The grass is greener

Israel is the world’s medical-marijuana research capital.

By JOANNA PARASZCZUK
Israel is the world’s medical-marijuana research capital (photo credit: REUTERS/BAZ RATNER)
Israel is the world’s medical-marijuana research capital
(photo credit: REUTERS/BAZ RATNER)
On Tel Aviv's trendy Dizengoff Street, Adam Kreis is on a mission to replenish his cannabis-smoking supplies.
Turning down a narrow alley, he follows a thin strip of unnaturally green AstroTurf that leads to a tiny store tucked out of sight of the main street. Its window is packed with whimsical cannabis-themed accessories – ashtrays in the shape of marijuana leaves, an ornament featuring three anthropomorphized joints lounging on a sofa. The store’s sign, written in ’60s-style psychedelic swirling font, reads: Rolling Stoned.
The uninitiated, coming across Rolling Stoned, would think they had stumbled on a pothead’s paradise, a stoner’s Shangri-la.
In reality, however, the closest thing one can find to grass here is the AstroTurf carpet.
Founded by Roi and Guy Kurgan, South African immigrants, Rolling Stoned was opened to supply a range of specialist smoking accessories like medically approved vaporizers, for Israel’s growing community of medical-cannabis users.
Kreis, of course, is hardly a weed-smoking hippie, but a patient who has been prescribed the drug to treat a painful, chronic and incurable condition for which he has had six operations.
A former personal trainer from Virginia, Kreis says he was prescribed cannabis six months ago. As well as helping manage his pain, he says the drug relieves depression and anxiety, and has given him back his lost appetite.
“I was given other medications for these conditions before, but they were addictive,” he tells The Jerusalem Report. “That, plus they didn’t work.”
Kreis is one of around 14,000 Israelis who currently have prescriptions for medical cannabis. Health specialists estimate that number will rise to at least 40,000 by 2018.
Patients are prescribed cannabis to help relieve some of the symptoms from a raft of conditions, including cancer and AIDS.
The drug is also prescribed to some patients with chronic, painful diseases like multiple sclerosis and inflammatory conditions such as Crohn’s and arthritis.
In addition, 10 hospitals, including Hadassah and Ichilov, have licenses to offer patients cannabis directly in the hospital – mostly as palliative care for cancer patients. The cannabis is produced in Israel by eight dedicated growers, who cultivate some 10 different strains of the plant with varying amounts of its active ingredients.
In recent years, Israel has grabbed international headlines for its progressive attitude toward medical cannabis and its pioneering role in clinical research into the effects of the drug on patients.
CNN’s medical correspondent, Sanjay Gupta, dubbed Israel “the medical marijuana research capital” in his 2013 TV documentary “Weed.” After all, as Health Minister Yael German pointed out last year, Israel distributes more medical marijuana than any European country – nearly 400 kilograms of cannabis per month, compared to just 150 kilograms per year in Holland.
Why has Israel become the Amsterdam of medical cannabis? How has this tiny country come to stand on the front lines of what some say will be a revolution in how pain and other chronic symptoms are treated? The reason seems to be a combination of an Israeli tradition of entrepreneurship, a willingness among some government figures to support medical cannabis, and a long history in pioneering scientific research of marijuana.
It was an Israeli scientist, Raphael Mechoulam, who first discovered and described the two active ingredients in cannabis: tetrahydrocannabinol (THC) and cannabidiol CBD.
Mechoulam says he became interested in cannabis after he took up a post at the Weizmann Institute in Rehovot. Now a distinguished professor, the then post-doctoral researcher says he began reading old French, German and Russian scientific papers on the marijuana plant.
Realizing that scientists had not yet managed to isolate the active constituents of can-nabis, Mechoulam decided to get hold of some of the drug and attempt to do so. The enterprising young scientist went to the best source of cannabis – police headquarters in Tel Aviv. He managed to obtain five kilograms of what he calls “superb, smuggled Lebanese hashish” and carried it back to Rehovot on the bus. “Nobody on the bus realized the smell from my bag was from hashish,” he would recall later.
Back in Rehovot, Mechoulam and his colleague, Yuval Shvo, became the first scientists to discover and isolate a substance he named CBD. In 1964, Mechoulam and another colleague, Dr. Yehiel Gaoni, discovered THC.
Today, Mechoulam is convinced that THC and CBD have a future as important medicines. THC, the most well known of marijuana’s active ingredients, is what gives smokers their “high”; CBD is not psychotropic [does not affect the mind or mental processes].
Clinical studies have shown that both these substances have an anti-inflammatory effect in some diseases, including certain variants of Crohn’s and colitis.
“I strongly believe that cannabinoids – the constituents of cannabis – may become major drugs in the future. One of them, CBD, which is not psychotropic and is not toxic, is particularly promising,” he tells The Report.
Ma’ayan Weisberg, a project manager at Tikkun Olam, the oldest and largest of the country’s eight medical-cannabis growers, agrees with Mechoulam (whom she dubs “the father” of Israel’s medical-cannabis industry).
Weisberg believes medical cannabis could revolutionize treatments for many diseases.
To push that revolution forward, Weisberg says Tikkun Olam does far more than “just grow cannabis,” an ethos that is reflected in its name – a Jewish concept that means “repairing the world.” “We want to create a chain that grows and breeds cannabis but also promotes clinical trials, so that we can know the effects and side-effects for various diseases,” she tells The Report. Tikkun Olam started out in 2005 as a family business. Its founder and owner, Tzachi Cohen, got a license to grow marijuana for about 100 patients at his family home in the Upper Galilee.
Beforehand, Weisberg recalls, those patients had to procure cannabis from the police.
Today, Tikkun Olam’s cannabis is grown on an ultra-high-security farm, and its product is delivered to pharmacies by the security firm Brinks. The Cohens used to allow reporters to visit the farm, but recently stopped, Weisberg says, because the government had become concerned the country would earn a reputation as a “pothead paradise.”
Despite these reservations, in recent years, Israel has taken a giant leap forward both in attitudes towards prescribing cannabis and in research into the drug’s effects on patients.
According to Tikkun Olam’s Weisberg, there has been a sea change in the attitudes of many Israeli physicians over the past several years. While previously many doctors would not countenance the concept of treating patients with medical cannabis, more and more are taking note of its possibilities, she claims.
Weisberg believes Tikkun Olam’s efforts to compile data on how different strains affect patients and convey these results to physicians has helped effect this change.
Individual innovation from within the pro-cannabis faction also has gone a long way to help normalize the prescription of marijuana to patients, including in hospitals, and to find ways other than smoking for patients to take the drug.
Roi and Guy Kurgan, the founders of Rolling Stoned, started the company to help patients find solutions, other than smoking, to take cannabis. Many patients either did not wish to smoke, or could not do so for health reasons. Smoking is also completely banned in all hospitals.
Roi Kurgan, who helped found Tikkun Olam, says that in 2009, he and his brother brokered a deal between the Health Ministry and the German company Storz & Bickel, which manufactures a cannabis vaporizer device called the Volcano. Storz & Bickel developed a medical version of the Volcano that is now used in Israeli hospitals, including in cancer and children’s wards across the country.
The brothers have worked out a scheme whereby the devices can be rented to share the cost of purchase and use.
One important outcome of Israel’s comparatively progressive attitude toward prescribing medical cannabis is that it has produced a large cohort of patients with a variety of diseases taking the drug. One physician who is taking advantage of this is Dr. Timna Naftali, a gastroenterologist at the Meir Medical Center in Kfar Saba.
“In Israel, there seems to be an exceptional development of research into medical cannabis,” says Naftali, who has undertaken initial clinical research into the effects of cannabis on Crohn’s and is planning what she believes is the first ever double-blind placebo trial of the drug for this disease. Cannabis is used to treat a variety of symptoms in Crohn’s patients, including abdominal pain, diarrhea and intestinal inflammation.
Naftali, says that although many patients with Crohn’s – an autoimmune condition that causes painful bowel inflammation – report that cannabis improves these symptoms, so far there has been very little formal medical research to examine this anecdotal evidence. Part of the reason is that, unlike other drugs, which are marketed following extensive clinical trials, cannabis is prescribed as a result of “grassroots pressure” from patients. The medical literature on cannabis, Naftali notes, is mostly about cannabis addiction.
In Naftali’s first, small clinical study into the effects of cannabis on Crohn’s, she interviewed 30 patients who had been prescribed the drug. These patients reported that they had experienced a reduction in inflammation and that they were using fewer other drugs. “The big question is whether cannabis actually has an effect on the disease or whether patients who take it just feel better in themselves,” she tells The Report.
Naftali has designed a study that will examine this “big question.” However, she says one problem her team faces is finding funding for such a study. “Pharmaceutical companies will not invest in cannabis research because they can’t patent it. That is holding research back,” she says. According to Naftali, nonprofit organizations and the public sector must fund medical research into cannabis or things will not advance.
While Tikkun Olam’s Weisberg says pro-cannabis activists, including doctors, face obstacles from pharmaceutical companies, which may feel threatened by medical cannabis because it is far cheaper than traditional drugs and cannot be patented, Naftali believes no one is actively trying to prevent research. “Simply, the market is such that only those who have a financial interest in developing a drug can afford to invest in clinical trials,” she says.
Israel’s advances in medical research into cannabis are all the more impressive when set against the situation in other countries, notably the US. Although Naftali says her team has to get approval from the Health Ministry and an Ethics Committee for her studies into cannabis, the Israeli authorities are “very forthcoming.” “They are open to the ideas and to trying them,” she adds.
Mimi Peleg, the former director of Large Scale Cannabis Training for Mechkar, the medical-cannabis distribution center at Abarbanel Hospital, agrees that Israel has been supportive of cannabis research. According to Peleg, because marijuana is a Class 1 illegal substance in the US, medical researchers there face considerable hurdles.
“All research on cannabis [in the US] has to go through the National Institute for Drug Abuse,” says Peleg, an American immigrant who takes medical cannabis for posttraumatic stress disorder.
Peleg, who works for an organization named One World Cannabis, which she says is dedicated to collecting and sharing data from clinical studies of medical cannabis, says she is “proud of Israel for taking the bull by the horns and making research into cannabis possible.”
While Israel is certainly a medicalcannabis pioneer, the situation for patients and researchers is not perfect. Some people have feigned illness to obtain cannabis.
There is even a network of “consultants” who, for a fee of several hundred shekels, will advise people how to convince doctors they need cannabis. “This harms the system, because lots of doctors don’t want to deal with that sort of thing. It also harms medical research into cannabis,” Naftali says.
Medical-Cannabis patient Kreis says it took him two and a half years to get a license to use the drug. Part of the problem, he says, is that there are too few pain specialists licensed to prescribe medical cannabis so waiting lists to see them are very long. Also, he adds, doctors are not allowed to prescribe cannabis until a patient has first tried all the other more traditional pain medications to relieve symptoms, which can take some time.
However, Kreis relates that he did not let the long waiting lists and bureaucracy deter him, insisting that despite these setbacks the situation in Israel is far better than in his native US. “Here in Israel, [medical] cannabis is subsidized,” he says. “In the States, you have to pay a lot more for a prescription.”
According to Naftali, the subsidies make cannabis far cheaper than on the black market, which is good for patients.
To help guard against the problem of long waits, in January, the Health Ministry increased the number of specialist physicians permitted to prescribe medical cannabis from 21 to 31. That move came after the Ministry and the Israel Medical Association voiced strong objections to a proposal by MK Moshe Feiglin (Likud) to authorize family doctors to freely prescribe cannabis.
Although many difficulties remain and many in the medical community are not yet convinced about the efficacy of medical cannabis, Tikkun Olam’s Weisberg is positive the drug has a bright future and that more and more medical professionals will get on board the cannabis bandwagon.
“Cannabis is not a secret anymore. We are talking to doctors, we are training nurses.
We need to continue this research,” she says.
“And the world is looking at Israel.” While the medical cannabis lobby and physicians such as Naftali are keen to push more medical research, cannabis patients just say they’re grateful to have a prescription for the drug.
“You know, speaking as a patient, I’m really glad Israel is so pro-cannabis,” asserts Kreis as he rests for a moment outside Rolling Stoned’s storefront, nursing a heavily bandaged arm – the result of his latest operation.
“Cannabis makes my day bearable. Having cannabis makes my life a whole lot better.”