Greener grass: Should Israel's policy on medical marijuana be replicated abroad?
Israel has a long list of diseases for which treatment with medical marijuana is permitted; one American expert says this system should be a model for the practice internationally.
Anyone who happened into the at the Health Ministry's national center for the approval of treatment with marijuana one day recently would have witnessed an amusing scene. An Israel Prison Service officer in full uniform, and bearing a suitcase, arrived at the center, which is located at the Abarbanel Psychiatric Hospital in Bat Yam, and which also operates a station for the distribution of the substance to patients. The officer, who was on a mission from the Israel Prison Service, proceeded to fill the suitcase with cannabis cookies, to be distributed to sick inmates in correctional institutions who had received authorization for treatment with medical marijuana.
"It's a strange situation," says Dr. Yehuda Baruch, the director of Abarbanel, who is the person in charge of the national system for treatment with medical marijuana. "Theoretically, someone could be in prison for possession or sale of marijuana, and right next to him there's someone who is getting treatment with the substance for a specified illness." Still, he says that only a few prisoners are receiving marijuana, all of them suffering from diseases for which the substance can be prescribed.
Medical marijuana has been in use in Israel since the 1990s. Currently 9,300 patients hold permits for treatment with it, as compared with a mere 64 in 2004. Lately, the Health Ministry has been trying to tighten supervision, but the demand for medical marijuana just continues to rise. The management of the Assaf Harofeh Medical Center, for example, recently instructed one of the senior doctors there - who holds a Health Ministry license to prescribe medical marijuana to cancer patients - to stop accepting patients who have requested such authorization but don't suffer from cancer. The directive was handed down after the functioning of the oncological pain clinic at the medical center was disrupted because 500 people who are not cancer patients had requested permission to use medicinal marijuana.
The local system has admirers abroad. "Israel is gradually becoming the model for provision of medical marijuana to patients," said Drug Policy Alliance head Ethan Nadelmann earlier this month. The DPA, an organization that promotes the legalization of drugs in the United States, was the organization that blazed the trail to the first authorization of the use of medical marijuana, back in 1992 in California. Currently 17 of 50 states allow such treatment, from which some 1.2 million Americans now benefit. Nadelmann, who in early September toured the national authorization and distribution center at Abarbanel, is the prime mover behind these policy decisions in each state.
Here, the Health Ministry is also planning to allow distribution of medical marijuana through pharmacies beginning in 2013, a move that Nadelmann defines as "a breakthrough on an international scale." Today, the only pharmacy licensed to distribute it is at Eilat's Yoseftal Medical Center. Globally, Holland is the only country in the world where pharmacies are currently allowed to provide patients with marijuana for medical use, and even this is a relatively limited phenomenon.
Pharmacies that want to participate will have to commit to certain security measures, including installation of safes. The agency that will serve as the middleman between the growers and the pharmacies is Sarel Ltd., already the largest supplier to medical institutions in Israel. It will purchase the marijuana from the growers, test it to ensure that the concentration of the substance complies with the standard and supply it to the pharmacies that win the tender, slated to be issued after Sukkot, next month.
Nadelmann was impressed by the planned system. He observes that the level of tolerance in Israel for medical use of the drug is "higher than it was, for example, in the 1990s. Then they would arrest anyone who possessed a small amount of the substance." At the same time, he says the number of patients who receive permits to use marijuana is still relatively small. At the Health Ministry, too, they estimate that when the new system is fully in place, about 40,000 Israelis will be treated with marijuana for relief of their symptoms.
According to Nadelmann, compared to the system planned locally, the provision of medical marijuana in the United States is still complex and problematic. The main reason for this is the gap between the laws in states that do permit the use of medical marijuana and the federal law that still defines it as a dangerous drug.
In Israel, there are 12 designated and guarded fields whose owners possess permits to grow cannabis, all of which have received police authorization. The supply centers are allowed to charge NIS 360 for a monthly supply of 20 to 100 grams. For rolling the cigarettes they charge an additional NIS 24 and NIS 100.
Up until 2009, the Health Ministry also permitted the growing at home by approved users of up to 12 marijuana plants up to a maximum height of 1.5 meters each, but these permits have started being phased out gradually in recent months, at the request of the police. Nadelmann has been active for years in promoting the decriminalization of drug users. In his opinion, there's a need "to distinguish between the dangers of drugs and their legal status. The two legal drugs, alcohol and tobacco, kill more than all the other drugs combined."
Nadelmann is currently anticipating the November elections in the United States, when the citizens of Washington, Colorado and Oregon will have the opportunity to vote on allowing the free use of marijuana, subject to the same restrictions currently applied in the country on the sale of alcohol. Two years ago the electorate in California rejected a similar proposal, although by a very small minority - 53 percent. Similar proposals have also been rejected in Alaska and Nevada.Most of the supporters of legalization are young people aged 18 to 29, while, according to a survey conducted last year, the principal opponents are Americans over the age of 65.
Nadelmann's organization also promotes distribution of other drugs to addicts. In Israel there is now a program for distribution of synthetic narcotic substitutes to 4,000 people who are addicted to opiates, mainly heroin. Six countries in Europe - Switzerland, Germany, Holland, Britain, Denmark and Spain - as well as several provinces in Canada, allow provision of pure heroin to chronic addicts in order to reduce the morbidity entailed in illegal use of the drug.
"We are opposed to programs that offer the drug itself to addicts undergoing rehabilitation, because that kind of treatment does not reduce the use of the drug," says Abarbanel's Dr. Baruch.
According to the Health Ministry, addicts in Israel are also eligible receive clean syringes as a method for minimizing medical complications, but "at this stage there is no joint decision by us and the Anti-Drug Authority to adopt the method of giving heroin."
No one wants to become ill with one of the diseases that entitle one to receive treatment with medical marijuana. On the not very short list of these are, among others, cancer, AIDS, Parkinson's disease, inflammatory bowel disease, a number of rare hereditary diseases and various psychiatric disorders.
The findings of a pilot study completed recently in Israel, examining the use of treatment with marijuana among 29 patients suffering post-traumatic stress disorder from the 1973 Yom Kippur War and the first Lebanon War, are due to be published soon. The researchers have defined initial findings of the study, which have recently been analyzed, as "promising." The study was conducted during the past two years.
In the wake of the success , an additional study is already under way regarding the efficacy of medical marijuana treatment of PTSD patients. The findings are expected within nine months. Participants will receive the substance in an oil reduction to be swallowed while the control group will receive an oil that lacks THC, the active ingredient in marijuana. According to Yehuda Baruch, ingestion the oil is leaves one more clear-headed than smoking marijuana.
The Health Ministry has formulated a list of diseases for which it is currently possible to receive permission for pain-reduction treatment with medical marijuana. The permit is given by Baruch, who is in charge of the matter on behalf of the Health Ministry, only as a last resort after other treatments have failed and only upon the recommendation of a specialist. In addition, last year, oncologists at Sheba Medical Center, Tel Aviv's Sourasky Medical Center (Ichilov ), Assaf Harofeh, Rambam Hospital and the Rebecca Sieff Hospital were authorized to issue permits for medical marijuana to cancer patients in order to cut down the waiting time for a permit from the ministry.
Multiple sclerosis is also on the list of diseases, although recently it was decided to append to the permit connected to that disease a risk warning. This came in the wake of a study conducted in Australia, whose findings (which were published in the June issue of the journal Brain ) suggested that prolonged use of medical marijuana is liable to damage the brain's white matter - myelin. Myelin damage is also the cause of the sclerosis.
Another disease on the list in principle is glaucoma, the eye disease caused by degeneration of the optic nerve and pressure within the eye, from which thousands of Israelis suffer. According to Dr. Baruch, only one patient has to date received a permit for marijuana use in connection with glaucoma, because, "nowadays there are effective medications for treating glaucoma. Treatment with medical marijuana is given only after failure of the treatments with pharmaceuticals."
According to a comprehensive study carried out recently here, lung cancer is the most common cancer for which a medical-marijuana permit is given, comprising 21 percent of patients. That is followed by breast cancer (12 percent) and pancreatic cancer, which is considered one of the most deadly kinds of cancer.
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