Israeli Pharmacies Prepare to Sell Medical Cannabis

Following launch of new Health Ministry reform, Super-Pharm is discussing distribution and sales possibilities; meanwhile, over 200 have applied for permits to grow and sell the substance.

Ido Efrati
Ido Efrati
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Cannabis.
Cannabis.Credit: Olivier Fitoussi
Ido Efrati
Ido Efrati

Pharmacies around Israel are preparing to make medical cannabis more accessible as part of a reform in the use and sale of the substance, spearheaded by Health Minister Yaakov Litzman. In the last two months, the ministry has received more than 200 applications for a license to grow, distribute or sell medical cannabis.

Haaretz has learned that in recent weeks representatives of Israel’s largest pharmacy chain, Super-Pharm, have been meeting with the head of the ministry's medical cannabis unit, Yuval Landschaft, and other ministry officials to implement the plan to allow prescription and provision of medical cannabis by authorized doctors and pharmacists.

At present, some 27,000 Israelis are legally allowed to use the substance to relieve pain and other symptoms caused by a range of diseases.

According to sources in the health establishment, Super-Pharm and ministry officials are also discussing the possibility that the chain will both distribute medical cannabis and sell it.

Despite the fact that it is not currently known when patients will actually be able to purchase the substance in local drugstores, Super-Pharm reports that it is already looking into integrating its sale in at least some of its 225 branches around the country.

A worker harvests cannabis plants at a plantation near the northern Israeli town of Nazareth, May 28, 2013.Credit: Amir Cohen/Reuters

To that end, the company issued the following statement: “Super-Pharm strictly observes Health Ministry guidelines and is participating in reforms that improve the lives of Israeli patients. We are currently studying all aspects and consequences of the subject [at hand], with the intention of taking part in this field later on.”

According to the new ministerial scheme, there will be no limit on the number of drugstores licensed to sell the substance. Those interested must contact the ministry; they will be required to meet its stringent requirements for storage and securing of the cannabis on their premises, as well as for training pharmacists to dispense the product.

Currently, those growing medical cannabis are also those providing it to patients, either through distribution centers or by home delivery. As part of the new distribution procedures, pharmacy sales will constitute the final stage in the new supply chain. Before the branches are allowed dispense the product, however, the work done beforehand – by those who develop the strain and the seeds, the growers and others – has to be more carefully examined and regulated.

In any event, the upcoming reform reflects a total change in the attitude toward the plant in Israel, although it is still difficult to imagine it being sold in a large commercial chains, even if pharmacists already use the same counters to mete out opiate painkillers and psychiatric drugs.

For one, Miki Ofer, a former chairman of the Pharmaceutical Society of Israel and a member of the organization's professional committee that is studying the issue, welcomed the reform.

A worker from the Tikun Olam company rolls cannabis in Tel Aviv, before its distribution, August 23, 2010Credit: Reuters

“The Pharmaceutical Society of Israel encourages the sale of cannabis in drugstores,” Ofer told Haaretz. “We think that this is the right place for dispensing the substance, just as it is for other narcotic drugs. Also, economically, we think that this will be a potential source of profit point for the pharmacies.”

Ofer believes that “after the program comes into effect and more doctors are certified to issue prescriptions, the number of patients using the plant will skyrocket to around 100,000."

Other major players in the local health system – in particular the health maintenance organizations – have yet to deal with the implications of the new reform plan. Meanwhile, the Health Ministry is recruiting some 100 doctors who will undergo training and be certified to issue prescriptions; 36 doctors are currently authorized to do so.

“We are talking about the medicalization of a substance that up to now was mostly considered to be a dangerous drug, and are trying to bring it to a place in which it becomes a ‘friendly substance’ in the world of medicine,” says Prof. Arnon Afek, deputy to the director general of the Health Ministry.

Afek is one the drafters of the “Green Book,” a manual that's intended to acquaint doctors with medical cannabis and to prepare them for working with it, and has set guidelines for treatment with the substance, even though it will not have the status of a full-fledged medicine. “We have been contacted by other countries and asked for permission to translate the book,” Afek added. “This is the first time this process has been done.”

A worker stands near cannabis plants at a growing facility for the Tikun Olam company near the northern city of Safed August 22, 2010Credit: Reuters

Boon to the economy

The process of institutionalizing the medical cannabis market is one of the most interesting and mysterious phenomena taking place in Israel today. The plan extends far beyond the confines of the health system. The steering committee overseeing the process includes members from the Ministry of Finance, Ministry of Agriculture, and the Ministry of Public Security, in addition to the Health Ministry. The reform has far-reaching economic consequences, both for the state and for entrepreneurs.

At the end of July, the Health Ministry published on its website guidelines and other information under the title “Road Map.” These documents, which define the terms for participating in the local medical cannabis industry, heralded the quiet beginning of an important market reform. Despite the fact that this information didn’t appear on the public radar or in the press, within two months the Health Ministry received over 200 applications for an initial permit to participate in some way in the new industry – mostly for permits to operate cannabis farms. These applications came, as far as is known, from farmers and members of moshav and kibbutz cooperatives; indeed, such entities are well acquainted with the commercial ins and outs of the field of agriculture and can appreciate the financial potential of the new crop.

Sources at the ministry admitted that they did not expect the fact that so many organizations and individuals would ask to enter a field so full of uncertainties and controversy, and be willing to invest in a crop that will still be stamped with a label reading “dangerous drug” in red. But it turns out that some people have been preparing for this moment for months and even years. According to estimates, as many as 20 applicants seeking a permit to grow medical cannabis have been approved to take the first step: setting up a nursery under specific conditions defined by the state and with tight security. Only once they meet all requirements defined by the government, they will be approved to continue to the next step and begin growing cannabis.

Last week the online magazine Cannabis revealed that among those approved to date were Sdot Yam, a kibbutz near Caesarea; and Noa Barel and Dana Melzer of Hatzeva, a moshav in southern Israel. Barel and Melzer moved to Hatzeva following their partners, and have been growing peppers and other vegetables there.

“When you come from the outside and enter the world of agriculture, it is really strange: You put all your effort into it, work really hard, but live with a great sense of uncertainty,” Barel, 35, told Haaretz. “You have no clue what the produce will be like, how much you are going to get per kilo, what the market will be like. It may not be a very good deal.”

She explains her decision to enter the new field thus: “We were looking for a field that would both take advantage of the benefits of the Arava and involve a dimension of development and science that will not be subject to too many fluctuations. The idea of growing cannabis started to occur to us seven or eight years ago, but then the field was closed off.”

The process of getting a license demanded more than a year of preparation with the assistance of a representative of the local authority. During the preparation process, Barel and Melzer evaluated economic studies from other countries and became convinced that the growing of cannabis was the most profitable field in agriculture. The economic potential of this new branch of agriculture has also not been lost on the Ministry of Finance, which assigned a team of economist to study the field.

One question that still remains unanswered is whether the Israeli market in medical cannabis will be open for export. A decision on this matter is due to be made by the government in the coming months. Persons in the know say that such an industry would be worth billions to the Israeli economy and could also create many jobs.

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