The Israeli cabinet has voted to legalise the use of cannabis for medicinal purposes. Commenting on the development, Professor Wayne Hall from the University of Queensland, explained that the preparation of cannabis licensed by the government would be an important factor influencing whether Israeli patients opt to accept the treatment:
“If the Israeli government is allowing doctors to prescribe medical cannabis preparations, such as Sativex which is licensed in Canada, then I don’t see any radical change in policy. It would be very interesting to learn how many patients take up the product, if this is the case.
“If they propose to allow the medical use of the smoked cannabis plant and also provide patients with the plant then my prediction (based on previous experience in Canada and the Netherlands where similar schemes were introduced) is that the Israeli government will find much less patient demand for medical cannabis than they may expect. They may also find doctors reluctant to prescribe a smoked drug and so find it very expensive to provide cannabis for the small number of patients who request it.”
The active ingredient in cannabis, THC, is “moderately effective” in treating nausea and vomiting, appetite loss, and acute and chronic pain, according to Professor Hall. However, moderating the doses of THC can be problematic and Professor Hall advocates developing medicines which utilise THC without necessitating the smoking of cannabis, “The best prospects for the medical use of cannabinoids lie in finding ways to deliver THC that do not involve smoking and in developing synthetic cannabinoids that produce therapeutic effects with a minimum of psychoactive effects.”
A Member of the World Health Organisation’s Expert Advisory Panel on Drug Dependence and Alcohol Problems, Professor Hall points out that major acute adverse effect of smoking cannabis is “impaired psychomotor performance”. This would account for the Israeli Police Force’s assertion that cannabis using patients should have their driving licences revoked. In addition, the necessary long-term use of cannabis to control certain symptoms would carry risks to the respiratory system and would also risk addiction of the patient to the drug.
Synthetic versions of the drug would be costly to develop, according to Professor Hall, and any uses for naturally occurring elements of THC would not be patentable. In the absence of sufficient controlled clinical trials, doctors face issues, not only of legality, but also of knowing what doses to prescribe to patients and what likely side effects these patients may face.
In assessing the impact of Israel’s decision to allow the medicinal use of cannabis, Professor Hall stated: “How things turns out will depend very much on what type of system of supply they have in mind”.