Spain approved medical cannabis by royal decree in October 2025. Yet for a whole year it reached no patients at all, because there was no registered manufacturer. In October 2026, the first deliveries to hospital pharmacies are finally under way. This overview explains what is allowed, who has access and why patient groups consider the model too restrictive.
The key points. Royal Decree 903/2025 allows magistral formulas made from standardised cannabis preparations in Spain. Only hospital specialists may prescribe them, they are dispensed exclusively by hospital pharmacies, and only for four indications once other treatments have failed. The first preparations were registered in July 2026, and hospitals have been receiving supplies since October 2026.
Royal Decree 903/2025: what Spain has decided
Real Decreto 903/2025 of 7 October 2025 was published in Spain's official gazette (BOE) on 9 October 2025. It does not cover cannabis flowers or over-the-counter products, but a tightly defined route: magistral formulas prepared in hospital pharmacies from standardised cannabis extracts. These extracts must have a defined composition and be listed in a public register kept by the Spanish medicines agency (AEMPS).
Preparations containing 0.2% THC or more are classed as psychotropic substances and are subject to the corresponding controls. Industrially manufactured cannabis medicines that are already authorised fall outside the decree.
The four indications
A prescription is only possible when authorised treatments have not worked well enough or were not tolerated, in the following cases:
- spasticity associated with multiple sclerosis,
- severe, treatment-resistant epilepsy,
- nausea and vomiting caused by chemotherapy,
- refractory chronic pain.
Who prescribes, and where is it dispensed?
- Only hospital specialists may prescribe these formulas. GPs are excluded.
- Only hospital pharmacies prepare and dispense the formula. Community pharmacies are not involved for now.
- The basis is an AEMPS monograph (FN/2026/FMT/043), published on 20 January 2026, describing a standardised oral solution containing THC and CBD.
- For adults, the maximum daily amounts are 32.4 mg of THC and 25 mg of CBD per kilogram of body weight. For children, CBD-dominant formulas are recommended.
Patients remain within the hospital system for the entire treatment. The Ministry of Health has not yet set out how it will be funded in the public system.
Why it took a year
The decree alone was not enough: without a registered standardised preparation, no hospital pharmacy could make the formula. As late as January 2026, AEMPS said there would be no product until a manufacturer was registered. Only in July 2026 did it register the first two preparations, CAN-1 and CAN-2, from the company Curaleaf. Of the four cultivation licence holders in Spain, it was the only one to have completed registration at that point.
Meanwhile, two pharmacy organisations (CEOFA and the General Council of Official Pharmacists' Associations) filed appeals with the Supreme Court in December 2025 and January 2026. No date has been set for a ruling.
October 2026: the first deliveries
In mid-October 2026, AEMPS completed the procedure that allows dispensing in hospitals. According to trade media, around 50 public and private hospitals were due to receive supplies in the week of 19 October, with nationwide availability targeted for the end of October. Access depends, case by case, on the specialist's assessment and on each hospital's stock.
Criticism: a very narrow framework
Patient groups and experts welcome the launch but see the model as very restrictive: only four indications, only as a last resort and only in hospital. Pharmacologist Manuel Guzmán estimates that around 300,000 people in Spain use cannabis for medical reasons, and that only a small share will gain access to the new system. The patient organisation Dosemociones calls it a first step, not the finish line.
Spain, France and Germany compared
| Criterion | Spain | France | Germany |
|---|---|---|---|
| Access for new patients | Yes, since October 2026, very limited | Not possible at present | Yes, on a standard prescription |
| Who prescribes | Hospital specialists | In future, hospital doctors | Any doctor |
| Dispensing | Hospital pharmacies only | Planned via hospital and pharmacy | Community pharmacies |
| Cannabis flowers | Not included | No smoking, inhalation only via a medical device | Can be prescribed |
| Indications | Four, fixed | Five in the pilot | No closed list |
CBD in Spain: not to be confused with medical cannabis
Spain has many CBD shops. The industrial hemp products they sell, such as cosmetics or aromatic products, are not medicines, may not be promoted with health claims and have nothing to do with the new medical system. Foods containing CBD cannot be sold in the EU, where CBD is considered an unauthorised novel food.
On Big CBD Product, we compare CBD and hemp products. Medical cannabis is a matter for doctors and pharmacies.
Frequently asked questions about medical cannabis in Spain
Is medical cannabis legal in Spain?
Yes, since Royal Decree 903/2025 of 7 October 2025. It allows magistral formulas made from standardised cannabis preparations, prescribed by hospital specialists and dispensed by hospital pharmacies.
Which conditions can medical cannabis be prescribed for in Spain?
Four indications: spasticity in multiple sclerosis, severe treatment-resistant epilepsy, chemotherapy-induced nausea and vomiting, and refractory chronic pain, only after other treatments have failed.
Can a GP prescribe cannabis in Spain?
No. Only hospital specialists may prescribe these formulas, and they are dispensed exclusively by hospital pharmacies.
Since when has medical cannabis been available in Spanish hospitals?
The first preparations were registered in July 2026. Hospitals have been receiving supplies since October 2026, with nationwide availability targeted for the end of October 2026.
Are cannabis flowers allowed as medicine in Spain?
No. The Spanish model does not include flowers, but standardised preparations from which hospital pharmacies make an oral solution.
This article is for general information only and does not replace medical or legal advice. Information as of 21 October 2026.