Green gold: Israel sets a new standard for legal medical marijuana research, production and sales
Just over six years ago, in the lush Upper Galilee of northern Israel, the nation’s first large-scale harvest of legal medical marijuana was flowering on the roof deck of Tzahi Cohen’s parents’ house, perched on a cliff overlooking the bright-green farming village of Birya. Until then, fewer than 100 Israeli patients suffering from a short list of ailments had been allowed to grow the plants for themselves, but this marked the first harvest by a licensed grower.
The Cohen home soon became a temple in the area for believers in the healing powers of cannabis — a legendary family operation that, in this early golden era, served as a grow house, a pharmacy and a treatment center all in one. In “
Strain samples at Tikun Olam’s distribution center in northern Tel Aviv.
“We think that medical cannabis should be distributed to the patients as any other medical drug — at pharmacies,” Ministry of Health spokeswoman Einav Shimron Grinboim wrote in an e-mail.
The ministry first announced that a new, cutting-edge distribution program would be unveiled in spring 2012, but — due partly to a turnover in the Israeli Knesset, and the challenges of setting up such an unprecedented structure — the ministry now predicts it will go into effect by the end of 2014.
The head of Israel’s newly created Medical Cannabis Unit, political unknown Yuval Landschaft, has a no-press policy of his own, and the Ministry of Health will not reveal the details of his new plan. But insiders told the Jewish Journal that Landschaft and a team of brand-new hires, whose sole duty is to oversee and redesign Israel’s medical cannabis program, are racing to build a streamlined pharmaceutical system that could set a new global standard in the field.
“Yuval’s dream is that everything be sent to a central warehouse, where it’ll be packaged for distribution,” said Mimi Peleg, director of patient training at Abarbanel’s cannabis center.
Under the plan, government-affiliated pharmaceutical supplier Sarel Ltd. would be in charge of testing each batch of cannabis to verify its quality and consistency, and would then stock pharmacies across Israel with measured doses of marijuana — as it does with any other medication.
Similar programs have previously been tested in both Canada and Holland. However, Canadian officials recently announced that they will hand the industry back to private suppliers in 2014, eliminating the federal government’s previous role of approving and educating cannabis patients. And in Holland, the number of patients has dropped to less than 1,000, with critics alleging that the quality of legal coffee-shop weed consistently tops the medical stuff.
State and city programs across the United States have spiraled even further out of control: A patchwork of conflicting laws at the local and federal levels have prevented a cohesive program from taking shape in any of the 20 states (plus Washington, D.C.) where medical marijuana is legal.
If Israeli officials can overcome this cannabis curse — requiring them to fit a radically complex, villainized and under-studied plant into a rigid pharmaceutical system — the small Jewish nation could become the first to pull off a federal program that the medical community can get behind.
WEST COAST ROOTS
Right around the time the Cohens founded Tikun Olam, former Los Angeles resident Yohai Golan fled the Wild West medical cannabis scene in California to start growing small and humble again at his mother’s house in Israel.
Golan and the Cohen family each received founding grants in 2008 — $15,000 and $50,000, respectively — from David Bronner of the Dr. Bronner’s Magic Soaps fortune, who told the Jewish Journal he was inspired to donate the money because “the government in Israel looked like they were going to set an example of a more reasonable approach.” Bronner also funded a visit to Israel from leading cannabis experts at the Wo/Men’s Alliance for Medical Marijuana in Santa Cruz, who coached the growers through their startup phase.
Sitting at an outdoor cafe in Tel Aviv in early September, dressed in a stone-studded Peter Pan hat worthy of Burning Man, Golan told turbulent stories of growing medical cannabis in Venice Beach and San Francisco in the late 1990s and early 2000s, running with the crews of big celebrity pot advocates like Jane’s Addiction front-man Perry Farrell and actor Woody Harrelson. Although Golan claimed he was legally licensed to grow in California, he said his grow houses were subjected to constant raids by local police, Drug Enforcement Agency (DEA) agents and even motorcycle gangs.
“California is where it began, but it became a mess,” he said. So Golan returned home to Israel, where he poured everything he had learned growing marijuana in California into a farm he later named Better.
“My friend is the owner of Bodhi Seeds out of Santa Cruz, and he went and took master strains that I liked and cross-bred them especially for me to use in Israel,” Golan said. “He created a Purple Kush strain — a cross of Purple Kush, Bubba Kush and Sour Diesel — that was made especially for the desert.” It has since become Better’s most popular strain.
Unlike the Cohens, who chose their spot in the Upper Galilee for its pure mountain air and mystical history, Golan eventually decided to base his farm a few hours south, in the Valley of Elah. “We have no humidity and desert winds that drop into the mercaz,” he said. The Better farm now grows another buzzed-about strain called “cheesepie,” which contains 13 percent CBD and less than 1 percent THC, along with seven other standardized strains and many more in the development stage.
Various cannabis growers in Israel confirmed that a few months ago, they received a letter outlining some of Landschaft’s proposed changes — including grouping the strains into four medicinal categories based on their levels of CBD and THC.
Nativ Segev, CEO of Better, said that as long as strain experimentation isn’t limited, he believes the strongest cannabis growers will still be able to thrive within the ministry’s egalitarian vision. “The best thing to do is specialize in growing — to grow the best you can, and then sell it to the government,” he said. “If you grow good things, if you grow the best [strains], you will be OK.”
Other farms are hesitant to move toward a more socialist system, which would involve sharing their gardening secrets with the feds, said Dr. Yehuda Baruch, Abarbanel’s director and former head of the cannabis program (before a changing of the guards in January).
“I tell the growers, ‘This is not the THC Olympics,’ ” said Boaz Wachtel, one of Israel’s original cannabis advocates and founder of the country’s fringe Green Leaf Party. “They’re very competitive.”
Up to now, a healthy competition between farms, as in many Israeli industries, has livened up the market and encouraged top product quality. However, a more centrally regulated system under construction at Israel’s Medical Cannabis Unit would eliminate some farms’ current branding advantages, and would allow patients and doctors to choose from all the farms’ strains, instead of just one. (Currently, patients report that it’s almost impossible to switch from one farm to another.) “If every grower has a number of great strains to offer, it won’t be a problem,” Wachtel said.
“The most important thing is that we stabilize phenotypes so that we can depend on what we’re getting from one season to the next,” said Abarbanel’s Peleg, who does strain testing for three of the farms. “The way to get there is to start sharing genetics — to have this national grow where we have a nursery for everybody, and start making better and more healthy clones that we’re giving away to the growers.”
However, she added, “this sharing attitude is not popular here.”
Doctors and other cannabis experts who spoke to the Jewish Journal agreed that one of the keys to writing cannabis into modern medical history, and to completing the clinical trials needed to more fully legitimize its use, will be to create standard strains or oils that can be replicated and expected to have consistent results, patient-to-patient.
Peleg said she hopes ego wars among growers won’t block Israel’s road to a more compassionate system. “We have the opportunity to really do something better” than anywhere else in the world, she said. “And I hope we take advantage of it.”
The outer wall of the Tikun Olam laboratory is inscribed with a passage from the Bible, in which God instructs Moses to anoint the altar with a special incense. Many believe this incense included cannabis.
MEDICINE OR SNAKE OIL?
In the United States, the exasperated Drug Policy Alliance, a leading organization in the fight to turn around backward cannabis policy, has long argued that American scientists and physicians interested in studying and prescribing cannabis are stuck in a sort of catch-22.
Amanda Reiman, policy manager for the alliance’s California branch, wrote in a March 2013 op-ed in the Los Angeles Times: “Marijuana’s Schedule I classification, which places it alongside heroin, defines it as being too dangerous for most research. Consequently, almost no research on marijuana’s medical benefits gets funded, so there’s practically no way to find the evidence that would result in marijuana’s reclassification.”
Due to this lack of hard evidence, doctors in Los Angeles — from the so-called Dr. Feelgoods along the Venice Beach Boardwalk to pricey boutique physicians in Beverly Hills — are not even technically allowed to prescribe cannabis. Instead, they issue patients a recommendation slip, no questions asked.
“A doctor can recommend cannabis, but they can’t tell [patients] where to get it, and they can’t have a conversation with them about using it,” Reiman said in an interview, adding that in Israel, on the other hand, “when your federal government participates in the program, doctors don’t have to worry that if someone finds out, they’re going to get a bad reputation.”
Peleg, who worked for many years in Santa Cruz for the respected dispensing collective Wo/Men’s Alliance for Medical Marijuana before moving to Israel, added that in California, “Doctors aren’t supposed to talk about strains and methodologies, and sellers aren’t supposed to talk about diseases and implementation.” This leaves patients in the dark about the nuances of the cannabis plant in relation to their symptoms, and they find the right strain and dosage through trial and error.
“It’s irresponsible for us to consider this a medicine and treat it like snake oil,” Peleg said. “Just because it works on everything doesn’t mean it’s snake oil. We need the studies for the right reasons — because people deserve to know what to expect. We need to know really basic questions, like do strains matter or not, or do cannabinoids matter? Let’s prove it.”
Although there is a world of research to conduct before the ingredients of marijuana are 100 percent understood within a medical framework, much of what doctors do know has come out of the Holy Land. “In many ways, Israel is providing the research we need to move forward,” Reiman said.
Researchers in the United States complain that due to the National Institute on Drug Abuse’s stronghold on the scientific cannabis supply, it’s near impossible to conduct the studies and clinical trials that doctors need to more confidently prescribe marijuana to their patients.
Conversely, in Israel, a tiny country of 8 million with intimate connections but big dreams, a circle of talent in the field — including cannabis growers, scientists and physicians — are all within one phone call to a friend-of-a-friend.
Professor Raphael Mechoulam, known internationally as the grandfather of cannabis research for being the first to isolate THC in the 1960s, remains today a top professor and researcher at Hebrew University. In the middle of an interview with the Jewish Journal, the kindly and soft-spoken 82-year-old took a panicked phone call from a local physician who wanted to know whether his cancer patient could benefit from cannabis. “I get that several times a day,” he said.
“Until well-designed clinical trials have been done and have been published, physicians don’t know what to do,” he added.
Mechoulam famously got his hands on his first batch of Lebanese hashish in the early ’60s, through a friend who had connections at the National Headquarters of the Israel Police. “Later we found that both the head of the investigative branch of the police and I had broken quite a few laws,” Mechoulam wrote in the British Journal of Addiction. “The Ministry of Health was in charge of illicit drug licensing and not the police, and I had broken the severe drug laws. Luckily, being ‘reliable,’ I just had to apologize.” He would later go on to receive the Israel Prize in exact sciences, the nation’s highest honor, for his work with cannabis.
In the decades since Mechoulam’s groundbreaking discovery, he and dozens of other Israeli scientists, in collaboration with their peers around the world, have built a foundation of knowledge on which a sane medical cannabis program can be built — all with the crucial blessing of the federal government.
Professor Ruth Gallily at Hebrew University has proven herself the queen of CBD research, confirming it highly effective in treating many types of inflammation, including that which leads to severe spine and back pain and even some heart disease.
“I can really tell you that CBD is a fantastic anti-inflammatory,” she said. “I have seen the benefit of it to so many people.”
Dr. Ephraim Lansky, an Israeli physician who specializes in studying herbs, published a now-famous case study based on a cancer patient who came to him with a golf-ball-sized tumor in his head. Lansky treated the young man with about one gram of high-CBD cannabis per day, ingested orally.
“Prescribed Grass” filmmaker Zach Klein, left, visited the Hadarim nursing home in southern Israel with CNN’s Dr. Sanjay Gupta, center, to show him the benefits of cannabis for some patients there. Also pictured is nurse Inbal Sikorin, who helps administer the cannabis to patients. Photo courtesy of Zach Klein
Eight months later, according to Lansky, the tumor had shrunk by 75 percent, and his patient’s seizures had faded completely.
“Cannabis is just another herb, and it belongs within the wider context of herbal medicine,” Lansky told the Jewish Journal. “Of all the other herbs I use, it’s the most useful. I’d even have to put it ahead of garlic.” He hopes to spend the next few years publishing case studies on his cannabis patients, which could become the building blocks for full-scale clinical trials.
Mechoulam is likewise interested in the greater context of cannabis as a sort of cure-all: He continues to explore and lecture about his discoveries within the human body’s own natural endocannabinoid system, a network of receptors that line up with the dozens of active ingredients in marijuana. The system could hold the secret to why marijuana is able to ease such a wide variety of symptoms and illnesses.
Their work is not going unnoticed.
Dr. Alan Shackelford, a Colorado physician who treated an epileptic 5-year-old with high-CBD cannabis as the crux of Gupta’s CNN documentary, has announced that he is immigrating to Israel to take advantage of the more expansive research opportunities.
“We have an obligation as a medical community to study cannabis so that we can understand how it works, and more effectively decide what cannabinoids are most effective for what, and at what dose,” Shackelford told the Jewish Journal in a phone interview. He added he is “humbled by the opportunity to take what I know and expand on it in collaboration with these committed people in Israel who have done so much more.”
Shackelford hopes to study cannabis’ effectiveness in treating seizure disorders, among other conditions. “Israel’s the perfect place to do it, because of the openness to inquiry, and because of the relative lack of pejorative government opinion — because federal legislation is not restrictive,” he said.
Shackelford is also determined to help set up a system in Israel wherein physicians are involved in learning about the particulars of cannabis as a medicine.
The real remaining obstacle to putting scientific theories about cannabis into medical practice, and setting up a sound pharmaceutical system, is a lack of funding for clinical trials on humans, said Shackelford — a problem echoed by many other experts in the field. Researchers must first test various combinations of THC and CBD (and other cannabinoids) on patients, under strict controls, before the medication can be properly prescribed.
“Clinical research is not an easy thing to do,” Mechoulam said. “And because cannabis came from the wrong direction, from the direction of an illicit drug, it’s difficult to get it into the clinical trials.”
The Israeli government has approved some of the only clinical trials involving cannabis in the world, including an exciting look at the response of PTSD patients to cannabis high in THC. However, these trials have only just touched the tip of the iceberg. And while some pharmaceutical companies have taken cautious interest in refabricating the elements of marijuana and running their own trials, they still seem generally unsure of how to brand and patent such a complex product of Mother Nature.
Thanks to this absence of conclusive research, it’s not easy for patients to snag a coveted pot license from the Ministry of Health.
A single storage locker at Abarbanel Mental Health Center holds the majority of the nation’s cannabis supply, after the marijuana has been tested at the lab and before it is packaged for distribution.
Although the number of license holders in Israel has been growing in recent months — according to the ministry, the total now sits at about 12,700, up from about 11,000 at the start of the year — estimates by pro-cannabis politicians and even the Ministry of Health itself put the number of potential cannabis patients still left out in the cold at between 40,000 and 100,000.
Doctors in California can recommend medical marijuana for any condition as they see fit, while Israel’s Ministry of Health instructs doctors only to prescribe marijuana as a last resort and keeps a strict list of medical conditions that qualify for treatment, such as Crohn’s disease, multiple sclerosis and cancer. Some patients wait months, even years, before they see their requests approved.
Israeli activists have not stood idly by: An angry mob staged a hunger strike outside Health Minister Yael German’s house in May, responding to a further tightening of the list. (German has since expanded the list to include Parkinson’s disease and Tourette syndrome.)
An Israeli psychiatrist who wished to remain anonymous said he has seen a mere four or five new cannabis licenses issued to his PTSD patients in the past few years, out of hundreds who have applied. This, despite the fact that he has seen “spectacular results in patients with post-trauma.”
A recent pilot for a clinical trial out of Abarbanel showed similarly promising results. However, “In order to convince the specialists to agree that cannabis is good for post-trauma, you need to [isolate] certain cognitive functions that you can test very precisely,” the psychiatrist said. Rick Doblin, founder and director of the Multidisciplinary Association for Psychedelic Studies (MAPS) in California, also attested that the study was “very haphazard and irregular, with no information on things like how much marijuana they used — but still it showed that it seemed to be helpful for quite a few people.”
Tragically, as researchers fumble in uncharted territory, many of the unusually high number of Israelis with PTSD are unable to find relief in the top-of-the-line bud their country has to offer.
THE HAVES AND HAVE-NOTS
“We have to consider, what are we doing when we don’t give people this medication? That’s the real question,” Dr. Itai Gur-Arie, then-chairman of the Israel Pain Association, said in the documentary “Prescribed Grass.” “It’s not that the patients won’t get any medication at all. They’ll get other medication — opiates. In other words, we won’t give them marijuana, we’ll give them heroin.”
Wachtel, one of Israel’s first cannabis advocates, had to rush out of an interview to consult a family whose teenage daughter, stuck at home for the last nine months with fibromyalgia and chronic fatigue syndrome, couldn’t get cannabis through her doctor — “so the family decided to go to the black market, to see if it helps,” Wachtel said.
On the positive side, patients in Israel lucky enough to meet the government’s cannabis criteria — and, in many cases, persistent enough in pressuring their doctors — are overwhelmingly impressed with the results.
A 32-year-old cannabis patient in the western Galilee who wished to remain anonymous said he experienced violent spasms in his legs after being paralyzed in a swimming-pool accident a couple of years back. After trying marijuana on his own, he found that it instantly relieved the spasms.
So the quadriplegic told his doctor he needed cannabis for back pain, because pain is one of the approved conditions on the Ministry of Health’s list — and was prescribed 20 grams a month, the ministry’s conservative starting dose. Although the patient said he believes he needs a few more grams per month, he has been highly impressed with the strains he receives through IMC Agriculture, another licensed grower in Israel. (He said he chose IMC over Tikun Olam because the latter “became too commercial.”)
“When I go to swim, if I’m not using the cannabis, my body starts having spastic seizures — my body becomes completely stiff,” the patient said. But with a few puffs of cannabis beforehand, his paralyzed limbs are able to relax in the water.
With the help of cannabis, the 32-year-old has eliminated all but one of seven pharmaceuticals from his daily regimen.
Paulette Azar, 55, a recovering breast-cancer survivor who lives on a kibbutz in the Golan Heights, said she fights for about three months each year to renew her annual cannabis license to treat her lingering cancer pain and PTSD symptoms.
“It was very painful, the cancer — very painful,” she remembered, clutching her forearms tightly. “The doctors tried to give me other medications, but I didn’t let them. I had to be rude with them. I shouted, so I got [the cannabis]. And since then, I have no more pain when I smoke it, and I am very happy. I put music in my house, and I can live my normal life.”
Since the humble beginnings of the Ministry of Health’s cannabis program, the standard dose has plummeted from 200 grams to 20 grams per month. “At the beginning of the month, there are so many people who need their medicine, so we have to wait in line for, like, two hours,” Azar said.
Still, Azar said she is shocked and grateful that such a security-obsessed government allows her up to 70 grams of Tikun Olam product monthly.
Another Tikun Olam patient, Mor Hagdi of the Ramat Gan suburbs, was diagnosed with leukemia when he was just 22. He said he tried cannabis as a last resort, when his cocktail of pain pills wasn’t able to ease his suffering and was turning him into a zombie. “The pain is chemo pain,” he said. “I swear to God, I wouldn’t want even my enemy to get this pain. Now when I am talking about this, I cannot sit, I must walk — it’s something I wouldn’t wish on anybody in the world. But when I smoke the cannabis, I just feel the pain going down. It’s relaxing — and now there is no more pain.” The marijuana has also helped stoke his dwindling appetite.
Three years ago, Zach Klein, the filmmaker behind “Prescribed Grass,” initiated a very do-it-yourself clinical trial at the Hadarim nursing home just south of Tel Aviv — the same one where CNN’s Gupta watched a Holocaust survivor smoke away his dark past.
Yossi Segev, left, and Mimi Peleg were two original employees of Israel’s central cannabis distribution center, located at Abarbanel. Here, Peleg weighs cannabis during the center’s early days. Photo courtesy of Mimi Peleg
“One of the families [of a patient] saw the documentary and asked the head nurse for medical cannabis,” Klein remembered. “She said, ‘No, that’s ridiculous.’ But they insisted. So she called me and told me, ‘You made this movie, so now come here and help me out.’ ”
Klein, who worked as head of research and development for Tikun Olam at the time, came to the home and tried blowing cannabis in the face of a 75-year-old woman with dementia.
“I saw an immediate change,” he said. “She stopped shouting; she created eye contact with me. The nurse almost collapsed, because for months, this was the tiger in the place. And after a few minutes, we actually had some kind of communication — I was calling her name, and she was responding. After a few minutes, she was even laughing.”
One of the most outspoken medical pot advocates in the Israeli Knesset has also been the most unlikely: Knesset member Moshe Feiglin, the same religious conservative who ignited the Israeli right this year when he posted to Facebook that he didn’t see anything wrong with shaking women’s hands. Feiglin is furious that it has taken Israel so long to build a system wherein marijuana is prescribed to everyone who needs it.
“Israel has reached a very, very high level of research and development of new kinds of cannabis,” Feiglin said in a phone interview. “It can help the whole world, and it can help the Israeli economy tremendously. I find it hard to believe that people are trying to restrict it. You cannot stop something that is so clear — so good for the patients and so good for the economy.”
Currently, only Holland allows its medical cannabis farms there to export marijuana to other countries, and the quality of Dutch medical strains is hugely lacking, according to Israeli activist and expert Wachtel. Israeli cannabis farms are anxious to share their strains with the world. At least two farms have been preparing for the coming revolution: Tikun Olam and Better have grown a loyal following around the world via social media, racking up about 1,300 and 24,000 followers on Instagram, respectively. Better’s fans drool over close-ups of the harvest, leaving comments such as “Dank!” “Gorgeous!” “Teach me your ways” and “You’re an inspiration to growers everywhere.”
Beverly Hills PR maven Cheryl Shuman, who calls herself “the Martha Stewart of marijuana,” made a highly publicized trip to Tikun Olam territory in early September, bringing back with her high praise for the Holy Land.
“What I’ve seen in Israel is the ﬁrst time a business model is working on all cylinders — with the government, growers, counselors and patients all engaged on such a high level,” Shuman told the Jerusalem Post Magazine for a cover story on her visit. “This is the perfect role model to take to other countries. … That’s why I’m here. I’ve got tons of money behind me, and investors who believe in what I’m doing. They’re counting on me to bring them the right people to take this industry to the next level, and I’ve found them in Israel.”
At a lab located on the Tikun Olam farm, various forms of marijuana — including, from left, capsules, cigarettes, whole buds and liquid tincture — are tested.
Tikun Olam spokeswoman Weisberg said the farm is more than willing to meet that tall order. “This is a product that we can send to the whole world,” she said.
One of Colorado’s most active medical pot advocates, Bill Althouse, said he has communicated with growers in Israel about the possibility of sharing cannabis strains by shipping their genetic material internationally. Yet, the Ministry of Public Security, which runs Israel’s police department, has been a roadblock to the farms’ expansion, arguing in government meetings that medical cannabis is “leaking” into the hands of non-patients. Police keep a close eye on the farms — mandating video security systems worthy of Israel’s nuclear research center in Dimona — and poke around every once in a while to make their presence known.
Tikun Olam has received numerous warnings to stop selling “special” baked goods such as chocolate praline and tahini cookies containing cannabis butter, on the basis that their effectiveness has not been properly researched. Police sent an undercover agent to Tikun Olam’s cramped storefront in northern Tel Aviv three years ago to prove that the supplier was over-selling to patients.
“I don’t think they themselves know why they’re here,” said Weisberg on our tour of the Tikun Olam farm, ducking into the portable office building when she realized cops had arrived to survey the premises.
But despite ongoing complaints from growers and patients that Israel’s medical cannabis program is too tightly regulated, many experts see the strict and tedious beginnings of the Israeli program as essential to its eventual success.
“The con in Israel is there are a large number of patients who can’t get recommendations because they don’t meet this limited list of conditions that have been chosen to start the process,” said MAPS’ Doblin. “But the advantage is that Israel is building public support in a pretty steady way, with no backlash. When you have these broader, anything-goes [policies], there often is the potential and actuality of a backlash.”
Peleg, who is working as MAPS’ liaison in Israel, agreed that the Israeli government’s heavy hand has been a blessing in disguise.
“In a democracy, you’ve got to take into consideration that it’s all about compromise. And in terms of slow and steady growth, we are having a responsible growth rate,” she said. “I was shocked when I recently did a tour of cannabis clubs in California and Colorado to learn that in those states, you don’t have to be taught how to use cannabis, ever. There’s a real disconnect going on there that I think we’ve got solved here.”