São Paulo expands access to cannabidiol in the public health system

Although slowly, access to cannabidiol-based medications (also known as CBD) is expanding in Brazil as a therapeutic alternative. The city of São Paulo has become a pioneer in this movement by expanding the availability of cannabidiol in the SUS (Unified Health System) for more than 30 types of diseases.

The São Paulo Municipal Health Department's measure was announced in August. In practice, what changes is that patients who previously had to resort to legal action, import, or purchase medical cannabis at high prices will now be able to obtain medical cannabis through the capital's public health system, with a prescription and a doctor's prescription.

The medications, according to the ministry, will initially be used for more severe or refractory cases, such as epilepsy, chronic and neurodegenerative diseases, autism spectrum disorder, and rheumatological pathologies. Additionally, other conditions have been included, such as depressive disorders, anxiety, sleep disorders, and fibromyalgia.

To obtain the medication, patients must undergo a medical consultation and obtain a B1 prescription (the blue type). The recommended municipal pharmacies will be responsible for dispensing the medication.

For physician Juliana Paiva, who works with medicinal cannabis in Campinas, São Paulo, the change is a positive one. "Besides expanding access and providing more options for patients, it means that the São Paulo city government has recognized the demand," she argues.

Demand for medicinal cannabis grows in the country

The recent expansion of access in São Paulo's capital reflects national demand. In 2024, Brazil reached the milestone of 672,000 patients being treated with medicinal cannabis, according to the 3rd Yearbook of Medicinal Cannabis in Brazil, produced by Kaya Mind , a consulting and market intelligence firm focused on the cannabis sector. This number represents a 55% increase compared to the previous year: in 2023, 431,000 people were being treated with medicinal cannabis, according to the consultancy.

In other regions of the country, access through the public health system also continues to expand, albeit for a more limited number of syndromes, such as refractory epilepsies. Since the beginning of this year, for example, Santa Catarina began making cannabis-based medications available through the Unified Health System (SUS) for the treatment of Dravet Syndrome, Lennox-Gastaut Syndrome (two forms of severe epilepsy), and Tuberous Sclerosis Complex.

According to the Kaya Mind survey, at least 19 of the 26 Brazilian states, in addition to the Federal District, have already approved regulations for the distribution of cannabis in the SUS, under conditions similar to those of Santa Catarina.

In addition to the public health system, there are other ways to purchase CBD-based medications in Brazil:

• Conventional or compounding pharmacies: since 2019, Anvisa has authorized the sale of medicinal cannabis in pharmacies, which can be purchased with a doctor's prescription;

• Importation by Anvisa: with a medical prescription, patients can complete an import authorization for medications containing CBD and THC;

• Patient associations: In Brazil, some associations have judicial authorization to cultivate and distribute medicinal cannabis-based medications. To purchase, you must be a member, have a doctor's prescription, and follow the rules of each organization.

Even with access still limited in much of the country, the increased availability of cannabidiol-based medications in São Paulo, one of the country's largest cities, marks an important step forward for society, according to physician Juliana Paiva. "Brazil has improved both in terms of prejudice and knowledge about cannabis. Several Brazilian universities are working on cannabis research, and more doctors are specializing in the field," the specialist celebrates.

The Brazilian market is following this growth. Also according to Kaya Mind's yearbook projections, the medical cannabis sector generated R$852 million in revenue in 2024, representing a 22% increase compared to 2023. Looking ahead, the consultancy projects that increased demand for products and the broader regulatory framework for medical cannabis will increase this figure to R$1 billion by the end of 2025.

Advantages of using medicinal cannabis

Medicinal cannabis has been used as a supplement or treatment for various chronic or degenerative diseases and for pain relief. It's primarily indicated in cases where other conventional treatments are no longer effective, according to physician Juliana Paiva. "Medical cannabis has many advantages. The first is that it can be a relief for patients who have tried everything else. Furthermore, it tends to have fewer side effects and reacts well to the body."

Several studies in recent years have demonstrated that cannabidiol has analgesic, anti-inflammatory, and anticonvulsant properties. A study conducted last year by Yale University in the United States, for example, showed that cannabinoids—the name given to chemicals found in cannabis, such as cannabidiol (CBD), cannabigerol (CBG), and cannabinol (CBN)—reduced the activity of a protein that plays a key role in pain signaling in the peripheral nervous system.

There are also many reports of significant improvements in the quality of life of patients with severe syndromes. This is the case of Olívia, the teenage daughter of Henrique Fogaça, chef and host of the cooking show Masterchef. He recently shared on social media that his daughter, who has been using CBD oil for eight years, has experienced a 90% improvement in her refractory epileptic seizures. "I know that Olívia chose me to be her father so that I could be a channel of information for thousands of people and families who have someone with special needs at home," the chef wrote in the post.

CBD medications come in various forms, including capsules, sprays, creams, and oils. And while they're often considered "natural," they require specialized medical supervision, like any medication, especially when used in conjunction with other treatments.