mimi

Mimi Peleg uses cannabis and MDMA to treat PTSD in herself and others. Credit: Ori Sharon.

The issue of drugs, and psychedelic drugs in particular, generally opens up questions which cannot be ignored by anyone seeking a more just and caring society. Current global policies towards psychedelic drugs range from the cruel to the barbaric. Every country in the world, excluding Portugal, currently prosecutes or otherwise severely penalizes individuals who use psychedelic substances.

Since the 1960s, this prosecution has come under question. This is particularly true in the U.S. To many, the pro-psychedelic movement that emerged out of the anti-war movement seems frivolous and non-essential. To observers with these attitudes, psychedelics are viewed as recreational diversions. People who see psychedelics in this way may be bewildered to know that the Multidisciplinary Association for Psychedelic Studies (MAPS), an organization aimed at studying the medical benefits of MDMA (the pure compound in the illegal drug Ecstasy), cannabis, and other drugs, has chosen Israel as a key location for psychedelic research.

To those who follow the growing body of medical research on psychedelics, this choice is much less surprising. Increasingly, scientists have come to view psychedelics as the most powerful tool we possess in treating PTSD, radically changing the old picture of the drug. According to The Israel Center for the Treatment of Psychotrauma (ICTP), a group that has been active since 1989 to contend with the growing phenomenon of psychotrauma in Israel, an estimated 9% of Israelis suffer from PTSD. While this is in the mid-range of PTSD rates in areas near Israel, it is three times the rate of PTSD in the U.S. and other Western countries. Israel’s high rate could be due to the many wars, presence of first and second generation Holocaust Survivors, and numerous other factors.I am an American/Israeli from Ohio, Virginia, and California. I currently reside in Tel Aviv where I work for the MAPS. As the association’s CRA (Clinical Research Associate), I monitor a clinical trial that studies the effect of MDMA-assisted therapy on Post-Traumatic Stress Disorder (PTSD).

My work for MAPS is not my only job in Israel. I am also the Director of Large Scale Training at the Medical Cannabis Distribution Center (MECHKAR – an acronym meaning “research in Hebrew”), which serves thousands of patients from Abarbanel Hospital, Israel. Every Monday and Wednesday morning for the past five years I have met with licensed medical Marijuana patients like myself, to help them get started successfully using cannabis.

plants

Young marijuana plants grow in a sheltered greenhouse in Tel Aviv. Credit: Mimi Peleg.

I currently focus on patients who are issued licenses to use cannabis for the first time. These patients come in with any of these or other conditions: Chronic Pain due to a proven organic etiology; Orphan diseases (rare enough to affect small percentages only); HIV patients with loss of body weight greater than 10% or CD 4<400; inflammatory bowel disease (as opposed to irritable bowel syndrome); multiple sclerosis; parkinson’s disease; malignant tumor in various stages of the disease; psychotic episodes, panic attacks, generalized anxiety disorder, amotivational syndrome, chrones, fibromyalgia, epilepsy, and PTSD.

Like many of my patients, I too have PTSD. Treating PTSD by way of cannabis and MDMA is up close and personal for me both privately and professionally, and I perceive my contribution to the collective goal of “tikkun,” or repairing the world, to be working on expanding medical research into alternative medications in Israel.

“Posttraumatic Stress Disorder (PTSD) is a widespread and devastating illness for which we urgently need more effective treatments,” states Dr. Allan Frankel of Los Angeles and Tel Aviv. PTSD symptoms include re-experiencing the trauma through nightmares, obsessive thoughts, and flashbacks (feeling as if you are actually in the traumatic situation again). There is an “avoidance” component as well, where the individual avoids situations, people, and/or objects that remind them about the traumatic event (e.g., a person experiencing PTSD after a serious car accident might avoid driving or being a passenger in a car).Finally, PTSD patients also tend to suffer from increased anxiety in general, sometimes with a heightened startle response (e.g., very jumpy, startled easy by noises).

PTSD can be a chronic, devastating illness that severely impacts quality of life. Sufferers often struggle to maintain healthy lives and relationships. It involves changes in the brain, such as decreased activity in areas associated with memory and learning, and increased activity in areas associated with fear.

MAPS is making every effort to recruit Israeli combat soldiers with PTSD to the MAPS study of MDMA and psychotherapy. MAPS is currently conducting five other clinical trials around the world in: Switzerland, Australia, UK, Canada, and the U.S. MAPS is studying whether MDMA-assisted psychotherapy has the potential to heal the psychological and emotional damage caused by sexual assault, war, violent crime, and other traumas.

joints

Medical marijuana joints produced in Tel Aviv. Credit: Mimi Peleg.

In short, MDMA-assisted psychotherapy is a treatment that combines psychotherapy with the administration of MDMA, which catalyzes the therapeutic process. So far results have been eye-opening: Four years after participants went through just a few MDMA-assisted psychotherapy sessions, results show long-lasting, clinically meaningful benefits and absence of harm. This is especially astounding considering that the participants were all resistant to conventional drug treatments (where existing treatments are not always effective). Astoundingly, in fact, a third of all PTSD patients do not respond adequately to established psychotherapies and even after treatment, patients still suffer from symptoms.

In Israel, the first two participants have already been treated. Eight additional subjects will soon be enrolled in a randomized, double-blind active placebo-controlled study, with five subjects receiving 125 mg (high dose) and three subjects receiving 25 mg (active placebo or low dose), with an optional supplemental half-dose available 1.5 to 2.5 hours after the initial dose. Participants will have two experimental sessions of MDMA-assisted psychotherapy scheduled at a three- to five-week interval with pre and post therapy sessions.

MAPS put together a therapy team of six and flew many of them to the U.S. for extensive training to ensure adherence to the strenuous protocol in order to ensure the greatest levels of comprehension and expertise.

I returned to Israel in 2009 partially to help kick start the cannabis movement here along with about 100 other activists. I didn’t know it at the time but I came back at a crucial juncture – directly prior to the start of centralized, state sanctioned distribution and storage. Today this facility, MECHKAR, serves about a third of Israel’s approximately 12,000 patients. For the entire first year of distribution, all patients in Israel received cannabis free of charge. In 2010 the price was set at ~100 USD per patient month. Legally this is a price for the service of receiving cannabis, not the monthly gram allotment that varies from 10 to 100 grams. Most patients start with between 20 and 30 grams per month. Israel’s patients come from all religions, age groups, and ethnicities. Some groups (such as holocaust survivors and people in financial need) are eligible for subsidies for both their cannabis and a vaporizer.

Today, different strains are known for having different active ingredients. Our Ministry of Health guidelines aim for three offerings: a low CBD (under 3%) high THC (20% and above) strain; a low THC (under 14%) high CBD strain (6% and above) and a mid-range THC (14-20%) mid-range CBD (3-6%).

Dr. Frankel treats people primarily with cannabis oils. The reason for using cannabinoid oils is because the oil extracted from the plant is in fact the whole plant medicine. All medicine from cannabis and most other plants is within the plant oils and waxes. When the cannabis oil and waxes are tested and then blended with diluents, such as grape seed oil, it is fairly straightforward to create a dosing scheme for the patients. The oils tested and blended to specific doses can be used to treat many illnesses.

(Credit: Rick Doblin/ MAPS)

I asked Dr. Frankel if cannabis is a cure for PTSD. He chuckled. Through the VA, Dr. Frankel has treated around a dozen recent war veterans with documented PTSD from recent wars. These patients for the most part are living increasingly comfortable lives and beginning to reach out to other veterans to spread the knowledge. Dr. Frankel reports that veterans using cannabis tend to sleep better, memory of atrocities seem to be less painful, and their overall life function is far improved. Frankel’s studies are neither double-blind nor controlled, but the initial results are extremely encouraging and require more research.

Yet, Dr. Frankel asserts:

There is no reason to speak about “cures.” Cures are very rare in medicine. We tend to control or manage disease processes and relieve symptoms. There is evidence that cannabinoids allow a better quality sleep, relieve anxiety/panic and allow bad memories and nightmares to abate to a significant degree in limited studies…

Why are these studies so limited? For an answer we can look to Dr. Sanjay Gupta, (CNN Chief Medical Correspondent). When Wolf Blitzer recently asked “why did you change your mind on cannabis?” Dr. Gupta responded: “when you look at the literature surrounding marijuana, if you do a search through the medical journals, you know, some 20,000 papers will pop up. And I was keeping up steadily on the scientific literature, but what I was realizing was that the vast majority of these studies talked about the harm, the perils, the problems with marijuana. A very small percentage, less than 10 percent, close to 6 percent actually evaluated benefit.” As Gupta highlights, it has been practically impossible to do clinical trials on cannabis in the U.S. that evaluate benefits.

Dr. Allan Frankel seeks to fill this gap. He will be conducting a PTSD study in cannabis in Israel to determine how cannabis might diminish the effects of traumatic memories, alter emotional states, reduce anxiety, and improve general mood. The study that he is conducting along with Principal Investigator Dr. Yehuda Baruch intends to validate the assumption that use of cannabis ameliorates symptoms of PTSD through reduction of nightmares, sleep betterment, anxiety abatement, and general mood improvement.

Dr. Frankel’s study aims to isolate which cannabinoids best help reduce PTSD testing various ratios of THC/CBD and placebos in participants’ blood streams via appropriate lab tests and by administering self-reported questionnaires at specific intervals. There will be baseline, bi-weekly and long term follow-ups and daily phone calls.

Dosing in all groups will be one dosed spray, or 3 mg CBD per spray and mg/spray of THC depending upon above ratios. Patients will begin on 1 spray on the morning on the first day. On subsequent days participants will be asked to increase the number of sprays by one additional spray every other day increasing up to a maximum of 15 sprays per day (pending Institutional Review Board approval).

Research like Frankel’s will provide a scientific foundation for doctors both in and out of Israel who currently remain skeptical about the validity of cannabis as medicine. As such, there is a great need for continued education on every level in Israel. Many doctors do not know about the benefits of cannabis and many still fear it. Doctors still fear reprisals for prescribing cannabis. Doctors fear becoming “pot shops.” Lack of education is one of the key reasons for patient attritions along with new health issues and license revocation. Cannabis and MDMA education and research in Israel suffers from a severe lack of funds and this is where any one of us anywhere can be of tremendous help. If we can’t get the research done in the U.S., we will have to do it elsewhere – like Israel, a place with a long history of miracles with sacred oils.

To make a donation to MAPS’ MDMA-assisted psychotherapy for the treatment of PTSD in Israel Fund, visit MAPS’ website.

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Mimi Peleg, CRA for the MDMA/PTSD Israeli Study, is also Director of Large Scale Cannabis Training for MECHKAR, Abarbanel Hospital, Israel. Peleg recently co-authored “The Ladder” with Galia Halfi – a self-help guide to inner peace (beshalom.org). You can contact Peleg at mimi@mcdc.co.il.

 


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