About 15% of medical cannabis consumption in Israel is used to treat Post Traumatic Stress Disorder (PTSD). This amounts to nearly 20,000 people, with many more asking doctors to prescribe it to them.
The rising number of people suffering from PTSD due to the war is further increasing demand, and yet there is no consensus in the medical community on its effectiveness. There are even those who argue that cannabis is ineffective and damaging for treating PTSD
Two months ago, the coalition of doctors treating PTSD published a report warning about the damage cannabis can do for this indication. Following the report, it was decided to establish a committee to examine the issue, headed by Dr. Gilad Bodenheimer, head of mental health services at the Ministry of Health. Among the committee members is Prof. Eyal Fruchter, head of the coalition for the treatment of post-trauma and author of the severe report.
The committee is scheduled to hear from dozens of experts from the worlds of psychiatry and mental health, as well as public representatives and cannabis companies. In fact, the committee was supposed to present its conclusions by January 2025, but Globes has learned that it has not even begun its work.
Its members are expected to meet for the first time this month and submit conclusions within two to three months.
Hundreds of millions of shekels at stake
PTSD patients in Israel who want to continue receiving medical cannabis have reason to be concerned. Fruchter has said in the past that cannabis is not a cure for the disorder.
"It has not been proven to be a substance that is effective for PTSD," he said last September at a Yedioth Ahronoth conference. "Moreover, it has been proven to be a substance that can be harmful. We know that cannabis may help with certain symptoms of PTSD in the short term, but the price in the long term may be heavy. When you decide to prescribe a substance that has dangerous potential, you have to be careful about how you decide to prescribe it and to whom."
The head of the coalition previously told the media that "medical cannabis is a seal of approval for the drugging and poisoning of an entire generation of Israelis. Cannabis intoxicates and kills."
However, Fruchter's statement is far from the consensus in the field.
The Ministry of Health is currently signaling to the cannabis industry that it has no plans to remove PTSD from the list of conditions that can be treated by cannabis.
PTSD patients are "heavy" consumers of cannabis and are responsible for hundreds of millions of shekels in revenue per year from this market, in end-consumer terms.
However, there are still concerns about the Ministry of Health's approval. A negative opinion from the committee could deter doctors from registering cannabis for other conditions as well, thus harming a market that in Israel is worth around a billion shekels a year.
More than 40 companies operate in this market in the cultivation, processing, and distribution of marijuana. Among the companies listed are Intercure, Together, Seach, IMC, mBazelet, Cronos, and Trichome.
Patients are pressing, psychiatrists are trapped
The information available on the effectiveness of cannabis in treating PTSD is scarce and controversial. The report by the doctors' coalition cites several studies, including a review published in the Journal of Clinical Psychiatry that examined articles from over the last 30 years.
However, only 14 of the studies cited were properly conducted. While they all concluded that there was a minor improvement in intrusive thoughts and hyper-arousal, there was a risk of worsening suicidal thoughts and violent behavior.
The website Cannabis attacked the conclusions of Fruchter's report. The studies that found harm mostly involved subjects who also suffered from cannabis addiction, while some other studies revealed a clear benefit from the substance, reporter Shai Freedman claimed. The authors of the original article themselves concluded with the insight that further studies, preferably real clinical trials, are needed to understand the effect of cannabis on PTSD.
Psychiatrists Globes spoke with, including those who are open to the idea of using psychoactive substances in treatment, reinforced the conclusion and added that there are not enough large-scale studies to decide on the effectiveness.
"This does not mean that cannabis cannot be effective for certain patients who suffer from the disorder," a senior psychiatrist told Globes. "Every psychiatrist today meets patients who say that for them cannabis is a lifesaver. However, there is a difference between a description of patients and large-scale studies that will confirm this, and medical indications are supposed to be based on research data.
"There is also the issue of short-term versus long-term. It is clear that a large number of patients experience momentary relief from symptoms, but what are the long-term effects? In some cases, it can help with functioning, but in others, especially if problematic use develops, it can actually harm.
"The world lacks many large and significant studies on the effectiveness of cannabis treatment because it is also very difficult to conduct them. Every plant is different, every patient inhales a different amount into their lungs. We still do not have the right research language to conduct clinical trials with cannabis."
Another psychiatrist told Globes that he does not know of any other drug that can be given in imprecise doses and without understanding the composition of its ingredients like cannabis. "It is very difficult for doctors to recommend such a drug, and on the other hand, it is difficult to find a doctor who will say that cannabis is bad and dangerous because they do not know that either. Today, the feeling is that this is not exactly compassionate treatment, but rather treatment that is given when all other options are exhausted and we say — 'let's try.'"
Dr. Dedi Segal, owner of Panaxia, which produces medical grade cannabis, talks about pressure from patients.
"They vote with their feet. We see that this is a treatment, which is less about resolving the trauma and more about escaping from the trauma, but that is also very important."
Dr. Segal notes that around the world, people are trying to treat cannabis as a medicine.
"In France, they are currently conducting a trial using cannabis on 3,000 patients, although not for PTSD. They are not currently opening the market for this condition," he says.
Will Israel become a research powerhouse again?
Israel was once a powerhouse in cannabis research. From Prof. Raphael Mechoulam, who first isolated the active ingredient in the plant, to pioneering experiments in psychiatric and geriatric hospitals, to databases developed by leading companies in the field in Israel that aim to link certain cannabis strains to medical benefits.
Since consumers were not looking for clinical trials when the market was established, and regulations did not require them, trials eventually became uneconomical for cannabis companies. So, how will the Ministry of Health committee make a decision?
The Health Ministry could require the industry to conduct research as a condition for marketing cannabis for PTSD, but so far, the Ministry of Health has not indicated that this is the direction it wants to go.
Cannabis has been used in Israel to treat PTSD for several years, so the ministry can examine the surface-level accumulated data. However, since most patients thus far have received their license from the Ministry of Health, investigations can begin.
The government could also fully legalize marijuana. Each person would decide for themselves whether cannabis is beneficial or harmful to them, without the involvement of the medical system, but also without its help and guidance.