On Tuesday the Spanish Congress of Deputies passed medical cannabis reform. The decision to do so was based on the report of a special health commission which formally examined the issue between March and May of this year. It is also widely expected that as of June 27, the full Health Commission will formally approve the report. Then it will take another six months for the Spanish Health Agency (AEMPS) to produce guidelines for actual dispensation.

No matter the hurdles still in the way, this means that medical cannabis will be available upon prescription via Spanish hospital pharmacies by the end of 2022. According to estimates there are about 300,000 domestic patients who could immediately benefit from this change in the law even though most of them will fail to get access due to the high levels of bureaucracy that remain. Further, because only the public hospitals can prescribe, patients with private health insurance are being left out for now.

It is clear, as a result, that while positive, this is an extremely limited first step. Medical use of cannabis will only be allowed for conditions including cancer, pain, endometriosis, fibromyalgia, and epilepsy. 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.

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 dedicated to cannabis reform, medical cannabis could be available via regular pharmacies eventually. The change now pending for the end of the year still creates an onerously small window of access. “Most patients will still be forced to source their medicine via clubs, home grow and the black market,” she said. Despite the beginning of an extremely limited window of access, Perez is nonetheless happy that at least this first step has been taken. “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 Is 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. The countries where this is possible at this point includes Germany, France, Italy, Portugal, Luxembourg, and Greece. In Holland, it is legal to buy cannabis at a pharmacy, but tragically, since 2017, Dutch insurers have refused to reimburse claims. As a result, most Dutch patients must rely on their own cultivation, the black market, or the cafes. Unless Spanish medical access is considerably broadened, it is also likely that this will remain the status quo here as well.

What the formal acceptance of medical efficacy does mean unequivocally is that the currently-operating four medical cannabis cultivation companies in Spain with authority approved by AEMPS will no longer solely have to export their product but can now distribute to domestic patients. It also means that foreign medical producers can enter the Spanish medical market.

Where Does This Leave The Clubs and Recreational Reform?

It is clear that Spain is being pulled down a path that other European countries have already trodden. 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. In Madrid, for example, it is easier to get cannabis delivered than go to a physical club as of June.

It is also unclear what the fate of the clubs will be in this new environment. 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. More likely is the approval of a broader medical market and eventually, just as in Holland, the establishment of a formalized recreational market. Even if the first step towards the same is some kind of national cultivation plan or, as in Luxembourg and Malta, limited home grow becomes formally legitimized.

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. Recreational reform in countries including Germany, Luxembourg, Portugal, Holland, and Switzerland also means that the entire conversation about the use of cannabinoids is now finally in full swing across Europe.

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