Europe Is the 51st State for MSOs: The Next Growth Engine Has Arrived

By Michael Sassano – CEO – Somaí Pharmaceuticals

With heavyweights like Trulieve (NYSE: TRLV) and Glass House Brands (NYSE: GLAS) making historic moves to uplist on the NYSE, one thing is abundantly clear: medical cannabis is bankable, and Wall Street knows it. U.S. Multi-State Operators (MSOs) are rapidly learning that to sustain this newfound institutional momentum, they desperately need a new avenue for massive growth. That next frontier is Europe.

Meet the MCO (Multi-Country Operator)—and why every U.S. MSO needs a global strategy right now.

Most U.S. executives raise the same objections: We have enough issues at home. We have other growth opportunities in the US. We don’t have the knowledge to expand overseas. Valid points, but while U.S. operators debate the hurdles, European medical cannabis markets are racing toward a multi-billion-dollar future. The global medical cannabis market is on track to exceed $2.5 billion in annual sales, and it will surpass Canada in total size within a few short years. Any market sitting at $2.5 billion and heading straight for $5 billion is one no MSO board can afford to ignore.

The MCO Model: Europe’s Answer to the MSO

In Europe, the equivalent of the U.S. MSO is the Multi-Country Operator (MCO). A handful of early movers have already built true vertically integrated, multi-country platforms: Curaleaf International (OTCQX: CURLF), Aurora Cannabis (NASDAQ: ACB), Tilray Medical (NASDAQ: TLRY), Organigram Global (NASDAQ: OGI; TSX: OGI), Little Green Pharma (ASX: LGP), and SOMAÍ Pharmaceuticals (privately held).

The critical insight for U.S. MSOs is simple: one EU-GMP cultivation and manufacturing facility in a single EU country can legally supply medical cannabis to every country in Europe—and any global market—with a medical framework. That includes Germany, the UK, Australia, Israel, Poland, Italy, Portugal, Switzerland, Spain, France, Ireland, Czechia, Denmark, Malta, New Zealand, Costa Rica, and more coming online.

• No duplicated infrastructure per market.
• No state-by-state regulatory walls.
• No punishing taxation like 280E.

You invest once, distribute across the continent, and scale your market share. But as price compression inevitably hits, the only sustainable answer is margin control, which only vertical integration delivers.

How the Early Movers Built Their Positions

Many early MCOs paid heavily to enter the space through aggressive acquisitions. Here is what the leaders spent to build their platforms:

Curaleaf International: Built the largest European footprint through an estimated $500 million in acquisitions. This included the $286–$343 million buyout of EMMAC Life Sciences in 2021, Germany’s leading distributor Four 20 Pharma, Rokshaw/Curaleaf Laboratories purchase in the UK, Clever Leaves’ EU-GMP processing facility in Portugal (2023); Fitocan medical clinics in Poland. The result? Over €172 million in European revenue in 2025 (up 63% YoY) and currently annualizing above €200 million.

Aurora Cannabis: Entered early by acquiring Pedanios (Germany’s largest distributor at the time) and later MedReleaf Australia. Their FY2026 results show $112.1 million in total international medical cannabis revenue, with Europe driving an estimated $75–$80 million of that total.

Tilray Medical: The product of Aphria’s 2021 reverse acquisition of Tilray, which kept the Tilray name. Aphria’s anchor European acquisition was CC Pharma, acquired in January 2019 for €18.9 million cash plus up to €23.5 million in earn-outs — against €262 million in revenue and €10.5 million EBITDA. One of the sharpest entry prices in European cannabis. Tilray contributed an EU-GMP cultivation campus in Cantanhede, Portugal, built from 2017, and Aphria an indoor grow facility in Neumünster, Germany, licensed in 2019. Post-merger, they added the Italian distributor FL Group and 14U Pharma, creating a platform supplying over 16,000 pharmacies in Germany.

Organigram Global / BAT: The newest MCO entry. Canadian producer Organigram, backed by British American Tobacco (~30% shareholder), closed its acquisition of Berlin-based Sanity Group in April 2026 for €107.3 million — with an earnout that could reach €227 million. Sanity grew from €9 million in 2023 to €60 million in 2025 and commands tobacco-sector multiples. Prior supply partnerships with Cannatrek in Australia and 4C Labs in the UK round out an emerging multi-market vertical.

Little Green Pharma: Made a defining move in 2021 by acquiring Canopy Growth’s 21,500 m² Danish facility for C$20 million. Later, Health House International will bolster Australian distribution and clinic access. They recently paired this EU-GMP infrastructure with Cannatrek’s Australian balance sheet through a reverse merger in
2026.

Somaí Pharmaceuticals is a private company that took a highly capital-efficient path. Rather than spending hundreds of millions, Somaí built vertically from a single EU-GMP manufacturing facility in Lisbon. In 2024, they acquired RPK Biopharma (an indoor grow in Sintra) for just $2 million in cash and built out a 13-country distribution channel. Today, Somaí carries the industry’s largest EU-GMP extract portfolio (100+ SKUs) and successfully brought global brands like Cookies, AiroPro, Bedrocan, Sherbinskis, and Jack Herer to the EU-GMP market.

Buy, Piece It Together, or Build: Formulating a Plan

For U.S. MSOs weighing their entry, there are three primary routes. You need a formulated
plan because the days of blindly throwing capital are over.

1. Buy: Acquire an existing MCO or key assets. A fast-growing €30–100 million European business is a very different conversation today, yet achievable for an MSO prepared to invest 20–30% of its market cap for a genuine multi-country footprint.
2. Piece It Together: Follow the Curaleaf model. Add cultivation and manufacturing, then go country-by-country, acquiring distribution networks. It requires navigating complex country risks and building a cohesive culture across borders.
3. Build: The slowest, but most margin-accretive path. Since well-run German distributors command lofty prices, MSOs that own their flower can start by building a European distribution license. GACP cultivation plus EU-GMP packaging is all you need to start direct exports to Europe. This will take about 3 years to develop fully at a fraction of the cost, but a reasonable path for longer-term objectives.

The Clock Is Ticking

Acquisition targets in Europe are limited, and the best-positioned MCOs are not standing still. EU cannabis companies are predominantly profitable and are building pharmacy relationships and brand equity every single quarter.

The global medical cannabis explosion has already arrived. With Germany alone reaching nearly €1 billion by 2025, and markets like the UK, Australia, and Poland scaling rapidly behind it, the European investment thesis is undeniably stable.

Any U.S. MSO without a credible global strategy by 2027 is going to have some incredibly difficult conversations with its board. The only question left is whether U.S. operators will step up to lead the charge or just watch the multi-billion-dollar action from the sidelines.