With over twenty-one countries that have some flavor of medical and/or adult-use cannabis legislation, it was interesting to hear Dr. Michael Dor speak about Israel’s medical cannabis program.
How it works In Israel: For the past five years, Dr. Dor has been the senior medical advisor at the Israeli Ministry of Health’s Medical Cannabis Unit. This means that every one of Israeli’s approximately 38K medical cannabis patients has been approved by Dr. Dor and his team of fifteen advisors. Patients must have a qualifying condition (cancer, chronic neuropathic pain, post-traumatic stress disorder, colitis, Parkinson’s, epilepsy, HIV/AIDS, Crohn’s disease, multiple sclerosis, Tourette’s syndrome, terminal illness, and fibromyalgia) and submit paperwork including an assessment from a family physician. This last point is very important to Dr. Dor because the family physician is more likely to provide a wholistic patient evaluation. For example, a person with lung disease might still qualify for smokable cannabis if his Crohn’s symptoms are intractable. A patient with schizophrenia, in his opinion, is not a good candidate for medical cannabis because “we don’t know enough.” He stressed that often, what might be considered contra-indications to cannabis use, can be overlooked, as long as patients and their physicians make informed decisions. Dr. Dor also noted that approval is readily granted to cancer and end-of-life patients but is considered a second- or third-line of treatment for most other conditions. In future, this will likely change. Once a patient is certified, that patient can only purchase cannabis medicine from one of eight approved cultivators. And, recently, Dr. Dor established rules whereby patients can continue to access cannabis medicine while hospitalized, as long as the treating physician approves, and the medicine is not smoked, is not used in the presence of others, and is safely locked.
Dr. Dor feels lucky to be in Israel, where the government doesn’t interfere much in decisions about research direction or potential cannabis indications and routes. He is very optimistic about recent Israeli studies and the potential of cannabis to treat numerous conditions. Even so, he often finds himself trying to manage opinions from multiple contingencies: physicians who want to forge ahead more quickly than the evidence might support, physicians who are steadfast against non-traditional medication, patients who are clamoring for a longer list of qualifying conditions; and the media and private business representatives who see medical cannabis solely as an entrée into a broader adult-use program. On this point, Dr. Dor remains steadfast. He is a physician and can make medical decisions; “social” decisions are best left to politicians who must weigh costs and benefits. He was sure to point out, however, that the social cost of adult-use cannabis would likely be less than the cost Israel currently pays for either nicotine or alcohol.
– Sarah Cohen
