Thousands of patients in limbo as ministry temporarily shuts top cannabis grower
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Thousands of patients in limbo as ministry temporarily shuts top cannabis grower

As health officials cite concerns with hygiene, patients left with with no way to fill prescriptions fume at both ministry and Tikun Olam company over ‘broken system’

Medical marijuana smoking supplies at a store adjacant to the 'Tikun Olam' store in Tel Aviv, on April 10, 2016. Tikun Olam Ltd. is the largest supplier of medical Cannabis in Israel, operating under license from the Israel Ministry of Health since 2007. (Hadas Parush/Flash90)
Medical marijuana smoking supplies at a store adjacant to the 'Tikun Olam' store in Tel Aviv, on April 10, 2016. Tikun Olam Ltd. is the largest supplier of medical Cannabis in Israel, operating under license from the Israel Ministry of Health since 2007. (Hadas Parush/Flash90)

The Health Ministry has issued a temporary stop work order against Israel’s largest medical cannabis company, Tikun Olam, over concerns that the company’s cannabis drying process was not up to code, leaving thousands of patients in limbo.

The ministry said it had temporarily suspended work at the company starting last Thursday in order to run laboratory tests on all of the cannabis products to ensure quality, including closing the dispensaries, the only way for patients to obtain their medication. On Tuesday, the ministry announced it would allow the Tikun Olam dispensary to reopen and distribute cannabis as each batch is tested and approved.

The ministry was “concerned about severe faults on the farm — lack of hygiene, improper growth (in the open air and not in an enclosed greenhouse), trimming and laying the cannabis on the ground, use of prohibited pesticides, drying the buds in a unhygienic setting, and manufacturing cannabis products under unacceptable conditions.”

Patients who get their cannabis through Tikun Olam were unable to obtain their medication for a five-day period. Medical cannabis prescriptions in Israel are tied to one of eight medical cannabis companies and patients can only fill their prescriptions through that company.

Tikun Olam provides 15,500 people per month with medical cannabis, out of the approximately 38,000 who have medical cannabis prescriptions in Israel, and many patients were incensed that there weren’t backup plans in place to assist those who needed to fill prescriptions.

The Tikun Olam dispensary in Tel Aviv was closed from last Thursday through Tuesday.  The dispensary is expected to partially reopen Wednesday afternoon, though many strains may not be available and Tikun Olam is expecting longer-than-usual lines. The company has asked all patients who have at least a week’s worth of cannabis not to come into the dispensary until next week.

Medical marijuana at the Tikkun Olam dispensary in Tel Aviv on September 1, 2016. Along with guidance from Tikun Olam’s specially trained nursing staff, patients can decide to purchase their prescription in flower form, pre-rolled joints, pills, or tinctures. (Melanie Lidman/Times of Israel)

“If this happened with insulin, and suddenly over half of the diabetics in the country were left without a way to get the insulin they needed, there would have been an uproar,” said Dana Bar-On, the CEO of the Medical Cannabis Association.

She said patients are furious with the Health Ministry for its handling of the situation.

“The problem is not with Tikun Olam — though of course we’re expecting them to meet the necessary standards, because at the end of the day this is medicine,” Bar-On added. “But there’s also a way to deal with this without creating even more damage. What kind of regulation is this? We are very angry about how the process came about. [The Health Ministry] isn’t thinking about this as a medicine. They aren’t thinking about leaving 15,000 patients without medicine.”

Bar-On added that with an average three-month time period from harvesting through drying and processing to packaging, there were ways to address problems on the farm without closing the dispensaries and leaving patients without access to their medicine.

A sign on the door of the Tikun Olam Tel Aviv dispensary on November 5, 2018, informing patients that the dispensary is closed until further notice from the Health Ministry. (Melanie Lidman/Times of Israel)

She noted that Tikun Olam, a $400 million company that operates on three continents, is going to survive the temporary stop work order.

“This kind of company isn’t really damaged from closing for a few days,” she said. “Who are the true victims? Us. There is a total and utter lack of consideration of patients.”

The Health Ministry declined to comment as to why it closed both the farm and the dispensary without creating a backup plan for patients.

Tikun Olam foreign press spokeswoman Ma’ayan Weisberg said, “There has never been and will never be a situation in which Tikun Olam markets a product to its customers that is not of the utmost quality and that meets all of the required standards.”

Weisberg said the company is facing unprecedented growth, and is in the process of moving to a larger facility in order to be able to grow and process more marijuana.

In an effort to speed the production process, the company decided to dry some of the cannabis outside rather than in greenhouses, Weisberg said.

“Because we have such a high demand, because we have received so many patients, we reached a point where we didn’t have enough material, and we had to grow a lot more than we ever planned to,” she said. “The drying facility wasn’t big enough, so we dried some of the material not to the exact standard [of the Health Ministry].”

Weisberg said the company signed a contract to have all of the cannabis radiated by an outside company to make sure nothing could harm patients from mold on cannabis dried outdoors.

Tikun Olam foreign press spokeswoman Maayan Weisberg holds medical cannabis products at the Tel Aviv dispensary on September 1, 2016. (Melanie Lidman/Times of Israel)

Tikun Olam is hopeful the ministry will finish its tests in the next few days and allow production and distribution to resume as normal.

Currently, cannabis is approved to treat cancer, chronic neuropathic pain, post-traumatic stress disorder, colitis, Parkinson’s, epilepsy, HIV/AIDS, Crohn’s disease, multiple sclerosis, Tourette’s syndrome, and terminal illness. Soon, cannabis is expected to be approved for autism and fibromyalgia. The Health Ministry receives 300 applications per day for medical marijuana use, and there is a huge backlog for approvals.

Tikun Olam is not currently accepting new patients because its current production is at its maximum, said Weisberg.

There are currently eight licensed marijuana-growing companies in Israel for local medical marijuana consumption. Tikun Olam is the largest.

Israel is considered a leader in the medical marijuana field for the consistency of the product. Because cannabis is a plant, it is difficult to ensure that each harvest has the same ratios of active ingredients. Often, patients find that one strain of the cannabis plant is much more effective than others for handling their specific medical needs. Each of the eight companies grows different strains, so patients cannot simply switch to another company if there is a disruption in their supplier.

A Tikun Olam pharmacist metes out a patient’s monthly medical marijuana prescription at the Tel Aviv dispensary on September 1, 2016. (Melanie Lidman/Times of Israel)

Tikun Olam offers 18 medical cannabis strains with different levels of cannabidiol (CBD) and tetrahydrocannabinol (THC). THC is the primary psychoactive compound in marijuana that gives users a “high.” CBD is the more medicinal, healing part of the plant that does not produce the high feeling associated with marijuana.

Tikun Olam patients are furious at the way the Health Ministry has handled the situation over the past week. Many are also angry with Tikun Olam for its lack of transparency and communication with its 15,000 patients, and said this was an ongoing problem with the company.

H., who has been a cannabis patient for four years to treat chronic pain from an autoimmune disease, said he noticed a significant decline in the quality and diversity of strains at the Tikun Olam dispensary over the past year and a half, as Tikun Olam has ramped up production in an effort to serve more and more patients.

He said that in recent months, the Tikun Olam dispensary sometimes had only three or four of the 18 strains normally available. Additionally, he has been forced to wait in line for over two hours in order to enter the dispensary, which he called “humiliating.”

“They make you feel like you’re waiting at a methadone clinic,” he said. Tikun Olam also offers delivery service, but with a six-hour delivery window, it forces patients to take the entire day off of work in order to receive their monthly prescription.

A cancer patient shows his concentrated marijuana pills in the Tikun Olam guidance center in Tel Aviv on September 1, 2016. (Melanie Lidman/Times of Israel)

H. said that he is frustrated by the government’s portrayal of Israel as a medical cannabis world leader, while the Health Ministry’s stringent licensing requirements make obtaining cannabis difficult. He called the entire system of obtaining medical marijuana “broken.”

“I went to pain clinics, I was on a diet of Percocet, I got shots directly into my joints,” said H. “When I switched to medical marijuana, it was a game changer. It allowed me to have my life back.”

H. said he was worried that if the Health Ministry could so abruptly close Tikun Olam without leaving patients with a backup option, it could happen again.

“What am I supposed to do at this point? Go back to addictive opioids? This is not a path I want to go down.”

H. said he felt Tikun Olam was focusing more on international expansion, which is expected to net the company hundreds of millions of dollars, at the expense of treating its current patients in Israel. “They can’t paint this picture that they’re ‘repairing the world’ and then ignore the people in their backyard,” he said.

Illustrative: A worker tends to cannabis plants at a growing facility for the Tikun Olam company near the northern city of Safed, August 31, 2010. (Abir Sultan/Flash 90)

Weisberg dismissed the accusation that Tikun Olam’s international aspirations are affecting domestic production. “The global operation has nothing to do with the Israeli operation,” she said. “It’s not like we’re growing apples or dates. We can’t send this stuff abroad.”

Weisberg said the company plans a number of internal improvements as a result of the temporary stop work order. “We really hope the industry in general learns from this. We are going to improve ourselves and we’re going to change a lot of things in the way we run things,” she said.

Saul Kaye, the founder and CEO of iCAN, a cannabis development company, said he hoped Israel will soon adopt the “tag-and-trace” system, which he said is a “gold standard.” Tag-and-trace systems already in place in California help track the movement and inventory of cannabis products so that government and health officials know at all times where certain cannabis originated. This means if there is a health issue discovered on a specific piece of cannabis, such as mold growth, health officials can quickly and efficiently trace where the cannabis came from so they can address problems on that farm or processing plant.

“Patients must have access to pharma-grade medical cannabis and the suppliers in Israel should be held to global GMP and testing standards to ensure quality of care throughout the entire chain of production,” Kaye said. He hopes the Health Ministry will support the implementation of tag and trace in Israel in order to pinpoint problems in the future to avoid shutting down an entire operation.

However, some wondered if the Health Ministry’s surprise inspection was connected to other events. On November 1, the day before the Health Ministry issued the temporary stop work order, Tikun Olam signed a deal to begin operating a 400 dunam (100 acre) growing facility in Greece, in order to start exporting medical cannabis to Europe, Calcalist reported.

Bar-On, of the Medical Cannabis Association, is suspicious that the Health Ministry’s temporary stop work order was more connected to Tikun Olam’s expansion to Greece than an actual problem at the farm. “Patients have been complaining about mold and the use of banned pesticides for years with all of the suppliers, and [the Health Ministry] never listened to us,” she said. “I don’t know of a single episode where the Health Ministry conducted a surprise quality control check on any of the farms in Israel.”

“The Health Ministry wasn’t trying to help the patients,” she said. “Instead, they are hurting patients over some internal dispute with Tikun Olam.”

“As long as there is a situation where not all strains are available to all patients because each supplier creates specific strains, they need to figure out a solution to the problem without closing a single dispensary,” she said. “Why should the public undergo this kind of extra stress, especially when we are talking about a sick population that doesn’t need this type of stress.”

She noted that many cannabis patients take the medicine for anxiety or PTSD, so the idea that they could be without access to something that helps them control their symptoms could make their symptoms even worse.

“This just doesn’t look good for the Health Ministry, especially when the only victims are the patients,” Bar-On said.

Hopes that Israel could become a leader in cannabis exports have sputtered in the past year as the government committee tasked with approving the regulations has dragged its feet.

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