Israel waters the grass

Mixed news, what else is new?

The High Court (finally) made a decision on the request for a stay on the Reform of Medical Cannabis. The stay comes long months after the Reform was proposed, and a full six weeks after the Health Ministry put its Reform into high gear while its lawyers played for time.

For newcomers, up until half a year ago the Israel Medical Cannabis Authority (IMCA) granted licenses to patients whose specialists made a formal request. The license was dedicated to only one of the eight Growers, and the patient and the Grower would work out what the patient needed. The license specified only a monthly amount (for many patients this amounted to arbitrary underdosing). The monthly fee was 370 NIS regardless of the amount supplied.

This was an imperfect system. Suppliers would sometimes sell what they needed to sell rather than than what a patient needed. Some bureaucrat who never examined a patient determined if the license was justified and set the dose. Inexperienced patients (for example the parents of autistic children, 600 of whom are in my care) had to scramble for and sometimes pay extra for guidance, usually not medical. Communications were managed by unweidly faxes. Imperfect but perfectable.

For years IMCA CEO, one Magister Yuval Landschaft, has been trying to implement a “reform” that completely dismantles this medical program. True, he discovered emails in 2018 to replce faxes, and true, having medical cannabis available from pharmacies as well makes shopping easier. The rest is bad, bad news. The core of the bad news is Landschaft’s insistence that cannabis is not a plant, but a factory, and an imperfect one, for producing different levels of two molecules, THC (the reason people smoke pot) and CBD, which has many medicinal properties. Why would anyone say something so stupid and false? There are hundreds of other molecules in cannabis and each strain is different and affects people differently despite the smae CBD and THC levels. This is called the “entourage effect” as anyone with any familiarity with plants knows. Why reduce a complex -and imperfectly known – natural product to something that smells like a parmaceutical. The answer might be in the question. Rafa has already marketed a THC:CBD drug and more is likely to come. So the pharmacies serve not merely as one more venue, but as a defining marker. Medical Cannabis is a pharmaceutical. By decree of the Magister. Anyone can guess what motivates this and where it may be going – but what is good for patients is not a consideration.

By dillydallying, the Court essentially allowed Landschaft to effect his reform before it could be stopped. When the High Court hearing finally took place on September 22, many of Israel’s 50,000 Medical Cannabis patients had already been impacted concretely by a lack of continuity of supply, and just about all 50,000 were driven to distraction by the way Landschaft managed his coup. One might think that the High Court would rule that the Reform was poorly conducted and should be abandoned for that reason (easy idea –  if it had anything good to it, why on earth did it have to be handled by totalitarian methods?). Instead, the Court made a drama of slapping IMCA’s wrist and taking upon itself, as it were, to insure that the implementation of the Reform would hurt no one. Without the obvuous question: If IMCA needs the High Court to protect IMCA’s patients from its CEO and his Reform, just maybe there is something the matter with the Reform and this CEO?

After another two weeks of dillydallying the Court came out with its decision just this afternoon. The decision continues the spirit of the hearing. Now IMCA has to report to Daddy every month to explain (but no penalty for lying) how it is not hurting its patients. And the prvious system will stay in place for veteran patients. Until March 30, then the Reform will go ahead.

The response of pateints is, as would be expected , mixed. The fact that the Patients’ Organization and its two fearless lawyers were granted a “YES” by Israel’s Highest Court – in a dispute with a Minstry – well, that is in and of itself amazing. The Courts hardly ever finds against the State. But come March 30, cannabis will become a pharamceutical by caveat, and all patients will be negatively impacted. They will all have precriptions of amounts of T and C (example, T1C20 means 1% THC and 20% CBD) but pahramcies can fill the precription with any product or strain or mix of strains they please. So goodbye continuity of care; the Magister decides what is continuity and what is not. In March. For children in June. But not later.

Now at the hearing Magister Landschaft told what as best I can tell is a lie. He told the Court that there are really no “strains” at all, all are equivalent based on T&C. What silly patients call “strains” are not “strains” at all because their genetics are not worked out. And the Court did not allow a physician present at the hearing (me, as it happens) 2 minutes to counter this lie.

Two thoughts arise from this situation. First, as a layman I had the idea that perjury let alone to the High Court was a pretty serious felony. Second, patients now have until March to get organized to grow what the State has decided at the highest level that it will no  longer provide. Third, well maybe by March a new goverment, maybe legalization to put the Reform out of everyone’s misery. But perjury is still perjury.

About the Author
Alan Flashman was born in Foxborough, MA, and gained his BA from Columbia, MD from NYU, Pediatrics, Adult and Child Psychiatry specialties at Albert Einstein College of Medicine, The Bronx, NY. He has practiced in Beer Sheba since 1983, and taught mental health at Hebrew University, Tel Aviv University and Ben Gurion University. He is currently CEO of Family Instiute of Neve Yerushalyim, sponsoring a first fully accredited post-masters training in family therapy for the Haredi community. Alan has edited readers on Therapeutic Communication with Children (2002) and Adolescents (2005) in Hebrew, translated Buber's I and Thou anew into Hebrew, and authored Losing It, an autobiography, and From Protection to Passover.
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