Marijuana has had a roller-coaster ride over the years. It remains illegal in many countries for recreational use, while some have decriminalized it, but others in the Far East and Arab countries have much more severe penalties, and violators are imprisoned for years.
It was later stigmatized with the influx of Mexican immigrants and became increasingly prohibited in the US in 1970, with its possession and sale becoming federal crimes. In recent decades, many US states liberalized their laws, with Oregon becoming the first state to legalize recreational use, followed by 27 more.
Marijuana use was prohibited in Israel for many years, but then, due to popular demand, claims that it provides medical benefits for numerous conditions, from cancer pain to multiple sclerosis, and pressure from growers, the Health Ministry adopted a more liberal stance.
Today, over 140,000 Israelis are reportedly licensed users of medical cannabis in Israel – and they can purchase it at nearly every pharmacy. Anyone walking on a city street can attest that there is an untold number of people who use marijuana recreationally as well. Pharmacy prices for a 10-gram package range from NIS 100 to 350 in Israel.
The use of medical cannabis is rising speedily around the world, but many healthcare providers and medical professionals still feel unprepared to counsel patients or recommend treatment when appropriate, and the subject is barely taught in medical schools here and around the world, so most physicians are at a loss to know for what and how to prescribe it, except perhaps for those who were specially trained and approved by the ministry but are pressed by the queues of patients.
Now, research has been published whose lead author was Dr. Yuval Zolotov, a senior research associate in the Regional Alcohol and Drug Abuse Research (RADAR) Center at Ben- Gurion University of the Negev (BGU) in Beersheba, and center director and senior adviser Prof. (Emeritus) Richard Isralowitz. Dr. Ofer Edelstein from the BGU’s social work department did much work collecting the data on medical cannabis use. The study also included leading experts from top American universities.
The article in the Journal of the American Medical Association (JAMA) Network Open under the title “Developing Medical Cannabis Competencies: A Consensus Statement” was written to provide the essential knowledge and skills doctors need to integrate medical cannabis into clinical practice responsibly. It sets forth the essential knowledge and skills physicians need to integrate medical cannabis into clinical practice responsibly.
The fact that the RADAR Center – which has only a few employees and at a time when Israel has become a pariah state in many countries, even related to medical research – has managed to reach international prominence on the subject through JAMA is a major achievement.
At the forefront of research and education on medical cannabis, its experts spoke last year on the subject at the US National Institute on Drug Abuse (NIDA) International Forum in Montreal. In 2018, the center launched a multi-national study on medical cannabis attitudes, beliefs, and competencies among healthcare professionals that was meant to develop a consensus-based set of core competencies for educating medical students about cannabis, including its use on patients, risks, legality, and medical evidence.
Isralowitz, an American-born social worker who has devoted the last 25 years to the subject of medical cannabis, told The Jerusalem Post that medical school curricula here are already bursting at the seams, and many subjects, including geriatrics, as well as medical cannabis – are given little or no attention. In a national survey of US medical school curriculum deans, 66.7% reported that their graduates were not at all prepared to prescribe it. The expert panel had varied opinions regarding the time to be allocated to the subject, which ranged from one to 40 hours, with most suggesting eight to 10 hours.
“Every patient is different,” he said. In one person, it could relieve chronic pain, certain rare and severe forms of epilepsy, multiple sclerosis-related spasticity, chemotherapy-induced nausea and vomiting, post-traumatic stress disorder (PTSD), insomnia, and inflammation.
But for others, he continued, the benefits could be modest or even harmful. “If taken by Parkinson’s patients, for example, medical marijuana can cause lack of balance, resulting in falls and broken bones, which can have even more serious long-term effects.”
The medical risks of cannabis use
Proven medical risks of medical cannabis include addiction, psychosis, a rapid heart rate, respiratory problems from smoking, and cognitive impairments affecting memory and coordination. Cannabis use is not risk-free, Isralowitz stressed, and it’s vital to be aware of potential side effects and risks that also depend on the form it’s taken and dosage.
The expert panel led by the RADAR Center included 14 physicians across multiple specialties, along with nurses, a pharmacist, and individuals with leadership roles in academic medicine. They concluded that there is “good-quality clinical evidence for the therapeutic benefit of cannabis for medical conditions, such as pain, muscle spasticity, and chemotherapy-induced nausea and vomiting.”
Factors that can prevent eligible patients from gaining access include limited access to a registered health care practitioner, high costs with no insurance coverage, stigma, misinformation about cannabis, and institutional regulations that may prohibit medical professionals from certifying patients for medical cannabis.
Isralowitz said that after October 7, many people suffering from PTSD ran to pharmacies and hospitals to try to get the drug.
“Supervision could be lax; regulations are only as good as their enforcement. I’m not saying ‘yes’ or ‘no’ about it – it’s certainly not a magic bullet.”
Consumption can cause road accidents, and toddlers have become sick from eating cannabis cookies and “rubber candies” left around by their parents.
The two lead authors concluded that “future research should explore how tailored patient education and clinician training can address these differences and improve guidance for medical cannabis use.”
Accompanying the JAMA article was a commentary by Dr. Darshan Mehta, who is medical director and director of medical education for the Benson-Henry Institute for Mind-Body Medicine at Massachusetts General Hospital. He wrote that “this work represents a tremendous breakthrough…High-impact empirical evidence confirms both benefits and risks of cannabis that demand scientific literacy. A large meta-analysis of 32 randomized clinical trials that included 5,174 patients found modest yet significant improvements in pain and quality-of-life domains with oral medical cannabis.”
Mehta concluded that “we now must act. Medical cannabis is here. Will physicians catch up, or will we, through omission, continue to let patients navigate therapeutic uncertainty alone?”