Medical Cannabis: Facts, Myths, and the Future of Pain Management in Spain

In this new episode of *Pirates of Pain*, our Medical Director, Dr. Jorge Orduña, speaks with Dr. Chus de Santiago, a leading figure in the cannabinoids working group of the Spanish Pain Society. Together, they discuss the imminent arrival of standardized cannabis preparations in clinical practice and how this tool could revolutionize the quality of life for many patients.

What is the endocannabinoid system?

Although it was discovered only a few decades ago, the endocannabinoid system is essential to our bodies. It acts as a regulator of homeostasis, controlling such vital functions as body temperature, memory, appetite, sleep, and, of course, pain.

When we experience chronic pain, this system tries to protect us. The medical use of cannabinoids aims precisely to modulate these “gates” (CB1 and CB2 receptors) through external messengers in order to restore the body to a state of balance.

Differences Between Medical Cannabis and Recreational Use

It is essential to dispel stigmas: medical cannabis has nothing to do with the recreational use of the plant. While recreational marijuana is highly variable and unregulated, medical cannabis uses standardized preparations.

This means that, just as with any other medication, the doctor knows exactly what dose of THC and CBD they are administering. These preparations are titratable, stable, and meet all pharmaceutical safety standards, eliminating contaminants such as heavy metals or pesticides that are often found in unregulated products.

Clinical Applications and Patient Profiles

Although still limited, the scientific evidence is growing rapidly, with high-quality studies demonstrating the effectiveness of these treatments, particularly in:

• Refractory neuropathic pain: Already classified by the Spanish Pain Society as a third-line treatment.

• Spasticity: Very common in neurological conditions that do not respond to conventional medications.

• Cancer pain: Cannabinoids are exceptionally effective in this context. Not only do they help manage pain, but they also improve sleep, reduce chemotherapy-induced nausea, and increase appetite, while also allowing for a reduction in opioid doses.

The Dangers of “Street CBD”

Our Medical Director, Dr. Jorge Orduña, and Dr. De Santiago warn about the risks of CBD oils sold in health food stores or shops that are not subject to health regulations. Because they are labeled as cosmetics, they do not undergo the same testing as medications.

Many of these products contain undeclared traces of THC, which can trigger psychotic episodes in vulnerable individuals. In addition, CBD can interfere with serious treatments, such as cancer immunotherapy, reducing their effectiveness. For this reason, its use should never be taken lightly without medical supervision.

The 2026 Horizon: The Royal Decree

Following the approval of the royal decree in March 2025, Spain is preparing to make medical cannabis a tangible reality in hospital pharmacies. It is expected that, by the end of 2026, specialists will be able to prescribe standardized compounded formulations for selected patients.

As our Medical Director, Dr. Jorge Orduña, the goal is for cannabis to become a standardized therapeutic tool within a year—treated with the same scientific rigor as any other medication—to offer a safe alternative to those living with chronic pain.