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Date Published: 16/01/2026

Spain's medical cannabis milestone comes with training warning

Patients and doctors welcome new rules but say specialists must learn to prescribe it

Patients and medical groups have cheered a key step towards legal medical cannabis in Spain, which was agreed in October, but warn the real test will be training doctors who can actually prescribe it. The Spanish Agency for Medicines and Health Products (AEMPS) has published a monograph in the National Formulary listing cannabis preparations as official medicines, following last October's royal decree.

The document covers oral cannabis use up to 32 milligrams daily for four main conditions: chronic pain, multiple sclerosis spasticity, severe epilepsy, and chemotherapy nausea/vomiting. Anesthesiologist Jesús de Santiago from the Spanish Pain Society's Cannabinoid Working Group called it "a historic milestone" and "a tool that many patients are waiting for and ask us about every day". He sees it as "a glimmer of hope" for those resistant to other treatments, with preparations expected within six months once labs register.

Carola Pérez, who has used cannabis for 15 years after opioid addiction and leads the Spanish Observatory of Medicinal Cannabis, also welcomed the move as "a great step forward". She notes most patients use less than the maximum dose and likes the document's open approach. Still, she worries cannabis is relegated to last-resort status after all other drugs fail, especially for chronic pain. "We should be more generous," she says, suggesting it as a step between low and high-potency opioids to give patients a better chance.

The biggest hurdle remains doctor training. Most specialists lack knowledge beyond existing drugs like Sativex and Epidiolex. "If doctors aren't trained in medicinal cannabis, they'll rely more on industrial medications," Pérez cautions, asking when hospital oils will be ready. The Pain Society is stepping up with a university course at King Juan Carlos I University this year and a session at Madrid College of Physicians on Thursday January 30.

Pharmacists are challenging hospital-only dispensing at the Supreme Court, arguing it breaks medicine distribution laws. Meanwhile, patient groups like the European Observatory stress access barriers could clash with rights, as seen in Germany and Canada. Thousands already self-treat; now formal options are closer, but only if doctors are ready.

You might also be interested in: How many cannabis plants can I grow legally in Spain?

Image: Terrance Barksdale/Pexels

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