“Our job is to make it easier for patients.”

During the five years that Dr. Johnny Greenfeld has been recommending the use of medicinal cannabis for oncology patients, he has discovered just how great the positive effect of the plant is. In an interview, he explains the difference between using vaporization and cannabis oil and why adhering to the medicinal “label” is not the way to go, in his opinion.

Over the past 10 years, Dr. Johnny Greenfeld has been involved in providing supporting treatment for oncology patients. He is a neurologist by specialization and, over the course of his medical career, he has dealt to a great extent with pain treatment and control. The assistance that he provides to oncology patients has exposed him to a broad range of medical complaints: From pain through difficulty in falling asleep, vomiting and nausea, and up to and including anxiety. Over the past few years he has assisted patients in obtaining medicinal cannabis and, according to him, many patients react positively and significantly to the effects of the plant.

The effects were impressive

“As part of my treatment of patients suffering from pain,

I was first introduced to medicinal cannabis about 5 years ago”, he relates. “As everyone knows, we, in the medical profession, do not always have the optimal solution to the plethora of medical complaints. There are those for whom western medicine does not have the answer to their complaints, even if the doctors bend over backwards. It was against this backdrop that I came across a number of cases where cannabis, to my great surprise, provided the solution which could not be achieved by any other means. It happened with certain types of pain where the treatments applied did not succeed in controlling it, nor the mental-emotional distress brought on by the pain on which psychiatric treatment had no effect. Cannabis also helped in situations where muscles cramped up painfully. But, in general, cannabis provided a solution to a combination of these complaints together and not to one particular aspect. In some of the cases a reaction that brought about substantial relief was recorded, above and beyond what I expected.”

During that same period, Dr. Greenfeld heard vaguely that the Ministry of Health permits obtaining medicinal cannabis via a unique mechanism set up for this purpose. “The effect of the plant was so impressive that I dug up everything I could about the mechanism proposed by the Ministry of Health, which issues the authorizations. Because I did not have the experience at that time, I, of course, had that uneasiness that characterizes many new doctors in the field. I can understand what they feel and why they react as they do, but as I accumulated experience, the apprehension dissipated because I saw what it did to people. In parallel, I also read a great deal of literature on the subject in order to better understand the entire issue.

“Because there are very few doctors in Israel who feel comfortable recommending the use of medicinal cannabis, people go out of their way to find doctors who are prepared to assist them. The moment the public in any particular place understood that I am prepared to submit such recommendations, more and more people came to see me.”

There is a difference between oil and vaporization

“Medicinal cannabis has the potential of being useful in many cases of medical complaints and phenomena”, Dr. Greenfeld explains, without giving details, “its effects are so varied that I can give a long list of situations in which it helps, which will fill up this entire article. I have been exposed to many such situations. I see oncology patients with every imaginable distress, including pain, difficulties in falling asleep at night, vomiting, nausea, itching, tingling, and anxiety.”

Is there a difference between vaporization of cannabis and taking it in oil?

“There is no doubt that each form has different characteristics and we know this from experience. Of course there is terminology from the pharmacology world that we refer to, which explain how medications are absorbed by the body, the rate of absorption, how they spread through the body, how they adapt and change form. The body can break down medications or alter them to a point where they create new active substances.

“In this context, it is crucial to remember that cannabis contains a large amount of substances that are labeled cannabinoids, and the doses vary from species to species. In any case, when smoking or vaporizing, absorption is much faster and the effects are apparent far more instantaneously. When swallowing the medication, it passes through the digestive system and in actual fact, undergoes some sort of transformation. In such a case, the rate of absorption is slower and the type of substance that reaches the brain and affects the person is different from the substance affecting a smoker.” The personal preference of each patient comes into play in this matter. “Some don’t want to smoke and prefer vaporization because they want an instantaneous effect, others want the substance to act more mildly and slowly, so they prefer a drop of oil under the tongue. The effects of oil are longer and the desire to sleep through the night and not awake after a few hours gives oil an advantage. Smoking in bed is also dangerous and spouses are, in some cases, opposed to smoking in their presence. In contrast, there are some people who can’t stand the taste of oil in their mouths.”

We are not here to play cop

One of the controversial issues surrounding the use of medicinal cannabis is medical indications. That is, which patients can use it and which patients cannot. Dr. Greenfeld opines in this matter that “the whole issue of indications is a really weird idea. They peek askance towards a term taken from other activities in the world of medicine that supposedly proves what is good and what is not so good based on clinical trials. We rely upon our experience and not upon literature based knowledge. There is nothing better than seeing how it affects people and then to take pursuant decisions as to what to administer, in what form and dosage. If we see that it helps, it is difficult to justify precluding administering the substance to those people”.

However, Dr. Greenfeld is aware of the existing difficulties under the current situation. “The medical profession fears being taken for a ride and that people will pull the wool over their eyes by reporting dishonestly in order to get hold of the coveted narcotic. This is problematic to a certain extent because of manipulative people, but we are not here to play cop and to oversee who gets what, but rather we make sure that those who suffer from some or other condition get what we can give them in order to provide relief.”