Across news sites, TV screens and radio shows, one headline stands out, the kind that makes noise: Spain joins the list of more than forty countries that have integrated cannabis into their healthcare systems. It will be for medical use only and dispensed exclusively in hospitals. This regulatory leap is being hailed as a guarantee of safety for patients and users.
However, for those who have spent years fighting for legalization, the new decree feels “too restrictive.” It will only be prescribed when traditional treatments no longer work. It is progress, yes, a rule that opens the path forward. But the struggle continues.
“The way I see this decree,” says Carola Pérez, president of the Spanish Observatory for Medicinal Cannabis, patient and full-time activist, “is that finally, and despite facing a lot, a lot of resistance from medical associations, some scientific societies and even parts of Spain’s parliament, we can celebrate.”
Throughout this long back-and-forth journey, full of turns and ideas, Pérez was invited to join a subcommittee of experts and, she says, revealing part of the backstage, “it was like starting a soccer match with the referee already bought.” Over these years of struggle, the activist lived through surreal moments, took hits from every side and, riding on the results, feels satisfied for having managed to “get a foot in the door so they can’t close it again.” What comes next? Breaking stigma and giving shape to legal uncertainty.
Under the new decree, patients will not have access to the cannabis flower, but they will have access to compounded formulations, standardized preparations distributed free of charge in public hospitals within the national health system. “The hard part and the trick is figuring out how to actually reach it,” Pérez admits, “because all across Europe, public hospitals are being privatized.”
In addition, some users fear bottlenecks with the waiting lists and are still waiting for clear guidelines on which conditions and symptoms will qualify. “But it’s a big first step,” says Pérez, caught somewhere between doubt and celebration, media appearances and everyday life. “Until the very last moment, I was trembling, afraid they’d make a sudden U-turn.” And so, the first major milestone is this: cannabis has officially entered the healthcare system.
In that regard, Guillermo Velasco, professor of Biochemistry and Molecular Biology at the Universidad Complutense de Madrid and researcher of cannabinoids’ anti-tumor effects on brain cancers, sees the news as a “major step forward compared to the previous situation” and “the first stone on which to carve a path.” At the same time, Velasco calls for broader access and the democratization of prescriptions so that they are not limited to specialists but can also be issued by general practitioners.
“It could end up making access difficult for patients,” he explains, “because this medication has to be dispensed in hospital pharmacies, which might create bottlenecks if there is high demand and few specialists to handle it. And then there’s the problem of big cities: in smaller ones, it might be even harder to get cannabis.”
Even so, the researcher values the “step forward” and firmly believes that progress can be made toward “a less strict regulation.” After years of stigma and marginalization, regulated and quality-controlled medical cannabis now stands as the beginning of a meaningful solution for patients.
For his part, Manuel Guzmán, also a professor of Biochemistry and Molecular Biology at the Universidad Complutense de Madrid and member of the Royal Academy of Pharmacy, thanked the government, the Ministry of Health, the Spanish Agency of Medicines and Medical Devices, and the political parties that supported the initiative.
“We hope the program reaches patients, that it truly helps them, and that it allows us to keep advancing in this field in our country,” Guzmán says. “These are patients with chronic, highly debilitating diseases who are in need of new therapies, and this could help them. And of course, it could remove the stigma and the legal and medical uncertainty they currently live in.”
Still, he acknowledges there are two sides to this coin, one of them being restrictive. “Dispensing will take place exclusively in hospital pharmacies, not in community ones, and preparations will be limited to compounded formulas, with herbal cannabis not being allowed. Hopefully, all this will improve in the future. My evaluation is positive, with the wish that things keep getting better over time,” concludes the researcher.
Formally, Spain’s Council of Ministers approved the Royal Decree regulating the use of medical cannabis within the national healthcare system, a measure born from years of struggle and, as the main voices say, still open to improvement. “We’ll keep working to broaden it as much as possible,” Pérez concludes. Thus, another page is written in the winding history of medical cannabis in Europe.
