Users of medical marijuana will soon be able to choose from among a variety of smoking products classified by the Health Ministry according to the concentration of active ingredients they contain, in an effort to better match the drug to the needs of the individual patient.
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Today patients are supplied with dozens of different strains of the plant, with varying degrees of active ingredients, as suppliers make an effort to tailor the concentrations to the individual patient. As part of the Health Ministry’s recently published plan to regulate the supply of medical cannabis it was decided that the ministry would set uniform standards for the product in accordance with the concentration of its active ingredients, tetrahydrocannabinol (THC) and cannabidiol (CBD), so there will be relative uniformity among the products supplied by all eight authorized growers of medical cannabis in Israel. The plan is to go into effect in September.
The Health Ministry has published a table of products that the growers are authorized to market, with reference to smoking products, oil-based extracts and cookies.
There are eight categories of smoking products which have been given names like “Cannabis Lite Day/Night,” Cannabis Forte Day/Night,” and “Cannabis CBD,” in accordance with the concentration of active ingredients. For example, the Cannabis Lite product will be produced from plants whose THC levels average 10 percent, with CBD levels averaging 2 percent. It will be marketed in two versions – a day version based on the sativa strain, which studies have shown is more energizing and stimulates the appetite, while the night version will be based on the indica strain, which promotes relaxation and sleepiness.
Cannabis Forte, which will also be marketed in day and night versions, will have stronger concentrations. Cannabis CBD will have relatively stronger concentrations of that component. All the products will have an expiration date of at least six months from date of sale.
The table also includes five oil-based cannabis extracts and five types of cannabis cookies, which the Health Ministry is designating for use by children needing the drug.
About 14,000 Israelis have prescriptions for medical marijuana. Until now, matching the plant species and method of use to the patient has been done by representatives of the growers, who instruct the users and tailor the strain of plant to the patients’ symptoms.
“As part of the process of regulating [medical cannabis] the Health Ministry is formulating professional standards in different contexts, including everything relating to the range of ingredients in the various cannabis products authorized for sale,” the ministry said. “The table of products that was previously approved was recently reevaluated in conjunction with [cannabis expert] Prof. Raphael Mechoulam, doctors and pharmacists, growers, chemists and biochemists. The final result of this reevaluation is as detailed in the Table of Products Permitted for Sale.”
Limiting the use of cannabis cookies to children was a decision reached after a year of debate. In early 2013, the Health Ministry’s pharmacy department was asked for its opinion on offering cookies as an option to patients, and the department opined that dried cannabis for smoking or drops were the preferred methods of supply, noting that patients who didn’t want to smoke the drug could either prepare their own cookies from the dried plant or put the drops on any food they chose. The department raised questions about the quality of the finished product, given that the cookies are baked at temperatures of 160-200 degrees, which could affect the concentrations of the active ingredients. The department also cited the risk of misuse by the patient or by others who might misidentify the cookies, which look like regular cookies but actually contain a dangerous drug.
As a result, the sale of cannabis cookies was scheduled to be halted as of June 2013, but the order was delayed because sellers, patients and doctors objected. One reason given was that there was an advantage to a product that was eaten and absorbed by the digestive system, with its effect kicking in after 30 to 90 minutes and lasting for an average of eight hours. The suppliers noted that the cookies were baked under careful supervision and the level of active ingredients in the finished product could be assured. They added that those using the cookies, most of them children, were very satisfied with this method of treatment.
In light of these responses, Health Ministry director-general Prof. Ronni Gamzu decided in November that the cannabis cookies would be sold solely to qualifying children, packaged in child-resistant packaging, and must meet the provisions of the law regarding food labeling, including the listing of all the ingredients.