North Macedonia: Medical Cannabis Market Overview 2025

North Macedonia has become one of Europe’s leading medical cannabis production and export hubs, despite having limited domestic patient access. The country legalised both the cultivation and manufacture of medical cannabis in 2016, establishing one of the earliest comprehensive regulatory frameworks in the region.

Since legalisation, North Macedonia has issued 66 cultivation and production licences (as of 2022), though only a portion of these companies have successfully achieved commercial output or export certification. A growing number of operators have since obtained EU-GMP accreditation, positioning the country as a strategic production base for the European medical cannabis supply chain.

While the export-oriented industry continues to expand, domestic patient access remains minimal, reflecting regulatory and clinical conservatism within the healthcare system.

The Law on Control of Narcotic Drugs and Psychotropic Substances (2016) governs medical cannabis cultivation, production, and use in North Macedonia. The framework allows for:

Licensing and Compliance:

In recent years, North Macedonia has undertaken legislative revisions aimed at harmonising its framework with EU pharmaceutical standards, with a focus on quality assurance and export competitiveness.

North Macedonia’s cannabis industry is predominantly export-oriented, supported by favourable climatic conditions, low production costs, and a skilled agricultural workforce.

Key Industry Characteristics:

Export Markets:

North Macedonia’s role as a low-cost, high-capacity producer has made it a preferred source for European pharmaceutical intermediates and extracts.

While medical cannabis production and export are well-established, domestic patient access is extremely limited. The same 2016 legislation that legalised cultivation also permitted medical use under strict conditions, but implementation has been slow and highly restrictive.

Who Can Prescribe? Only government-approved doctors with recognised specialisations in certain diseases are permitted to prescribe medical cannabis.

Approved Indications:

Prescription and Access Barriers:

As a result, domestic patient numbers remain exceptionally low, and medical cannabis use in North Macedonia is primarily pharmaceutical and export-focused, rather than patient-driven.

North Macedonia’s medical cannabis framework illustrates a dual reality: an internationally competitive production industry contrasted with limited local therapeutic application.

The country’s export-oriented ecosystem, bolstered by growing numbers of EU-GMP-certified producers, positions it as a key player in Europe’s medical cannabis supply chain, particularly for bulk extracts and intermediate products.

Future growth depends on:

If local access pathways are modernised, North Macedonia could transition from a purely export market to a comprehensive medical cannabis system encompassing both domestic treatment and global supply.

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