Canadian medical cannabis registrations at lowest level since legalization

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Image of an arrow designating a decline emblazoned on the Canadian flag

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(This story has been updated to reflect that Avicanna is based in Toronto, not Colombia.)

Active medical cannabis registrations and overall spending on the medicine in Canada fell to their lowest levels since before recreational marijuana was legalized in late 2018.

The number of active patient registrations with a federal license holder was 212,700 as of the end of March, according to the latest data from Health Canada and Statistics Canada.

That’s 38% lower than the 345,520 active registrations in October 2018, when Canada legalized marijuana for adult use.

The Health Canada figures are consistent with Statistics Canada data showing falling spending in the medical cannabis sector.

In the first half of calendar 2023, spending on medical cannabis amounted to 185 million Canadian dollars ($135 million), according to the StatsCan data, the lowest first-half total since 2016.

In calendar year 2022, Canadian patients purchased CA$410 million of cannabis products for medical use, 7.4% lower than in 2021, according to Statistics Canada.

Canada’s annual medical cannabis expenditures haven’t been that low since before 2017.

Sales were CA$279 million in 2016.

One reason for the trend is the increasing availability of non-medical cannabis via expanding recreational storefronts across Canada.

No pharmacy dispensing 

The Canadian government has been resisting calls to dispense medical cannabis in pharmacies, even though that’s generally where the product is prepared and sold in many European jurisdictions.

Shoppers Drug Mart, the largest pharmacy chain in Canada, had lobbied for years for approval to sell medical cannabis in its stores.

After it became evident the government wouldn’t make such an allowance, Shoppers dumped its medical cannabis business this year for only CA$2.6 million to Avicanna, which has its head office in Toronto.

Ken Weisbrod, who oversaw the creation of the cannabis portfolio for Shoppers, suggested the dramatic decline in the medical cannabis market highlights the fact that the Canadian government “does not appear to have any true interest in having a proper medical system” for the drug.

“Other countries around the world which are exploring medical cannabis understand the need for current existing health care systems and providers to be involved,” said Weisbrod, a licensed pharmacist in Canada and the United States, via email.

“Unfortunately, for the most part, retail pharmacy has been left out of the conversation and the medical (marijuana) industry has had to adhere to the ‘medical cannabis process’ rather than cannabis following the current existing processes and standards for all medicine.

“These lack of standards have only increased the apprehension of health care practitioners to use this medicine in their treatment of patients.”

Weisbrod said it begs the question, “Why has Health Canada abandoned its (pre-legalization) mantra of treating cannabis ‘like any other medicine’?”

The Canadian government’s commitment to taxing medical cannabis at the same rate as recreational marijuana is said to be another factor driving patients away from the medical system regulated by Health Canada. 

“The fear that people will flock and abandon the adult-use market to avoid the tax is not credible given that in other jurisdictions which have a dual system of taxation for medical (i.e., not taxed or taxed at a lower rate) and adult use (e.g., Colorado) this issue has not occurred,” Weisbrod said.

Medical cannabis in Canada is generally shipped via mail directly from a licensed producer or is grown by patients, or someone designated to grow it for them – known as designated production registrations.

The number of approvals to grow medical cannabis, either personal or for someone else, has also fallen since 2018.

In October 2018, there were 25,945 such registrations. In March 2023, there were 19,076, or 26% fewer.

As domestic medical sales are falling, medical exports from Canada have been soaring.

In the 2022-23 fiscal year, Canada shipped medical cannabis products worth CA$160 million, a 50% increase over 2021-22’s CA$107 million.

When domestic sales are included with exports over the same time period, Canada’s medical cannabis market was worth a little more than CA$560 million last year.

Potential solution

Weisbrod, now a consultant in the international health care industry, suggested one potential solution is for provinces to implement their own medical systems outside Health Canada.

“Although this could be a good policy, Health Canada should lead the way by placing medical cannabis where it belongs – within a pharmacy and under the traditional framework for medicine,” he said.

By doing so, Weisbrod said, not only would certain standards be implemented, such as for chemical, microbial, toxicity and emissions testing, but the acceptance of cannabis by the traditional health care industry would increase.

Some experts are concerned that medical cannabis patients appear to be using recreational channels, which don’t have trained staff or pharmacists to talk about the drug’s interaction with other medicines.

“Consuming cannabis like any other drug has pros and cons,” Weisbrod said.

“What we have in Canada is an unabated drug consumed mostly by smoking 90% of the time, mostly by people under the age of 30.

“We need to get our health care providers involved now so our young adults are aware and have the appropriate oversight on what they are consuming.”

The data is available here.

Matt Lamers can be reached at