An event held on Monday in Tel Aviv celebrated the more than 1,200 heroin and painkiller addicts who have been treated by the Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse Treatment & Research, giving them a new lease on life.

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The event to honor the  30-year-anniversary of the founding of the clinic – which has since become the leading treatment center for opioid abuse victims – was attended by Dr. Adelson and other Adelson family members, Director of the Tel Aviv Sourasky Medical Center – Ichilov Prof. Ronni Gamzu, Tel Aviv Mayor Ron Huldai, former Jewish Agency for Israel Chairman Natan Sharansky, and the head of the clinic Yali Abramsohn.

Dr. Adelson, which founded the clinic in 1993 with her husband – the late businessman and philanthropist Sheldon Adelson – spoke at the event. "For every patient saved from addiction, there are also a dozen family members who are spared the anguish and burden of this disease. Sheldon, may his memory be a blessing, used to say, 'It feels good to do good.' I am glad to be able to provide some of my expertise for the sake of the patients and those who have needed it for the past 30 years."

Dr. Miriam Adelsn is the publisher of Israel Hayom.

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"People who take cannabis to treat PTSD are like a man who uses a cane. This prevents them from moving on to psychotherapy," Professor Yifrah Kaminer, a senior Israeli physician who has studied the effect of drugs on society, warns. Kaminer, who lives in the US, has tried for many years to put a mirror in front of us so that we won't fall into the trap of legalizing marijuana, despite the growing trend to decriminalize recreational use. 

Kaminer, whose expertise on this topic extends three decades, has seen how the drug can affect people. He believes that if you prescribe it to people suffering from mental issues just so they could use it as a walking cane, this would ultimately backfire and worsen their situation, and adversely impact society. 

Kaminer has witnessed the results with his own eyes in the US, where about 20 states have already legalized recreational use, including his home state of Connecticut. 

"We have seen how teens in junior high school use this drug, and the younger the starting age is, the greater the risk of developing serious issues down the road, including psychosis," he warned in an interview with Israel Hayom. 

"The second group is people who suffer from depression and anxiety, which comprises some 15-20% of the population. Studies show that using cannabis may help them in the short term, but then it begins to give them repeated depressive episodes that only get worse; we have seen a dramatic increase in suicidal tendencies [in the wake of legalization]." 

According to Kaminer, the voice of those two groups – teens and those with mental struggles – has been drowned out by the pro-legalization camp, in part because of interest groups that eye windfall profits.  

"I have been studying the treatment of adolescent substance abuse for over 30 years. I have studied more than 2,000 teens over the course of my research and what I see is that the age is getting lower and lower. And my colleagues have also noticed that teens are becoming more psychotic at a younger age, even without any familial history of psychosis," he laments. 

Not like cigarettes 

Kaminer adds that many have overlooked the big difference between cigarettes and marijuana because they don't realize that it's a matter of concentration of the substance. Legalization would make it part of people's daily lives and in high concentrations. Many also believe the drug can help cope with mental issues, but the effect has not been proved. 

"A study conducted among US veterans who were using the drug to deal with PTSD shows that those who believed that it was helping them, saw gains in the short term. Those who said they did not believe it could help them, did not see this. But both groups had experienced the same kind of PTSD, so it's very much a placebo effect. Also, those who truly believe this is a magic bullet cannot easily transition into psychotherapy and can't properly function without cannabis, and this is one of the challenges facing the healthcare professionals," he said. 

Kaminer believes that approving the recreational use of marijuana has unintended consequences. "When you smoke a cigarette, the amount of nicotine is about 0.5%. As for cocaine, the ranchers in the Andes chew on leaves that have only about 0.5% of the drug, which does not lead to addiction. But cocaine on the market is about 30% or even 60%. This is what is beginning to happen with cannabis. Cannabis products on the street can have a concentration of about 20%, which can lead to a euphoric state of mind. In oils and pastes, this can be as high as 80% or 90%. Teens who use this get psychotic." 

Just recently, with the swearing-in of a new government in Israel, the effort to legalize marijuana has picked up steam. A new Knesset committee is about to be formed on this matter and even though the coalition has failed to muster enough votes in the Knesset plenum, the proposed legislation has been moving forward and could result in people being able to sell and use the drug in small quantities. Kaminer believes that there is not enough data that would justify such a measure, especially in light of the effect this could have on at-risk populations such as adolescents. 

"To slow this train, I tell lawmakers: Before you pass such legislation, add a few amendments to control the concentration of the substance in products and to ensure vendors can only sell it at a safe distance from public buildings. Also, add a mechanism that would help keep it away from teens. It's like having a new road paved in a neighborhood but without any traffic lights, asphalt, or speed limits and then asking the public to cross it at their own risk. That is just beyond the pale.

"If the Knesset proposal sees the light of day, we have to include various amendments that would impose certain restrictions and allocate resources for enforcement of road traffic violations. In Washington and Colorado the number of deaths among drivers who had been using marijuana has doubled since legalizations in those states," he said. 

Kaminer is a psychiatrist and a senior physician at the University of Connecticut and has been at the forefront of the effort to counter the growing trend in the US to legalize the substance, and even around the world. He believes that ultimately it is the American taxpayer who would have to pay the price for the adverse effects of the move because it would hurt the development of youngsters and because it would only make PTSD patients feel worse in the long run. 

Kaminer believes that marijuana is not a gateway drug. "Those who are going to cash in from all this are the stockholders and former officials who are eager to make money off of this," he warned. 

Kaminer stresses that those who want to adopt the Dutch liberalization model of cannabis use are misguided because the substance is only legal in regulated "Coffee Shops" and generally banned in the Netherlands. About 60% of cases of drug-addiction therapy in that country are a result of cannabis use. 

Mitigate the damage

Those who believe the legalization train has already left the station claim that Kaminer is out of step with the global trend, but he believes that things are not as clear-cut. He notes that not a single country in Europe has legalized recreational use nationwide. He and others have been sounding the alarm on the impact on teens, stressing that there are not enough studies on this. "Lab mice's teenhood is just two weeks," he says. This, he claims, makes it all but impossible to extrapolate findings on human teens. 

Kaminer is on the board of the Smart Approaches to Marijuana (SAM), an advisory group that seeks to inform lawmakers of the ramifications of legalization. Its experts, including Kaminer, testified in the Connecticut State Senate and most likely helped water down some of the provisions of the law they recently passed, by imposing restrictions on the how and where the drug can be sold. For example, some of the restrictions deal with keeping it away from schools or on how it can be advertised. 

As an Israeli, his focus now is on making sure Knesset members hear expert advice before moving forward with legalization. "Every such bill must include a budgetary estimate on the cost this could have on the economy and how to fund it, and I believe this could total some NIS 4 billion ($1.3 billion). 

"We must take into account the expected rise in car accidents and the collateral damage: loss of days of work, treatment for psychiatric disorders that could come up or get worse, including psychosis, more enforcement, and prevention efforts that would target children as early as elementary schools."

He is particularly interested in having limits imposed on the concentration of the substance on the products that would be sold if cannabis is approved, especially food products. He also seeks to close the loophole on the use of substances in vaping. "The work is cut out for us; we must engage in rigorous planning and preparations so that we don't make an unwise dash toward legalization," he warns. 

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Gila Hammer, the 18-year-old daughter of Rabbi Shalom Hammer, an educator in Israel for the past 30 years, died by suicide on Dec. 5, 2019.

Hammer told Jewish News Syndicate that following the shiva, the traditional seven-day mourning period, "I decided the only way that I could make sense of my loss, our loss – the only way that I could possibly continue and persist to exist – would be commemorating her by helping other people who are suffering, and hopefully, making an impact and saving their lives so that they should never have to experience or feel the tragic loss that we do every single minute of every day."

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A month after Gila's passing, Hammer, a resident of Beit Shemesh, was approached by Stuart Katz, the owner of a travel business whose own daughter was struggling with mental-health issues, about getting involved in a new initiative that he was introducing in Israel to help those who are at the onset of crisis.

Katz had founded the Israeli branch of Mental Health First Aid (MHFA), an Australian-based organization that since 2000 has been training individuals in countries worldwide to serve as "mental-health first-aiders" – those able to deliver initial help to people identified as grappling with certain issues until appropriate professional support is received or until the crisis resolves.

Hammer underwent the necessary training to become a certified mental health first responder as well as a trainer. On July 4, Hammer, along with instructor Ruchie Bromberg, launched the first-ever, 14-hour MHFA Israel Youth Course in Beit Shemesh with 17 participants to provide the tools they will need to become certified mental-health first-responders and help teens in crisis.

"The idea of the course is not to diagnose and not to offer therapy; it's a first-aid course for responders," said Hammer. "Just like someone from Hatzalah or [Magen David Adom] who arrives to help someone who is physically sick or in danger of losing their life knows how to respond, the same response [would apply] with regard to mental health."

Participants are taught how to spot the signs and symptoms of mental health problems in young people, as well as learn effective initial help strategies and how to guide a young person towards appropriate treatment.

Hammer noted that mental-health emergencies are more challenging to treat because such issues are simply more difficult to identify and more complex by nature.

He added that as a first responder, the goal when identifying teens who are suffering is to "bring them back to be grounded, more at ease, and then they would be willing to remind themselves that 'I do have reason to live, I do have options that I can explore,' and bring them to the next stage, which would be therapy or a hospital."

Hammer explained that the course is geared for anyone who works with youth under the age of 18, including educators, youth directors, guidance counselors and parents (the subset he feels are most in need of the course), along with mental-health professionals themselves.

Fourteen of the 17 participants who started the course on Sunday are from the Lema'an Achai organization, which fights poverty in Israel, while the other three joined independently.

'An army of people who can help save lives'

Avi Tenenbaum, an Israel-based mental-health counselor who since 2010 has been running a private practice specializing in addiction treatment and acute trauma that occurs following a catastrophic event, also served as the former director of the Psychotrauma and Crisis Response Unit at United Hatzalah of Israel. He has trained thousands of first responders in psychological first aid. (The United Hatzalah Psychotrauma and Crisis Response Unit are currently in Surfside, Fla., working with survivors and family members of the recent condominium collapse.)

As a result of Tenenbaum's expertise in providing aid for families coping in the wake of large-scale disasters, he was called to the scene in the immediate aftermath of the Tree of Life Synagogue mass shooting in Pittsburgh in 2018, Hurricane Harvey that ravaged Texas and Louisiana in 2017, the 2016 Haifa fires and many other tragedies.

Tenenbaum, who was contacted by Katz to serve as a consultant and help design the curriculum for the MHFA Youth Course, told JNS that he is a big believer that average individuals, with a minimum amount of training, can play a huge role in saving lives.

"In the addiction field, one of the biggest resources is the 12-step groups, like Alcoholics Anonymous. What it essentially is," he explained, "is a peer support group – a grassroots group where you are able to give very minimal training to people, and then they go and help each other with their own life experience and their own knowledge, and are able to help one another in a tremendous way."

Tenenbaum discovered "that in the addiction field, and then in the trauma field with the unit that I ran as well, we were able to take regular people, first responders, without psychology degrees and give them a basic course, and basic tips and tools in crisis intervention, and with minimal training, they made enormous differences in people's lives during crises."

He said, "You can tap into this enormous resource of regular people who are already in the community and who know people, including the teens who are suffering. Maybe it's their gym teacher or mini-market guy that sells milk, but they are there already. Just give them the tools to help others. All of a sudden, you have an army of people who can help save lives."

In terms of the current picture of teens suffering from mental health issues in Israel, Tenenbaum said that, unfortunately, statistics from government agencies on the topic, specifically from the Health Ministry, are not available. "Whether teens or adults, I found that the statistics in Israel are greatly lacking in a shocking way. Israel is a leader in the world in many areas, but when it came to the statistics about mental health among teens, it was so lacking."

He added, "You don't have the information. We don't even know our own situation. You have this very imperfect picture of how bad it is. And it's worse than it is. It's not that we have zero information, but it's very incomplete."

'Pay more attention to our teens'

Tenenbaum said that when he needs information or statistics, he often turns to the research commissioned independently by Headspace, an organization in Israel with centers in Jerusalem and Bat Yam, and which offers walk-in mental-health services for Israeli teens.

According to research per their website, more than 80% of adolescent mental disorders are not diagnosed or treated properly. In Israel, only 34% of adolescents aged 14 to 17 years suffering from mental disorders seek professional help due to inaccessible services, lack of knowledge and the stigma attached to seeking treatment.

Tenenbaum described Headspace's statistics as being "alarming."

"We hope Israel will be able to pull more information to get a clearer picture of the situation," he said." That will create the urgency to pay more attention to our teens, to allocate more resources to do whatever it takes to help them."

Katz told JNS that he got involved in the mental-health field when his daughter self-diagnosed herself three years ago.

"One thing I realized pretty fast, and which was verified by the professionals, is that the biggest obstacle is the stigma surrounding mental health issues," he acknowledged. "Mental health is a taboo topic until you come face to face with it. What people don't realize is that 50% of the population at some point of their lives will face mental-health issues head-on. Tragically, people don't realize it even when they are facing it."

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It is for those reasons that Katz not only became certified as a first responder, taking the course in the United States but became certified as a trainer as well. There are currently only five Israelis (including Katz and Tenenbaum) who can train the trainers and 12 individuals (including Hammer) who can teach the course.

Katz said that for the past two years, he has been advocating for the MHFA youth courses in Israel and for the past 10 months has been building the foundation, leading to this week's initial course.

"If someone is not literally bleeding from their brain, but in pain, something is wrong, and we have to be able to know how to assist them," he said. "We like to deal with this in non-crisis situations, and we don't want them to become crisis situations, just like with any type of physical issue."

He said he hopes that the number of those who achieve certification will "multiply like rabbits," so as to increase the chances of potentially saving lives.

Reprinted with permission from JNS.org.

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Health Minister Nitzan Horowitz is set to propose legislation to combat smoking addiction in Israel, including disposable electronic cigarettes that have become popular among Israeli teenagers.

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According to sources privy to the issue, "There is concern that in the past the decision-making of the political echelon with regards to e-cigarettes was motivated by unprofessional considerations." In contrast, "Horowitz intends to investigate the matter of disposable electronic cigarettes and government policies and restrictions on smoking products … with the consideration of public health alone."

As part of his initiative, the health minister is looking to raise the tax on vapors to equal regular cigarettes and tobacco; withdraw the special permit that had been granted to newspapers and other written advertising to print cigarette ads; and adopt graphic warnings on cigarette packages – a measure not yet applied in Israel but used in 120 countries worldwide.

Disposable vapors have become popular among Israeli teenagers due to their lower cost compared to reusable alternatives. They also come pre-filled with e-liquid and a pre-charged battery, making them usable immediately upon purchase.

"The idea to make electronic cigarettes disposable is a sophisticated and dangerous marketing manipulation," CEO of nonprofit Smoke Free Israel Shira Kislev said.

"Because teenagers then think they are not risking getting addicted to cigarettes because their vapor will only last them one time. But the nicotine content makes these e-cigarettes addictive, and in a cruel way, repeated use makes teenagers smoke them more and more."

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Twenty-eight years after it was first opened at Tel Aviv Sourasky Medical Center, the new facility of the Dr. Miriam and Sheldon G. Adelson Clinic for drug abuse treatment and research was unveiled on Thursday.

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Dr. Miriam Adelson and her late husband, philanthropist Sheldon Adelson, founded the treatment center, which has helped thousands of drug addicts since it was founded.

Thursday's unveiling of the new clinic was attended by Director of Sourasky Medical Center Professor Ronni Gamzu, chairman of the Association of Friends of Sourasky Medical Center Jonathan Kolber, and association director Vered Roth.

Video: Moshe Ben Simhon

Former Chief Rabbi Yisrael Meir Lau affixed a mezuzah to the door of the new center, which can now offer treatment for more addicts and more addictive substances.

"May this home be an opening of hope of welfare and rescue for the many people who will enter it, thanks to Miri and Sheldon, may he rest," Lau said.

Gamzu said that "The Adelson clinic is one of the most important in Israel, and it treats the drug-addicted population with clinical excellence and great humanity."

"The clinic staff has rehabilitated thousands of addicts, treated them, and brought them back to functioning and to society. Thanks to the new building, we will be able to expand our activity on behalf of this weaker population, all in a public clinic," Gamzu added.

"We thank the Adelson family for its enormous donation. I feel as if we've built a tower," the professor added.

Adelson spoke at the opening of the new clinic, saying that "The person who most deserves to be here, and is no longer with us, is my late husband, Sheldon. He was my partner. Although he himself was not a scientist, he intuitively understood the importance of our treatment approach. He gave his time and his expertise, without limits.

"As our sages said, anyone who saves a soul saves an entire universe. That is how I feel – that for every patient I save, I save at least 20 people. His wife, his child, his neighbor, the insurance companies, the economy, and more," Adelson said.

Clinic director Oren Avitan said, "I am committed to us being better, more humane, more professional, and more merciful."

The clinic at Sourasky Medical Center was inaugurated the same week that a new building housing the Dr. Miriam and Sheldon G. Adelson School of Medicine was dedicated at Ariel University in Samaria.

The modern building, which includes study areas and research labs, is also set to include a regional medical center with four operating rooms, a gastrointestinal imaging institute, and university clinics for paramedical professions, among others.

Dr. Adelson is physician who practices internal medicine and emergency medicine. She has researched narcotics addiction and become an expert in the treatment of it, and founded two research centers devoted to containing narcotics abuse – one in Tel Aviv and another in Las Vegas.

Sheldon Adelson, who passed away in January this year, co-owned Israel Hayom with Miriam Adelson. Aside from his philanthropic activity, in which he donated millions to organizations and institutions, Adelson also funded a Boston-based research foundation focused on live-threatening illnesses.

The Adelson family owns the company that is the primary shareholder in Israel Hayom. Dr. Miriam Adelson is the publisher of Israel Hayom.

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Israelis are gaining weight, and nearly one in five adults smoke, according to a new report from the Israel National Institute for Health Policy and Health Services Research that looks into the work of Israel's various healthcare providers for 2019.

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The report examined 40 parameters linked to heart disease and vascular disease, pre-cancer screenings, mental health, infectious disease, diabetes, and the promotion of a healthy lifestyle. When it comes to the issue of excess body weight, the data from 2019 indicate that 62% of men and 55% of women were overweight.

In addition, the report showed that excess weight is a growing problem among young Israelis, with 10.9% of 14-year-olds suffering from excess body weight in 2019, compared to 10.5% in 2018 and 10.2% in 2017.

How many Israelis smoke? According to the report, nearly one-fifth (19.6%) of the population aged 16-74 are smokers. In recent years, steps to curtail smoking have been taken at various levels, such as banning smoking in public areas, offering easier access to medications that help people break their addiction to smoking, and Health Ministry public service announcements, but the percentage of smokers remains high.

In 2019, 27.3% of Israeli men and 12.4% of Israeli women smoked, which marked an increase compared to 2018, when the percentages of smokers by gender were 27% and 12.1.%, respectively. Israel has a higher percentage of smokers than the OECD average of 18%.

According to the report, 2019 also saw a decrease in the percentage of women who underwent mammograms to detect breast cancer, with 71% of women aged 50-74 having undergone mammograms, compared to 72.5% in 2018. The rate of colon cancer screenings remained the same year-on-year.

However, for the first time, the report looked at the numbers of patients who tested positive for fecal occult blood and found that one-third did not undergo colonoscopies to examine the findings, as recommended by their doctors.

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According to the report, which was released on May 16 under the title, "Addressing Problematic Opiod Use in OECD Countries," data from 2014-2016 put Israel in 11th place out of 37 OECD countries for opioid use, a 13% increase from 2013, when Israel ranked 24th. However, Israel leads the pack when it comes to the rate of increase in opioid use – from 2011-2013 to 2014-2016 Israel experienced a 125% increase.

The report explains that "opioids are a type of narcotic medication that have become the basis of therapy for moderate to severe pain in many developed countries," and goes on to say that prescriptions of opioid analgesics have been steadily rising in OECD countries, including for "chronic, nonmalignant pain."

The report points to over-prescription of opioids as one of the main contributing factors in the growth of problematic opioid use.

In the 2014-2016 period, among the countries above the OECD average in availability of analgesic opioids, only four saw decreased use: the United States (-12.9%), Belgium (-7.3%), Denmark (-18.2%) and Australia (-10.9%).

The report revealed that some 87,000 Israelis use opioid analgesics on a daily basis.

Information on opioid-related deaths is apparently not collected in Israel, but in the 25 OECD countries in which such data is collected the average rate of opioid-related death has increased by 20% in recent years. In the United States, between 1999 and 2017, 399,230 people died from an opioid overdose.

The Health Ministry has reportedly established a committee to address the issue.

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