Spain Approves Medical Cannabis Reform: Pharmacy Dispensing Planned for Late 2022

On Tuesday, the Spanish Congress of Deputies approved the reform of medicinal cannabis. The decision to do so was based on the report of a special health commission that formally investigated the matter between March and May this year. It is also widely expected that the full Health Commission will formally approve the report on June 27. Then it will take another six months for the Spanish health authority (AEMPS) to draw up guidelines for the actual delivery.

Notwithstanding the hurdles that remain, this means that medicinal cannabis will be available on prescription through Spanish hospital pharmacies by the end of 2022. However, it is estimated that there are around 300,000 domestic patients who could benefit immediately from this change in the law, but most of them will not be able to access it due to the high level of red tape that remains. In addition, since only public hospitals can prescribe, patients with private health insurance are left out for the time being.

It is therefore clear that while this is positive, it is an extremely limited first step. Medical use of cannabis is only allowed for conditions such as cancer, pain, endometriosis, fibromyalgia and epilepsy. Most patients will also not have access to flowers, which are still limited for “research” purposes. Cannabinoid extracts will also initially only be sold via hospital pharmacies and only specialists will be able to prescribe them.

According to Carola Perez, a well-known patient advocate and president of the Spanish Observatory for Medicinal Cannabis, a group of patients, doctors and researchers committed to cannabis reform, medicinal cannabis could eventually be available through regular pharmacies. The change that is now pending at the end of the year creates a burdensomely small access window. “Most patients will still be forced to get their drugs through clubs, home growers and the black market,” she said. Despite starting an extremely limited window of access, Perez is nonetheless glad that at least that first step has been taken. “We’ve been fighting for this moment for the last seven years,” she said over the phone from her home in Spain. “It is also clear that we still have a lot to do.”

What is changing in Spain?

Spain has just entered the “medical cannabis club” in Europe, where patients can, in theory at least, obtain cannabis on prescription from a pharmacy, with the national healthcare system covering most of the cost. Countries where this is currently possible include Germany, France, Italy, Portugal, Luxembourg and Greece. In Holland it is legal to buy cannabis from a pharmacy, but tragically Dutch insurers have refused to reimburse claims since 2017. As a result, most Dutch patients have to rely on their own cultivation, the black market, or the cafes. Unless medical access is expanded significantly in Spain, it is likely to remain the status quo here as well.

What the formal recognition of medicinal efficacy clearly means is that the four medical cannabis cultivation companies currently operating in Spain, with an AEMPS-approved permit, no longer just have to export their product, but can now distribute it to domestic patients. This also means that foreign medicine manufacturers can enter the Spanish medicine market.

Where are the clubs and the leisure reform?

It is clear that Spain is being dragged down a path that other European countries have already trodden. The interesting thing about this latest (and inevitable) development is that it creates two distinct and bifurcated domestic cannabis markets — a formal medical market and a well-developed, if less than legitimate, gray one made up of the cannabis clubs. Clubs, mostly located in Catalonia and the Basque Country, still exist in every major city – although many have not reopened or no longer function in the same way post-COVID. In Madrid, for example, from June it will be easier to get cannabis delivered than to go to a physical club.

It is also unclear what the fate of the clubs will be in this new environment. It could be that the Spanish authorities, like Holland, use this first medical opening to close the clubs – although that’s not really feasible at this point. More likely is the admission of a broader medical market and eventually, just like in Holland, the establishment of a formalized leisure market. Even if the first step is a kind of national cultivation plan or, as in Luxembourg and Malta, limited self-cultivation is formally legitimized.

No matter how brief the move, Spain has now confirmed medicinal efficacy – meaning medicinal cannabis use is legal in all major economies within the bloc. Recreational reform in countries like Germany, Luxembourg, Portugal, Holland and Switzerland also means that the whole discussion about cannabinoid use is now finally in full swing across Europe.