Connecting THC/CBD Concentrations with Specific Medical Indications
In 2016 Israel instituted the Reform, a revised medical cannabis program that was intended to make medical cannabis more accessible and more regulated to benefit patients. One of the results of this process was the production of the Green Book, a 153 page guide to the Israeli Medical Cannabis (IMC) Good Clinical Practices protocols. An English language version of the Green Book can be found here.
Most recently updated in 2019, the Green Book is a comprehensive manual on the medicalization of cannabis. The guide establishes the groundwork for the regulation and standardization of the use of a medicinal product that is considered an illegal narcotic drug. All the facets of medical cannabis practice, from cultivation to delivering products to patients, are covered in detail in this guide, which is considered by many to be the bible of medical cannabis.
Medical cannabis treatments are divided in the Green Book into two major categories: THC-rich and CBD-rich. The standard for THC-rich products dictates THC concentrations of 10%, 15%, and 20% and for CBD-rich products 10%, 15%, 20%, and 24% concentrations of CBD. The other cannabionids are not considered in this categorization due to a lack of evidence. Based on extensive research of the literature and available observational data, the authors associated recommended CBD/THC concentrations with specific indications. The following table presents these recommendations:
Once these guidelines were established, cultivators were faced with a serious problem. When these rules were implemented, only a few of the strains needed to produce the specified concentrations were available in Israel. Some of the growers could supply a few of the required concentrations while others had to obtain completely new strains. This situation upset the supply chain to patients who realized that they would not be able to access the medicinal cannabis they had been using. The resulting uproar led to an extension of the period of enforcement of the new regulations to allow cultivators to obtain new strains.
Today over 30 companies provide products to the Israeli market, several of which are overseas suppliers including Aurora, Tilray, and Aphria. Over 300 products, covering the entire range of recommended treatments, were available June 29, 2021 as per the Cannabiz database which tracks product availability on a 24/7 basis. As the industry continues to evolve, Israel's medical cannabis regulatory framework provides cultivators, medical professionals, and patients with a knowledge based platform for treating illnesses, pain, discomfort, and a range of symptoms.