The Spanish Congress of Deputies approved medical cannabis reform on Tuesday. This decision was made based upon the report of the special health commission that formally reviewed the matter between March and May this year. A majority of the public expects that the full Health Commission will approve the report by June 27. It will then take six more months for AEMPS, the Spanish Health Agency to create guidelines for dispensation.

Despite the obstacles, medical cannabis will soon be accessible upon prescription through Spanish hospitals pharmacies. There are approximately 300,000. Domestic patients could benefit immediately from the change to the law, according to estimations. However, most will not be able to access the legal cannabis due to high bureaucratic hurdles. Patients with private insurance will be left behind as only public hospitals are able to prescribe.

This makes it clear that although this step is positive, it’s only the beginning. Only conditions such as cancer, epilepsy, pain, endometriosis and fibromyalgia will be permitted to medically use cannabis. Most patients will also not be able to access flower which is still limited for “research purposes.” Dispensation of cannabinoid extracts will also occur initially only via hospital pharmacies and only specialist doctors can prescribe.

Carola Perez (a well-known patient advocate, president of The Spanish Observatory for Medicinal Cannabis), a group composed of doctors, patients, and researchers who are committed to the reform of cannabis, believes that eventually medical cannabis may be accessible through regular pharmacies. Even though the change is pending until the end of this year, it still leaves a very narrow window for access. “Most patients will still be forced to source their medicine via clubs, home grow and the black market,” she said. Perez says that even though there’s a limited time window for access to the medicine, she is happy that this has finally been accomplished. “We have been fighting for this moment for the last seven years,” she said by phone from her home in Spain. “It is also clear that we still have much to do.”

What’s changing in Spain

Spain has just entered the “medical cannabis club” in Europe, where patients can, theoretically at least, obtain cannabis by medical prescription via a pharmacy, with the national health system underwriting the bulk of the cost. It is now possible to obtain cannabis by prescription via a pharmacy in Germany, France and Luxembourg. Although it’s legal to obtain cannabis in Holland from pharmacies, Dutch insurers refuse to cover claims. Most Dutch patients have to rely on the internet, black markets, and cafes for their cannabis. This will likely continue unless Spanish medical access is significantly extended.

Official acceptance of medical efficacy clearly means that currently operating four cannabis production companies in Spain, with AEMPS approval, will not only be allowed to export their product, but also can distribute it to local patients. The Spanish legal market can now accept foreign medical products.

Is this the end of recreational reform and clubs?

Spain seems to be on a road that European countries have already traveled. What is interesting about this newest (and inevitable) development is that it creates two distinct and bifurcated domestic cannabis markets—a formal medical one and a well-developed if less than legit grey one consisting of the cannabis clubs. Mostly located in Catalonia and Basque country, clubs nevertheless exist in every major city—though many have not reopened or are not operating in the same way post-COVID. It is much easier in Madrid to order cannabis online than to go to a club.

The fate of clubs in the new setting is not yet known. It could be that, like Holland, the Spanish authorities use this first medical opening to close down the clubs—although that is not really feasible at this juncture. It is more likely that a larger medical market will be approved and, eventually, a formalized recreational marketplace. The first step in the right direction is to establish a plan for national cultivation or allow limited home grows, just as it was done in Luxembourg and Malta.

Regardless, no matter how short the step, Spain has now affirmed medical efficacy—which means that medical cannabis use is legal in every major economy within the bloc. Europe’s entire conversation on cannabinoids has now reached its conclusion with the introduction of recreational reform in several European countries, including Germany Luxembourg, Portugal and Holland.