Medical cannabis will soon become legal in Ukraine. What will this look like and why now?

On February 15, Ukrainian President Volodymyr Zelensky signed into law a bill legalizing the use of cannabis for medical purposes. The new law is set to take effect in August 2024. But not everyone is happy: a large contingent of politicians and activists insist the legislation will be useless for Ukrainian patients without some serious fine tuning. Meduza explains how the initiative made it through parliament and what problems it aims to solve.

Expedited by war

Cannabis legalization has long been a topic of political discussion in Ukraine; for years, however, every attempt to make it a reality met resistance from politicians and citizens who feared it would lead to an overall increase in drug use. At the same time, many doctors, scientists, journalists, activists, and public figures supported the idea, pointing to the positive effects decriminalization has had in other countries and trying to debunk myths about its likely consequences for Ukraine.

Volodymyr Zelensky expressed support for legalizing medical cannabis during his 2019 election campaign, though he later changed tack after winning the presidency:

However, in 2020, Zelensky’s team conducted a survey of Ukrainian citizens and found that about 65 percent of respondents supported the idea of legalizing cannabis. At this point, the government began looking at the idea more closely, though it still met plenty of resistance. Here’s how Taras Ratushnyy, a cofounder of the pro-legalization Freedom March initiative, described this period:

In other words, the legalization issue seemed at risk of being tabled indefinitely. But everything changed when Russia launched its full-scale invasion of Ukraine in February 2022. Suddenly, the legalization of medical cannabis became eminently relevant due to the rapid increase in injured civilians and wounded soldiers.

Soldiers, journalists, athletes, politicians, and scientists increasingly began calling for changes to Ukraine’s cannabis laws. Doctors noted that the drug may be helpful for people with post-traumatic stress disorder (PTSD), though its efficacy is unproven.

Few studies have examined the effects of cannabis on veterans with PTSD. Many of those that have been conducted are of poor quality, and only some of them have shown a positive effect. More reliable studies and systematic reviews have found no significant difference in the reduction of PTSD symptoms between placebos and cannabis-based treatments.

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Cannabis-based medications are sometimes used to treat chronic pain; with the exception of oncological diseases, however, there’s no compelling data that indicates they are effective. At the same time, there’s no reliable or effective alternative.

In June 2022, the Verkhovna Rada registered a bill on the legalization of medical cannabis. In February 2023, a parliamentary committee made several amendments to the legislation to bring it more in line with E.U. standards. The new version would directly define the content of tetrahydrocannabinol — the main psychoactive element found in cannabis — in industrial hemp and medical cannabis and ban imports, among other things. Ukraine’s Health Ministry endorsed these changes.

At the same time, many conservative politicians continued to oppose the bill. Parliamentary deputy Yulia Tymoshenko and her Batkivshchyna party, for example, blocked the bill’s passage, decrying marijuana as a “hard drug” whose legalization would turn Ukraine into “another Colombia.”

Like other European countries, Ukraine does have a black market for marijuana. In 2020, for example, Ukrainian courts handed down more 370 sentences for cannabis trafficking and more than 4,000 sentences for illegal possession without intent to sell. It’s impossible to say exactly how many people in the country use cannabis, but the number, at least among teenagers, is reportedly decreasing. Additionally, approximately 4,000 Ukrainians were on record as having medical cannabis dependency in 2022.

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Despite the opposition, the Verkhovna Rada approved the medical cannabis legalization bill on December 21, 2023, and President Zelensky signed it into law in February 2024. The new rules will come into effect in August.

Ukraine’s Health Ministry celebrated the law’s passage as a “historic decision” that millions of people were awaiting. Health Minister Viktor Liashko described the change as follows:

At the same time, Liashko noted that the state would “tightly monitor the circulation of cannabis-based medication,” and that recreational cannabis use would remain illegal.

Inna Ivanenko, the Patients of Ukraine Foundation’s acting director, also welcomed the new law:

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How will the law work?

Implementing the law will require a number of additional bylaws, but the original legislation contains the key provisions. Here’s what we know:

• Doctors will have the right to prescribe medications containing cannabinoids. Only electronic prescriptions will be allowed.
• Patients with prescriptions will be allowed to purchase and possess cannabis-based medications.
• Patients will be allowed to enter and exit Ukraine with their prescribed cannabis-based medication (in small amounts) if they show a prescription and documentation confirming their diagnosis.
• Businesses will be able to obtain a permit and a special license to grow hemp in Ukraine for the purpose of pharmaceutical production. Growing facilities will be required to install round-the-clock surveillance cameras that police can access, and each hemp plant will have to have an individual code.
• Samples of the medications will be tested for their concentration of tetrahydrocannabinol.

What could go wrong?

While Ukrainian society has responded positively to the law’s passage overall, many politicians and activists still see problems with it.

“Not only is this document an artificially created deadlock situation for cannabis that will fail to solve the problem of access to medicine,” says Taras Ratushnyy. “There’s also a cynical lie about the law’s value for European integration, which could only be needed for reports on the latest step of Ukraine’s ‘harmonization with European legislation.’”

In the activist’s view, “medical use” and “patient access to medication” are just “nice-sounding words” since the law contains gaps that, in practice, will allow neither medical research nor the production of medication.

For example, the legislation divides psychoactive substances into four groups based on their usefulness and comparative harm (similar to the U.S. government’s schedule system):

• I (especially dangerous, circulation prohibited)
• II and III (circulation limited)
• IV (precursors)

Cannabis and its derivatives remained in Group I for multiple months after the new law’s passage, and existing Ukrainian law only allows substances from Groups II and III to be used in medicine. In other words, for cannabis products to be used in medication, either they needed to be reclassified or the law needed to be amended to allow Group I substances to be used in medication. This was not done until May 2024.

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Deputies from Petro Poroshenko’s European Solidarity party voted against the legislation for similar reasons: they believe that in its current form, the bill is unlikely to change anything for patients. Lawmaker Mykola Kniazhytskyi explained the decision as follows:

Deputy Olha Stefanishyna from the country’s Servant of the People party dismissed Kniazhytskyi’s comments as “political manipulation.”

Gennadii Shabas, head of the Ukrainian Association of Medical Cannabis, is also skeptical of these criticisms:

In any case, four months after Zelensky signed Ukraine’s medical cannabis legalization law, the industry is still in the process of preparing to take advantage of it — and experts foresee numerous difficulties ahead.