During the coronavirus pandemic, consumer habits have been shifting. Wonder what items were in the top sales? Sanitisers, masks, pyjamas and board games! Indeed, health and medical products, groceries and home supplies broke sales records at the beginning of 2020. According to retail experts, people are fulfilling three primary needs, such as connection, protection, and entertainment. By that logic, there is no surprise that sales for cannabis and CBD products have skyrocketed. Besides their potential to alleviate neurological and pain conditions, these products may help with stress and anxiety associated with pandemic and lockdown. Furthermore, the need for medical cannabis users remained the same and even increased.
Let’s see how coronavirus has influenced the cannabis industry.
Why did COVID-19 cause so much panic?
You might be surprised, but coronaviruses were known since the 1960s. Virions with so-called solar corona may cause respiratory tract infections ranging from mild to lethal. Mild illnesses include common cold, while more lethal types can lead to SARS, MERS, and COVID-19.
The most common symptoms of COVID-19 include:
- shortness of breath
- dry cough
Infected people may also suffer from a runny nose, sneezing, sore throat, appetite loss, fatigue, muscle and joint pains, nausea, diarrhoea, and vomiting. The catch is that such symptoms may indicate other diseases, such as allergy or cold.
The virus is cunning in a way it spreads from human to human – mostly via airborne droplets. No need to jump away each time someone sneezes or coughs, but keeping a 1.5-metre distance is the right thing to do. Infected people may also have mild symptoms or no symptoms at all. You can also get the virus by touching the contaminated surface and then touching the face. There is still no evidence that pets can spread the virus, though several cases of infected animals are present.
Is it time to put your hands down?
Relax and keep your chin up. Even though there is no cure against COVID-19, simple precautionary measures may help to prevent the virus spread and lower the risk to catch it:
- Stay home and keep social isolation;
- Regularly wash your hands with soap and water or use a sanitiser;
- Keep the distance and avoid contact with other people;
- Use a tissue when sneeze or cough;
- Avoid touching the face with dirty hands;
- In case you feel unwell and have a fever, cough and shortness of breath, seek medical help and follow the directions of your local health authority.
So far, there is no approved vaccine or medications that may fight against the virus. The treatment is aimed at symptoms relief and health support. The WHO does not recommend to self-medicate with existing antiviral drugs or antibiotics. The hopes come from a long list of pharmaceutical companies, engaged in the vaccine development and clinical trials available on market drugs.
Can medical cannabis help during Covid-19 outbreak?
Unfortunately, it is far too early to declare any success. In April 2020, Canadian cannabis researchers made a claim that the plant-based drug may increase resistance to SARS-CoV-2, the novel coronavirus. Preliminary findings are part of research on the use of medical cannabis in treating cancer. According to a published paper, scientists have developed strains of cannabis that may effectively prevent the virus from entering the body. There is an angiotensin-converting enzyme II (ACE2), found in lung tissue, in oral and nasal mucus, in the kidneys, testes, and gastrointestinal tracts, that act as a gateway for the virus. Newly developed cannabis strains have the potential to block ACE2. The research is yet to be peer-reviewed and verified.
Besides the potential antiviral effect, medical cannabis, or medical marijuana has many other useful properties. Cannabis prescribed by doctors is taken for medicinal purposes. Even though medical cannabis is derived from the same parts of the cannabis plant as a recreational one, only this type is used to treat various health conditions. The cannabis plant has over a hundred of multiple cannabinoids. All of them cause a different effect on the body, but two shining stars of the plant named tetrahydrocannabinol (THC) and cannabidiol (CBD) are used in healthcare. THC can also cause a psychoactive effect, known as the “high”.
You may think of cannabis as a drug of the hippies time, but people have been using the cannabis plant for medical purposes for centuries.
Medical cannabis may be helpful in various health conditions:
- Chronic pain
Under GlobalData cannabis consumer research of 2019, up to half of all cannabis users were taking it to manage pain. Studies prove that it makes sense as cannabis may act as an effective analgesic and potential opioid substitute. During the studies, the use of medical cannabis helped to relieve pain with fewer side effects. Cannabis may help to relieve the pain caused by multiple sclerosis and nerve pain. However, NICE (The National Institute of Health and Care Excellence), an arm of the NHS in the UK, haven’t recommended the use of medical cannabis for pain conditions.
- Neurological disorders
Trials on the combination of a drug Nabiximols/Sativex, combining cannabis derivatives tetrahydrocannabinol (THC)/cannabidiol (CBD), have shown significant improvements in pain and spasticity, without changes in disability measures. Medical cannabis has shown to reduce seizure frequency and have a positive impact on people with Parkinson’s disease.
Nausea and vomiting
Medical cannabis has shown to be effective in nausea and vomiting (CINV), that is a common side-effect of cancer treatments such as chemotherapy. Studies have suggested that cannabinoids may bring more relief than some conventional antiemetics. Dronabinol and Nabilone, synthetic cannabinoids, have also been approved for the treatment of CINV.
Post-traumatic stress disorder (PTSD)
Up to 1% of the UK population suffer from PTSD. Medical cannabis has shown to relieve some PTSD symptoms such as nightmares and insomnia. Studies revealed the potential of cannabis-based medications such as Nabilone being a mostly safe and effective treatment for ongoing conditions in severely mentally ill correctional populations.
In November 2020, NICE published guidance on medical cannabis for health and social care practitioners. As of 2020, only three cannabis-based medications can be prescribed and legally used in the UK:
- Epidiolex. According to NHS approval, doctors can prescribe Epidiolex for children with Dravet and Lennox Gastaut syndromes, severe types of epilepsy that cause multiple seizures.
- Sativex. The drug is approved for the treatment of spasms and muscle stiffness, known as spasticity, in people with multiple sclerosis (MS).
- Nabilone. The drug is used to treat nausea and vomiting caused by chemotherapy in cancer patients. A doctor can prescribe Nabilone to relieve a patient’s symptoms if other treatments have not helped or are not suitable.
Countries that allow cannabis for medical purposes include Canada, Chile, Colombia, Australia, Greece, Germany, Israel, the Netherlands, Italy, Poland, Portugal, Peru, and Uruguay. Canada, the US, the District of Columbia and 33 states have legalised recreational cannabis.
Is there any difference between medical and recreational cannabis?
The main differences are the reason for use and the laws of the country on cannabis. Recreational cannabis or marijuana is used without medical recommendation.
Here is how the main differences between medical and recreational cannabis:
- Quality control
There are more precise and strict requirements for cannabis strains used for medical purposes. For example, the manufacturers should adhere to Good Manufacturing Practices (GMP) and other quality standards to sell it as medical cannabis. GMP practices include testing to ensure cannabis doesn’t include harmful components and contain promised levels of CBD (cannabidiol) and THC (tetrahydrocannabinol). Moreover, it means the same quality for every product batch. Even though recreational cannabis undergoes strict tests for heavy metals, microbes and cannabinoids content, the standards for such cannabis are not as stringent as for the medical one.
- Purchase conditions
Purchasing cannabis for medical use requires a prescription. If you have a qualifying condition prescription, the doctor (in the UK: a doctor registered on the General Medical Council Specialist Register) may issue a prescription. The purchase can be made at a regulated dispensary or pharmacy. These rules apply to the US, Canada, Germany, UK, Italy, the Netherlands and Denmark. In the UK, the medical use of cannabis was legalised in 2018, but it is still complicated to get prescriptions for cannabis-based medications and receive medications on NHC. Recreational cannabis is legal in Canada and 11 states, two territories, and the District of Columbia in the US and doesn’t require a medical recommendation.
In all countries, you should be over 18 to buy cannabis and cannabis-based medications. In the US, you need to be over 18 to purchase medical cannabis and over 21 to buy recreational cannabis.
Can CBD help for the novel coronavirus?
In short, CBD, the most well-known compound of Cannabis Sativa plant, is not a cure against the novel coronavirus, although it has many potential properties that may be useful during pandemic times. In previous research, following the SARS outbreak in 2002, cannabis terpenes have shown to cause an antiviral effect. Some terpenes that came into contact with the SARS might reduce its severity and damage by withholding a protein that replicates the RNA. It could prevent the virus from penetrating healthy cells and using them for replication.
Studies show that cannabinoids may cause an effect on the immune system, viral pathogenesis, and replication. Cannabis has the therapeutic potential for the treatment of viral hepatitis. CBD may benefit the immunity system, which helps in managing viruses. Cannabis plant’s molecules may suppress the immune response to the COVID-19 coronavirus, known as ‘Cytokine Storm’ that causes inflammation and challenges the disease. These studies on potential antiviral effects are still ongoing.
Cannabidiol may cause anti-inflammatory effects in people with multiple sclerosis, which has potential for inflammatory conditions.
CBD may also promote cell death in infected cells, that accumulate mutations and become dangerous. By doing so, CBD use hasn’t affected healthy cells.
Due to an unusual bi-directional effect, CBD can either suppress or promote the production of cytokine, interleukin-2 (IL-2), and its receptor IL-2R, important components for maintaining the balance.
In general, CBD products may support the endocannabinoid system, which is necessary for the balance in the immune system and its response to novel viruses. The strong immune system can adapt to the high-risk environment easier, suppressing excessive over-reactions, and improving under-reactions.
Why is medical cannabis access critical?
Photos of long queues outside coffee shops in the Netherlands were widely shared on social media. As businesses were ordered to close, decided to restrict their activities or redeploy the staff during the COVID-19 outbreak, cannabis users tried to stockpile in advance. There is also a quieter and not always visible queue with people who have pain and mobility issues. Even in normal times, they had trouble getting medical cannabis. During COVID-19, this process got even more challenging for those who can’t go to the store without posing a real risk to health. So, one of the toughest concerns for patients is how to get medical cannabis safely. The UK government has published emergency legislation, which would allow patients to get access to controlled drugs during the pandemic from local pharmacies, without a prescription. If these measures become into force, they would encourage people to stay at home and reduce pressure on the healthcare system.
If there were access to medication legally, there would be no temptation to purchase illegal cannabis that is more expensive, harder to buy, and may be harmful to health.
Some dispensaries remained open, keeping the recommendations of social distancing and cleaning surfaces and premises regularly. Some dispensaries have established special hours for older people and other vulnerable groups. Private clinics offer online consultations for medical cannabis users with an option to get cannabis via courier.
Who is a typical user of recreational cannabis?
As recreational cannabis is perceived as an illegal drug, the market and global trends of its use are non-transparent. Canada is one of the few countries that legalised cannabis for both recreational and medicinal purposes. The Canadian Cannabis Act came into effect on 17 October 2018 and formally legalised the production, possession, acquisition, and consumption of cannabis and its by-products. Due to data available on legalisation and federal regulation of cannabis, further behaviour of recreational users can be considered an example of Canadian consumers.
The Cannabis Act has established strict regulations regarding cannabis, stating that adults of 18 years of age or older can legally:
- buy dried and fresh cannabis and cannabis oil from federally-licensed producers or a provincially-licensed seller;
- share not more than 30 grams of legal cannabis with other adults;
- own up to 30 grams of legal cannabis in dried or equivalent in non-dried form in public;
- grow cannabis from licensed seed or seedlings (not more than 4 cannabis plants per residence for personal use);
- produce cannabis products such as beverages and food at home provided that organic solvents are not used to produce concentrated products.
In December 2019, Canada allowed authorised retailers and distributors to sell cannabis extracts, cannabis edibles (candies, baked goods), and cannabis topicals (lotions, oils, makeup) for adults.
According to BDS Analytics report, the legalisation in Canada affected the recreational cannabis spend: it has already reached US$112.5M and is expected to hit US$4.8B by 2024. The recreational cannabis intake in Canada is expected to double by 2022 compared to 2018.
According to ‘A society in transition, an industry ready to bloom’ report by Deloitte, there are two typical users of recreational cannabis:
- Young people with a high school or college education, prone to take risks and live their lives to the fullest. With time, they may increase the intake, even at the risk of being caught in an illegal act or have their health compromised. The National Cannabis survey by Statistics Canada states that about 5.3M people over 15 years old consumed recreational cannabis in Q1 2019. Males aged from 15 to 24 years consume the most of it.
- Middle-aged university or school graduates, named by Deloitte conservative experimenters. Considering familial responsibilities, these people do not believe in defying the law. Most of them had experience with cannabis before: 74% have consumed recreational cannabis, and 41% tried it in the last five years.
The majority of recreational consumers in Canada used cannabis to relax and sleep properly or reduce stress and anxiety.
The risk-takers also took recreational cannabis for the following reasons:
- to party with friends
- to increase the mood
- to heighten senses
- to make activities more exciting
The study from the Journal of Studies on Alcohol and Drugs stated that young people in the US also use cannabis to feel better, relieve boredom and frustration, ease tension, get distracted, and change the effects of other medications. Canadian users had similar reasons for recreational use.
About 20% of current users used cannabis every day, while 33% of respondents used it at least once a week. Conservative groups prefer to use cannabis from time to time.
Despite a significant difference in prices between legal and illegal cannabis, Canadian consumers prefer legal options. According to the National Cannabis Survey, more users chose legal cannabis from illicit sources in 2019 (38%) compared to 2018 (51%). Deloitte’s report states that due to a guarantee on the safety of cannabis, up to half of the users bought from government or licensed private stores. A third of cannabis consumers purchased cannabis online to remain anonymous.
Does the future for the recreational cannabis market look bright?
In 2019, recreational cannabis was considered legal only in Canada, Uruguay, and 11 states and the District of Columbia in the US. The Single Convention on Narcotic Drugs of the United Nations in 1961 prohibited cannabis use for both recreational and medical purposes. For that reason, recreational cannabis is still illegal in many countries, and information on its intake is lacking.
Based on Euromonitor International report of 2019, the cannabis global market value is US$150B, with the most extensive legal market in North America. The sales of recreational cannabis in the US surpasses half of the total legal cannabis sales in 2018 and tend to do so up to 2024, while Canada’s sales reached the fifth part of total legal sales. These countries may have more significant perspectives in the recreational cannabis market. BDS Analytics has reported that Canada might reach 93% contribution or US$4.8B, from recreational sales to total legal cannabis sales in 2024; similarly, National Cannabis Industry Association has stated the US might reach over 69% contribution from the legal recreational market, or US$15.7B, in 2022. Uruguay legalised recreational cannabis in December 2013, but the sales in pharmacies began just in 2017. The growth in the country’s for legal cannabis market was rather slow due to supply-related concerns.
According to The European Cannabis Report, the European illegal drug market was more than €40B in 2018, with a significant share of cannabis. If medical and recreational cannabis are legalised in Europe by 2023, the European recreational market may reach €65B by 2028. New products, improved supply and distribution channels may also encourage market growth.
Recreational cannabis use, though in small amounts, has been decriminalised in Spain, Italy, Netherlands, Greece, Portugal, Belgium, Austria, Malta, Croatia and Slovenia. The European Cannabis Report 4th Edition has shown that some countries, including Germany, Denmark, Malta, Greece, and Italy, were considering an entirely regulated recreational cannabis market. Luxembourg has announced plans to legalise recreational cannabis use before 2023. France has already legalised products with high CBD/low THC ratio but doesn’t plan to legalise recreational cannabis and may approve it only for medical purposes.
Italy, France, the Czech Republic, Spain and the Netherlands are among the countries with the highest rates of cannabis use in Europe. Amsterdam remains a haven for recreational cannabis. Italy sells high-CBD/ low-THC cannabis, named “cannabis light” all over the country, but high-THC cannabis is sold in the black market.
The ECMDA, Statistics Bulletin of 2018, has placed the UK in 9th place with 6.6% rate of cannabis use in Europe.
In Asia, cannabis was used in traditional medicines up to the 1930s and considered mostly legal. The situation changed when the United Nations added the cannabis plant to Single Convention on Narcotic, and multiple country religions declared a zero-tolerance toward its use. The UNDOC World Drug Report of 2019, assessed the Asian market of recreational cannabis as underdeveloped. The level of cannabis use is low, amounting 1.8% in 2017.
Asian Cannabis Report in 2019 by Prohibition Partners, has stated that the size of the recreational market in Asia might hit US$2.7B by 2024. All the countries of the region (except China) are expected to legalise medical cannabis and issue regulations on recreational cannabis by 2024.
The rate of cannabis use in Africa reached just 6.4% in 2017. African Cannabis Report by Prohibition Partners states that the recreational cannabis market can exceed US$6.3B by 2023 following the legalisation of medical cannabis and regulation of recreational cannabis by this time. This assumption relates to South Africa, Lesotho, Zimbabwe, Nigeria, Malawi, Morocco, Ghana, Zambia, and Eswatini.
LATAM Cannabis Report by Prohibition Partners states that the market of recreational cannabis in Latin America may hit US$4.2B by 2028, provided the market is regulated and legalised. With the help of a favourable climate for cannabis growth, cheap land, and mild labour laws, the prices for cannabis products in Latin America are the lowest in the world.
How did coronavirus affect the cannabis industry?
Demand for cannabis and CBD products has surged during the coronavirus crisis, as millions of people were forced to stay at home and find new ways to handle pandemic buzz. Following COVID-19 outbreak, the demand for CBD and alternative healthcare products increased significantly. Alphagreen.io has published research, based on a survey of 5,000 adults. The survey revealed that since the beginning of 2020, about eight million adults in the UK, that equals 15% of the population, have bought CBD products worth £150 million. With such a boost, the market can reach £450 million in 2020, which is a 50% growth in comparison to £300 million in 2019. The main reasons for CBD sales surge included:
- anxiety, stress and sleep loss, caused by COVID-19 crisis
- heightened interest in natural health and wellness solutions
There was a concern if interest in CBD products in the UK will remain when the crisis is over. Alphagreen.io’s research has shown that 53% of purchasers purchased their first CBD products in the last 12 months. The good news is that the trend may be sustainably supported by the global interest in natural remedies and savvier users.
Moreover, the UK government keeps working with industry to find ways to reduce costs and encourage constant access to cannabis-based medications. In March 2020, the UK import restrictions were changed so people with prescriptions for cannabis-based medications could get used to their treatment faster and without interruptions. The changes may help patients with severe epilepsy or multiple sclerosis.
Licensed wholesalers will have the chance to import more cannabis-based products and hold cannabis supplies for future use by patients with prescriptions. The government also plans to engage with medical associations and patients to create evidence, with the use of trials in the UK and increase the understanding of medical cannabis benefits. That is important for broader prescribing by NHS clinicians in future.
As for the US, demand has surpassed supply before the COVID-19 pandemic. 2019 was a grand year for cannabis sales in the US, and the further pandemic panic has strengthened the increase. The cannabis market has been expanding in the US and all over the world with more countries and states legalising cannabis sales for medical and recreational use. According to Jefferies equity research in 2018, the legal market for cannabis was worth over $11bn globally, aiming to hit $50bn by 2029.
Verified by a Healthcare Professional
Anastasiia Myronenko is a Medical Physicist actively practicing in one of the leading cancer centers in Kyiv, Ukraine. She received her master’s degree in Medical Physics at Karazin Kharkiv National University and completed Biological Physics internship at GSI Helmholtz Centre for Heavy Ion Research, Germany. Anastasiia Myronenko specializes in radiation therapy and is a fellow of Ukrainian Association of Medical Physicists.