Israeli HMOs Given Temporary License to Prescribe Medical Marijuana

But Association of Family Doctors in Israel and HMOs object, saying they were not informed of Health Ministry decision.

Ilya Melnikov

The Health Ministry is to temporarily allow family doctors to provide their patients with prescriptions for medical marijuana. The ministry is trying to deal with the heavy load on pain clinics, the medical units that are allowed today to grant the prescriptions.

The new regulations will allow family doctors to write the medical cannabis prescriptions under two conditions: when it is an extension of an existing treatment, and only keeping to an existing dosage.

There are some 18,000 permits for the use of medical marijuana in Israel today, and this number is expected to grow to some 40,000 by 2018. Demand for medical cannabis in Israel has been rising steadily, and the list of conditions and treatments for which it is authorized has also been growing over time. Recently, medical marijuana was also authorized in the treatment certain types of epilepsy for children, as well as in cases of post traumatic stress disorder, in addition to a long list of diseases and conditions for which patients are allowed to use medical marijuana.

The idea to have family doctors, who work in health maintenance organization clinics, write cannabis prescriptions was raised in the past but met with fierce opposition - both from the family doctors themselves and from the HMOs - and was never implemented. Instead, the ministry decided in its new medical marijuana regulations to authorize 10 additional doctors to provide such prescriptions, in addition to the 20 doctors permitted to do so before. The ministry thought this would be adequate to relieve the pressure on the doctors in the pain clinics and reduce the long waiting times for patients to see these doctors.

The Association of Family Doctors in Israel and the HMOs were surprised to hear of the new regulations from the press. No one asked us, there was no discussion or consultation on the matter," said the family doctors association chairman Dr. Shlomo Vinker. "The ministry appears to have issued the regulations on its own, and that is not acceptable to us.

The previous attempt to have family doctors write such prescriptions failed. Then-Health Ministry director Prof. Ronnie Gamzu sent the directors of the HMOs a letter requesting names of family doctors to be authorized to write medical marijuana prescriptions, but in response he was met with firm opposition. The Leumit health maintenance organization told Gamzu at the time it objected to widening the circle of doctors allowed to write such prescriptions as it provided a further burden on its already overloaded resources, as well as harming its community medicine services, and provided a very dangerous slippery slope and harmed those who truly needed treatment.

Leumit said the use of medical cannabis should be very limited and measured - and the authority to prescribe it should remain in the hands of a very few specialists and the state, and not in the hands of community doctors who are already collapsing under their burdens. Leumit also said the pain clinics were flooded with people asking for medical marijuana for various and sundry reasons - often without proper clinical justification. Doctors were being pressured, threatened and even attacked physically by patients wanting cheap and high-quality marijuana, said Leumit.

The Health Ministry does not know at this stage when the new instructions will take effect, or for how long. But it is already clear that both family doctors and HMOs will not accept the decision without opposition.