Medical marijuana transforms into big business in Israel
1,200 patients will soon be authorized to use Cannabis, which was approved for medical purposes in 1999.
How did Yohai Golan-Gild go from being an organizer of psychedelic drug parties to being a provider of medicinal marijuana in Israel - with the full approval of the Health Ministry?
"The 90s were the golden age of chemicals," Golan-Gild said. "In every forest clearing there were people taking ecstasy and LSD and dancing themselves silly. People didn't get married unless pills were promised to the guests. Thousands protested at Rabin Square urging us to 'give trance a chance.' There was a feeling that something was about to change. But in Israel, people love to party, but they don't love paying for it. I lost millions, I collapsed financially, and that is how I found myself in California. Very quickly, I became the owner of three grow houses of medicinal marijuana, until six months ago, when I go a phone call from my American friend Rick Doblin."
The path taken by Golan-Gild represents the quiet but fascinating revolution that Israeli society has undergone over the last decade. In 1999, the Health Ministry legalized the use of Cannabis, the plant from which marijuana and hashish are derived, for use by patients suffering from serious symptoms such as pain, nausea and loss of appetite.
As the cultivation of the Cannabis plant became legal, the number of patients prescribed medicinal marijuana grew from two in 2000 to more than 700 today. The number is expected to reach 1,200 within three months. Cannabis growing is on the verge of becoming an economic goldmine and entrepreneurs seeking to tap its potential are eyeing the endeavor. The consumption of cannabis products, which was completely forbidden up until ten years ago, is now becoming regulated and may eventually gain the status of any other drug supplied to the general public.
"I issue 40 new prescriptions every month, with an average prescription calling for 100 grams per patient per month," boasts Dr. Yehuda Baruch, the head of the psychiatric hospital "Abarbanel" in Bat Yam. Baruch is also the Health Ministry's point man for medicinal marijuana prescriptions.
The aforementioned revolution has not yet been completed, and the use of medicinal marijuana is currently in a sort of twilight zone. It is considered a legitimate medical treatment, under the supervision of the Health Ministry, but is viewed as a "stepson" of sorts. Baruch, the sole provider of prescriptions, is only employed by the ministry part time, and many patients find themselves waiting for him to clear time from his busy Abarbanel schedule to renew their prescriptions.
"Baruch is already causing a bottle neck. What will happen in September when we reach 1,200 patients with prescriptions?" asks Liat Benny (37), a Tel Aviv resident, who suffers from a rare genetic disorder and is prescribed marijuana to ease her symptoms. She has recently established a non-profit organization to promote the use of medicinal marijuana like any other prescription medication.
"Our battle is against an institution mired in prejudice," she said. "The stigma is that patients who smoke are messed up, or high, but that is not the way we are. The Cannabis, for me, comes in place of other drugs, and it allows me to function. Don't compare me to a healthy person who smokes." She added that she has often encountered doctors and nurses at conferences where she'd lectured who responded with giggles and asked to take her picture next to the plant.
Just to be clear, Benny's complaints are not directed at Baruch. On the contrary - patients laud the Health Ministry and Baruch in particular for smashing the conventional closed-mindedness in regard to the use of medicinal marijuana. Dr. Itay Gur-Ariyeh, the head of pain management at Sheba hospital and the chairman of the Israel Pain Association said that Baruch is on the right track, but that the issue must be completely regulated.
Up to ten plants
The problematic nature of the status of medicinal Cannabis is most evident in its production. The Health Ministry committee that decided to permit the use of medicinal marijuana back in 1999 stipulated that the drug be given only to patients with extreme symptoms, and only in order to ease pain directly stemming from their disease. But the committee had trouble defining how the patients were to obtain the drug, which was not legally grown in Israel at the time.
Thus, until 2005, the prescriptions for medicinal marijuana were given only to ten patients, among them Benny. The ministry allowed them to independently cultivate up to ten Cannabis plants, and to possess up to 200 grams of processed plants (imagine what would happen if your doctor prescribed you a drug and then asked you to produce it yourself).
This was not the only problem. The growing of Cannabis requires some physical work, as well as time. Since the first patients to be prescribed the drug were all terminally ill, this aspect took on an ironic twist, even if not intentionally. The backwards result wasn't far behind - Yossi Bozaglo, of the first patients to be prescribed marijuana, was tried in 2001 for buying marijuana from a drug dealer. The incident made it very clear that the ministry must take responsibility over providing the drug.
Then "angel face" arrived. That is how the patients call the man, who to this day insists on remaining anonymous, who approached the ministry and offered to provide the Cannabis to the patients. Somewhere in the north, he and his family have been growing the Cannabis with the authorization of the state for the last four years. The availability of the drug, thanks to angel face, greatly increased the number of patients who were prescribed the drug. His grow house holds dozens of plants, all of which bear the names of patients who were treated with Cannabis and have since died.
In a small apartment in Tel Aviv, patients huddle almost daily to get their joints or the raw materials from angel face and the volunteers at the organization he founded, named "Tikkun Olam." The distribution of these cigarettes, at the improvised "clinic" and with the government's blessing, is perhaps the most surreal and heartwarming sight to be seen at any medical facility - light years away from the atmosphere at oncology wards at hospitals.
Angel face provides relief for Parkinson's patients in wheelchairs alongside Crohn's disease sufferers and cancer victims, who smoke together in the yard. Patients over 70 years old suddenly get up from their chairs and begin to move around. A child suffering from Tourette Syndrome, who was forced to leave her school due to ridicule from her peers, stopped cursing thanks to the drug, went back to school, and is now in a relationship with her first boyfriend. And everyone has a smile on their face. The Cannabis they receive has a much higher concentration of the active ingredient than marijuana sold illegally.
The process of obtaining the authorization to supply marijuana can testify to the quiet revolution. At first, only angel face was permitted to handle the drug and prepare joints. Then, due to the growing demand, Baruch authorized several volunteers to help prepare the drug. Ultimately, the volunteers were given authorization to transport the drug all across the country.
Angel face doesn't receive any payment from the state for the production of the Cannabis, and the patients don't pay for it either. However, it is clear to everyone that this cannot continue, in light of the growing demand and the cost of production. "There must be payment," Dr. Gur-Ariyeh declared. "Who will pay for this - the state, the HMOs or the patients - that's a different question." Baruch, as a representative of the Health Ministry, shares Gur-Ariyeh's opinion and has already begun compiling a financial model.
Medicinal Cannabis - a combination of helpless patients and a drug with a hint of the wild - has sparked the attention of many entrepreneurs. The phone call Yohai Golan-Gild received a year ago was from his American friend, Rick Doblin, the founder of the Multidisciplinary Association for Psychedelic Studies, which promotes the use of these substances in medicine and research. When he heard about the revolution underway in Israel, Doblin quickly contacted his friend Golan-Gild, who was in California at the time. Last week, Baruch and other ministry representatives visited the hothouses built by Golan-Gild and his two partners, with an initial investment of NIS 1 million. (They asked not to make public the location of the hothouses, for fear of theft.) They will be the second supplier of medicinal marijuana.
The Health Ministry - which thinks it is impossible to rely on one supplier for a drug that is grown agriculturally and is susceptible to disease or other potential damage - plans to increase the number of authorized medical Cannabis growers to five or six. According to Baruch, this number would grow and supply enough Cannabis to meet the expected demand. At first patients would receive the drug for free, but they will soon be asked to pay for it.
"There are 160 varieties of Cannabis in the world and each one has its own side effects," said Golan-Gild, adding, with pleasure, "I can suit each patient with his or her type - one that will cause exhaustion, one that will turn you into a ball of energy in the morning and one that will cause a diagonal erection."
Baruch sees "the potential market in Israel reaching tens of thousands of medicinal Cannabis users, with each one paying NIS 5 or 10 per gram of the drug, or NIS 5,000 to NIS 10,000 per person per year."
However, Golan-Gild claims that growing one gram of Cannabis costs NIS 15, more than what Baruch expects patients to pay. The difference, he says, would need to be subsidized by the Health Ministry or HMOs, in the same way that they do for drugs included in the public health basket.
The inclusion of Cannabis in the public health basket seems far off, especially considering most HMOs are developing complementary insurance programs, which serve as additional source of income for them and traditionally include more alternative therapies.
In the mean time, Golan-Gild plans to open three "mercy centers," as he calls them, in Jerusalem, Tel Aviv and Ra'anana. There patients can not only smoke joints, but also - for an additional fee - participate in yoga and Pilates classes and receive training on how to use the Cannabis properly.
Light years away from all these initiatives, in a small simple Tel Aviv apartment, the "Tikkun Olam" group continues to distribute Cannabis for free and insist that patients must not pay for it out of their own pockets.
When Cannabis was approved for medicinal purposes in 1999, it was originally intended for terminal cancer and AIDS patients. Today it is being used in earlier stages of illness and for a wider array of diseases, including Parkinson's, Tourette Syndrome, Multiple Sclerosis, chronic pain and shell shock. The medical establishment is also increasingly recognizing Cannabis' effectiveness in treating illness.
At the Hadassah Ein Kerem hospital's Bone Marrow Transplantation department, patients including children and babies are treated using drops of oil derived from Cannabis. "It has no side effects and is largely effective in treating patients," said department chief, Professor Reuven Or. "I would say it is effective in 80 percent of patients, which is a lot."
Professor Or continued, "It stimulates the appetite and minimizes nausea and vomiting, which is of great importance in Oncology. It also has anti-inflammatory properties, which helps in cases of infection or inflammation caused by radiation. Along with this, Cannabis eases the coping process for patients - it improves their morale and lowers depression, and these are important parameters for patients battling disease."
Half of the patients being treated with Cannabis are Oncology patients, while about a quarter suffer from chronic pain.
A multipurpose medicine
At age 6, Liat Benny began experiencing pains that would over the years become stronger and spread, until doctors diagnosed her with a rare autoimmune disorder that harms blood vessels, the eyes and joints.
Benny describes the pain she feels every hour of every day as an "insane stabbing sensation." Three years ago, Benny's right eye was surgically removed, and while she still has vision in her left eye, she says it is limited and blurry. She has undergone dozens of operations, treatments and hospitalizations, in addition to multiple morphine treatments, but her disease worsened to the point that Benny had to stop working.
Ten years ago, Benny's father told her about medicinal Cannabis, and three years ago she was introduced to "Tikkun Olam." Today she is one of the patients authorized by the Health Ministry to use medical marijuana. Benny also lectures on the subject, tries to persuade more doctors to lose their preconceived notions about the drug and increase the number of users.
"I live with interminable pain that reaches level eight to nine (ten is considered the highest pain level)," said Benny.
"Smoking Cannabis allows me to talk to you and sound coherent even if I haven't slept all night," she continued. "Cannabis is a multipurpose drug that should be included in the public health basket. Its use significantly decreases the use of other drugs, which is cost-effective for the state. Cannabis improves all patients' functioning, and we are not just talking about relief from symptoms but also about a certain form of therapy."
Several weeks ago, Benny established an organization to advance the use of medicinal Cannabis. "I see this as my mission," she said.
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