Spain vs. the UK

The regulatory landscape for medical cannabis is evolving worldwide, with countries like Spain and the UK attempting to balance patient needs, public health, and industry growth. While Spain is on the cusp of implementing its first formal medical cannabis framework, the UK has been navigating its own system since legalisation in 2018. Both nations highlight the challenges of regulating cannabis for medical use, particularly in addressing patient access, prescribing practices, and the role of evidence-based medicine.

Spain: An Emerging Market with Limits

Spain is poised to take a significant step forward with its draft Royal Decree regulating medical cannabis. This long-awaited development, published in September 2024, outlines a framework allowing specialist physicians to prescribe cannabis-based medicines for a limited set of conditions. These include:

Severe refractory epilepsy
Spasticity and muscle spasms in multiple sclerosis
Refractory chronic pain
Nausea and vomiting caused by chemotherapy

While this is a milestone, the restrictions in the draft raise concerns. For instance, medical cannabis will only be available as hospital-dispensed, compounded formulations—not as raw flower or other plant parts. Critics argue that the proposal excludes a vast majority of patients who could benefit, with estimates suggesting only a few hundred patients will access treatment under the new rules, compared to the 250,000–500,000 Spaniards who could benefit from broader regulation.

Despite these limitations, Spain is a leader in medical cannabis production for export. The Spanish Agency for Medicines and Health Products (AEMPS) reported a 51.3-tonne output in 2024, a 42.5% increase compared to the beginning of the year. This positions Spain among the top seven countries globally in production volume, though domestic use remains heavily restricted. With over 60 companies investing €115 million in facilities, particularly in southern Spain, the industry’s focus remains firmly on exports due to limited local demand.

The UK: Broader Scope but Barriers to Access

The UK legalised medical cannabis in 2018, enabling specialist doctors to prescribe cannabis-based products for medicinal use (CBPMs) under strict regulations. The conditions for which cannabis is commonly prescribed include:

Severe refractory epilepsy (e.g., Dravet syndrome, Lennox-Gastaut syndrome)
Spasticity in multiple sclerosis
Chronic pain (though NHS prescriptions are rare due to limited supporting evidence).
Nausea and vomiting caused by chemotherapy (in cases unresponsive to other treatments).

UK doctors also have the discretion to prescribe CBPMs off-label for other conditions, such as anxiety, PTSD, cancer-related pain, endometriosis, and palliative care. This flexibility, however, is hampered by significant barriers, including limited NHS prescriptions (due to restrictive National Institute for Health and Care Excellence (NICE) guidelines), high costs for private patients, and a lack of sufficient long-term research.

Patients in the UK can access a broader range of cannabis-based products, including raw flower for vaporisation, oils, and capsules. Unlike Spain’s upcoming rules, the UK permits private prescriptions, which allows greater access for those who can afford it. However, this dual system creates inequities, with many patients unable to pay the high out-of-pocket costs for private treatment.

Key Differences Between Spain and the UK

1. Scope of Conditions

Spain’s draft Royal Decree restricts cannabis prescriptions to four specific conditions, while the UK framework allows doctors more discretion to prescribe for off-label uses, provided clinical justification exists.

2. Formats and Availability

Spain’s proposed rules limit medical cannabis to hospital-compounded formulations, excluding raw flower or plant-based products. The UK permits a wider variety of delivery methods, including raw flower for vaporisation.

3. Access Challenges

While both systems face challenges, the UK’s framework offers greater flexibility but is undermined by high costs and limited NHS prescriptions. Spain’s system, meanwhile, appears to be more restrictive and focused on export markets rather than addressing domestic patient needs.

4. Evidence Standards

The UK applies rigorous evidence-based standards for medical cannabis approval, resulting in limited NHS availability due to insufficient data. Spain’s framework is just beginning and may evolve as further research emerges.

5. Industry Focus

Spain has become a global leader in cannabis cultivation and export, with companies heavily investing in the production of medical cannabis. The UK’s focus is less on production and more on patient access, though barriers persist.

What the Future Holds

As Spain finalises its regulatory framework, questions remain about whether it will meet the needs of domestic patients or remain an export-driven market. Experts, such as Arnau Valdovinos of Cannamonitor, argue that the draft regulations are too narrow and will leave the majority of potential patients underserved.

In the UK, while the broader scope of eligible conditions and private prescriptions offer greater theoretical access, real-world challenges such as cost, supply chain issues, and stringent guidelines continue to limit uptake.

Both nations have significant potential for growth in their medical cannabis sectors, but achieving a balance between regulation, industry development, and patient access remains a complex challenge. As 2025 unfolds, Spain’s Royal Decree and the UK’s ongoing refinement of its policies will shape the future of medical cannabis in Europe, with each country offering lessons for the other.

What’s your view on the future of medical cannabis regulations? Will Spain’s framework evolve to include more patients, or will it remain export-focused? Let us know your thoughts in the comments

Published 11th March 2025