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Nov 29th
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The Medical Message

news1marijuana-trayFormer Santa Cruz resident helps lead Israel’s state-run medical marijuana program

It is Mimi Peleg’s job to teach people how to use pot—she imparts knowledge like how long to inhale smoke or vapor, how to administer sublingual drops, or how to ration out a pot cookie.

This is all part of her role directing large-scale cannabis training for the Israeli government’s state-run, discreet, successful and expanding medical cannabis distribution center, known as “MECHKAR.”

MECHKAR began as a tiny program serving just more than two dozen people in 2008. Today, supplied by eight farms located all over the country, the program distributes cannabis to more than 12,000 patients.

Peleg says that more than 20 doctors can now legally prescribe cannabis in Israel, some of whom are limited to the prescription of cannabis oil. Medical cannabis patients pay a flat, monthly fee of $100, regardless of the amount of cannabis they consume. Initially the program provided 100 grams a month to patients, and slowly the amount decreased. Today the average dose per month is about an ounce per patient.

Peleg, an American-born Jew, lived in Santa Cruz from 2004 until 2009, at first working on computers at the UC Santa Cruz campus to make a living. She wrote the book “Everything Is Under Control: Conspiracies, Cults, and Cover-Ups” with the “late, great” Santa Cruz local Robert Anton Wilson in 1995 (the City of Santa Cruz established July 23, 2003 as Robert Anton Wilson Day). When Wilson was dying he turned to the Wo/Men’s Alliance for Medical Marijuana (WAMM), a Santa Cruz nonprofit that provides cannabis to patients to help mitigate pain and other issues at the end of life. Peleg began working as an administrator for WAMM at that time, and says she learned from WAMM about the compassionate, pain-relieving properties of cannabis.

While working at WAMM she attended a party with her wife, who worked as a translator for the Santa Cruz organization Multidisciplinary Association for Psychedelic Science (MAPS). There, she met MAPS founder Rick Doblin, who is also Jewish. Together they dreamt of a time when medical cannabis would reach Israel.

So, when her wife’s American visa expired four years ago, the pair—both Israeli citizens—moved to Israel. At Doblin’s suggestion, Peleg started work at MECHKAR, which was a fledgling program in its first year. (Concurrent with cannabis training, Peleg is also the clinical research associate for MAPS’ ongoing, Israel-based study of MDMA-assisted psychotherapy for post-traumatic stress disorder—PTSD.)

news1cannabis-infused-tinctureFormer Santa Cruzan Mimi Peleg helps seriously ill patients learn about a range of cannabis products, such as the drops pictured above, that are available to them through Israel's state-run medical marijuana program.While Israel has long had a hash-smoking under culture, there is “not a pot culture, so to speak,” Peleg says.

Unlike California’s medical marijuana program, in which doctors recommend the herb for more mild conditions like headaches, anxiety, chronic pain and difficulty sleeping, cannabis in Israel is reserved as a last option drug for people with serious illnesses, often near the end of life. Before cannabis is an option for them, patients must exhaust all available pharmaceutical options and complete a long-winded bureaucratic process.

While Israel has a historically strict drug policy, it does not share the United States’ lengthy and tumultuous history with the cannabis plant. Peleg says there was never a “stoner” stereotype in Israel like the one in the states, and Israelis lack any stigma surrounding the use of the herb. So, she says, there was “never any question” that cannabis would be viewed as “strictly medical” when it was introduced to Israeli patients. However, many patients also lack any knowledge or experience with how to properly use cannabis, and that’s where Peleg comes in.

“For them [getting high] is an adverse effect,” she says, noting that most students arrive at her offices terrified they will hallucinate or lose their minds. “So I tell them what to do if they get too high, how to lower their senses a little bit, how to relax, things to expect, and how long they should expect it to stay in their body—which I tell them is between 45 minutes and two hours—before they’ll have to smoke or vape again.”

Peleg credits her friend and “favorite politician” Boaz Wachtel with bringing medical cannabis to Israel. Wachtel co-founded Israel’s Ale Yarok political party, which is best known for its work to decriminalize cannabis. For decades he has worked to reform the drug policies of his home country, meeting both successes and failures.

Wachtel says Peleg’s role is important not only to educate patients but also to alleviate fears.

“These patients have never smoked cannabis before, medically or recreationally, and they think they will see flying elephants in the room if they do that,” he says. “Mimi will give them a few strains to check on which strain fits them better. That’s why ... patient education must be a part of any successful cannabis program.”

On any given day, between 10 and 30 people with prescriptions for cannabis will come through the doors of the MECHKAR facility, where Peleg teaches the visitors about the plant’s properties and medicinal uses.

Peleg says the development of MECHKAR was no easy task. For the first few months the Ministry of Health (MOH) assigned the program to a room “the size of a postage stamp” with no air conditioning, in the bottom floor of a large building, below a drug rehab center. Today, the MECHKAR facility operates out of a couple of more substantial rooms inside of Israel’s largest psychiatric hospital, Abarbanel.

In addition to training and supplying cannabis to patients, MECHKAR is a mecca for unprecedented cannabis research, the likes of which remains banned in the United States.  

Wachtel says Israel—which has the highest ratio of university degrees to the population in the world and produces more scientific papers per capita than any other nation—has become a world leader in cannabis research as a result of the United States’ continued blockade of cannabis research. This, he says, is “wonderful” for Israel, but not for society at large.  

“By denying people access to medical cannabis, the U.S. has criminalized patients,” he says.

Doctors from all over the world, including the United States, arrive in Israel to research cannabis’ medical properties. Current studies are looking at cannabis’ uses in the treatment of basal-cell carcinoma, PTSD, fibromyalgia and Crohn’s disease.

Funding for cannabis research in Israel comes from the MOH as well as private donors. Peleg says the program is actively seeking research  funders.

Similar to her work with the MAPS study on the effects of MDMA on PTSD, Peleg helped write the abstract for a recent study conducted in Israel to assess the use of cannabis to treat chronic combat PTSD in 30 Israeli combat veterans, which turned out “promising” results. The study is currently under peer review at Journal of Psychoactive Drugs.

Peleg says the research results for all of the cannabis studies conducted in Israel have been “overwhelmingly positive.” She notes that a recent study conducted on fibromyalgia inspired many patients in an old age home to apply and become licensed cannabis users.

While she and other employees continue to live on a shoestring budget and minimum wage salary, Peleg says Israel’s cannabis program has grown markedly over its first four years.

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