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Can Israel Blaze a Trail in Medical Cannabis?

Governments and drug companies are loath to fund the research needed to bring the drug into general use. Israel offers ideal conditions for such research.

Ido Hartogsohn
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Ido Hartogsohn

"We in Israel have an opportunity, and vast responsibility, when it comes to international research about medical cannabis. Israel has a government-sponsored medical cannabis program and a convenient regulatory climate for research. We also have the health maintenance organizations, which possess rare databases of precious information about the effects of cannabis on thousands of patients who have undergone that treatment.”

The speaker is Mimi Peleg, who instructs patients in the use of medical cannabis and is the director of large-scale training at the Medical Cannabis Distribution Center in Abarbanel Mental Health Center, Bat Yam. In addition to her work as a monitor of clinical trials of MDMA ‏(the pure compound in the illegal drug Ecstasy‏) at the Be’er Yaakov Mental Health Center, Peleg was involved in Israel’s medical marijuana revolution in recent years. She wants to parlay the unique conditions that exist in Israel − the only country in the world where cannabis can be smoked in hospitals − to make it the center of global research on cannabis. “[Health Minister] Yael German said that once enough studies have been done on the subject, it will be possible to prescribe cannabis to patients like any other medicine,” says Peleg. “I want to ensure that these studies will actually be conducted, so that it will no longer be possible to say that cannabis is not being given to patients due to lack of research on the subject.”

Peleg’s next goal is to bring two world experts in the field here to lead a new wave of clinical studies, which will make medical cannabis more of a scientific product than ever and therefore help introduce it into the medical mainstream. With very little money or support, but with much faith in the rightness of what she is doing, Peleg views her efforts to have cannabis become standard medical treatment as nothing less than a spiritual and moral mission. Her eyes positively light up when she talks about the drug’s potential for medicine. She faces one minor obstacle: an international coalition that is firmly opposed to the project.

There was nothing in Peleg’s early life to suggest that she would devote herself to this particular field. Born in Ohio to parents who were lawyers, she grew up in Virginia. ‏(“It was very lonely growing up as a Jewish girl in a place like that. Guys would put pamphlets about the Elders of Zion in my locker and things like that.”‏) She came to Israel when she was 18 and did military service in the Nahal paramilitary brigade in the West Bank. She returned to the United States, spent some time road-tripping and then obtained a degree in computer sciences at UC Berkeley and worked in that field at UC Santa Cruz. Subsequently she met her current partner and raised a child with her.

Chance meeting

Peleg’s journey into the realm of medical cannabis was launched after a chance meeting with one of the icons of American psychedelic culture, the writer and thinker Robert Anton Wilson ‏(1932-2007‏). Wilson’s many books − on philosophy, psychology, mysticism, drugs and science − became cult items in the American counterculture of the 1970s and 1980s. Peleg met him in 1995 at a party in Santa Cruz. When she heard he was a writer, she asked him what he was working on and elicited a sigh in response. Wilson told her he was stuck because his computer had been down for a few days. Without knowing very much about who and what was involved, Peleg offered to fix the computer.

“When I got to his place I solved the problem fast,” she recalls. “It was embarrassing because he didn’t know how to pay me back and I didn’t want to get paid. I didn’t know anything about him; I’d never read any of his books and I didn’t have any special respect for him.” Wilson suggested that Peleg join him and his wife for a coffee. When he asked her, in all innocence, what he could do to ensure she would be available for him whenever his computer acted up, she replied, “Just make me a partner in writing your next book!” Bizarre as it sounds, that’s exactly what Wilson did. Peleg ‏(or Miriam Joan Hill, as she was then known‏) became a full and active cowriter on Wilson’s 1998 reference book, “Everything Is Under Control: Conspiracies, Cults and Cover-ups.”

Peleg became a close friend of Wilson and his wife, the late Arlen Riley, a writer and poet. Shortly afterward, Arlen suffered a serious heart attack. WAMM, the Wo/Men’s Alliance for Medical Marijuana, the oldest medical-cannabis collective in the United States, came to her aid. “WAMM has existed since 1993 and provides cannabis to patients free or at cost price,” Peleg relates. “At any given moment they have 150 to 250 patients at different stages of a chronic or terminal illness. They come to your house and look after you, sit with you, cook meals for you, do your laundry, help you deal with all the bureaucratic forms that you need to fill out to get your rights. They do whatever is needed to help you die with dignity, and do it on a volunteer basis. And they’re people it’s fun to spend time with. It’s more than therapy, it’s like family. They do very important work in America, because many Americans live alone, cut off, and are used to hiring everyone they need for money. WAMM does it all free, from donations alone.”

Arlen’s personal caregiver was Valerie Corral, the organization’s founder and a prominent medical-marijuana activist in the United States.

“Arlen wasn’t the complaining type, but you could see how the quality of her life was deteriorating,” recalls Peleg. “I spent a lot of time trying to cheer her up or pitying her, but only Valerie’s visits really had an effect.

“Not only did Arlen feel better every time Valerie arrived − the whole room filled up with positive energy and the approaching death experience became something positive. I asked myself what it was that she was obviously doing so right.”

As a result of meeting Arlen and Corral, Peleg herself joined WAMM, working as a volunteer and eventually becoming Corral’s office manager. “Those were wonderful years,” she recalls. “WAMM was good for my soul, and also for my professional development. Those were the years in which I learned how to practice activism. One time we moved 96 potted cannabis plants along with a convoy of patients in wheelchairs down the center of one of the main streets in Santa Cruz.” On another occasion, the Drug Enforcement Administration raided WAMM, impounded the cannabis plants and brutalized patients.

One of the organization’s members, a woman ill with polio, was tied up with her hands behind her back when she told the police that she was unable to get up due to her medical condition. The DEA eventually apologized. WAMM did not get the plants back, but obtained a court order that prevents the DEA from interfering with its activity.

In the course of her work in WAMM, Peleg met Rick Doblin, the founder of MAPS, the Multidisciplinary Association for Psychedelic Studies, the largest organization of its kind in the world. Doblin, a psychedelic activist with a warm Jewish heart, played a key role in the renewal of research into psychedelic substances in the past two decades and in Israel’s transformation into a world center of MDMA research. In 2008, when Peleg decided to come to Israel again, this time with her partner and their son, Doblin put her in touch with people in the local cannabis world.

Peleg arrived in Israel at a critical time in the history of the local program for the use of medical cannabis. In 2009, when Abarbanel opened the country’s first cannabis distribution center, under state license and with full state supervision, Peleg was already part of the revolutionary initiative. “We were given a room in the drug rehabilitation center, in building six at Abarbanel. It was a tiny room, with no air-conditioning and filled with medical equipment we didn’t need, but we were grateful. With the help of many volunteers, we opened the doors to 40 patients. Not a moment passed in that first night in which we did not fear the police would suddenly rush into the room and arrest us all. In the end, everything went quietly and we started the distribution. At first we were open four hours a week. We would arrive in the morning and get a supply from growers, pack it and distribute it that night. We took no money. It was all free, and the only consideration was how much the patient wanted. Those who wanted 80 grams took 80 grams, those who wanted 100 grams took 100 grams.

“We were in that small room for a year and a half,” she continues, “until we already had more than a thousand patients and the corridors around the office were jammed. Yehuda Baruch [the director of Abarbanel Mental Health Center and the official in charge of authorizing the use of medical cannabis] gave us building nine, which now houses the offices of [MCDC directors] Yossi Segev and Aviva Turkiya, and a room where I instruct patients in the use of cannabis. MCDC now serves about a third of all the patients in Israel who are being treated with medical cannabis, in accordance with the allocations and prices set by the Health Ministry.”

There is a central supply system that obtains its plants from different growers, Peleg notes, “so that the growers are not involved in the sale of the substance. When you think about it,” she adds, “that is as it should be: they should not be the ones who decide for the patients whether the strains they grow are suitable for them.”

Personal experience

In her capacity as an instructor in the use of cannabis, Peleg teaches her patients how to vaporize marijuana, how to use cannabis oil and what the proper dosage is for eating cannabis cookies. Peleg herself is being treated with cannabis for post-traumatic stress disorder, in the wake of sexual abuse she underwent in her childhood. “I used cannabis occasionally even before I became a patient,” she explains, “but through my work in WAMM I understood that cannabis was helping me function. Unlike some people who find it hard to concentrate with cannabis, I need it in order to be able to concentrate.” Cannabis also helped her undergo surgery without opium-based painkillers. “I had cancer and spent a month in Ichilov [Hospital]. When I told the anesthetist that after the operation I would want to try to use cannabis instead of morphine, he laughed and said I would beg for morphine, because the pain would be unbearable.

“After the operation I spent two days with an epidural in my back and then I switched immediately to vaporizing cannabis and felt no pain. It was very important for me to be able to have the surgery without introducing a toxic opium-based substance into my body that many people become addicted to.”

Is the fact that you yourself are being treated with medical cannabis significant in the training you provide?

“I think it is extremely important that I can tell the patients from personal experience what they are getting into. Even though a thousand and one different diseases are being treated, and even though every day doctors prescribe medicines they themselves have never tried, cannabis is different. I can explain to them, from what I have undergone personally, the difference between the various strains and which of them are available in Israel.”

Does smoking cannabis have additional effects on sick people who never smoked before – on their lifestyle, for example?

“The most frequent scenario is that a few months after I have instructed someone, I meet him in the corridor and he says, ‘You know what? This thing really works! Why wasn’t it prescribed to me 10 years ago?’ When people see how effective it is, they get angry because they didn’t receive it earlier, and instead took opiate drugs for years and suffered from side effects. Many of the patients develop a personal interest in this story. They become cannabis evangelists and tell their friends that they can get this substance that really helps.”

How many patients do you think this plant can help in Israel? What kind of numbers are we talking about?

“At the moment, the Health Ministry classifies cannabis as a last-resort solution. I definitely don’t think that is the right policy. I think cannabis can be used as preventive treatment for Alzheimer’s, diabetes and other problems. We are at perhaps 10 percent of our potential, and maybe only at 1 percent of the full potential of people who can benefit from cannabis treatment.”

Some people will say that widespread use of cannabis could bring about its de facto legalization, like in some places in the United States today.

“Yes, there are some who will say that. Cannabis can be deconstructed to a level at which everyone will have a prescription for something that needs to be treated with cannabis. But that reminds me of Wilson’s quotation, ‘Just because you’re paranoid doesn’t mean you’re not being persecuted.’ Just because cannabis is beneficial for innumerable medical situations doesn’t mean that access to it should be blocked to everyone who needs it. I think it could work better than most medications in the majority of cases.”

Cannabis paradise

Medical cannabis has been a growing and fashionable trend in the West in recent years, but the use of the cannabis plant for healing is as old as medicine itself. Indeed, from a historical perspective, the 76 years that have gone by since cannabis was outlawed are exceptional, in thousands of years of its medical use in every part of the world.

The pioneer of the modern therapeutic use of cannabis was William Brooke O’Shaughnessy ‏(1809-1889‏), an Irish physician, who came across cannabis while traveling in India. O’Shaughnessy investigated the effects of cannabis on different diseases and confirmed its effectiveness in popular medicine. He distributed cannabis extracts to Indian patients suffering from rabies, cholera, tetanus, epilepsy and rheumatism. He published his findings in 1842, in the first modern scientific article about cannabis written in English.

In the second half of the 19th century, cannabis and the various extracts produced from it became a staple in the Western medicine chest. Sir William Osler ‏(1849-1919‏), who is sometimes called the founder of modern medicine, recommended cannabis as the best medication for migraines. An extensive study carried out for the U.S. government in 1860 described a wide range of maladies that had been treated successfully with medical cannabis.

“At the beginning of the 20th century, nearly a third of all the medicines prescribed in the United States contained some type of cannabis extract as a prime component,” says Dr. Alan Shackelford, a Denver-based internist who specializes in treating patients with medical cannabis. All of this changed radically in 1937, when cannabis was outlawed in the United States in the wake of an anti-marijuana campaign spearheaded by the head of the Federal Bureau of Narcotics, Harry Anslinger, and the newspaper tycoon William Randolph Hearst. The two conducted a well-orchestrated campaign of propaganda and incitement, inflamed by terrifying headlines and demagogic use of the xenophobia stirred by the Depression. They linked the use of marijuana ‏(the Mexican word for cannabis‏) to abhorred minority groups, above all the Mexican migrants, and were able to persuade the American public that marijuana was the “devil’s weed.” Their campaign made people believe that cannabis was a cause of murder, suicide and obscene acts, and that it constituted an existential threat to the survival of the American nation.

“The American Medical Association objected vehemently to the proposed ban on cannabis in 1937, because cannabis was such an important part of medical practice in the United States,” Dr. Shackelford notes. Four years later, following pressure exerted by Anslinger, cannabis was removed from the U.S. Pharmacopeia, the official standards-setting authority for all medicines manufactured and sold in the United States. In the past, cannabis had been listed as a component in the treatment of more than 100 diseases. In the decades that followed, international drug conventions extended the cannabis ban to the rest of the world. The situation was further aggravated with the passage in 1970 of the Controlled Substances Act in the United States, which declared marijuana − by then a symbol of the political counterculture that seemed to pose a threat to the Nixon administration − a dangerous drug that has “no currently accepted medical use in treatment in the United States.”

The legislation placed cannabis in the most severe category, above drugs such as crack cocaine and methamphetamine. Since then, the federal government’s classification of cannabis as a substance with no medical use has served as a circular argument against any research in this field.

Still, there are a few places where the regulations against cannabis research are less stringent than in the United States and in which studies are continuing. One of those places is Israel, which enjoys a surprisingly high reputation among those who take an interest in the study of medical cannabis. In an extensive report which was broadcast recently on CNN and aroused wide interest, Dr. Sanjay Gupta, the network’s chief medical correspondent, noted that in many quarters Israel is considered “the [world’s] medical marijuana research capital.” In the program, Dr. Julie Holland, a leading expert in the field of medical cannabis and the editor of the most comprehensive book to date on treatment with cannabis ‏(“The Pot Book: A Complete Guide to Cannabis,” 2010‏), praised Israel’s openness to medical cannabis. Gupta himself recently explored the findings of the latest research and as a result revised his opinion: from opposition to the use of medical cannabis, to enthusiastic support. His report on CNN presented Israel as a paradise for medical cannabis, a country with “hospitals and nursing homes where patients are lighting up courtesy of the Israeli government.”

Whether that description is justified is another question. The many patients who are prevented by the Israeli health authorities from receiving cannabis and are told to make do instead with expensive medicines that cause multiple side effects tell a different story. Still, the relative tolerance shown by the state to research on the medical potential of the slandered, persecuted and illegal plant is radically different from the situation in other countries, notably the United States. A wide-ranging article published in the American magazine Cannabis Now about research on the subject in Israel compared the obstacles faced by a researcher who wants to conduct experiments involving cannabis in Israel to those confronted by a researcher in the United States. In contrast to four high and complex bureaucratic hurdles that can stand in the way of an American researcher, the Israeli researcher faces only one, relatively simple, hurdle, the article reported.

There is also another reason for the high repute Israel enjoys in this field. The name of the reason is Prof. Raphael Mechoulam, a chemist from the Hebrew University of Jerusalem. Mechoulam’s studies have laid the foundations for the entire field of cannabis, and won him the Israel Prize in Chemistry in 2000. In 1963, when he was only 33, Mechoulam isolated CBD, the ingredient responsible for the most important of cannabis’ medical properties. A year later, Mechoulam was the first to discover THC, the psychoactive component of cannabis, which is responsible for its consciousness-altering effects on users around the world.

Thirty years later, Mechoulam again played a critical role, this time in the discovery of endocannabinoids. This was a revolution that completely changed the scientific perception of the relationship between cannabis and the human body. The discovery of endocannabinoids − neuroreceptors that the body produces autonomously and naturally − and of special cannabinoid receptors in the brain, proved that cannabinoids have an important role to play in the health of every individual, even those who have never inhaled the smoke of the green plant.

The threat of research

The unchallenged star of medical cannabis in recent years is cannabidiol ‏(CBD‏), the molecule described by Prof. Mechoulam in 1963. It contains no consciousness-altering properties, but it does have a far-reaching influence on our physical and mental health. Prof. Mechoulam notes that researchers in his lab wrote about the beneficent potential of CBD in the treatment of epilepsy and schizophrenia 25 years ago. “But no one bothered to pursue the research,” he says. Recently, a German group showed that CBD is no less effective in treating schizophrenia than any of the major antipsychotic drugs, and without producing their side effects.” Indeed, the beneficial effects of CBD are now being publicized day and night, and a series of food products containing CBD ‏(which does not get you high‏) for patients and the community of health buffs is already available in the United States. The list of the medical properties of cannabis and the diseases it is capable of treating, based on studies done in recent years, is staggering. Israeli and Spanish researchers attributed the emergence of Alzheimer’s to a dearth of endocannabinoids, and pointed to the possibility of treating and preventing Alzheimer’s and dementia through the use of cannabinoids. Dr. Sean McAllister of the California Pacific Medical Center, found that CBD slows the rate of cell division in breast cancer and other types of growths. In an interview with the BBC, he said that treatment with cannabis is nontoxic and lacks the side effects associated with chemotherapy, which in his view should become a distant second option for cancer patients.

The Spanish researcher Dr. Manuel Guzman found that THC kills growth cells selectively, while sparing the healthy cells, in contrast to the mass killing of cells that occurs in chemotherapy. And the list goes on. Scientific studies have found beneficent effects of treatment with cannabis for pain, tension, nausea, anorexia, post-traumatic stress disorder, rheumatism, autoimmune diseases, inflammatory intestinal ailments, attention deficit disorder, diabetes, Crohn’s disease, colitis, muscular dystrophy, ALS, antibiotic-immune infections, intestinal cancer, pancreatic cancer, liver cancer and even lung cancer.

If even a small portion of what researchers say about the effectiveness of cannabis and its active ingredients is correct, it represents the most important medical discovery since antibiotics. Penicillin fomented a revolution in the treatment of infectious diseases and was a key factor in increasing the lifespan in the West, but in the past century the longer lifespan has been accompanied by changes in the causes of mortality in the Western world. Humanity has shifted from infectious diseases to chronic, degenerative or inflammatory ailments, such as heart disease, cancer and autoimmune diseases, for whose treatment cannabis can be of valuable aid. Yet, despite the impressive results of such treatment, governments − and in their wake universities and public organizations that should be interested in advancing research, such as the Israel Cancer Association − are refusing to fund more extensive research on the medical potential of cannabis. The result is that its use in treatment remains limited.

“The biggest obstacle to conducting the necessary research is funding,” Dr. Shackelford says. “Clinical studies are very expensive to conduct, and very little money is available through public sources. In the United States, for example, the National Institute on Drug Abuse [which underwrites the vast majority of cannabis studies] says that its task is to investigate the effects of abusing the drug, not to carry out studies that might indicate its medical benefits.”

The pharmaceutical companies are also disinclined to participate in research about medical cannabis. The pharmaceutical industry is vehemently against the use of a plant that cannot be patented and which threatens to offer a cheap, readily available solution that will render many of the industry’s products superfluous. When one considers the fact that in many countries, patients who are treated with cannabis can grow the plant by themselves, without resorting to paid medical treatment, the potential threat posed to the pharmaceutical companies becomes clearer.

The absence of governmental and commercial interest in cannabis is generating a shortfall in clinical trials of medical cannabis. This is precisely the situation that Mimi Peleg wants to change, with the aid of Dr. Shackelford and Dr. Allen Frankel, from Los Angeles. Indeed, the two physicians plan to make aliyah to Israel in 2014, in order to study the medical potential of cannabis. “What we need now is official clinical trials,” Peleg says. “That’s why we are looking for donations and for physicians who want to learn about the subject from Shackelford and Frankel. Both have had great success in using medical cannabis to treat patients, and both are conducting a very serious study on the plant, based on precise measurements of the different cannabinoid dosages which work best in treatment, and creating concoctions that are adjusted to the condition of each patient.”

In both Colorado and California, the states in which Drs. Shackelford and Frankel practice, respectively, medical cannabis is legal and in wide use. After having treated many patients with cannabis, the two physicians are coming to Israel in order to avail themselves of the possibility to conduct studies that will demonstrate how and why cannabis is so effective in treating such a wide range of diseases.

Dr. Frankel, an internist from Los Angeles, has used cannabis to treat former soldiers suffering from post-traumatic stress disorder. He started working with cannabis after becoming frustrated with the means at his disposal in his day-to-day practice. “I didn’t feel comfortable any longer prescribing painkillers and tranquilizers,” he says. “They usually led to complications of various kinds and they weren’t really effective.” Frankel’s work focuses on clinical survey trials and broad clinical trials. “The aim is to examine which cannabis treatments are the most beneficial for different patients with different diseases,” he relates. “It’s not just THC or CBD. Almost 950 molecules have been isolated from the cannabis plant. We find that certain molecules are useful for some medical problems, while others are better for other problems. It’s not just a question of the dosage of cannabinoids to the milligram level, but also integrating the treatment the patient is receiving with other treatments he is undergoing. I have found that small differences in the CBD or THC dosages can make a big difference.”

Why is it only now that we are learning about the potential of medical cannabis?

“There was an international effort to suppress research and knowledge about the beneficial effects of cannabis. There are precise studies about cannabis from the 1970s that show its advantages. The federal government in the United States registered patents on CBD and other cannabinoids already 10 years ago. You don’t register a patent on a worthless medicine. The studies exist, but were simply ignored and kept quiet.”

Dr. Shackelford carried out clinical trials involving nutrition, metabolism and behavioral medicine at Harvard Medical School. He gained fame when he appeared on Dr. Sanjay Gupta’s television program in connection with the moving case of Charlotte Figi, a 5-year-old who for years suffered from 300 powerful and life-endangering epileptic seizures a week.

“Charlotte was given every anti-epileptic medicine that’s available in the United States, and also some that were only available outside the States or were experimental,” Dr. Shackelford relates. “None of the drugs helped in treating her seizures. She had two heart attacks after using a prescription drug intended to treat epileptic seizures and she had to be resuscitated.” After trying all the options suggested by specialists, Charlotte’s parents decided to try cannabis, despite strong opposition by a large number of physicians, who expressed fears about giving the drug to a girl of 5.

“The results were dramatic,” Shackelford says. “After her first dose of a cannabis extract, Charlotte did not have a single seizure for an entire week. With several refinements in dosing, she has gone from 300 seizures a week to one minor, short-lived seizure a week or every two weeks. She can ride a bicycle, go to day care, and play with her brother and sister.”

What are the challenges currently facing medical practice with regard to the use of cannabis?

Shackelford: “Many families move to Colorado every month in the hope that their children will receive the same treatment as Charlotte. But we still don’t really understand how cannabis works or how to administer it in more effective dosages. We have a commitment to Charlotte and to others like her to study its extraordinary effects and develop clear and reliable methods of dosage.”

How can research in Israel be of help? A vast number of studies about cannabis have been published in the past few decades. How do the studies you want to conduct in Israel differ from those?

“Even though about 20,000 studies on cannabis have been conducted, most of them involved basic science, not clinical trials. The demand for additional clinical research is nourished by an increase in the interest shown by patients in this field and by the establishment of programs for treatment with medical cannabis in 20 American states and in a few other countries, including Israel, Czechoslovakia, Holland and Canada.”

What are the advantages Israel has to offer?

“Israel has a number of advantages. First, its national health system makes it possible to conduct retrospective studies about the medical problems of patients before and after cannabis treatment. Likewise, it is possible to monitor the costs of the use of cannabis, which are sometimes far lower than those of pharmaceutical drugs and achieve identical, if not better, results. However, the most important reason is the relative ease with which cannabis research can apparently be conducted in Israel, compared to the United States. In the States you have to obtain a series of permits in a lengthy bureaucratic process that in recent years has ended with more refusals than authorizations.”

Prof. Mechoulam agrees that Israel has considerable potential in this field. “Exceptional work is being done today in Israel in a number of hospitals, and basic research is being conducted in the universities in Haifa, Tel Aviv, Jerusalem and Be’er Sheva. There is no reason Israel should not continue to do important research in this field,” he says.

Despite the momentum enjoyed by medical cannabis of late, there remain a number of difficult obstacles to overcome before medical cannabis can become a drug in widespread use. Chief among these are national and international laws that classify cannabis as a dangerous, illegal drug, and attitudes ranging from indifference to outright hostility in the pharmaceutical industry, with its aggressive lobbyists.

None of this stops Mimi Peleg from dreaming. In reply to my question of how she would like to see the future of cannabis, she describes a world in which centers of cannabis-based medicine exist in every city, like the network of well baby clinics, staffed with physicians who specialize in treatment with cannabis and provide patients with strains suited to their needs and in the right dosages.

“You’ll be able to go to the drugstore and buy a small container that hooks up to a mini-vaporizer, like an electronic cigarette for cannabis, which makes it possible for you to know exactly how much active substance you are smoking each time. You will be able to monitor it from your computer and also control the level of heat at which the cannabis burns − different problems are treated with different levels of heat. At the end of the month, you throw away your empty container and collect a new one in the drugstore.”

You get 25 shekels ($7.15) an hour for your work at the cannabis distribution center, which is under constant threat. What gives you the strength to keep going?

“Not a day goes by without jokes about potheads. We have to cope with quite a bit of rubbish, but it doesn’t matter. The thing here is truly compassion, and people have to ask themselves how they would respond if someone dear to them were suffering from a disease and cannabis could ease his pain. Who doesn’t know someone with skin cancer, whom these substances can help? It doesn’t matter what people will do with the drug − they can’t get high on it, so what’s the big deal? Why can’t people get the medicine they need? I think that we in Israel owe it to one another to conduct this research.”

14,000 patients, 21 physicians

This week the cabinet approved a proposed bill, which if enacted into law will regularize the procedures for the use of medical cannabis in Israel. Sponsored by Health Minister Yael German and a team of medical experts, the legislation will make it possible to authorize another 10 physicians to prescribe cannabis and its products. The waiting time for receiving approval to use cannabis will also be reduced significantly. Henceforth, terminal patients will receive their cannabis within 48 hours and cancer patients in no more than a week after it is prescribed. The proposed legislation will also try to regularize the mechanism for distributing cannabis by taking it out of the hands of the growers and utilizing one private company to supply authorized drugstores.

At present, about 14,000 people have a permit to use cannabis, with thousands more permits being issued every year. At present there are only 21 authorized physicians to examine and approve the requests, within the framework of the Health Ministry’s unit for medical cannabis. Prescriptions are issued primarily to reduce pain and treat severe symptoms that significantly affect the functioning of people ill with cancer, AIDS, multiple sclerosis, Parkinson’s disease and intestinal inflammations, among other diseases. In rare cases, cannabis prescriptions are issued to individuals coping with psychological problems such as post-traumatic stress disorder.

Until now, the labyrinthine bureaucracy and the small number of physicians authorized to prescribe cannabis has made things very difficult for patients. The Health Ministry has also been unable to handle the increase in the number of patients who meet the criteria for treatment. Formally, the new legislation is intended to improve the service. But it is actually aimed mainly at another bill, submitted by MK Moshe Feiglin ‏(Likud). Feiglin’s bill goes much further, authorizing all family doctors to prescribe cannabis. The Health Ministry objects to this and similar suggestions on the grounds that there is as yet no specified dosage for the active ingredients in cannabis, and doctors lack criteria for deciding the method of treatment. Nor have inter-medicinal reactions and long-term effects of treatment been sufficiently studied. According to Health Ministry spokesmen, physicians are also seriously concerned that granting them the authority to prescribe such a coveted substance will bring them under massive pressure from people who don’t necessarily want it for medical reasons.

(Shay Fogelman)

A marijuana plant at the Knesset.Credit: Olivier Fitoussi
Doses of medical cannabis in a storeroom at Abarbanel Mental Health Center, Bat Yam.Credit: Ilya Melnikov
Dr. Alan Shackelford ‏(left‏) and Prof. Raphael Mechoulam. Potential in Israel.Credit: Ilya Melnikov
Mimi Peleg.Credit: Ilya Melnikov



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