Legalizing Marijuana: The Dangers and Risk-factors Being Ignored by Profiteers

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An adult cannabis plant at the medical cannabis company Together Pharma's farm in Uganda
An adult cannabis plant at the medical cannabis company Together Pharma's farm in UgandaCredit: Together Pharma

We’re talking to Omri Frish, a 67-year-old social worker from Kibbutz Mesilot, near Beit She’an, who is married with eight children and is founder and director of a rehabilitation community called Harmony Village (Kfar Izun in Hebrew). The village uses holistic methods, based on both Eastern and Western approaches, to treat individuals over a relatively short period who suffer from drug abuse and certain mental problems but not ongoing psychiatric conditions.

As someone who treats young people undergoing a crisis due to intense drug abuse, you are undoubtedly against the government’s attempt to legalize cannabis.

I’m not into being for or against. The world is moving in that direction and it’s hard to stop the trend, so it’s best to confront its faults. The train has already left the station.

Is the whole world really moving toward legalization?

Not entirely. Most of it is heading toward medical cannabis and decriminalization [of its use]. Few countries have actually legalized cannabis for recreational consumption.

Can you give us some numbers?

In the United States, four states approved legalization in the recent election, 36 states approved the use of medical cannabis and 27 approved a decriminalization policy in cases of recreational use. To date, 15 countries have approved legalization. Others are saying, “Let’s do it in stages, we’ll see the implications and consequences of non-incrimination and then decide how to proceed.”

So, why is Israel jumping in to be among the first?

Not for professional reasons.

How surprising. What are the reasons?

The reasons are political and economic. This is a market that’s expected to turn over billions. Look at the players already involved: former prime ministers, heads of the Shin Bet security service and Mossad, police commissioners, air force commanders. To politicians, it’s pretty clear that if today the prevailing assessment is that more than 50 percent of the 20-to-40 age group smokes marijuana – whether occasionally in the evening, on weekends or every day – this will bring them voters. Decriminalization makes sense, because it’s not reasonable to imagine 1.5 million normative people having a criminal record because of one joint.

Really – 1.5 million, half the population between 20 and 40 uses cannabis?

The last survey done by the Israel Authority for Prevention of Violence, Alcohol and Drug Abuse, before its dissolution in 2016, spoke of 1.5 million young users. I imagine that today there are a lot more.

How many of them will be hurt by their use?

That’s in dispute. Some cite very high numbers, but most agree on about 10 percent.

What can they anticipate?

Psychotic attacks, anxiety, paranoia, or they will become addicted, and then we’re talking about diminished motivation, reduced drive in life and potentially also other mental illnesses.

Packets that were dropped from a drone over a main Tel Aviv square and which Israeli police suspect contained cannabis are seen on the ground in Tel Aviv, Israel September 3, 2020Credit: Israel Police/Handout via REUTERS

Soldiers smoking grass

So you oppose legalization, after all.

I think it would be better to establish the use of medical cannabis and decriminalization, and at the same time set up a research body to examine the implications – especially among teens, who are the most critical group – and also to examine how the Israel Defense Forces is coping with the fact that soldiers are smoking on bases and even during operational activity.

There are still drugs in the army?

Obviously – I’ve spoken with hundreds of people [about this]. In private conversations, you discern that those in the young chain of command are also into it. They or their friends. So I can’t tell them to do this or that to every soldier who smokes grass.

Is the army aware of this?

I think so, and they’re also thinking about what needs to be done. When I established Harmony Village, 20 years ago, I was a reserve lieutenant colonel in a combat unit and a social worker specializing in drug abuse, and I received a lot of requests for help. It was alwasy the same story: members of combat units completed their service, or went through some war or other military operation, and flew off to India.

And what happened there?

They usually experienced a psychotic attack – flipped out. Lost their sanity. I met four people in India from the same army squad. One decided that ISIS was after him and he broke a window and arranged the shards of glass on his pillow. When the guys told him he was going overboard, he thought they had recruited them as well and tried to cut himself. Or there was a trekker who was convinced that a whole Indian village was made up of Palestinians who recognized him as an undercover soldier, and that if they were to catch him it would be the end. Paranoia is a very complex thing.

How long does an attack like that last?

It depends whether the person goes on using or not. For example, if you want to give him medical treatment, he’ll say: “You’re out to poison me.” To create trust in paranoids is complicated. Every unit has passed through Harmony Village: pilots, naval commandos, Sayeret Matkal [special-ops] – and also noncombatants, people who sit in the war room and see everything. I was in the Yom Kippur War, I know what posttraumatic stress is and the desire after you finish your service to travel and clear your head.

I meet people who do insane things. They say: “If I got through Operation Protective Edge [in 2014, in Gaza], everything else is a piece of cake.” Every military operation or traumatic event – Protective Edge, Defensive Shield, Cast Lead, Lebanon War, Philadelphi Route [near the Gaza-Egypt border] – generates a new wave.

Sad.

At least half of those who turn to us have a strong army background [to their situation]. And in therapy, too, the subject of IDF service plays a significant role. Men constitute about 75 percent of the community at Harmony Village, but in the past four to five years there’s been a significant increase in the number of women with posttraumatic stress disorder stemming from their army service – commensurate with the increase in the number of women in combat units.

We established the village because the only other solution in Israel for these people is closed psychiatric wards. So I collected a bunch of colleagues, and we decided to initiate an innovative solution that didn’t exist anywhere in the world back then, which treats people suffering from a dual diagnosis: drug abuse combined with mental impairment. We found a new type of people in crisis, whom we called “normative functional users”: people who don’t come from the criminal world or from a dysfunctional background or drug dealing, but who smoke joints or take psychedelic drugs.

Hallucinogenic drugs.

These are the drugs that affect the brain most potently, and then it’s crucial to know what someone took and how much. Those drugs can truly aggravate the situation. We had one person come to us with very complex posttraumatic stress disorder after a recent military operation. He arrived in a psychotic state, and it turned out he’d taken Ecstasy.

Encounters in India

What do the people you meet say to you?

I fly to India a lot and meet young people there. We sit around on mats with 150 to 200 young people and talk. There’s usually plenty of time there, so we sometimes sit for three hours. I met someone from the Duvdevan [undercover] unit who told me his whole squad was wandering around there. We went together to a village at an elevation of 3,500 meters with snow and a river, and talked about having to deal with a civilian population as a soldier. These people were trained to lock up their feelings, and suddenly I say: “Let’s talk about how you feel.” You’d never be able to conduct conversations like that in Israel.

One girl said to me there: “I’ve been traveling for half a year already, and soon I’ll be going back to Israel and I haven’t touched anything [i.e., drugs]. I decided I would take something once and wonder whether it should be Indian charas [cannabis plant extract] or acid. What does the expert from Israel say?”

An Israeli-style restaurant along a trekking route in India.Credit: Daria Maoz

Tough question – could you tell her not to take anything?

My answer was that the person taking it is as important as the drug itself. That’s the most significant thing in our understanding over the years. If I were to buy an Ecstasy pill now, cut it and give half to each of you, you’d both end up in different places. Even if you took half now and half in another two months, it’s not certain you’d react similarly, because your emotional state is different. So it’s impossible to draw up a clear chart that will predict who will be harmed and who will not.

Which drugs are we talking about?

The dramatic change that’s occurred in the past few years is that more than half of those we encounter in psychotic states or suffering from anxiety attacks, depression and paranoia were only on cannabis.

A lot of cannabis?

No. It has nothing to do with quantities, or even with how long a person has been smoking. We also discovered that more people are harmed by consuming cookies with charas or bhang lassi [yogurt with milk and hashish, widespread in India] than from smoking. It breaks down differently in the digestive system. Also in the past few years the quality of cannabis and the concentration of THC it has have risen dramatically.

A man smoking medical cannabis at Abarbanel Mental Health Center in Bat Yam, September 2012.Credit: Daniel Chechik

Flower-power days

You’re referring to the main psychoactive component in the cannabis plant, the one responsible for making people feel high.

Studies since the early 1970s – the days of the flower children, Woodstock and the Beatles – show that THC concentration then was less than 1 percent, whereas today there are no types with less than 25 percent.

Wow. Why shouldn’t the amount of THC in cannabis be limited as part of its legalization, as has been done with nicotine in electronic cigarettes?

Because the medical cannabis market is going for the potent type; it’s what dominates the market and there’s no way to remove it from there. It’s clear to me that economic interests will overcome others. I wish we were capable of doing an analysis that would allow us to say: “You could be harmed – you more so, and you less.” We get some people after a month of use, and also some after 10 years of smoking, during which everything was fine.

Ten years!?

Yes, and now he suddenly suffers a [psychotic] attack.

How can a person who’s been smoking grass for years suddenly go psychotic?

It has to do with his history, the experiences he’s had, his genetics, but also his current condition. Maybe I smoked weak stuff in the past and now it’s stronger. As I said, the cannabis that’s available on the market today is very potent.

What does an attack like that signify?

A disconnect from reality. Someone who thinks he’s the Messiah, that he’s Jesus, or that he’s a dolphin. Sometimes I hear arguments and discussions in the village: “‘I’m the Messiah!’ ‘No, I’m the Messiah.’” Cannabis has many benefits and good qualities, and it can help in multiple situations, but it is also harmful.

So what needs to be done?

We’ve been given a window of nine months [after which Justice Minister Avi Nissenkorn said he would submit a legalization plan for government approval]. During that time five or six specific issues have to be defined, and solutions found for them, and a decision needs to be made on the use of taxes and money from fines for the benefit of two main things: prevention and treatment.

What will happen in a case of legalization without precautionary measures?

That would be a catastrophe. This [legalization] is an issue that was very powerful in the last election campaign. It’s going to overwhelm us. We must prepare a response for situations such as cannabis use by teens and soldiers, for driving under its influence. Otherwise we will find ourselves facing an acute problem, because there will be a lot more users and more victims, cannabis will be used from an early age and there will be a heightened penetration of drugs into places like the army and medical teams.

If you were the IDF chief of staff, wouldn’t you cry out?

I don’t know if he wants to be involved, because it’s political. There are distinct differences between Israel and the rest of the world. The first is the security and military aspect of life here, and the second is that we are a country with stress, a country with anxiety, and we are more vulnerable than others.

In fact, you are in favor of prohibiting cannabis use during a person’s period of army service even within the legalization framework?

Yes, but the army is not the only issue. I’m not in favor of only taking a “do not” approach, but also of holding a conversation. We need to talk to these young people about their feelings and not admonish them straight off by saying “bad, bad, bad – smoking is prohibited.” The key is a close but balanced relationship. In general, we need to decide whether we tell everyone that over the age of 21, smoking grass is allowed, or whether there are professions in which it’s prohibited. Can a physician smoke during his shift? What about a preschool teacher? Truck drivers? Driving is a critical issue, because no one disputes that the influence of cannabis lasts for five-six hours.

Is there no breathalyzer-type device that checks cannabis consumption?

No. The urine test that’s given is like a pregnancy test; it just says whether you smoked or not, but gives no indication of whether it was an hour or longer ago; after a week the test apparently is not effective. Cannabis is the leading problem among adolescents.

How is that possible? After all, they aren’t even permitted to smoke [regular] cigarettes.

If I’m a 16-year-old kid who comes to a Friday evening meal and my older siblings and maybe even my parents are smoking grass, there’s a reasonable chance that I’ll smoke, too. More and more youths are starting to smoke at young ages.

What do you think about the idea that parents who smoke should hide on the balcony?

That’s very serious. Little, casual things have the greatest influence on kids. If you tell them to speak politely but they see you swearing, that’s what they remember most. Don’t lie. A parent has to conduct a dialogue with his child and set a personal example.

Forget tobacco – using drugs is a little more problematic. As a parent, you don’t want to share that.

That’s true, but maybe the conversation won’t be about saying “shame on you,” but rather: “Do you know what kinds of things using cannabis does to you, what kinds of bad things?” Teenagers have to be told that under the age of 21, it’s dangerous and liable to affect the brain. That’s a critical difference, because this can cause immense, irreversible damage. If I could succeed in deferring them from starting smoking from 7th grade to the 12th grade, that could be a great success. And if I get young people to only smoke grass and not take other drugs, that too would be a fantastic success.

Parents don’t conduct dialogues with their children. When I meet a mother who tells me, “I’m not a mother, I’m a friend,” I see that as a crossing of the line. But on the other hand, the conversation has to be two-way – not an interrogation.

You’re talking about a social bomb that will be hard to dismantle.

True. And in the past two years there has been a very significant increase in the use of Ecstasy and ketamine in the light drugs slot left vacant by [the decriminalization of] cannabis. Because if everyone is now smoking cannabis, then people will be going on to the next generation of light drugs. And you see many victims there. If cannabis was once considered a light drug, today in public consciousness it no longer belongs to the world of drugs at all. A mother calls me and says about her kid, “He doesn’t touch drugs.” And when I ask about cannabis she says, “That yes, but you asked me about drugs.”

Is it worse than alcohol?

At the moment more people are being harmed by alcohol, but we aren’t yet able to estimate the victims of cannabis. Many of them go to private clinics and not to public [treatment] centers.

A man smoking marijuana with photographers snapping pictures, in Canada. Credit: AFP

Alcohol consumption in Israel is quite low.

Yes, in part because there was welcome activity [on the part of the authorities]. Another important subject is crime and the underworld. It’s likely that if large-scale production [of cannabis] were to begin, the criminal world would not sit idly by but would want to get involved.

Does cannabis heighten violence?

No. In most cases it has a calming effect, but it can cause violence if a paranoid attack develops.

By how much will legalization increase usage?

By a great deal. It will also lower the price, because there will be competition, and that will lead to the production of better and stronger stuff. Israel is situated among the top countries today in terms of how expensive cannabis is per gram. It’s most expensive in the Persian Gulf states and cheapest in India.

Legalization has advantages, too, doesn’t it?

The advantage is that instead of a black market, we will institutionalize it and we’ll know who’s selling it and how much. Everyone will buy in an orderly way, under regulatory supervision. So decriminalization was the right move.

To what extent has the coronavirus crisis contributed to an increase in the number of cannabis smokers?

Dramatically. Operators of apps such as TeleGrass report an increase of 30 to 40 percent in sales. People are sitting home, there’s a lot of loneliness, there’s no action, no activity, no entertainment, you’re unemployed or furloughed and you don’t know what the future will look like and you’re in despair – so you start to smoke grass. And if before, you were a student and had a job and you only smoked in the evening and then went to sleep, now it’s all day long, because you’re at home. It’s a type of solace.

You see an increase in demand for and occupancy in mental health hospitals. At the start of the crisis, we talked mainly about the health aspect, and afterward the economic aspect was added. It’s time to add the mental aspect and talk about a triangle of health, economy and mental state.

There are also the high-school students, whose education has been disrupted.

Right. They tell their parents that it’s not criminal, that it’s medical and will soon be legalized. Here’s where the legalization connects with the coronavirus by means of chance timing that really influences the market. Another issue is semantic. We’ve had medical heroin for years, but no one ever thought of calling morphine “medical heroin.” So why call cannabis “medical cannabis”? Give it the name of a medication.

How did we get to a situation where Israel is among the first countries in the world that is moving forward with full legalization?

Advocates of legalization, who’ve tried time and again to get elected to the Knesset, understood that medical cannabis and non-incrimination might possibly be the window through which they would enter the House. And they were right.

What will you tell your grandchild if he decides to go to India?

That he should go, and I’ll even recommend places to visit. Many of my children have been in India, and I recommend to every parent to travel there with their child in order to undergo and understand the experience. Less than a year ago, I was there with four of my kids and my wife. We sat on the verandah of a guesthouse and someone who’s studying medicine decided to light up a chillum – a pipe of Indian grass. We thought of leaving, but she said with a laugh: “The Health Ministry says chillum is the last thing that can harm you.” She’ll be a good doctor, I’m sure, you have to understand their way of thinking non-judgmentally.

Were you afraid something would happen to her?

No. I accepted my wife’s viewpoint: “You’ve baked the best cake – wait for something good to come of it.” I prefer to talk to these people about the dangers and about emotional and mental states that can develop. Instead of telling them not to smoke grass, I give them a list of symptoms and tell them to get help immediately if they detect symptoms among their friends.

What are the symptoms?

It depends. In an externalized psychotic attack, the individual starts talking nonstop, and shifts from one subject to another, with plenty of “I am the Messiah, I am Jesus, I have come to save the world, the Shin Bet is stalking me.” The cases that are harder to deal with are the internalized ones, which create anxiety and depression. These people may slow down the pace of their travel and barely go out, but they continue to function. A person in that state is capable of boarding a bus or finding lodging at a guesthouse. People who don’t know him well won’t know what’s happening to him.

The more we get to know those symptoms, the better off we’ll be. For example, say you’re with three guys from your army squad and you’ve been traveling for two months in India, but you’ve reached Manali and one person wants to go here and another wants to go there, and suddenly you’re alone for the first time, without people you know, and you start to feel shaky – you need to know what’s happening and understand that this is not a good time to take drugs. Or after you’ve broken up with a girl you had a terrific relationship with – that’s not a good time to try drugs. Or when the body is weak.

India is a phase, and it passes.

But there is a schedule here at home and on the India trip there isn’t. Also, what you see there is people like you, and they’re smoking. In Israel a larger variety of people see you.

Advocates of legalization are always talking about enforcement accompanied by research. In light of what we’ve seen of enforcement during the period of the coronavirus pandemic, how likely is it that the state will be an effective regulator?

The proponents of legalization will say that there will be no need for that type of enforcement, only to make sure that it doesn’t get in the hands of teenagers.

I think that in the nine months ahead, a budget has to be finalized and a preventive program, an information campaign and treatment need to be put in place. I am an incorrigible optimist. I see the far-reaching changes we succeeded in bringing about with regulatory authorities, and it worked. One of our problems with decision makers is that they need to adopt a long-term point of view, but here the ministers are being replaced all the time.

Omri Frish. Credit: Ofer Vaknin

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