Spain's socialist government has given the go-ahead for the most wide-ranging trial of therapeutic cannabis ever conducted, putting the country at the forefront of global drug policy. Four hospitals, 60 pharmacies and up to 1,500 patients in Catalunya will take part in a yearlong pilot program sponsored by the regional government to establish the drug's effectiveness in treating a range of conditions.
"Experts agree cannabis has interesting therapeutic possibilities," said Rafael Manzanera, Catalunya's director of health resources. "We want to evaluate its efficacy. That has never been done before."
Patients will be prescribed cannabis capsules for four conditions: multiple sclerosis, the side effects of chemotherapy, lack of appetite among AIDS sufferers, and pain not eased by existing therapies.
The move follows decisions around the world to overcome anti-drug sentiments and carry out more studies into cannabis, many years after research first showed it could relieve pain. In the next few weeks, Canada is expected to approve the use of Sativex, which delivers cannabis derivatives into the bloodstream via a mouth spray.
There is growing frustration in the U.K. among those with chronic pain that nothing similar has been allowed here. The Medicines and Healthcare Products Regulatory Agency has asked Sativex's makers, GW Pharmaceuticals, for a confirmatory study of its product.
In most European countries, cannabis remains illegal, although authorities often turn a blind eye to those using it for therapeutic purposes. The plan for a trial in Spain was initially blocked but won support after José Luis Rodríguez Zapatero's socialists came to power last March. Zapatero has set an unapologetically left-wing social agenda since taking office. He has angered Spain's establishment with bold reforms on gay marriage, social housing and religious education, and his drug policy is expected to include a program of heroin prescription for long-term addicts.
Therapeutic cannabis use is widespread in Spain, but users have to rely on informal networks for support and information about the drug. "The majority of people we spoke to said using cannabis had improved their quality of life," said Rafael Borràs, a committee member at the College of Pharmacists. "But there was a lack of information. So we proposed this pilot."
Montse Domenech, of the Association of Breast Cancer Patients in Barcelona, says the group gets calls from women all over Spain looking for advice about cannabis. But while it is used widely among her members, it remains frowned upon. "We're older women and we have our hang-ups," she said. "When I started I had my oncologist's support, but I didn't tell my husband."
She says most oncologists will give patients the go-ahead to try cannabis, even if they won't admit it publicly. "We might as well provide support and control, since people are going to take it anyway."
British patients could be included in the Spanish program if they registered at one of the participating hospitals, but they wouldn't receive National Health Service funding. "The prescription will be tightly controlled," said Manzanera. "But if patients from outside Spain meet our criteria, they will be included."