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.

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.