Medical cannabis in Israel: Revolution or evolution?

This country could become not only one of the few countries manufacturing marijuana-based medicines but also a key world pioneer in the field.

311_Marijuana (photo credit: MCT)
(photo credit: MCT)
The standard image of cannabis is twofold. First is the one presented in the West’s films and pop subculture. Cannabis, also known as marijuana and “grass,” has been famous for centuries as a psychoactive, dreamy substance which, at the same time, is illegal in most countries and attracts a penalty if the user is caught.
Several generations of anti-establishment youth got off on hiding it and being part of a subversive underclass. Their non-cannabis-using peers were relegated to the term “squares” and accused of being boring.
The second attitude is one of recreational use in places like the Netherlands, where cannabis is openly ingested in the infamous cafes, with a denial that it is any more harmful than alcohol.
INNOVATIVE ISRAEL has taken a third path and put the nefarious weed into its proper place by recognizing it as medicine. And like all medicine, it has the potential for misuse. In any case, the use of cannabis derivatives as medicine is causing a small, silent revolution among hippies, squares and Dutch cafe users alike.
What is apparent, from much of the recent research, is that Cannabis sativa (the plant) has many properties that, administered correctly, offer a multitude of remedial benefits. In taking this forward, Israel is placing itself leaps ahead of worldwide competition, both scientifically now and commercially in the future.
Israel is one of the first countries to have permitted the use of medical marijuana. Tel Aviv’s cannabis clinics have been open for some time on an experimental basis, with government support.
They offer treatment for cancer, multiple sclerosis, HIV, colitis and other ailments. Recently too, Israel’s first-ever hospital to offer cannabis as a treatment, Sheba Medical Center in Tel Hashomer, started its pilot program. There patients obtain the necessary government permit, according to a strict protocol that the hospital developed, and then are provided with cannabis.
Soon smoking will be replaced with machines which vaporize the marijuana compound so they can inhale it with steam.
Cannabis for medical purposes is supplied by a Health Ministry approved, charitable company in Safed called Tikkun Olam, aptly named after the kabbalistic concept of restoring the world. Bags of neatly wrapped cannabis cigarettes from the company are distributed to licensed patients from various locations. The process is carefully controlled and monitored by the government under the watchful eye of Dr. Yehuda Baruch, director-general of Abarbanel Mental Health Center.
Medical cannabis guru Prof. Raphael Mechoulam of Hebrew University in Jerusalem famously pioneered research in 1964 to isolate tetrahydrocannabinol (THC), the main active ingredient in cannabis, which he was able to synthesize.
In 1993, he and his research team discovered another compound called anandamide, which occurs naturally in the brain and acts in a similar way to THC. Recent research has found this to link to neonatal appetite stimulation in the womb.
Now Mechoulam uses cannabis provided by the police to create different chemical compounds that may be useful in treatment.
The benefits of cannabis as medicine lie in reducing pain, increasing appetite, modulating mood and various positive effects on the nervous system, as identified with sufferers of multiple sclerosis.
The uses are wide and the potential benefit is huge, but what are the risks? THE CASE against cannabis is wholly based on harm-related research and legality. The first, most obvious, risk is crime. Security on cannabis clinics is high (no pun intended). Recently, reports suggested that there was a “cannabis drought” in the Middle East. When illegal cannabis does arrive in Israel, most of it is courtesy of Egypt, Lebanon and Jordan. The likely consequence, if there is indeed a drought, is a growing black market. The potential for sale of medical cannabis in such a market might prove too tempting for some. Criminal raids on legitimate cannabis providers may become an issue. Whatever happens, these factors will require careful monitoring.
Misuse and addiction are other issues. Usually, cannabis treatments are given in low doses to those with a significant health problem where other treatments may no longer be effective.
Often patients are over 30 and the expected benefits outweigh any harmful side-effects of the substance.
Clinics may have to monitor increasing trends in demand and ensure assessment is always rigorous.
Risks from cannabis lie in its mild hallucinogenic effect and potential to induce psychosis and paranoia in a small percentage of the population, particularly if ingested in large amounts. Its dependence potential has been questioned but exists at least psychologically, if not as a physical addiction.
There are also physical risks in the method of ingestion. Inhalation gets the active ingredients into the bloodstream rapidly but doing this using cigarettes can add damage from the other chemicals present in the smoke, such as various carcinogens and carbon monoxide. There may be risk to others of passive smoking. It should be noted, however, that most medicines have some kind of risk.
Israel’s innovation in treatment using cannabis derivatives really has the potential to be revolutionary. Clearly, cannabis is a substance that has significant risks attached to it and will need to be carefully regulated. The risks may decrease as cannabis derivatives are understood more and are made into safer formats, such as steam inhalation, tablets or liquids. It would seem further research is needed in many areas, in relation to benefits and risks, treatment methodology and outcomes, but then this is true for many new medicines.
If the risks are managed, through a solid process of clinical evolution, then the potential for the economy is significant. Israel could become not only one of the few countries manufacturing cannabis-based medicines but also a key world pioneer in this field. So it’s good-bye hippies and good-bye squares. Welcome to the new world of mature medicine, using plant derivatives as perhaps nature originally intended.
The writer is a freelance writer, therapist and former UK National Health Service manager. He has an MSc in clinical and public health aspects of addiction and a special interest in social marketing in health. He spends much of his time in Tel Aviv when he is not working in London.