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One day in the second half of April, after the tumult of elections, and probably after the Passover holidays, the "defining day" will be announced for the entry into force of the new cannabis reform. The potential of the Israeli market is not less than 600 million NIS, with some 46,000 patients using cannabis-based products, but despite the efforts of the Ministry of Health to explain exactly what the reform is, its impact on the quality of the treatment and the patients. & # 39; pockets, and how this will change the market, the number of producers and the way cannabis is consumed, the public is always confused. "Globes" spoke with people on the ground to put the confusion in order.
"The patient-farmer connection – the root of all evil"
This is Yuval Landschaft, head of the medical cannabis unit at the Ministry of Health and reform architect, who determined the appearance of the "next day". Landschaft, who seldom gives interviews, has agreed to talk about the reform at "Globes" in order to dispel what he sees as public ignorance.
Landschaft is a pharmacist by profession. He took up the position of Cannabis Unit Manager in 2013 and since then he has been the victim of many storms and his life has even been threatened. He was notably charged with conflict of interest because of his business dealings with pharmacies. "I feel like a marathon runner running for years with a small group and now we are entering the stadium," Landschaft said. "A few minutes of racing before the finish, and only now, they encourage us and scream at us and there is a big noise, and those who are very excited may throw us cans of drink by mistake."
Landschaft, however, seems to appreciate the drama and he therefore does not hesitate to say that the reform was essential to "break the link between the patient and the farmer, who is at the root of the harm of imprecision ".
It means that, until now, patients have received prescriptions stipulating the number of grams of cannabis that they are allowed to consume and have been allocated to a producer who is responsible for providing the product at the best of his knowledge. The grower mainly supplies a variety of cannabis, "but a dose of cannabis should not be measured in grams of the plant," says Landschaft, "but in grams of the active substance."
What products will it be possible to sell under the new reform?
"There are 40 active substances in cannabis, and we are developing a scale called a power estimate that will define the concentrations of as many of these substances as possible for the consumer." We initially focused on two of them. , THC and CBD, THC and CBD levels in the material according to twelve grades, in order to characterize the product. "
At the beginning of the reform, the patients and producers were unhappy that the concentrations of THC and CBD defined for the products did not correspond to those of the most popular plants of the producers. So, for example, if a patient was assigned to Tikoun Olam and used a pure strain of Avidekel, now, in order to get the concentrations allowed by the new reform, it would be necessary to mix Avidekel with another plant .
Landschaft asserts that the strain method does not contradict the ingredient quality method. "The study is the antidote to ignorance and all the complaints about the strains result from a lack of study. Under the new regulations, no patient will be able to get his blood pressure. We have built a conversion table, and if a patient says "Now I take Avidekel", the doctor will prescribe one of the twelve categories in which he falls the most. Landschaft will allow products to be labeled with the strain as well as the ingredients.
The rank method is a relatively new development of the reform; In the past, it was intended to indicate only the composition, not all the ranges. With this approach, some strains would disappear from the market. According to Dana Bar-On, CEO of the Medical Cannabis Association, the claim that all strains are included in the composition categories is not entirely true and the passage of varieties to compositions is not scientifically based. "For example, I'm using a strain containing 21% THC, but I absolutely must not use CBD because it totally paralyzes me.After years of being a guinea pig, the strain that suits me has has been identified, but this strain does not belong to any grade of reform.Also, each grade of reform allows for a range of ingredients, for example between 0% and 4% of CBD.I can not The focus on two ingredients and even 40 ingredients in the future, is not scientific because each strain contains thousands of different ingredients. "
The cannabis market in numbers
According to Yaron Berger, CEO of the online pharmacy epharma.co.il, who created the cannabis business under the name of Green Pharma, "When patients have failed to get the strain they were used to, they have continued using other strains from other In other words, this whole notion of strain does not stand up.For growers, it is important that a patient request a certain variety of cannabis, because he wants to keep his customers. "Berger thinks customers will quickly get used to asking for the product according to the proportions of THC and CBD, and not by constraint.
Subsequently, further developments will follow: the scale of the EP for the measurement and labeling of 40 active ingredients contained in cannabis, in the hope that doctors prescribe more precisely the composition adapted to the patient. The scale is an Israeli invention, like the reform as a whole. Israel is a start-up country in medical cannabis and it is very important for Landschaft that Israel retains its pioneering status, even if it means that in each area it has to develop both the know-how and mechanisms of regulation.
Nadav Gil, who leads the cannabis practice at Deloitte in Israel, agrees. "The whole world is looking at our regulatory framework," he said.
What will an order be like in the reform?
"We are not a buffer," says Landschaft. "Around the world, many doctors prescribe grass for a living.They are known as kush doctors (" kush "is the slang of a high quality cannabis – GW), and most doctors do not want to prescribe something that a bird has excreted and put directly into the lungs of a patient without an immune system.
"500 doctors have been trained to prescribe cannabis without the approval of the medical cannabis unit.The prescription specifies the active ingredient composition that the patient should receive.If a doctor who does not have has not followed training wishes to prescribe cannabis, he or she can do it, but such an order must receive the approval of the medical cannabis unit. "
How many doctors considered leaders in the cannabis field have not attended the medical cannabis unit course?
"Of the 100 or 500 doctors promised, only 30 were ready in December." The medical cannabis unit monitors prescriptions through its central computer.It's a Big Brother system that allows bureaucrats to make a decision contrary to the decision of the doctor.This is not democracy, "said Bar-On.
According to Dr. Ronnie Benshafrut, Senior Partner of Intellectual Property Law Firm Reinhold Cohn and Cannabis Expert, "As part of the reform, doctors and pharmacists do not enjoy a great deal of experience. freedom of action The Ministry of Health defines the composition But today, with regard to cannabis, because of genuine gaps in scientific knowledge, it is actually the patient who knows best what The listening of the patient is the missing part of the regulation in force. "
On what basis is the doctor able to write a prescription?
Landschaft: "We have published the" Green Book "containing all the existing scientific knowledge.It is known, for example, which composition is anti-inflammatory and that it should not be administered to a person suffering from an illness. We do not want to err on the side of caution, so we built a bridge, which could not be built on solid medical evidence length, but strong enough to handle 46,000 people, a regulator is not a bureaucrat ".
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Up to NIS 800 per month instead of NIS 370
After receiving a prescription, the patient is expected to go to the pharmacy and present the composition recommended to the pharmacist, and choose between several brands. There are currently about five brands on the market, but not all pharmacies stock all brands. Basically, what is on the shelf will determine what the patient will receive. "In my case, the competition for a place on the shelf is a competition on quality," Landschaft said.
Patients fear that the price will rise to several thousand shekels per month.
"According to the old regulation, each patient bought 370 NIS per month, whatever the amount prescribed by the doctor.After the reform, pharmacies could set the price of their choice and compete with each other. showed that for 82% of the patients, the doctors will prescribe up to 40 grams.For these people, the product will not cost more.For 15% additional, it will become a little more expensive.For 3%, the product will become more expensive, and we hope the government basket or health funds will fund it for them. "
Benshafrut warns that there could be a temporary shortage of equipment, but that even at the end of the year, the supply could be in surplus in the market. According to Adv. Hagit Weinstock of Weinstock Zehavi & Co., by the end of the year, about fifteen cannabis farms will be created and, in the longer term, 40 to 50 farms. "I think there will be prescriptions for 100,000 patients in Israel, double the number today, however, each of them will consume a smaller amount – they will not take more than 50 grams. and will not share it with the neighborhood anymore. "
An application has been filed in the High Court of Justice against reform by Adv. Miriam Brainin and Adv. Yasmin Mizrahi, who represents the Medical Association of Cannabis, contains harsh claims from patients about the scientific underpinnings of the Green Paper's approach, the high prices and the expected shortage of the plant, as well as the lack of information. approach of the strains. "Unfortunately, the interested parties are not concerned with the facts, nor do they relate to unusual extreme cases," Landschaft said.
Posted by Globes, Economic News in Israel – www.globes.co.il – April 7, 2019
© Copyright Globes Publisher Itonut (1983) Ltd. 2019
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