1. MEDICAL CANNABIS IN ISRAEL
Dr Bareket Schiff Keren

2. Some history
GLOBAL
AND
LOCAL

3. 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

4. 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

5. 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

6. 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

8. 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

10. 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

11.  LOH 2004 11

12. Science (STKE, 23 April, 2002) 12

13. 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

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

16. medicine ? is
Cannabis

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

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

19. Neuropathic Pain Pain from nerve dammage Nerve compression
Central pain

20. Pain clinic without cannabis

21. Unapproved indication
Glaucoma
HIV
Tinnitus
Asthma
Epilepsy
Fibromyalgia
Rheumatic disease

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

23. Contraindications
Mental condition
Drug abuse

24. 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

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

26. 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 -

27. 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

28. Thank you
شكرأ
תודה
danke