The debate over medical marijuana use in Israel has gained momentum in recent weeks, as evidenced by the vociferous attacks on Health Minister Yael German's Facebook page and the protests outside her home last week, as well as the Knesset Health Committee discussion on the subject on Monday.

That meeting ended with an announcement that 11 more doctors would be authorized to prescribe medical marijuana by the end of the year, bringing the total number of doctors authorized to prescribe the drug to 19 by year's end.

After the health ministry began regulating medical marijuana, only the ministry's medical cannabis unit was permitted to approve patient requests for the drug. In addition, eight oncologists from Sheba, Assaf Harofeh, Rambam and Rebecca Sieff hospitals were accredited to prescribe medical marijuana to cancer patients in an effort to shorten the waiting period for Health Ministry approval.

The ministry also said it intends to certify doctors outside of central Israel to directly prescribe marijuana treatment, including both oncologists and other specialist doctors.

The Health Ministry had previously refused a request by cancer and pain specialists to allow more doctors to prescribe medical marijuana for their patients, Haaretz reported recently. However, the ministry backtracked on this, apparently due to growing public pressure.

Even a passing glimpse at Health Minister Yael German's Facebook page illustrates how the ministry and the woman heading have been under attack. Each status posted by the minister, regardless of the subject, has been followed by a string of blistering comments on medical marijuana.

German has been singled out as the "bad guy" in this story, with opponents saying she's a dense bureaucrat at best, and a captive of drug companies trying to block the medicinal use of marijuana at worst. Patients have even staged a hunger strike outside her home.

The ministry, meanwhile, says the protesters are organized and coordinated, and that their cause is far from an authentic struggle on behalf of patients alone.

Here are a few facts to shed light on the issue: The number of people permitted to use medical cannabis in Israel jumped from 1,800 in 2009 to 11,000 this year, while the amount of marijuana used has nearly quadrupled from 100 kilograms a month to 370 kilograms. Distribution used to be free, and now a NIS 40 million-a-year industry has blossomed: Each permit holder pays NIS 370 a month for green goods, not including delivery.

According to protesters, the availability of new permits for patients using cannabis for medical purposes has been reduced due to new criteria and restrictions. Moreover, they say, patients who were previously entitled to use the drug are now being denied it. These are the reasons behind the current round of protests, they argue.

Patients also insist they should not be compelled to try stronger drugs, including narcotics containing opiates considered to be addictive, before being prescribed cannabis. Some doctors agree. Prof. Moshe Kotler, president of the Israel Society of Addiction Medicine, told the Knesset Research and Information Center that opiates are more addictive than medical cannabis and that the use of narcotics mustn't be a precondition for prescribing cannabis.

The Health Ministry, on the other hand, claims the issue of pain opens the door to a slippery slope. As nearly 70 percent of medical marijuana permits are given to chronic pain sufferers, some patients are demanding their doctors prescribe medical marijuana even for ailments like every-day back pain.

"The prevailing opinion is not using cannabis as a first-line treatment," says a top-level ministry official. "There is uncertainty about side effects and no one is sure there are fewer side effects [with marijuana] than with stronger drugs because not enough studies on the side effects are available."

There is no proof that drug companies are involved in the issue, and the Health Ministry vehemently denies such charges. Some in the ministry have said that cannabis growers and advocates for the legalization of cannabis are, in fact, behind the blitz against German.

"The outcry over the issue might be connected in one way or another to cannabis growers worrying that their licenses [up for renewal in August] won't be approved," German said from the Knesset podium, hinting that pressure on the ministry aims to bring about the legalization of marijuana.

The growers reject these charges outright. "Such statements have no basis," according to a response issued by the growers. "Rather than providing a solution to hundreds of patients who won't be able to continue receiving the only medicine proven effective for them, the Health Ministry is engaging in spin."

Meanwhile, lawmakers Dov Khenin (Hadash), Tamar Zandberg (Meretz) and Moshe Feiglin (Likud) are working to ease the criteria for receiving medical marijuana. Their approach appears to be: Forget the rules and restrictions – let each doctor decide whether to prescribe cannabis to a patient just as with other drugs.

The Health Ministry objects to that approach: First, the ministry is committed to international guidelines obligating a certain level of oversight of medical marijuana. The ministry official said that supervision would be too lax if individual doctors could prescribe it.

Second, doctors prescribe drugs according to specific indications: listed medical criteria. But in the case of medical cannabis, the indications haven’t been verified, so the Health Ministry has taken it upon itself to check them.

The ministry official said that there are already doctors – those treating HIV, for example – who have requested an indication be removed from the list. "There is no sense giving cannabis to someone who is HIV-positive," the official said. "They are trapped because there is a listed indication but they don't believe in it. Some patients tell me: 'We feel like we've been turned into dealers.'"

Open gallery view Medical marijuana buds being packaged in Israel. Credit: Daniel Tchetchik