Herbal medicine vs Pharmaceutical medicine

If all medicine is originally from herbs, why not just use herbal medicine instead of pharmaceutical medicine with harmful additives?

The doctors have given a great overview on the safety of additives and the potential harm from herbal medicines.

But why not just extract the natural product and use that natural compound?

To explain, we have to go back to the start of the biochemical engineering industry which had its roots in the development of penicillin.

Structure of penicillin

Production and Scale-up of Penicillin

After the well known story of Alexander Fleming and his moldy plates, the antibiotic's importance in infectious disease quickly took off and the US and British Government quickly made it a priority to produce large quantities. The original method of penicillin production was to grow massive quantities of fungi and subsequent extraction. It was a long, extremely expensive, and low yield process with multiple quality control issues.

“The mold is as temperamental as an opera singer, the yields are low, the isolation murder, the purification invites disaster. Think of the risks!”

-Jasper Kane

 

A female laboratory worker sprays a solution containing penicillin mould into flasks of Corn Steep medium, to encourage further penicillin growth. The spore suspension contained in the spray gun contains dust taken from the new mould which has been grown in test tubes from Professor Fleming's original mould.[1]

It wasn't until the development of fermentation by some company called Pfizer when they were able to engineer a process that took their gluconic acid and vitamin C process using deep-tank fermentation and extended it to penicillin. The first penicillin plant was built in 1944 with several 7,500 gallon tanks. In 1942, there was enough drug to for ten doses, by 1945 there was enough to treat 646 billion. [2]

Pilot plant production [3]

Derivatives of Penicillin

Penicillin is part of a broad class of antibiotics known as beta-lactams which inhibit cell wall synthesis in bacteria. However, the beta-lactam ring is extremely unstable as the strained ring will have a large tendency to open. Furthermore, penicillin was limited to Gram-positive bacteria. Fortunately, due to the work of organic chemist John Sheehan, the total snythesis of penicillin was determined and further derivatives of the compound could be designed.

Structures of the b-lactam ring in red

One of the earliest derivatives was Ampicillin which not only attacks Gram-positive organism but also Gram-negative organisms. It's development in 1961 by  a company named Beecham (now known as GSK) expanded the range and class of infections doctors may not attack. The key difference between the two molecules is the presence of the amine (-NH2) at the end of the molecule next to the benzene ring (go ahead, check for yourself). The whole class of compounds known asAminopenicillins allows for the drug to penetrate the outer membrane of gram-negative cells.

Structure of Ampicillin

Ampicillin isn't ideal for pills as it isn't well absorbed with a bioavailability of 40%. As a result, taking a pill based version meant that patients would have to take twice as much drug to get the appropriate dose. A subsequent version of the compound,Amoxicillin, was designed this time changing the benzene to a phenol. The addition of the hydroxyl group (-OH) now increases the bioavailability to 95% allow it to be taken orally in a pill/capsule/tablet form.

Structure of Amxocillin

Sometimes that might not be enough! Bacampicillin has an additional glycol chain to make it a prodrug with increased bioavailability

Structure of Bacampicillin

Many biologists don't actually use Ampicillin since it is fairly unstable. Instead Beecham designed a class of penicillin known as Carboxypenicillin, which has a carboxylic acid group (-COO) instead of the amino group . This increases the water stability of the drug, increases the solubility, and the byproducts tend to be less toxic. Unfortunately, they are limited to Gram positive cells.

Structure of Carbenicillin

Overcoming drug resistance

The bugs have evolved resistance to the drug with the advent of beta-lactamaseswhich generally hydrolyze the beta-lactam ring resulting in the lost of potency.

Mechanism of lactamase activity

The first group of compounds that overcame this activity were the Cephalosporin which came from another fungus and was ultimately developed by Eli Lilly. These compounds introduce an extended ring which stablizes the beta-lactam. There are now 5 generations of this compound and the latest group is currently MRSA effective.

Structural differences between penicillin (1) ad cephalosporins (2)

As the beta-lactamases continued to evolve, an entire new class of compounds,Carbapenem, were developed with even a more different core. Now, the sulfur (S) has been removed and a double bond has been introduced. Unfortunately, these compounds have poor bioavailability and will have to be delivered intravenously. As a result, these compounds serve as a last resort antibiotic. Merck, AstraZeneca, Daiichi all have versions of the drug.

Structure of Carbapenems

Specificity of antibiotics

Everything I have written so far has been about broad spectrum antibiotics. However, as noted in Christopher VanLang's answer to Antibiotics: If I was completely selfish and cared nothing for society, should I care if my doctor over-prescribes antibiotics?it isn't a great idea to completely wipe out your gut biome. As a result, it is often desirable to use a narrow-spectrum antibiotic. Medicinal chemists can do this by changing the specificity of the compound by adding functional groups that will by recognized by certain desired bacteria.

For instance we have

Gram-negative only with Phenoxymethylpenicillin

Syphilis with Benzylpenicillin

Rheumatic fever and Syphilis with Benzathine benzylpenicillin

Strept infections Propicillin

Gut only with Metampicillin

Gram positive only & staph with Cloxacillin

Making and approving the Drug Product

The FDA will ultimately not approve a drug but actually the drug product. This is the final form that ultimately goes to and into the patient and includes tablet, the needles, and all of the excipients that added to the drug. Key things include

• pH of the drug
• particle size of the granuales
• density
• stabilizers
• binders
• lubricants
• fillers
• tempertaure stability
• water stability
• color of the outside
• taste of the pill
• shape of the pill
• size of the pill

These components are all part of the quality control of the drug and ensures that when they get shipped India, they still work. For patients that take a lot of  daily drugs, the color, shape, and size enables them to tell the difference. Things like dosing regiments, taste, and chewablity affect patient compliance. The pH of the compound influences details as specific as whether the drug gets absorbed in the stomach or the small intestine.

Depending on the use of the drug, different delivery mechanism will have to be considered. If there is a skin infection, maybe an ointment will be use. Babies and certain disabled people won't be able to eat a pill so a liquid or injectable version will be designed.

Drug making as a whole

The point of making derivatives is to give a drug properties that didn't originally exist with the older compound.

• Sometimes, the drug can be made safer.
• Sometimes, the drug can be made more potent.
• Sometimes, the drug can be made to overcome antibiotic resistance.
• Sometimes the drug can be made to last longer, most stable, or eatable.
• Sometimes the drug can be made more inexpensive so that they can be given to the third world.

To be frank, there is a lot of things that we don't know in the drug making world. There will be mechanisms that are unknown, side effects that can't be predicted, compounds that refused to be synthesized. But it remains the priority and the goal of drug makers to get treatments to patients in a safe and efficacious manner and if it involves making safer, more potent, inexpensive synthetic compounds, we will do it.

For fun, here is an entire List of β-lactam antibiotics

The β-lactam core structures. (A) A penam. (B) A carbapenam. (C) An oxapenam.(D) A penem. (E) A carbapenem. (F) A monobactam. (G) A cephem. (H) A carbacephem. (I) An oxacephem.

Generic Antibiotics Online

Are there any drugs that actually cure a condition, and not treat it?

Cancer drugs and antibiotics cover a pretty large spectrum of drugs so this question is not at all annoying for search purposes.

From a mechanism of action point of view, when a drug hits a target, it is doing something. In the case of anti-cancer and antibiotics, drugs hit the target in hopes of killing the host. As a result it works by removing the root cause of the condition.

For genetically linked diseases like heart disease, diabetes, asthma, allergies, alzheimers, kidney issues, and neurological conditions, the drug doesn't work by killing a cell, it is neutralizing a genetic cause of the disease.

So it's a bit unfair to demand a "cure" for something like that unless you're willing to surgically remove or replace an organ (which we could) or to modify your genome (which we hope).

Providing a drug that for some reason causes your genetically messed up immune system to not attack your genetically messed up pancreatic cells to "cure" type 1 diabetes is sort of an absurd and unrealistic concept.

That being said, a lot of antivirals are effective cures. Although a good number of neurological diseases are genetic, some conditions can be treated by antipsychotics and bring a patient back to a chemically balanced state which is essentially a cure. Patients who suffer from tissue damage like a stroke or wounds can use drugs to hasten the regenerative aspects of their body and come to a more complete recovery. Dermatological conditions (including acne or sunburns) come to mind. In a manner, those drugs are "cures" in that the patient no long needs to rely on them to get better.

Generic Drugs as Good Alternative to a Branded Ones

"Billions wasted on pricey drugs" was the headline in the newspaper some time ago. Medicare claims that the program is wasting hundreds of millions of dollars because doctors continue to prescribe and patients continue to ask for pricey name brand drugs when cheaper generic drugs are available.

I agree that this is a major problem which needs to be addressed. My own medical group is working hard and with good success to change the prescribing habits of doctors to use the more reasonably priced generic drugs whenever possible.

What exactly are generic drugs? They are copies of brand name drugs which have the same dosage, side effects, intended use, risks, strength and safety of the brand name drug. In other words, the brand name drug and the generic version of it should be identical.

The generic version of a drug can be manufactured and sold once the patent on the brand name drug has expired. The generic costs much less than the brand name drug mainly because the generic manufacturers don’t have to duplicate the hundreds of millions of dollars spent on research, development and marketing conducted by the original manufacturer.

There is concern by many that generic drugs are cheaper because of a compromise in quality or effectiveness. However, the Food and Drug Administration requires that generics be as safe and effective as the brand name drug. The generic must be bioequivalent to the name brand product, which means that the amount of active ingredient is delivered to the body at the same time, and used in the body in the same way as the brand name. The generic will often be a different color, shape or flavor than the brand name and it also may have different inactive ingredients, but the active ingredients must always be the same.

There are a few classes of drugs, such as anti-seizure medications, thyroid hormone replacement, and blood thinning drugs, where it is best not to switch back and forth between generic and brand name versions. Your doctor can explain this in more detail.

Since nothing in life seems perfect, I recognize that there may be instances where a generic version of a drug just doesn’t seem to work as effectively as its brand name equivalent. This needs to be discussed with your doctor and dealt with appropriately since the number one issue in the doctor patient relationship should be: What’s best for the patient?

Patients do, for the most part, have a choice of generic versus name brand drugs, but must realize that both private and public insurance plans may not pay for the non-generic or will require a higher co-pay, thus increasing the out of pocket cost of the drug. Feel free to discuss this with your doctor and pharmacist.

Terry Hollenbeck M.D.

Most Men With Erectile Dysfunction Do not Seem to Get Treatment

In study of 6 million ED patients, 75 percent either didn't receive or fill prescriptions.

Never mind the commercials with men talking freely to their doctor about their erectile dysfunction, taking a prescription for treatment to the pharmacy and settling in for a romantic evening.

Despite a wide range of treatment options, most men with erectile dysfunction (ED) don't get treated, according to a new study.

"ED treatments, overall, are underutilized," said Dr. Brian Helfand, an assistant clinical professor of urology at Northshore University Health System and the University of Chicago. "Only 25 percent of men are actually treated."

Helfand led the study, which looked at the medical records of more than 6 million men with an ED diagnosis. He is due to present his findings Monday at the American Urological Association annual meeting, in San Diego.

The study was funded by the Havana Day Dreamers Foundation (which promotes men's health), the Goldstein Fund in Male Pelvic Health and the SIU Urology Endowment Fund.

Helfand used an insurance claims database and looked for the medical code for erectile dysfunction from June 2010 through July 2011. He found 6.2 million men aged 30 and older who received a diagnosis of erectile dysfunction. ED is defined as an inability to maintain an erection satisfactory for sexual performance.

He then looked to see how many filled a prescription. Patients were considered treated if they filled a prescription for an erectile dysfunction drug such as Viagra (sildenafil) or Cialis (tadalafil), drugs called prostaglandins that are given by injection or urethral suppositories, or androgen (hormone) replacement.

He considered them untreated if they received a diagnosis of erectile dysfunction but did not fill a prescription.

He took into account, too, the men's ages and other health problems.

Even though erectile dysfunction is likely to become more common with age, he actually found older men the least likely to be treated. Only about 18 percent of men aged 65 and above were treated.

When Helfand looked to see what bearing other health conditions might have had on treatment, he found those with prostate cancer were least likely to be treated. Only 15 percent were.

The study didn't have information on why the men went untreated, he said. But he speculates there are probably several reasons.

The undertreatment, Helfand said, is probably a result of doctors often not offering the prescription or patients getting a prescription but not filling it at the pharmacy.

"Men may not be bothered by it," he said. Or a doctor may not write a prescription because he may not think the man is a candidate, or perhaps they didn't respond to erectile dysfunction treatment in the past.

Other reasons, he said, could include costs and embarrassment.

For men, Helfand said, the message is: "There are available therapies out there. These can be useful if you have ED."

An expert who reviewed the study but was not involved said he isn't sure if it mirrors real life.

"To conclude from this study that three-fourths of the men who carry a diagnosis of ED are not treated doesn't fit with what we see in clinical practice," said Dr. Jacob Rajfer, a professor of urology with the David Geffen School of Medicine, at the University of California, Los Angeles.

"In order to determine how many men were treated or not treated, you need to interview the people," Rajfer said.

Men might get to the pharmacy, see the cost of the erectile dysfunction drug, and decide to go out of the country to get it and save money, or might get it by mail order, Rajfer said.

Another expert discussed possible barriers to men getting these drugs.

"Cost might be a big issue," said Dr. Ajay Nangia, an associate professor of urology at the University of Kansas Medical Center. He is familiar with the study findings.

Costs vary, but some erectile dysfunction drugs are about $4 a pill. Or even lower if you buy generic pills such as Kamagra or Tadalis.

"It's becoming much more open to talk about this stuff," Nangia said. Even so, some men may still be embarrassed.

How to avoid erectile dysfunction and protect your potency.

How to avoid erectile dysfunction and protect your potency.

Erectile dysfunction (ED) becomes more common as men age. But it is not necessarily a normal part of aging. How can you avoid ED? Here's what experts told us.

Watch what you eat

A diet that's bad for a man's heart is also not good for his ability to have erections.

Research has shown that the same eating patterns that can cause heart attacks due to restricted blood flow in the coronary arteries can also impede blood flow to and within the penis. The blood flow is needed for the penis to become erect. Diets that include very few fruits and vegetables along with lots of fatty, fried, and processed foods can contribute to decreased blood circulation throughout the body.

Anything that is bad for a man's heart is also bad for his penis, says Andrew McCullough, MD, associate professor of clinical urology and director of the male sexual health program at New York University Langone Medical Center.

Recent studies show that ED is relatively uncommon among men who eat a traditional Mediterranean diet, which includes fruits, vegetables, whole grains, heart-healthy fats including nuts and olive oil, fish, and wine, particularly red.
"The link between the Mediterranean diet and improved sexual function has been scientifically established," says Irwin Goldstein, MD, director of sexual medicine at Alvarado Hospital in San Diego.

Maintain a healthy weight

Being overweight can bring many health problems, including type 2 diabetes, which can cause nerve damage throughout the body. If the diabetes affects the nerves that supply the penis, ED can result.

Avoid high blood pressure and high cholesterol

High cholesterol or high blood pressure can damage blood vessels, including those that bring blood to the penis. Eventually, this may lead to ED.

Make sure your doctor checks your cholesterol levels and blood pressure. You might also want to check your blood pressure between doctor visits. Some stores and fire stations offer free screenings. Blood pressure monitors are also sold for home use.

If your cholesterol or blood pressure is out of whack, get it treated.

Blood pressure drugs can make it hard to get an erection. But doctors say many cases of ED that get blamed on these drugs are actually caused by arterial damage resulting from high blood pressure (also called hypertension).

Drink alcohol in moderation or not at all

There is no evidence that mild or even moderate alcohol consumption is bad for erectile function, Sharlip says. But chronic heavy drinking can cause liver damage, nerve damage, and other conditions -- such as interfering with the normal balance of male sex hormone levels -- that can lead to ED.

Exercise regularly

Strong evidence links a sedentary lifestyle to erectile dysfunction. Running, swimming, and other forms of aerobic exercise have been shown to help prevent ED.Watch out for any form of exercise that puts excessive pressure on the perineum, which is the area between the scrotum and anus. Both the blood vessels and the nerves that supply the penis can be adversely affected from excessive pressure in this area. Goldstein says bicycle riding, in particular, can cause ED.

An occasional short ride is unlikely to cause trouble. But men who spend a lot of time biking should make sure their bike fits them properly, wear padded cycling pants, and stand up frequently while pedaling.

"No-nose" bike seats protect against genital numbness and sexual dysfunction, according to the National Institute for Occupational Safety and Health.

Don't rely on Kegels

One form of exercise that doesn't seem helpful is Kegel exercises, which involve repeatedly contracting and relaxing the muscles in the pelvis. Kegels can be helpful for men and women suffering from incontinence. But there's no evidence that they prevent erectile dysfunction.

Keep tabs on testosterone

Even in healthy men, testosterone levels often begin falling sharply around age 50. Every year after age 40, a man's testosterone level typically falls about 1.3%.
Symptoms like a low sex drive, moodiness, lack of stamina, or trouble making decisions suggest a testosterone deficiency, as do lackluster erections. Your doctor can check on that.

Avoid anabolic steroids

These drugs, which are often abused by athletes and bodybuilders, can shrink the testicles and sap their ability to make testosterone.

If you smoke, stop

Smoking cigarettes can harm blood vessels and curb blood flow to the penis. And nicotine makes blood vessels contract, which can hamper blood flow to the penis.

Steer clear of risky sex

Believe it or not, some cases of erectile dysfunction stem from penile injuries that occur during sex. Taking your time and avoiding certain positions can help. It may be uncomfortable, but consider talking to your doctor about what to do and, more importantly, what not to do.

Curb stress

Psychological stress boosts levels of the hormone adrenaline, which makes blood vessels contract. That can be bad news for an erection. Anything a man can do to ease tension and feel better emotionally is likely to give his sex life a big boost.

Use kamagra oral jelly to fight ed symptoms

Cialis May Not Prevent Impotence in Men Treated for Prostate Cancer

Taking the erectile dysfunction drug Cialis while receiving radiation therapy for prostate cancer doesn't seem to help men's sexual function after treatment, a new study finds.

About 40 percent of men undergoing radiation therapy for prostate cancer suffer from erectile dysfunction afterward, according to the study. The researchers wanted to find out whether impotence could be prevented by having patients take Cialis (tadalafil) during the course of treatment.

But there was very little difference in outcome when Cialis was compared to a placebo pill.

"There is no indication to use Cialis in men about to undergo radiotherapy for prostate cancer," said lead researcher Dr. Thomas Pisansky, a professor of radiation oncology at the Mayo Clinic.

The report was published April 2 in the Journal of the American Medical Associationand partially funded by Eli Lilly & Co., the maker of Cialis. The study also received funding from the U.S. National Cancer Institute.

Dr. David Samadi, chairman of urology at Lenox Hill Hospital, in New York City, said, "Radiotherapy is the most common treatment for prostate cancer, but erectile dysfunction is a common side effect in a large number of patients."

This study clearly shows that there is no support for use of medications such as Cialis, Viagra and Levitra to prevent erectile dysfunction after radiation therapy, said Samadi, who was not involved with the research.

"All treatments come with side effects, and a good discussion with a urologist and the radiation oncologist about those side effects, upfront, is part of the decision-making process," Samadi said.

For the study, Pisansky's team randomly assigned 242 men with prostate cancer to receive daily doses of Cialis or a placebo for 24 weeks, starting when radiation therapy began.

The researchers found that at 28 and 30 weeks after the start of radiation therapy, 79 percent of those who received Cialis maintained erectile function compared with 74 percent of those who received placebo -- a difference of 5 percent.

After a year, there was still not a significant difference between the Cialis and placebo groups, with 72 percent of men who took Cialis and 71 percent who took the placebo able to maintain an erection.

Moreover, Cialis was not associated with an improvement in overall sexual function or satisfaction. Likewise, the partners of men who took Cialis saw no significant effect on sexual satisfaction, the researchers noted.

Dr. Bruce Gilbert, director of reproductive and sexual medicine at North Shore LIJ Health System in Great Neck, N.Y., took issue with the study.

"We have a problem in this study. The data that they are looking at is the patient's subjective response to whether or not their erections are good. We don't know if the patient had real problems with erections, only what he said about it," Gilbert said.

The real question boils down to the damage radiation therapy causes. If the damage is to nerves, then drugs like Cialis won't work because they only affect the blood circulation, Gilbert explained.

"Whether you have radiation or surgery you are going to have some impairment in your erections. When you are treating a cancer, you are treating the cancer. The side effects can be dealt with after," he said.

Gilbert said that treatments are available. "With sexual function, we can get most people working again," he said. "We use a variety of medications, possibly injected medications, or other alternatives that we have."

Source: WebMD

Medical Marijuana Industry Sprouts Up in Israel

Israel's medical-marijuana industry is thriving, and the Israeli government is funding breakthrough research on the healing potential of the cannabis plant.

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

Peleg directs large-scale cannabis training for the Israeli government’s state-supported, discreet, successful and expanding medical cannabis distribution center, MECHKAR. MECHKAR began as a tiny program serving about 1,800 people from 2008-2009. Today, supplied by eight farms located all over the country, the program distributes cannabis to 12,000 patients.

While medical marijuana has been approved in 18 U.S. states, and recreational use in two, U.S. federal law still criminalizes the drug, and its future remains uncertain. In Israel, however, the $40-million-per-year medical-marijuana industry is thriving. And, while research efforts have been continually hindered in the states by the National Institute on Drug Abuse and the DEA, the Israeli government is funding and supporting breakthrough research on the many healing potentials of the cannabis plant.

Likud Party MK Haim Katz, who chairs the Labor, Social Welfare and Health Committee in Israel’s Knesset, said in January that the number of doctors allowed to prescribe medical cannabis would double from nine to 20 by the end of the year. Mimi Peleg told AlterNet that has already happened, as more than 20 doctors can now legally prescribe cannabis in Israel, though some are limited to the prescription of cannabis oil.

While Israel has long had a hash-smoking underculture, recreational cannabis use is not nearly as common as in the U.S.

“There was always hash here, but not a pot culture so to speak,” Peleg said, noting that most students arrive at her offices terrified they will hallucinate or lose their minds.

“For them [getting high] is an adverse effect,” she said. “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.”

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 for people with serious illnesses, often near the end of their lives.

Patients must exhaust all available pharmaceutical options and complete a long-winded bureaucratic process before they can access cannabis.

While Israel has a historically strict drug policy, it does not share the U.S.’s lengthy and tumultuous history with the cannabis plant. Peleg says Israel doesn't have a “stoner” stereotype—while Israelis are often wary of trying the new drug, there is no serious stigma surrounding the use of the cannabis herb for medical purposes. 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 about how to properly use cannabis, and that’s where Peleg comes in.

Peleg credits her friend and “favorite politician” Boaz Wachtel with bringing medical cannabis to Israel. Wachtel co-founded Israel’s Ale Yarok political party, 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 told AlterNet that Peleg’s role is important not only to educate patients but 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 said. “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, somewhere between 10 and 30 people with licenses for cannabis will come through the doors of the MECHKAR facility, made up of a few small rooms at the end of a mental hospital. In addition to training and supplying cannabis to patients, MECHKAR is a mecca for the unprecedented cannabis research.

Wachtel said 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 U.S.’s continued blockade of cannabis research. He says this is wonderful for Israel, but not for society at large.

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

Doctors from all over the world, including the U.S., arrive in Israel to research cannabis’ wide-ranging medical properties. Current studies are looking at cannabis’ use in the treatment of basal-cell carcinoma, post-traumatic stress disorder, fibromyalgia and Crohn’s disease.

Funding for cannabis research in Israel comes from the Israeli Ministry of Health (MOH) as well as private donors.

Peleg is also the clinical research associate for an ongoing study of MDMA-assisted psychotherapy for PTSD, organized by the Santa Cruz, Calif.-based Multidisciplinary Association for Psychedelic Studies (MAPS). She helped write the abstract for a recent study conducted in Israel to assess the use of cannabis to treat chronic PTSD in 30 Israeli combat veterans, which turned out “promising” results. The study is currently under peer review in the Journal of Psychoactive Drugs.

“We took 30 combat veterans with treatment-resistant PTSD and gave them cannabis over time, and did testing before during and after,” she said.

Currently, about 200 PTSD patients are approved for medical cannabis in Israel, and Peleg said the number is on the rise. Peleg said the research results for all of the cannabis studies conducted in Israel have been “overwhelmingly positive.” A recent study conducted on fibromyalgia inspired many patients in a senior nursing home to apply and become licensed cannabis users.

How the U.S. Influenced Israel’s Cannabis Reform

Peleg, an American-born Jew, lived in Santa Cruz, Calif. until 2009, working as an office administrator with the Wo/Men’s Alliance for Medical Marijuana (WAMM), an organization that provides cannabis to patients to mitigate pain and other issues at the end of life. She said WAMM taught her 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 MAPS. There, she met MAPS founder Rick Doblin who is also Jewish. Together they dreamed of a time when medical cannabis would reach Israel.

So, when Peleg's wife’s U.S. visa expired four years ago, the pair—both Israeli citizens—moved to Israel in 2009. At Doblin’s suggestion, Peleg started work in Israel, and ended up at MECHKAR, which was a fledgling program in its first year.

Boaz Wachtel’s first inspiration to work with cannabis reform came from the U.S.

From 1981 to 1993 Wachtel lived in America, working in the late '80s alongside Howard Lotsof who discovered the anti-addictive properties of the psychoactive substance ibogaine. He said his work with ibogaine in the US and abroad taught him about “the ability of individuals to influence governments and create change.”

Peleg said the development of MECHKAR was no easy task. For the first few months the Israeli Ministry of Health assigned the program a room “the size of a postage stamp” with no air conditioning, in the bottom floor of a large building. Today, MECHKAR operates out of a suite of substantial rooms inside Israel’s largest mental hospital, Abarbanel.

“That first day, to have so much going on around us while we were just trying to get sick people their medicine, felt to me like a slap in the face,” she said. “But, I have to say in retrospect there have been some really positive outcomes from the placement of the center, which were unexpected.”

For one, Peleg said she thinks the fact that thousands of medical cannabis patients are now frequenting a mental health institution is helping to normalize the Israeli public’s perception of mental illness.

“There’s this feeling in Israel of ‘Buck up and take it, everybody’s got problems,’” she said. “And then people come into this mental hospital and they see that [the mentally ill] people here are really, truly suffering and not just making it up.”

Peleg said while some patients with ailments like  cancer near the end of life, and chronic, treatment-resistant pain have a relatively easy time acquiring a cannabis prescription, those with psychological problems have a more difficult time.

Even the many patients diagnosed with PTSD, a common problem in Israel, must cut through thick red tape. Before they can acquire a cannabis prescription, PTSD patients must work with a doctor for a year and show that all other approved medicines did not work.

Peleg said she has also seen cannabis licenses for phantom pain, anorexia, Crohn’s and fibromyalgia, all of which have psychological components.

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

Wachtel said that while the cannabis program is running successfully, it’s “not like everything is roses.”

Two years ago the Israeli government attempted to move away from local growers and import cannabis from the Netherlands—a move Wachtel calls a “major threat” as the Dutch medical cannabis program grows a limited number of strains at a very expensive price.

“It’s going to be cannabis for the rich if we import it, even though it may be politically more convenient for the government,” he said.

Wachtel and supporters led a campaign against importation, and met with government officials to explain how cannabis would become a drug for the elites if Israel were to import it. Those efforts eventually convinced the government to shelve importation, “for now,” Wachtel said.

Despite ongoing challenges, thanks to MECHKAR, cannabis has become an accepted, normalized medicine in Israel today.

But this was not always the case.

Naltrexone online for drugs abuse

Forming MECHKAR

After Wachtel returned to Israel from the U.S. he co-founded the Israeli foundation for drug law reform in 1994. The next year the fruit of his drug reform labors arrived in the form of a committee established by the Israeli parliament to study the legal implications of medical cannabis in Israel. Wachtel was one of two public representatives on that committee, and Israeli Raphael Mechoulam, famous in the '60s for his breakthrough isolation of the active ingredient in cannabis, tetrahydrocannabinol, or THC, was the committee head.

Wachtel said research on cannabis in Israel started during the 1960s. While it was illegal to use cannabis for personal consumption, it was never illegal to conduct research on the plant. Wachtel points out that the research of prohibited drugs is legal under the UN Drug Conventions everywhere in the world, including the U.S. It is federal law, not international law, that prohibits certain drug research in places like the U.S.

The committee brought an HIV patient to the Israeli Ministry of Health who requested permission to use medical cannabis to treat his symptoms. In response, the Ministry’s deputy director said the committee would be allowed to proceed if they found a way the program would not cost the government any money.

So, the committee got creative. First, they approached the police force see if they would provide confiscated cannabis for medical use, but the cops “didn't want to become known as cannabis suppliers for sick people,” Wachtel said.

After dozens of meetings and efforts, the committee circulated the idea that patients might grow cannabis for themselves.

“I knew this wasn't a good option because these are sick people, and sick people can’t be good gardeners,” he said. “But we went for that solution, and it was a limited solution for limited number of patients.”

In the meantime, the committee worked to educate medical personnel and the public about cannabis, via conferences and media outreach. Eventually a doctor named Yehuda Baruch, head of Israel’s Abarbanel Hospital was nominated to run a nascent program called the Medical Cannabis Initiative Program.

Several dozen meetings later, in 2007, the Ministry of Health assigned its first license to a patient to grow 50 cannabis plants.

The minister of health decided it wasn’t fair for just one person in the country to hold a cannabis grow license, so he asked Wachtel to bring other interested growers to his attention. Wachtel brought three more growers, then others joined and eventually the government awarded 18 grow licenses.

For the first year and a half growers gave cannabis to patients for free, though it soon became clear this was an unsustainable approach. Finally, the Ministry of Health decided to charge all medical cannabis patients a $100 flat monthly fee, regardless of the amount of cannabis they consumed. This system remains in place today.

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.

Wachtel said while unfortunately cannabis is not yet a first-line option for patients in Israel, it has finally become an accepted form of medical treatment.

“The cannabis medicalization movement, which I am proud to be a member of … has a lot to do with changing the public's and decision-makers’ perceptions of cannabis and reversing government's propagandistic and false descriptions of what cannabis is in reality,” Wachtel said. “The success of cannabis medicalization on national levels in countries such as Israel, Canada, Netherlands, is pointing to the fact that medical cannabis programs... help the sick and the dying.”