A 'new remedy’ that is not a ‘legal possibility’: Spain's draft law for medicinal use of cannabis

Cannabis is the most commonly used illicit drug in Catalonia and in Europe, but this controversial plant has been explored in recent years for its medicinal and therapeutic properties. 

On September 30, 2024, the Spanish health ministry published the draft of a royal decree that would allow certain doctors to prescribe therapeutic cannabis. 

These medications would balance the quantity of two substances that the marijuana plants have: tetrahydrocannabinol and cannabidiol. 

Doctor Magí Farré, the head of the Clinical Pharmacology services in Hospital Germans Trias i Pujol, explains the differences: "Tetrahydrocannabinol, or THC, is the substance that produces the pleasant effects -usually the substance why someone consumes cannabis- and it is also the one linked to addiction. Whereas cannabidiol (CBD) acts differently, as it has anti-inflammatory and relaxing effects mainly." 

Depending on the moment of harvesting, the amount of either of these compounds varies. Therefore, companies that grow the plant for pharmaceutical purposes monitor the amount of each chemical compound when they harvest it. 

This allows for a more specific medicine to be as adjusted as possible to the patient's needs, one of the benefits of this prescription that Doctor Farré mentions in an interview with Catalan News. 

"I think this new law would allow patients to try a new remedy that right now isn't a legal possibility,” he explains. “The patients who have tried it have bought it on the black market and are handling what is considered an illegal substance, that comes from an environment that is not controlled," Dr. Farré explains. 

"Cannabis clubs here in Catalonia do partially serve that medical function already. Substance abuse is prevalent in these clubs, but it is also a place where a lot of people can get the cannabis that they need," he continues. 

The new law would enable patients to go to hospital pharmacies, where pharmaceutically prepared cannabis-based medicines, such as essential oils, could be obtained.  

"This would be one of the easiest options for people, as they can just pick up the finished product from the pharmacy that is ready to take," Magí Farré says. Other options, such as infusions, could also be a possibility.  

And who could benefit from this medicine? According to the draft, the pathologies that could benefit from this new medicine would be the ones where there is scientific evidence of the advantages of cannabis.  

"The medical indications in Spain are quite restrictive compared to other countries, health authorities have indicated cannabidiol for some forms of epilepsy, also for those suffering from chronic pain, multiple sclerosis, and to alleviate the nausea and vomiting caused by chemotherapy," Doctor Farré explained. 

"But here there is also an annex clarifying that doctors can prescribe it to patients with Crohn's disease, insomnia, or other conditions," he continued. 

As with other medicines, not every type will work for every patient in the same way.  

A study by Hospital Clinic of Barcelona published in October 2023 showed that consuming cannabis represents a higher risk for patients under 25 years old as it can increase the possibility of psychosis. It is also not recommended for pregnant people as it can affect the fetus, and for drivers or people who operate machinery as it can cause drowsiness.  

About the circumstances in which the use of cannabis is not recommended, Doctor Farré explains: "It shouldn't be prescribed to patients who have previously suffered undesirable effects, like for example psychosis, neither should it be taken by patients who have previously suffered organ complications when taking cannabis. It is also not recommended for people with high blood pressure or heart diseases, as well as any kind of mental illness." 

Cannabis is a natural substance, and consuming plant-based remedies should be as controlled as any other medicine, which is what this new law draft proposes.  

As a final note, Doctor Farré concluded: "cannabis can be very potent for patients who have never come into contact with it before, and it should always be taken under a doctor's supervision."