Spain's royal decree creates a legal route to medical cannabis, but the first version is built around hospital pathways rather than routine outpatient prescribing. In practice, that means specialist-led prescribing and institutional protocols will decide how much access patients actually get. Spain may have "legalized" on paper, but whether this becomes a real market depends on whether the system is allowed to function at scale.
The old story goes that cannabis is going to get legalized within 5 years, yet we've been saying that for the past 15 years. Countries that have been one step away from regulating this industry have historically been more cautious than anything else. Take Spain, for instance. This southern European nation has been "on the verge" of medical cannabis for so long that the phrase may now be legally allowed to vote. But the royal decree is here, which means Spain is officially joining the countries that actually let patients access cannabis, at least in theory and at least through a hospital maze designed by someone who enjoys the sound of paperwork shuffling.
Spain has formally legalized hospital-based, extract-led medical cannabis access on paper, but the initial framework is designed to run through institutional hospital pathways rather than open outpatient prescribing.
Arnau Valdovinos from CannaMonitor has recently published a report on the state of the cannabis sector in Spain. The picture he paints is one of (unimaginably) slow momentum and untapped potential. "We work internationally a lot, mostly in North America and Europe, because until now Spain simply did not have a viable market."
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A Spanish story
The Spanish narrative is usually the same. The model is restrictive, expectations are low, and the trust in policymakers is even lower. But Arnau found something that does not quite fit the pessimism. "One third of the specialists who are allowed to prescribe are prescribing," Arnau said. "It is strict, but not as strict as you might think." While such an attitude shift may be regarded positively in many countries, in Spain it simply means we are starting from a very low bar.
Currently, this system is routed through hospitals, and Spain has 353 hospital pharmacies. As Arnau puts it, you can't call that a distribution network, rather, that's a dedicated bottleneck.
Meanwhile, more than 20,000 hospital specialists can theoretically prescribe cannabis. In practice, things don't work that way. "In the United Kingdom only 1% of doctors prescribe," Arnau noted. "If you apply that ratio to Spain, it is not enough."
Spain does have infrastructure for narcotics. Hospital pharmacies buy around 12 billion euros worth of controlled medicines each year. So yes, in the grand scheme of narcotics, cannabis is a very small slice of the pie. Less than 5% even in the best-case scenario. "But whether the system can carry the weight is not the question," Arnau remarked. "The question is whether anyone will be allowed to put weight on it in the first place."
The comparison everyone tries to avoid making is Germany. Last year, Germany imported 140 tonnes of medical cannabis. That represented only about 20% of total consumption. "Southern Europe has even higher use," Arnau says. Epidemiology puts Spain somewhere between 600–1200 tonnes of total cannabis use.
Under the current rules, Arnau estimates the Spanish medical market could grow to around 10% of the present German one. Getting anywhere near that number will require Spain to stop making easy things difficult. "Prescribing needs to be ensured through education," Arnau says. "Spain has more than 20,000 eligible doctors, but without education and guidance, regulators are building a market with a steering wheel made of smoke."
There are also obvious fixes that would not require a political miracle. "Let family doctors prescribe. Let community pharmacies dispense. Allow telepharmacy, since 58% of hospital pharmacies already follow patients remotely. And if Spain wants real world data, it needs to allow actual access. This is very important to generate evidence to expand the model."
Then there is the CBD situation, which is something between a regulatory misunderstanding and a bonfire. In 2021 someone decided that hemp grown for CBD flower should be treated as a narcotic. The result was predictable. The Spanish hemp market imploded, growers left, and retailers shut down.
Despite the legal uncertainty around CBD flower, the Spanish CBD market is still estimated at roughly €136m per year and about 3,000 jobs. At the same time, domestic hemp area has fallen 91%, from 688 ha (2020) to 62 ha (2024). The tobacco-law reform is positioned as a potential route to give inhalable CBD products a clearer legal framework.
Meanwhile, on the industrial side, Spain is already operating like a country that figured this out years ago. There are around 70 companies involved in medical cannabis. 30 have licenses. 4 are licensed growers today, with another five waiting on GMP validation that could bring the total to 9. 5 companies focus on genetics, 19 on research and development. One is running a clinical trial. Production tells the same story.
Last year Spainproduced 7.5 tonnes and in the first 9 months of this year exported over 22. "Not because Spain magically grew 22 tonnes but because Spanish companies are quietly becoming a European processing hub,"
Arnau says. "Biomass comes in from Portugal or Colombia, gets processed, gets re-exported. There are giant retrofitted greenhouses by Ondara (Soria) and Medical Plants (Almeria). Linneo Health in Murcia, born from an opium producer, Alcaliber, likely shipped out more than five tonnes last year alone."
Foreign capital is still an exception. According to Arnau, Grow Iberia in Cordoba has ties to a major distributor in the United Kingdom. Trichome Pharma has Australian backing. Total investment sits around €148M euros. But nothing compared to what Spain could attract if it had a coherent policy. As Arnau said, "If you look at Portugal, how tiny it is compared to Spain, and it has four to five times the production capacity."
"Spain has the climate, the expertise, the scientific base. Spain even has the consumers. What it does not yet have is a policy that admits any of this. In the next months, even if there is not much political willingness, there is room to play. There is an agenda for cannabis in Spain, something we have rarely had."
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