A Matter Of Substance

"The 1990s were the golden age of chemical substances. In every forest, you could find a group of individuals who had taken Ecs*asy pills and were tripping and dancing up a storm. People were even saying their ketubah [Jewish marriage contract] must include the promise that all wedding guests would receive Ecs*asy. Thousands demonstrated at Rabin Square [in Tel Aviv], voicing their support for the slogan 'Give trance a chance.'

"There was a widespread feeling that change was imminent. Yet, while Israelis love to party, they are not terribly fond of paying the piper. I lost millions, bankrupted myself, and that's how I found myself in California. Within a short time, I became the owner of three plantations for cultivating cannabis for medical purposes. Then, six months ago, I got a call from an American friend of mine, Rick Doblin."

This is how Yohai Golan-Gild describes his personal journey, from organizing parties where psychedelic drugs were freely offered, to supplying cannabis to seriously ill Israeli patients - with Health Ministry approval. In 1999, the ministry legalized the use of hemp, the plant from which hashish and marijuana are derived, for medical purposes including reduction of nausea, appetite stimulation, muscle relaxation, pain management, etc. In the wake of this step, the number of Israelis authorized to use the substance has climbed from only two in 2000 to more than 700 today, and it is expected to reach 1,200 in the next three months. Hemp cultivation is thus becoming a real industry, and entrepreneurs are showing increasing interest in tapping the economic potential of its product, medical cannabis. It is most likely just a matter of time until it has the same status as any prescription drug.

"Each month, I issue about 40 new authorizations to patients, with an average monthly prescription for 100 grams of cannabis," declares Prof. Yehuda Baruch, the Health Ministry official in charge of authorizing the use of medical cannabis. Although the ministry permits the legal use of cannabis in certain circumstances, however, it still has the status of a step-child.

Baruch is also director of the Abarbanel Mental Health Center in Bat Yam, and as such he is not able to work full-time issuing authorizations for patients to use medical cannabis - which means those in need of prescriptions sometimes have to wait a long time.

"Right now, Baruch constitutes somewhat of a bottleneck. What will happen in September, when the number of patients entitled to receive cannabis prescriptions reaches 1,200," asks Liat Beni of Tel Aviv, who suffers from a rare hereditary condition and is authorized to use cannabis for treatment. Beni recently established a public organization that promotes the use of medical cannabis and its status as a prescription drug.

"We are waging a war against an establishment that is still a prisoner of its own long-standing prejudices," she says. "Its members still believe that patients authorized to take cannabis get 'high' from the plant. But that is not true. In my case, cannabis allows me to reduce my other medications and, actually, to function. Please do not compare me with healthy individuals who smoke grass."

Beni adds that sometimes, when she lectures at medical conferences, the physicians and nurses on hand do not react seriously to her arguments and even ask her to pose for pictures holding a cannabis leaf.

It should be noted that Beni's criticism is not directed at Baruch. On the contrary: She and other "cannabis patients" have nothing but praise for the Health Ministry in general and for him, in particular, for "breaking the taboo" on using the substance for medical purposes.

Dr. Itay Gur-Arie, who heads the pain release unit of Sheba Medical Center at Tel Hashomer and is president of the Israel Pain Association, notes that Baruch's approach is correct, although there is a need to establish more detailed, proper procedures for the medical use of cannabis.

Grow-your-own drug

The problematic status of cannabis as a medication is related to its supply. The Health Ministry committee that originally legalized the substance in 1999 authorized its use to alleviate the suffering of patients with very serious diseases. However, the decision of the committee was complicated, among other things, by the fact that it didn't know to whom to give the authorization, and also because cannabis was not (legally) cultivated in the country back then. Thus, only 10 people were granted authorization to use medical cannabis prior to 2005. The ministry allowed them to grow it themselves, under two conditions: The patients were permitted a maximum of 10 seedlings and no more than 200 grams of the processed substance. (Just imagine your health maintenance organization asking you to create the prescription drugs your doctor has prescribed!)

It takes considerable time and effort to cultivate enough cannabis to satisfy ongoing consumption needs. Since the first patients who were authorized to use it were, for the most part, terminally ill, the ministry's stipulation appeared somewhat cynical, although it was not intended that way. It did not take long for an absurd situation to arise: Yossi Buzaglo, one of the first patients authorized to consume medical cannabis, was tried in 2001 on charges of purchasing marijuana from drug dealers. The Buzaglo case drove home the message that the Health Ministry must be in charge of supplying medical cannabis, or must at least assume indirect responsibility for its supply.

Then came "Angel Face" - the nickname of an individual who prefers to remain anonymous. Angel Face approached the ministry, proposing that he would supply patients with cannabis. Somewhere in northern Israel, it turns out, he and his family have been cultivating cannabis with the state's blessing for the past four years. As a result, the number of patients using cannabis has risen astronomically. Angel Face's hothouses contain dozens of pots bearing the names of patients who were treated with the cannabis grown there, but who have since died.

Patients gather almost daily in a small Tel Aviv apartment to receive joints or other forms of the substance they need from Angel Face and the volunteers of the organization he founded, Tikkun Olam (literally, "mending the world"), who supply it for free thanks to donations. This distribution process - in a makeshift "clinic" and with Health Ministry authorization - constitutes what is undoubtedly one of the most surreal and touching experiences an ill person can have, and in an atmosphere that is drastically different from that in any hospital oncology ward.

Angel Face and his volunteers provide sufferers of Parkinson's disease, confined to wheelchairs, with a way of inhaling the smoke directly into their lungs, while people afflicted with Crohn's disease or cancer gather in groups to smoke in the courtyard. People aged 70 and older suddenly get out of their wheelchairs and start moving around. Thanks to this treatment, a young girl with Tourette syndrome, who left school because her classmates would mock her, has stopped cursing; she has returned to school and even has a boyfriend today. And visitors to the Tel Aviv apartment wear a pleasant smile on their lips - perhaps because the concentration of the cannabis they receive is much higher than that of the hemp sold on the black market.

The process of authorizing the use of medical cannabis has spurred major changes. For instance, initially, only Angel Face was permitted to transport cannabis and prepare joints. However, the huge demand forced the Health Ministry's Baruch to allow additional volunteers to do these things as well.

The ministry does not pay Angel Face for growing and supplying cannabis, nor do the patients. But everyone is aware that this situation cannot continue for very long, because of the cost of growing increasing amounts of it for rising numbers of consumers.

"People will have to pay for the cannabis," Gur-Arie points out. "But the question of who will pay - the state, the HMOs or the patients themselves - is another matter entirely."

For his part, Baruch agrees and has already begun outlining a business model.

Government subsidies?

The medical use of cannabis is a story that features a cast of helpless patients, an aura of hedonism and the possibility of big profits. About a year ago, still in California, Golan-Gild received a call from Rick Doblin, Ph.D., founder and president of the Multidisciplinary Association for Psychedelic Studies (MAPS), which promotes the use of psychedelic substances for medical and research purposes. When he heard about the revolution occurring in Israel, Doblin contacted Golan-Gild. The ministry subsequently authorized the two to supply medical cannabis in the country.

Last week, Baruch and other Health Ministry representatives visited the hothouses Golan-Gild has now built in southern Israel, at an investment of NIS 1 million. (Their precise location is being withheld for security reasons.)

Meanwhile, officials at the Health Ministry believe it would be irresponsible to rely on only one supplier, especially when the product is agricultural (and thus exposed to diseases, pests, etc.). Therefore, the ministry is planning to increase the number of licensed cannabis growers to five or six by September, which in Baruch's opinion, will meet the expected demand. Furthermore, although the substance is still provided free of charge, in the near future, patients will be asked to pay for it.

Baruch believes that, "the Israeli market has the potential for tens of thousands of medical cannabis users, with each user paying NIS 5-10 for one gram. This means NIS 5,000-10,000 per patient annually."

However, Golan-Gild argues that the cost of growing cannabis is NIS 15 per gram, exceeding what Baruch believes patients can be charged. If Golan-Gild's calculation is correct, the Health Ministry or the HMOs will have to subsidize the difference, as is the case with medications included in the health basket.

For now, inclusion of cannabis in the health basket appears a distant prospect, especially given the fact that the HMOs are developing their own supplementary services, which constitute a lucrative source of revenue and include homeopathic and other unconventional treatments.

In the meantime, Golan-Gild says he's planning to open what he calls three "Compassion Centers" - in Jerusalem, Ra'anana and Tel Aviv - where patients will be able to smoke cannabis under the guidance of counselors, and to take part in yoga and Pilates lessons, etc.

"There are 160 different varieties of cannabis, each with a different side effect," he explains enthusiastically. "I can find the right variety for each patient: One variety can make you feel sleepy, another can turn you into a powerhouse in the morning, while yet another can give a man a diagonal erection."

Millions of light-years from the entrepreneurial and other schemes people have with regard to medical cannabis, in a small, modest apartment, the Tikkun Olam group continues to distribute it, insisting that disease-sufferers should not have to pay for the relief it brings out of their own pockets.


News Hawk- Ganjarden 420 MAGAZINE ® - Medical Marijuana Publication & Social Networking
Source: Haaretz
Author: Haim Shadmi
Contact: Haaretz
Copyright: 2009 Haaretz
Website: A Matter Of Substance
 
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