Israel’s medical cannabis: A premature obituary

Those of us who have had the privilege to help Israeli men women and children with cannabis have to admit that we have lost our struggle. A new day had been forced upon us all. We will see all of our patients have their successful and often life saving treatment abruptly interrupted this Sunday.

The State is preparing its reply to the Patients’ Association’ Appeal for an Order of Restraint to halt the confiscation of all medical cannabis. The State will undoubtedly request more time to reply, that will waste a good week at least, then the Appellants will need time to reply and BOOM! Elections on September 17. So why would the Court agree to mix in here, when the next scheduled hearing is (it just so happens) a mere five days after the elections, on September 22. As a result I will not go into the many details of a battle that is lost.

So all medical cannabis has been pronounced confiscated. Oh – according to what legal apparatus? Why, the Dangerous Drugs legislation – cannabis is  Schedule 1 over here, remember? Perhaps for just this purpose, it turns out? Now you cannot come up with a logical explanation of how Medical Cannabis that was grown under state license and sponsorship for medical use can be confiscated as a Schedule One substance which by definition has no medical use – relax, logic is for leftists. This government rules according to the rule of rule, no silly logic interferes here. 

What will the new day look like? There is no reason to think that Magister Landschaft has not already told us. In this reform we will have the IMCA control everything. Only physicians who are restricted to the Green Book will provide prescriptions for material that will be prohibitively costly and not always available in pharmacies. There is a claim that only a fool would believe that patients will be free to purchase from producers or from the pharmacies as they wish. And just how does this square with the confiscation? Business for the pharmacies will be good. It is not clear whether any normal business will be able to survive growing and producing. One suspects Landschaft may favor a move to drive out of business whatever he has been unable to control. And who will grow now?

Here is a hint from the deal struck between Feiglin, who has just sold out legalization, and the Prime Minister. New businesses will be free from taxation for two years. In the land of sneaky deals (modern Hebrew: kombinot) one suspects Landschaft will be encouraging and controlling such new enterprises, and considering Israel’s enormous tax burden investors will see such startups as a good if temporary investment. Placing people’s health in the market place is just what the (non)doctor ordered.

So the winners are clear -business will be good, tidy, completely controlled, perhaps just perhaps a bit of profits for some of those involved. Why, is that illegal in Israel? Business is business and the courts and “laws” of leftists only inhibit free enterprise. That’s what is left (bad choice of words) of “Legalization” Feiglin.

How badly have we lost?

Let me project how the new day will affect parents of autistic children

  • None of my current 600 patients -almost none- will be able to continue treatment that has proven helpful or even life saving. None will be able to receive 30% concentration oils- none! This is not on the Green Book (Heaven only knows why not). 
  • What will they receive? Some oil they have never tried and with which I have no experience. According to the Green Book, oils will be provided by THC and CBD content only, not by strain. This means that every month a child could receive randomly any oil that the pharmacy has in stock (  i.e. finds profitable to sell). Now according to the Feiglin-Netanyahu accord, which just now Vice Minister Litzman has praised and says he will bring to the new Knesset for approval, (what approval?) patients will be able to choose from any strain they wish, imported or home grown. Anyone familiar with Landschaft’s Green Book knows that this is simply never going to happen. No one has announced that the Green Book is annulled.. Short of announcing that the Green Book is history, there is no reason to assume from an accord written on ice that this will happen. After the elections, oops, we meant that all the strains are equivalent, so the way we see things, it is free since they are all the same.
  • New patients will go to the Ministry doctors where they can get prescriptions for 12 months. Which doctor, well any doctor. A surgeon can prescribe medical cannabis for an autistic child, since he just looks up in the Green Book what to prescribe. Then the parent goes to the pharmacy where the pharmacist may be able to overrule the prescription and give a different combination. Why in Heaven’s name would he do this? Well, on the shelf.. A sale in the hand is worth two on the shelf.
  • The parents might wonder how to use cannabis oil. He could consult with some excellent cannabis nurses or some parent groups. He could even consult with me. But if he calls me, here’s what I will have to say as best medical advice:
    • “Start with one drop and increase every few days until…oh, by the time you get a result it is time to refill your prescription, and you have no idea if you can be sure to continue the same oil. Well, with the new prescription just start over.. Look, the Green Book says all the oils are equivalent, try to stuff your kid into the Green Book. If he doesn’t fit, he has that GBOS (Green Book Outlier Syndrome) Probably needs hospitalization. Oh, I forgot to mention, the number of free psychiatric hospital beds for children in Israel, when I checked last Tuesday, was zero.
    • Every month? Aren’t I better off just ..? What?

So here is a new ethical dilemma. As a physician I am sworn not to withhold from a sick patient any agent that could offer substantial relief of suffering. But using medical cannabis according to the Reform may be more harmful and certainly has little chance of achieving significant consistent relief.

I have been saying for years that considering the way Israel runs its medical cannabis unit, the only alternative is legalization. Feiglin used to say it even more forcefully, but now that is history. Today this has become all the more relevant. The health of 4000 children cannot be left in the hands of an IMCA that wantonly tramples every basic element of medical practice. Same for the health of tens of thousands of adults.  Is the only alternative what some folks have been suggesting? “Grow, grow, grow your weed, gently treat yourself…” If 50,00 patients operate on the free market creating a quasi legal situation common in many countries, they could drive IMCA into the irrelevance it has now fully earned. Just saying. 

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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