A year after the decree was approved, medical cannabis is starting to reach Spanish hospitals. According to the AEMPS, Spain’s medicines agency, the first orders of standardised preparations arrive at hospitals from this week, in stages and with no single start date for the whole network. It is the first real supply through the channel created by Royal Decree 903/2025.
A closed, hospital-only channel
Spain’s model is among the most restrictive in Europe. Only hospital-based specialist doctors can prescribe, the hospital pharmacy service compounds the magistral formula and dispensing takes place there too. Community pharmacies are excluded, and so is dried flower: what is dispensed are standardised magistral formulas made from standardised preparations listed in the AEMPS register.
The decree sets four clinical situations: refractory chronic pain, multiple sclerosis spasticity, severe forms of epilepsy, and chemotherapy-induced nausea and vomiting, always where conventional treatments have failed. The National Formulary, drafted with the Spanish Society of Hospital Pharmacy (SEFH), sets out dosing, compounding and prescribing conditions. In practice, according to the SEFH, prescribers will mainly be anaesthetists in pain units, oncologists and haematologists, and neurologists.
One supplier at launch
The preparations register opened on 19 January. By March only two companies had applied, and in July the AEMPS authorised the first two preparations: one THC-dominant and one CBD-dominant, both from Curaleaf through its Spanish subsidiary Medalchemy, based in Alicante, according to Público. For now, that is the product that can reach hospital pharmacies.
For the industry, this detail matters more than the headline. Spain has around twenty AEMPS cultivation licences and its output has gone mainly to export, with Germany and the UK as the main destinations. The domestic market is opening, but with a high entry barrier: registration of each preparation, pharmaceutical quality standards and a single sales channel, the hospital.
What it means for business
- Licensed producers: the register remains open. Selling in Spain requires a registered standardised preparation; the AEMPS has up to six months to decide.
- Laboratories and quality control: traceability and batch characterisation are a condition of access, not an extra.
- Pharmaceutical distribution: the customer is the hospital pharmacy, with public procurement, different speeds by region and small teams in mid-sized hospitals.
- Medical education: demand will depend on how many specialists prescribe. Scientific societies and pain units will be key partners.
What to watch
Initial volumes will be small and uneven across regions. The points to follow are how many hospitals place orders in the coming months, whether new preparations enter the register and whether the Ministry of Health widens indications or channels once usage data exist. For companies operating from Spain, the domestic market is no longer hypothetical, but it will be won hospital by hospital.
These issues, from AEMPS registration to hospital pharmacy access, will be on the agenda at Spannabis B2B Bilbao 2027, on 11 March in the VIP Hall at BEC. If your company grows, tests or distributes medical cannabis, get your ticket or book a B2B table to meet buyers, laboratories and partners from across the sector.