“Cannabis is a substance that is defined as a “dangerous drug”. Medical Cannabis is not a medicine, it is not registered as a medicine, and its efficacy and safety when used for medical purposes has not yet been established. Nevertheless, there is evidence that cannabis could help patients suffering from certain medical conditions, and alleviate their suffering.”
Thus opens the homepage of the Medical Cannabis Unit of the Ministry of Health (MoH) with as much clarity of purpose as can be mustered for the apparently loaded subject.
Over twenty thousand patients currently have permits for the use of medical cannabis in Israel, and over many years the means of supplying the substance to those in need have slowly progressed to the point where Israeli researchers, growers and distributors have gained international recognition as innovators. The evolution of policies is ongoing, with an expansion of availability seemingly around the corner. Still, the following is a summary of the current state of affairs, and will be updated when the MoH administration plans are fully implemented.
Cannabis is Not in the Healthcare Basket
“The Ministry of Health wishes to remove obstacles to the supply of this drug to patients who could benefit from it medically and who wish to purchase it at their own expense.”
This means that the MoH regulates who is allowed to use medical cannabis and who is allowed to supply it, but they are not obliged to provide it through the public healthcare system or cover its cost. Instead, permitted patients subscribe to a specific licensed supplier and pay a monthly fee. Currently this fee is NIS 380 per month, to which additional charges may be added for delivery, equipment, or other accompanying expenses.
One issue that has been recognized by patients and officials is the fact that the monthly fee bears no relationship to the prescribed amount of the drug that the patient receives. This may be changed in future policies, and there is always the possibility that eventually the committee in charge of the health basket will add cannabis to the list of medications that the government primarily finances for patients.
Another innovation that is planned by the MoH is to have the drug available from regular pharmacies instead of specially designated distributors, though this plan has not yet been implemented.
How to Receive a License
The request for a permit is an electronic form available on the MoH website that is filled out on the computer and then printed to be faxed or mailed to the Medical Cannabis Unit by a doctor specializing in the medical field of which the patient is afflicted. One notable exception The Ministry of Health has given oncologists in most of the major hospitals in the country the direct authority to issue medical cannabis licenses.
Currently, requests are not accepted from family doctors and general practitioners, though ministry officials have stated their plan to offer a short training course to any doctor in order to qualify for prescribing the drug. Theoretically, they will even be allowed to issue licenses directly, though this will not be clear until the plan is implemented.
The Recommending Doctor’s Responsibilities
The patient-doctor relationship plays a central role in the MoH’s approach to issuing licenses. The recommending doctor is specifically associated with the license that is issued and if the patient changes doctors the license will have to be updated. If there is any change of status of the patient under treatment, it is the responsibility of the doctor to update the Medical Cannabis Unit’s administration. The doctor must perform medical follow-ups with the patient every three months for the first year of treatment and every six months afterwards.
Recognized Conditions and Indications
The following conditions are currently recognized explicitly by the Ministry of Health as entitled to consideration for a license:
- Oncology Patients
- Chronic Pain
- Crohn’s Disease
- Ulcerative Colitis
- Multiple Sclerosis
- Parkinson’s Disease
- Tourette’s Syndrome
- Terminally ill patients
- Post-Traumatic Stress Disorder (PTSD)
In most cases patients are expected to have exhausted other conventional treatment options before they can receive a license. There are also other explicit indications for treatment for each condition.
All specialist doctors may make a recommendation for a medical cannabis license and either petition the indications committee of the Ministry of Health to add a new indication to the list or request individual exceptions for conditions not currently in the list that the doctor feels warrants the use of cannabis for the patient.
Ministry of Health:
- Medical Cannabis Unit
- Request for Permission to Use Medicinal Cannabis
- Directive 106 – Procedures and indications for issuing licenses (Hebrew)
Tikun Olam, Israel’s most prominent growing, research, and distribution organization: