In July last year, post-traumatic stress disorder became the only psychiatric condition for which the Health Ministry approves the use of medical marijuana. The decision, backed by the Israel Psychiatric Association, was a cause for optimism among many Israelis suffering from PTSD.
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But it wasn’t long before difficulties cropped up, like finding a psychiatrist to recommend cannabis and obtaining a permit from the Health Ministry. In public clinics psychiatrists don’t recommend medical marijuana or make haste in filling out the necessary forms. In private clinics the situation isn’t much better.
“We are a very small group of three or four psychiatrists who believe that in some PTSD cases cannabis is helpful,” says psychiatrist Dr. Ilya Reznik, a member of the executive board of the International Association for Cannabinoid Medicines.
“The pressure on our clinics is impossible. This is partly because people who get a permit and don’t come in every three months for follow-up risk losing their permit.”
The Health Ministry, for its part, cites studies “indicating significant dangers in giving cannabis in cases of mental illness or addiction.”
D., 22, a married father of two, was diagnosed with PTSD and doesn’t work; he lives on a disability pension. “I have two kids and I don’t function,” he told Haaretz. “The nightmares, flashbacks, depression – I hardly leave the house.”
In 2007 and 2008, D. belonged to a cult in which he suffered physical and psychological abuse, including rape. During psychiatric hospitalizations he discussed what happened to him and was diagnosed with PTSD by a psychiatrist who recommended medical marijuana.
But D. was rejected; the Health Ministry’s cannabis unit sent the psychiatrist a letter stating that membership in a cult indicated other psychological problems and therefore D.’s diagnosis of PTSD could not be determined for sure. The letter was signed by the unit’s chief medical consultant, Dr. Michael Dor, whose specialty is family medicine and who had never met D.
Reznik says he’s furious that Health Ministry doctors, some of them without training in the field, rule out diagnoses by board-certified psychiatrists.
“The most serious drugs we give – addictive drugs – there’s no problem, but when it comes to cannabis, the Health Ministry feels it has to protect the patients,” Reznik says. “Cannabis is the only material where the Health Ministry interferes in the doctor-patient relationship.”
The long list of therapeutic uses for marijuana shows that it can be beneficial, but the fact that it is illegal for recreational use has an effect on the medical establishment.
Medical use for pain and psychiatric conditions that don’t necessarily have visible symptoms are particularly suspect. Yet with PTSD, many studies published in Israel and abroad attest that cannabis significantly reduces symptoms and improves quality of life.
“Israel produces many cases of PTSD,” says psychiatrist Michael Segal, a PTSD expert. His patients run the gamut from veterans of the Battle of the Chinese Farm in the 1973 Yom Kippur War to veterans of the 2014 Gaza war and victims of the collapse of a Jerusalem wedding hall in 2001. More than 300 have patients received cannabis on Segal’s recommendation.
At a conference in May, Segal presented statistics: Before treatment, 29 percent of a group of patients studied or worked, a percentage now at 67 percent. Among this number are patients who have been able to significantly reduce their use of other medications, Segal says.
Neither Reznik nor Segal claim that cannabis should be prescribed automatically, they just want to see it as part of accepted therapy. Still, most doctors do not want to use it; they say the clinical and scientific evidence is insufficient.
“Research is not good enough to ascertain the connection between cannabis and reduced symptoms,” says psychiatrist Shauli Lev-Ran, head of the addiction clinic at Sheba Medical Center, Tel Hashomer. According to Lev-Ran, a recent study showed that cannabis worsened symptoms; in any case, a lack of clear-cult research results is the reason for the strict regulation.
To receive a cannabis permit, a patient must have at least a 30-percent disability according to National Insurance Institute criteria and must have tried at least two other medications for at least two months each. Patients must not have a history of psychosis or drug abuse.
Such criteria frequently contradict the background of PTSD sufferers. Patients who are rejected for not meeting the criteria can file an appeal with a special committee.
According to the Knesset Research Center, by May, 10 months after cannabis had been approved for PTSD treatment, 388 patients had received permits. The Heath Ministry’s cannabis unit released figures this week stating that since approval arrived for PTSD, it has approved 1,153 of 1,500 applications.
Reznik and others say they doubt these figures considering how they themselves are treated by the unit. “We are under constant persecution and many of the applications are rejected for no good reason, such as a form filled out by hand rather than typed,” Reznik says.
MK Tamar Zandberg (Meretz), chairwoman of the Knesset Committee on Drug Abuse, also criticizes the medical establishment. “The attitude of the medical establishment toward PTSD victims is a delaying factor in the process of these people’s recovery,” she says.
“We find many patients and their families who report relief of symptoms, improved sleep and reduced anxiety following cannabis use. And yet the establishment has trouble seeing cannabis as a legitimate and beneficial medication.”
Zandberg said her committee would meet to “focus on PTSD patients and their poor treatment to improve the situation.”
The Health Ministry responded: “A specialist (in a public or private clinic) is authorized to make a recommendation. A recommendation for high doses of cannabis requires the approval of a director of a hospital/relevant department in a hospital/HMO district in keeping with Procedure 106, which can be found on the Internet. In recent years studies have been published indicating significant dangers in giving cannabis in cases of mental illness or addiction. The most senior mental health specialists in Israel are on the consulting team to the cannabis unit.”
According to the ministry, “for reasons of medical confidentiality, and especially to prevent pressure on specialists [involved in the approval process], it was decided that the signatories to the permits and rejection letters would be two people: Dr. Michael Dor – the chief medical consultant to the cannabis unit – and master’s degree holder Yuval Landschaft, the director of the cannabis unit, who have been authorized to do so by the Health Ministry director general.”