One year after the Royal Decree, Spain's medical cannabis framework is reaching its first patients. According to a report of 21 October 2026, the first deliveries are going to about 50 hospitals. It sounds like a breakthrough. The catch: access is narrower than in almost any other large EU country.
What is established
The Royal Decree was approved on 7 October 2025 and published in the official gazette (BOE) on 9 October 2025. It governs magistral preparations made from standardised cannabis products. The Spanish medicines agency AEMPS published a clinical monograph in January 2026. It covers four indications and sets daily maximums of 32.4 mg THC and 25 mg/kg CBD. CBD-dominant formulas are the default.
Who may do what
- Prescribing: hospital specialists only, not GPs.
- When: only after authorised medicines have not worked sufficiently.
- Dispensing: hospital pharmacies only. Community pharmacies are excluded. Flower and commercial products are not part of the scheme.
How this compares across the EU
In Germany, doctors of any specialty can prescribe cannabis flower, and pharmacies dispense it. Spain chose the opposite: a closed hospital circuit covering prescription, preparation, dispensing and follow-up. That is more controlled, but it also means far fewer patients. Advocacy groups estimate around 300,000 current users in Spain, and only a small share is likely to qualify.
