxiety, PTSD, glaucoma, Tourette’s syndrome), the evidence is limited or insufficient.

Risks and side effects

The report also clearly indicates risks: increased risk of traffic accidents while under the influence of THC, risk of developing psychotic disorders in genetically predisposed individuals, and effects on fetal development. However, NASEM found no evidence of a link between cannabis use and lung cancer, despite long-standing concerns.

The report NASEM (2017) „The Health Effects of Cannabis and Cannabinoids” analyzed over 10,000 scientific publications. Three indications received the highest evidence category: chronic pain in adults, chemotherapy-induced nausea, and spasticity in multiple sclerosis. For many other indications, the evidence remains limited.

How are social attitudes changing in Poland?

Polish society is increasingly favorable towards medical marijuana. Research from CBOS, Eurobarometer, and the ESPAD report indicates that support for medical legalization has risen from about 50% in 2010 to around 80% in 2024. Recreational legalization remains contentious, but the percentage of supporters is also increasing, especially among those under 40.

CBOS – 70-80% in favor of medical legalization

Surveys Public Opinion Research Center from 2018-2023 shows that over 70% of Poles support the legalization of cannabis for medical purposes. This is a higher rate than in many Western European countries. The increase in acceptance is greatest among the 25-44 age group and among residents of large cities.

ESPAD – school youth

The European ESPAD project (European School Survey Project on Alcohol and Other Drugs) studies substance use among teenagers. Results for Poland from 2019 indicate that about 21% of students aged 15-16 have had contact with cannabis at least once in their lives. This number has remained stable for a decade, despite regulatory changes regarding medical cannabis.

Eurobarometer and the European context

Research by the European Commission within the Eurobarometer shows that Polish public opinion is close to the EU average regarding acceptance of medical cannabis, but more conservative regarding recreational use. Separating these two debates is, according to Commission analyses, key for future regulatory reforms.

What does the patient pathway look like in Poland?

To legally access medical marijuana in Poland, a patient must go through five steps: medical consultation, assessment of indications, issuance of an Rpw prescription (electronically in the P1 system), filling at a pharmacy (usually specialized), and continuation of treatment with follow-up visits. The Rpw prescription is valid for 30 days from the date of issuance.

Who can issue an Rpw prescription?

Any doctor with the right to practice in Poland can issue an Rpw prescription for medical marijuana if they assess the clinical indication as justified. In practice, most prescriptions are issued by specialists: anesthesiologists dealing with pain management, neurologists, psychiatrists, oncologists, and family doctors with experience in chronic pain therapy.

Costs: 50-80 PLN per gram of flower

Analysis of current price lists from Polish pharmacies shows that the cost of 1 g of medical flower ranges from about 50 PLN (products imported by major distributors) to 80-90 PLN (rarer strains, special concentrations). For a patient with a dose of 1 g per day, the monthly cost of therapy amounts to 1500-2700 PLN. NFZ reimbursement is point-based and limited to a few cases.

Supply shortages – a chronic problem

The Polish market has repeatedly faced shortages of medical marijuana. After the first import from Canada (2019), there have regularly been gaps in the availability of specific strains. In 2023-2024, the list of suppliers was expanded (Aurora, Tilray, Spectrum, Bedrocan, Cantourage, Cellen). Despite this, logistical problems still affect patients requiring continuity of treatment.

From the perspective of an observer of the cannabis market in Poland, it is clear that the biggest barrier for patients is not price, but the unpredictability of supplies. A patient who responds stably to a specific strain often has to change the product after a few months, which requires new dose adjustments and reassessment of tolerance.

What is the difference between CBD available in stores and medical marijuana?

CBD (cannabidiol) from hemp is legal for sale outside pharmacies in Poland, provided it meets THC content standards. Following the EU reform in 2021, the threshold for agricultural raw material is up to 0.3% THC. CBD does not require a prescription, but it is also not „medical marijuana” – it is a dietary supplement or cosmetic, not a medicine.

The legal status of CBD in Poland

According to the critical review by WHO ECDD (2018), CBD does not exhibit addictive or harmful potential at typical doses. This position has become the basis for the reclassification of CBD at the UN level (CND commission, 2020). In Poland, CBD derived from EU-compliant hemp is available in physical and online stores.

CBD oil vs. medical marijuana oil

The difference is fundamental. Store-bought CBD oil mainly contains cannabidiol with a marginal amount of THC (below the threshold) and serves as support for daily well-being. Medical marijuana oil (by prescription) has controlled THC content (e.g., 5%, 10%, 20%) and is used for specific clinical indications under physician supervision.

CBD Flower – relaxation, not therapy

CBD flower from hemp (for smoking, vaporization, or as a collectible material depending on jurisdiction) contains trace amounts of THC and mainly CBD. It is a recreational-relaxation product, not a drug. Individuals interested in therapeutic support must choose between over-the-counter CBD and prescription Rpw medical marijuana.

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What are the myths and facts about medical marijuana?

There are many misunderstandings surrounding medical marijuana. Below is a summary of the five most common myths and what science says about them. According to the report NASEM (2017), some popular beliefs have no basis in clinical data, while other warnings are fully justified.

Myth 1: "Medical marijuana is the same as illegal marijuana"

Fact: Medical marijuana has standardized THC and CBD content, is produced according to GMP pharmaceutical standards, and is subject to quality control. This is a fundamental difference from black market material, whose composition is unknown, and contaminants (pesticides, heavy metals, mycotoxins) are a real risk.

Myth 2: "Cannabis causes lung cancer"

Fact: The report NASEM (2017) found no conclusive evidence of a link between cannabis use and lung cancer, despite long-standing concerns. However, smoking flower is harmful to the respiratory system, which is why vaporization represents a safer form of cannabinoid delivery.

Myth 3: "Anyone can get an Rpw prescription"

Fact: An Rpw prescription is a decision made by a doctor after assessing the clinical indication. The absence of a specific disease from the list of "recognized" indications still requires medical justification. Doctors differ in their approach, leading to unequal access to therapy depending on the region of Poland.

Myth 4: "CBD is pseudoscience"

Fact: Cannabidiol is the active substance of the registered drug Epidiolex (FDA, 2018) in pediatric epilepsy therapy. A study Devinsky et al. (2017) published in "NEJM" showed a statistically significant reduction in seizures. CBD is also the subject of hundreds of active clinical trials in various indications.

Myth 5: "THC always causes addiction"

Fact: Cannabis Use Disorder (CUD) affects an estimated 9-10% of regular recreational users, according to classic epidemiological studies in the U.S. In the context of medical marijuana, dosed and supervised by a doctor, the risk of addiction is lower than with opioid pain medications.

Paradoxically, one of the stronger arguments for broader use of medical marijuana in pain management is its safety profile. Cannabis has a significantly lower potential for fatal overdose than opioids. In U.S. states that have legalized medical cannabis, some observational studies have reported a smaller increase in opioid-related deaths than in states without such regulation.

What does the future hold for medical marijuana in Poland?

Polish medical marijuana faces three main challenges for the years 2026-2030: stabilizing supplies, educating doctors and patients, and the potential introduction of domestic cultivation. In 2024, the Polish regulator (GIF) still does not allow the cultivation of cannabis for medical purposes, despite pressure from patient organizations and the agricultural sector.

Domestic cultivation – a matter of time?

Arguments for domestic cultivation are economic (lower costs, greater supply stability) and strategic (independence from imports). Opponents point to risks of quality control and potential leaks to the black market. Experiences from Germany and the Czech Republic, which allowed controlled domestic cultivation, show that it can be done responsibly.

NFZ reimbursement – point-based, but increasing

NFZ currently reimburses only a few cases: primarily Sativex in selected MS centers and Epidiolex/Epidyolex in pediatric epilepsy. Pharmaceutical flower remains fully paid. Expanding reimbursement requires the registration of specific indications in the standard procedure, which the patient community and some doctors expect.

Education of doctors – a key pillar

The lack of systematic education on cannabis pharmacology in Polish medical universities remains a barrier. Postgraduate courses have been established (including the Cannabis Education Center, programs of the Polish Drug Policy Network), but nationwide, the number of doctors actively issuing Rpw prescriptions is estimated to be in the thousands. Patients still often seek doctors "specializing in cannabis".

Frequently Asked Questions (FAQ)

Is medical marijuana legal in Poland in 2026?

Yes. Medical marijuana has been legal in Poland since November 1, 2017 (amendment to the Act on Counteracting Drug Addiction). The raw material is dispensed by prescription Rpw through a pharmacy. The first prescriptions were filled in January 2019, and by 2024, the number of filled prescriptions is counted in the hundreds of thousands annually.

How to obtain an Rpw prescription for medical marijuana?

An Rpw prescription can be issued by any doctor with the right to practice if they assess the clinical indication. In practice, they are most often issued by anesthesiologists dealing with pain, neurologists, psychiatrists, and family doctors. Consultations are often paid. The prescription is electronic, valid for 30 days, and filled at a pharmacy with available raw material.

How much does monthly therapy with medical marijuana cost?

The cost of flower in Polish pharmacies ranges from 50-80 PLN per gram. A patient with a typical dose of 1 g daily spends 1500-2400 PLN monthly. NFZ reimburses selected preparations (Sativex, Epidiolex) for specific indications, but pharmaceutical flower remains fully paid. Some pharmacies offer loyalty programs and discounts for regular patients.

What is the difference between CBD and medical marijuana?

CBD from hemp stores comes from industrial hemp (THC below the legal threshold, up to 0.3% in agricultural raw material after the EU reform in 2021) and does not require a prescription. Medical marijuana contains controlled amounts of THC (up to 22% and more) and CBD, is produced according to GMP, and is dispensed only by Rpw prescription through a pharmacy.

Is medical marijuana addictive?

The risk of addiction exists but is lower than with opioids or benzodiazepines. Classic American studies (Anthony et al., 1994) estimate that about 9% of regular cannabis users develop a use disorder (CUD). In medical therapy, controlled by dose and indication, the risk is lower than in recreational use, according to the NASEM report (2017).

Can I drive after using medical marijuana?

No. THC in the body is detected by drug tests and leads to loss of driving rights and criminal liability, regardless of the Rpw prescription. Polish regulations do not provide for a "medical exception" for THC, as is the case for some opioids. Patients treated with medical marijuana must refrain from driving or use THC-free products (pure CBD).

What are the side effects of medical marijuana?

The most common side effects are: dizziness, dry mouth, drowsiness, concentration disturbances, tachycardia, and appetite changes. At higher doses of THC, anxiety states, paranoid thoughts, and psychosis may occur in predisposed individuals. According to Whiting et al. (2015), the risk of side effects is about three times higher than in the placebo group, but most are mild.

Does medical marijuana help in cancer treatment?

Medical marijuana has documented effects in alleviating symptoms associated with cancer treatment (nausea after chemotherapy, lack of appetite, pain), but it is not a proven causal therapy for cancers. Claims of "curing cancer with cannabis" go beyond the current state of medical knowledge. Any decision regarding complementary therapy should be consulted with the attending oncologist.

Does CBD require a prescription?

No. Pure CBD derived from legal industrial hemp is available without a prescription in physical and online stores as a dietary supplement, cosmetic, or smoking product. The exception is pharmaceutical CBD (Epidiolex/Epidyolex) registered as a drug for pediatric epilepsy. According to WHO ECDD (2018), CBD has a low potential for addiction and a favorable safety profile.

How does vaporization differ from smoking medical flower?

Vaporization heats the flower to a temperature of 180-220°C, releasing cannabinoids without combustion. Vapor is produced, not smoke. This eliminates most harmful combustion products (tar, carbon oxides). Polish doctors recommend only vaporizing medical flower, not smoking. Medical vaporizers (e.g., Mighty Medic, Volcano Medic) are certified as medical devices.

Summary

Medical marijuana has undergone a journey over three decades from a banned substance to a pharmaceutical in pharmacies in 38 U.S. states, most EU countries, and over 50 jurisdictions worldwide. In Poland, it has been available by Rpw prescription since November 2017, and the number of patients is growing exponentially. The strongest scientific evidence points to three indications: chronic pain, chemotherapy-induced nausea, and spasticity in MS, according to the NASEM report (2017).

However, the Polish patient journey requires patience: supply shortages, high costs, and limited reimbursement are barriers that most patients still face. CBD from hemp remains a legal, widely available alternative for those seeking cannabinoid support without a prescription, keeping in mind the expectations – it is a supplement, not a substitute for medication. If you are considering therapy, the first step should be a consultation with a doctor knowledgeable about cannabinoid pharmacology. A compendium of CBD oil – what you should know before purchasing.