September 12, 2013
Medical Marijuana Industry Sprouts Up in Israel
By: April M. Short
AlterNet dives deeply into Israel’s successful medical marijuana program, which effectively provides Israeli citizens with effective medicines while allowing scientists to conduct research into the medical benefits of the drug. MAPS Clinical Research Associate Mimi Peleg speaks with Alternet about the history of medical marijuana in Israel, how she prepares patients for treatment, and how Israel’s stance on medical marijuana is an example of how countries like the United States can move forward with medical marijuana.
Originally appearing here.
Mimi Peleg’s job is to teach people how to use pot—how long to inhale smoke or vapor, how to administer sublingual drops, or how to ration out a pot cookie.
Peleg directs large-scale cannabis training for the Israeli government’s state-supported, discreet, successful and expanding medical cannabis distribution center, MECHKAR. MECHKAR began as a tiny program serving about 1,800 people from 2008-2009. Today, supplied by eight farms located all over the country, the program distributes cannabis to 12,000 patients.
While medical marijuana has been approved in 18 U.S. states, and recreational use in two, U.S. federal law still criminalizes the drug, and its future remains uncertain. In Israel, however, the $40-million-per-year medical-marijuana industry is thriving. And, while research efforts have been continually hindered in the states by the National Institute on Drug Abuse and the DEA, the Israeli government is funding and supporting breakthrough research on the many healing potentials of the cannabis plant.
Likud Party MK Haim Katz, who chairs the Labor, Social Welfare and Health Committee in Israel’s Knesset, said in January that the number of doctors allowed to prescribe medical cannabis would double from nine to 20 by the end of the year. Mimi Peleg told AlterNet that has already happened, as more than 20 doctors can now legally prescribe cannabis in Israel, though some are limited to the prescription of cannabis oil.
While Israel has long had a hash-smoking underculture, recreational cannabis use is not nearly as common as in the U.S.
“There was always hash here, but not a pot culture so to speak,” Peleg said, noting that most students arrive at her offices terrified they will hallucinate or lose their minds.
“For them [getting high] is an adverse effect,” she said. “So I tell them what to do if they get too high, how to lower their senses a little bit, how to relax, things to expect, and how long they should expect it to stay in their body—which I tell them is between 45 minutes and two hours—before they’ll have to smoke or vape again.”
Unlike California’s medical marijuana program in which doctors recommend the herb for more mild conditions like headaches, anxiety, chronic pain and difficulty sleeping, cannabis in Israel is reserved as a last option for people with serious illnesses, often near the end of their lives.
Patients must exhaust all available pharmaceutical options and complete a long-winded bureaucratic process before they can access cannabis.
While Israel has a historically strict drug policy, it does not share the U.S.’s lengthy and tumultuous history with the cannabis plant. Peleg says Israel doesn’t have a “stoner” stereotype—while Israelis are often wary of trying the new drug, there is no serious stigma surrounding the use of the cannabis herb for medical purposes. So, she says, there was “never any question” that cannabis would be viewed as “strictly medical” when it was introduced to Israeli patients.
However, many patients also lack any knowledge or experience about how to properly use cannabis, and that’s where Peleg comes in.
Peleg credits her friend and “favorite politician” Boaz Wachtel with bringing medical cannabis to Israel. Wachtel co-founded Israel’s Ale Yarok political party, best known for its work to decriminalize cannabis. For decades he has worked to reform the drug policies of his home country, meeting both successes and failures.
Wachtel told AlterNet that Peleg’s role is important not only to educate patients but to alleviate fears.
“These patients have never smoked cannabis before, medically or recreationally, and they think they will see flying elephants in the room if they do that,” he said. “Mimi will give them a few strains to check on which strain fits them better. That’s why… patient education must be a part of any successful cannabis program.”
On any given day, somewhere between 10 and 30 people with licenses for cannabis will come through the doors of the MECHKAR facility, made up of a few small rooms at the end of a mental hospital. In addition to training and supplying cannabis to patients, MECHKAR is a mecca for the unprecedented cannabis research.
Wachtel said Israel—which has the highest ratio of university degrees to the population in the world and produces more scientific papers per capita than any other nation—has become a world leader in cannabis research as a result of the U.S.’s continued blockade of cannabis research. He says this is wonderful for Israel, but not for society at large.
“By denying people access to medical cannabis the U.S. has criminalized patients,” he said.
Doctors from all over the world, including the U.S., arrive in Israel to research cannabis’ wide-ranging medical properties. Current studies are looking at cannabis’ use in the treatment of basal-cell carcinoma, post-traumatic stress disorder, fibromyalgia and Crohn’s disease.
Funding for cannabis research in Israel comes from the Israeli Ministry of Health (MOH) as well as private donors.
Peleg is also the clinical research associate for an ongoing study of MDMA-assisted psychotherapy for PTSD, organized by the Santa Cruz, Calif.-based Multidisciplinary Association for Psychedelic Studies (MAPS). She helped write the abstract for a recent study conducted in Israel to assess the use of cannabis to treat chronic PTSD in 30 Israeli combat veterans, which turned out “promising” results. The study is currently under peer review in the Journal of Psychoactive Drugs.
“We took 30 combat veterans with treatment-resistant PTSD and gave them cannabis over time, and did testing before during and after,” she said.
Currently, about 200 PTSD patients are approved for medical cannabis in Israel, and Peleg said the number is on the rise. Peleg said the research results for all of the cannabis studies conducted in Israel have been “overwhelmingly positive.” A recent study conducted on fibromyalgia inspired many patients in a senior nursing home to apply and become licensed cannabis users.
How the U.S. Influenced Israel’s Cannabis Reform
Peleg, an American-born Jew, lived in Santa Cruz, Calif. until 2009, working as an office administrator with the Wo/Men’s Alliance for Medical Marijuana (WAMM), an organization that provides cannabis to patients to mitigate pain and other issues at the end of life. She said WAMM taught her about the compassionate, pain-relieving properties of cannabis.
While working at WAMM she attended a party with her wife, who worked as a translator for MAPS. There, she met MAPS founder Rick Doblin who is also Jewish. Together they dreamed of a time when medical cannabis would reach Israel.
So, when Peleg’s wife’s U.S. visa expired four years ago, the pair—both Israeli citizens—moved to Israel in 2009. At Doblin’s suggestion, Peleg started work in Israel, and ended up at MECHKAR, which was a fledgling program in its first year.
Boaz Wachtel’s first inspiration to work with cannabis reform came from the U.S.
From 1981 to 1993 Wachtel lived in America, working in the late ‘80s alongside Howard Lotsof who discovered the anti-addictive properties of the psychoactive substance ibogaine. He said his work with ibogaine in the US and abroad taught him about “the ability of individuals to influence governments and create change.”
Peleg said the development of MECHKAR was no easy task. For the first few months the Israeli Ministry of Health assigned the program a room “the size of a postage stamp” with no air conditioning, in the bottom floor of a large building. Today, MECHKAR operates out of a suite of substantial rooms inside Israel’s largest mental hospital, Abarbanel.
“That first day, to have so much going on around us while we were just trying to get sick people their medicine, felt to me like a slap in the face,” she said. “But, I have to say in retrospect there have been some really positive outcomes from the placement of the center, which were unexpected.”
For one, Peleg said she thinks the fact that thousands of medical cannabis patients are now frequenting a mental health institution is helping to normalize the Israeli public’s perception of mental illness.
“There’s this feeling in Israel of ‘Buck up and take it, everybody’s got problems,’” she said. “And then people come into this mental hospital and they see that [the mentally ill] people here are really, truly suffering and not just making it up.”
Peleg said while some patients with ailments like cancer near the end of life, and chronic, treatment-resistant pain have a relatively easy time acquiring a cannabis prescription, those with psychological problems have a more difficult time.
Even the many patients diagnosed with PTSD, a common problem in Israel, must cut through thick red tape. Before they can acquire a cannabis prescription, PTSD patients must work with a doctor for a year and show that all other approved medicines did not work.
Peleg said she has also seen cannabis licenses for phantom pain, anorexia, Crohn’s and fibromyalgia, all of which have psychological components.
While she and other employees continue to survive on a shoestring budget and minimum-wage salary, Peleg said Israel’s cannabis program has grown markedly over its first four years.
Wachtel said that while the cannabis program is running successfully, it’s “not like everything is roses.”
Two years ago the Israeli government attempted to move away from local growers and import cannabis from the Netherlands—a move Wachtel calls a “major threat” as the Dutch medical cannabis program grows a limited number of strains at a very expensive price.
“It’s going to be cannabis for the rich if we import it, even though it may be politically more convenient for the government,” he said.
Wachtel and supporters led a campaign against importation, and met with government officials to explain how cannabis would become a drug for the elites if Israel were to import it. Those efforts eventually convinced the government to shelve importation, “for now,” Wachtel said.
Despite ongoing challenges, thanks to MECHKAR, cannabis has become an accepted, normalized medicine in Israel today.
But this was not always the case.
After Wachtel returned to Israel from the U.S. he co-founded the Israeli foundation for drug law reform in 1994. The next year the fruit of his drug reform labors arrived in the form of a committee established by the Israeli parliament to study the legal implications of medical cannabis in Israel. Wachtel was one of two public representatives on that committee, and Israeli Raphael Mechoulam, famous in the ‘60s for his breakthrough isolation of the active ingredient in cannabis, tetrahydrocannabinol, or THC, was the committee head.
Wachtel said research on cannabis in Israel started during the 1960s. While it was illegal to use cannabis for personal consumption, it was never illegal to conduct research on the plant. Wachtel points out that the research of prohibited drugs is legal under the UN Drug Conventions everywhere in the world, including the U.S. It is federal law, not international law, that prohibits certain drug research in places like the U.S.
The committee brought an HIV patient to the Israeli Ministry of Health who requested permission to use medical cannabis to treat his symptoms. In response, the Ministry’s deputy director said the committee would be allowed to proceed if they found a way the program would not cost the government any money.
So, the committee got creative. First, they approached the police force see if they would provide confiscated cannabis for medical use, but the cops “didn’t want to become known as cannabis suppliers for sick people,” Wachtel said.
After dozens of meetings and efforts, the committee circulated the idea that patients might grow cannabis for themselves.
“I knew this wasn’t a good option because these are sick people, and sick people can’t be good gardeners,” he said. “But we went for that solution, and it was a limited solution for limited number of patients.”
In the meantime, the committee worked to educate medical personnel and the public about cannabis, via conferences and media outreach. Eventually a doctor named Yehuda Baruch, head of Israel’s Abarbanel Hospital was nominated to run a nascent program called the Medical Cannabis Initiative Program.
Several dozen meetings later, in 2007, the Ministry of Health assigned its first license to a patient to grow 50 cannabis plants.
The minister of health decided it wasn’t fair for just one person in the country to hold a cannabis grow license, so he asked Wachtel to bring other interested growers to his attention. Wachtel brought three more growers, then others joined and eventually the government awarded 18 grow licenses.
For the first year and a half growers gave cannabis to patients for free, though it soon became clear this was an unsustainable approach. Finally, the Ministry of Health decided to charge all medical cannabis patients a $100 flat monthly fee, regardless of the amount of cannabis they consumed. This system remains in place today.
Initially the program provided 100 grams a month to patients, and slowly the amount decreased. Today the average dose per month is about an ounce per patient.
Wachtel said while unfortunately cannabis is not yet a first-line option for patients in Israel, it has finally become an accepted form of medical treatment.
“The cannabis medicalization movement, which I am proud to be a member of … has a lot to do with changing the public’s and decision-makers’ perceptions of cannabis and reversing government’s propagandistic and false descriptions of what cannabis is in reality,” Wachtel said. “The success of cannabis medicalization on national levels in countries such as Israel, Canada, Netherlands, is pointing to the fact that medical cannabis programs… help the sick and the dying.”
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