MEDICAL CANNABIS IN ISRAEL Dr Bareket Schiff Keren

Some history GLOBAL AND LOCAL

Gan-zi-gun-nu – the drug that takes away the mind Azallu – hand of ghost, poison of all limbs (neurological diseases?) Qunnabu – used in religious rites 3

For the relief of certain kinds of pain, I believe, there is no more useful medicine than Cannabis within our reach. J. Russell Reynolds, Archives of Medicine 2, 154 (1859) 4

1941 cannabis taken off the US pharmacopiea 1915 – Sir William Osler – CANABIS INDICA –the best remedy for migraine 1930 – Federal Bureau of Narcotics Political campaign – Harry Anslinger Associated with immoral behaviour and psychosis (fibers industry, cotton industry , paper industry ) 1937 Marihuanna Tax Act 1938 a medical review – Cannabis for Migraine 1941 cannabis taken off the US pharmacopiea

Controlled substance act of 1970 1970 – Dr Roger O Egeberg Assistant Secretary of Health: Marijuana classified as Schedule 1 substance Controlled substance act of 1970 DEA – Drug Enforcement Agency N0 accepted medical use Marinol (Drunabinol) and Nabilone = synthetic THC 1968- GLAUCOMA 1990 – MIGRAINE 2013 –Dr Sanjay Gupta CNN Chief Medical Correspondant 23 states – legal medical cannabis

Patients experience with Cannabis: Pain disappears – wears off Pain persists – but can be put aside Periodic pain – less frequent short attacks Sleep – uninterrupted & refreshing Appetite

9-tetrahydrocannabinol (9-THC) Gaoni and Mechoulam: J.Amer.Chem.Soc. 86, 1646 (1964) O H CH 3 9-tetrahydrocannabinol (9-THC) Mechoulam and Shvo: Tetrahedron 19,2073 (1963) 10

 LOH 2004 11

Science (STKE, 23 April, 2002) 12

THE HISTORY OF CANNABIS IN ISRAEL USE OF JASHISH WAS COMMON BRITISH MANDATORY LAW EARLY 90’S – COMPASSIONATE TREATMENT LICENSE FOR GROWING HOLDING AND CONSUMING COMPASSIONATE DISPENSARIES GROWING AND DISTRIBUTING PERMITS GOVERNMENTAL INVOLVEMENT Form no 106 Computerized system Supervision over Good Agricultural Practice Packing and Distribution Cannabis Products

MEDICAL CANNABIS UNIT INDICATION COMITTEE MINISTERY OF HEALTH SPECIALISTS IN EACH INDICATION INTEROFFICES COMITTEE POLICE MINISTERY OF AGRICULTURE MINISTERY OF INTERNAL SECURITY

medicine ? is Cannabis

The approved indications Cancer in active treatment Neuropatic pain Crohns & ulcerative colitis Parkinsons & tourets Multiple sclerosis Post trauma

Cancer and cannabis Nausea & vomiting Pain Cachexia Anxiety and depression Sleep

Neuropathic Pain Pain from nerve dammage Nerve compression Central pain

Pain clinic without cannabis

Unapproved indication Glaucoma HIV Tinnitus Asthma Epilepsy Fibromyalgia Rheumatic disease

Other indications Diabetes Anorexia nervosa Disseminated osteoporosis Menopausal syndrome Endometriosis Opioid dependance Sleep disturbance All autoimmune diseases

Contraindications Mental condition Drug abuse

LICENSE PROCEDURES AN OFFICIAL FORM FILLED ONLINE SENT BY FAX RECIEVED AND TRANSFORMED SENT FOR AN APROVAL BY SPECIAL DOCTORS A REPLY AFTER 45 WORKING DAYS

Follow up Change supplier Raise in the approved amoumt RE-EVALUTION RENEW APPLICATION Change supplier Raise in the approved amoumt Continueing the license

Regulators dillema The source of medical cannabis Quallity of the strains and which strains Suppliers and distributers The funding – the way patients pay The situation now: Monopoly No control on the delivered substance No education policy No standardised instructions to the patients Rigid regulations as for the amount and the preparation -

MY VISION RESEARCH - EDUCATION APPLICATION 1 CENTRAL DATA COLLECTION 2 BETTER OBSERVATIONS AND REPORTS IN THE PRIMARY CARE LEVEL EDUCATION 1 BASED ON THE KNOWLEDGE AVAILABLE 2 REEVALUATING AND KEEPING TO CONTEMPORARY NEW INFORMATION APPLICATION FLEXIBLE RESPONSE BY THE MEDICAL ESTABLISHMENT

Thank you شكرأ תודה danke