The way to provide cannabis for medical purposes, while protecting the public’s safety and preventing the drug from leaking out to non-medical usage, is through legalizing the sector. That is the position taken by Israel’s government, and that is our purpose in the reform program initiated by the Minister of Health, Rabbi Yakov Litzman.
The current Israeli process of medical cannabis legalization is the world’s first of its kind. It is a complex process involving creation of a system governing the production chain of cultivation and manufacture for cannabis products, as well as creation of proper methodology and medical procedures. The quantity of applications to the Medical Cannabis Unit is growing steadily and significantly, and we examine each application on its merits.
As of the start of 2019, there are 36,868 patients in Israel with active licenses for medical cannabis, and some 10,000 additional cancer patients who are treated with cannabis but do not yet appear in the central data system. The number of patients treated with medical cannabis, more than 46 thousand, is the world’s highest number as a fraction of the population. There is no similar ratio in any other country.
The reason for such a high number of patients per unit of population in Israel lies in medicalization. The Israeli government decided that we must make the cannabis plant available for medical purposes like any other pharmaceutical treatment. We are leading a responsible, patient-centered legalization, with understanding of the benefits as weighed against the possible damage.
Thus in Israel the medical establishment is leading the process of legalizing cannabis, and as in any proper and orderly medical process the physicians are the most important factor, not the popular movements or the activists promoting blanket permission for use of the drug. The medical/research infrastructure that we are creating includes, among other things, cooperation in research studies and creation of the “Green Book” (IMC-GCP) for training physicians in medical cannabis therapy.
In addition, the process covers all the necessary levels for issuance of cannabis, such as cultivation under conditions of proper quality; valid high-quality production (as already practiced for medications), definition of a production chain for cannabis products at “medical grade” level so that the products will be issued to the patients at pharmacies and the transfer, issuance, and pharmaceutical administration of the cannabis products will be as customary for narcotics, subject to adjustment as required by instructions from the Medical Cannabis Unit. The Israeli medicalization process has reached an advanced stage, and to date Israel is also leading the entire world in this aspect.
In the manufacture of medications, food, or anything else that touches on the health of the public, proper quality principles must be upheld and licensing is necessary. Just as we believe that no medication should be used without the proper scientific infrastructure for safety and effectiveness, it is the same for cannabis.
The Ministry of Health would not approve prescribing a medication for treating a certain disease without proof that the medication is safe and is helpful in treating that disease, and similarly cannabis is approved only as indicated on the basis of reasonably convincing accumulated information regarding the helpfulness and safety of its use. Our guiding principle is that the preparation the patient receives must be the product of proper work processes as customary in the medical field and that the product’s nature and contents must be known. That principle cannot and must not be relaxed.
Make no mistake: This is a complicated, unusual, innovative, unprecedented process of initiative and pioneering in the establishment of an extensive system under proper quality standards for a chain of cultivation and manufacture of any kind, and of course specifically for a methodology, proper medical procedures, and medical training governing the prescription of cannabis like any other medical preparation in accordance with indications.
Gradually, some of the trained physicians have now been absorbed, and others are in the process of absorption, into joint efforts, into committees, and into the approval process for medical cases. In addition, a pilot has begun for testing the computer systems, the interfaces between them, and the continuity within the model.
At the same time, all our efforts on the other levels, which complete the process, are advancing at an accelerated pace, and that includes plantations and production facilities for cannabis products at the proper quality as well as completing the deployments that provide control and security, prevent leakage, and ensure proper medical procedures.
The reform is expected to take effect within a few months, and cannabis products at “medical grade” quality will be available as products with known and controlled concentrations, enabling the attending physician (with appropriate training) to prescribe cannabis — and the patient to buy it at the pharmacy.