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EP. 431: Dr. Silviu Brill, Tel Aviv Medical Center

Cannabis Economy Podcast
EP. 431: Dr. Silviu Brill, Tel Aviv Medical Center

EP. 431: Dr. Silviu Brill, Tel Aviv Medical Center

Dr. Silviu Brill, of the Pain Institute of Tel Aviv Medical Center, is passionate about the need for personalized medicine in Israel and around the world. Although he believes that some standardization is necessary, it is indisputable that each person and condition requires a unique ratio of THC and CBD. As Honorary Secretary of the European Pain Federation, Brill also spends much of his time researching how to best treat chronic pain in Europe. Nowadays, there is an unprecedented open-mindedness about ensuring safe patient access and sensible regulations.

Transcript:

Seth Adler: Dr. Silviu Brill joins us. Welcome to Cannabis Economy, I'm your host, Seth Adler. Download episodes on canneconomy.com, that's two n's and the word "economy", or wherever you currently get your podcasts. Canneconomy.com has a ton of direct insight these days from scientists, policy makers, and business leaders in the space. First a word from MedMen and then Dr. Silviu Brill

MedMen: MedMen continues to expand its footprint on the cannabis landscape, opening new stores in Los Angeles, Las Vegas, and the iconic 5th Avenue in Manhattan. They've also opened a 45,000 ft high-tech cannabis cultivation and manufacturing facility in Nevada. The company has reached a one-million-dollar valuation, making it the country's first cannabis unicorn, and it's just the beginning.

MedMen: Learn how MedMen is building the future of cannabis today at MedMen.com.

Silviu Brill: Hi, my name is Silviu Brill, I'm director of the pain institute of Tel-Aviv Medical Center in Tel-Aviv. Past president of Israeli Pain Association, and for the last few months, Honorary Secretary of European Pain Federation.

Seth Adler: And so.

Silviu Brill: And so.

Seth Adler: You are one of these people, one of these physicians that has helped kind of bring cannabis forward. Especially here in Israel.

Silviu Brill: Yeah, I start use cannabis for medical reasons long time ago, twelve, thirteen years ago. In the medical clinic in Tel [inaudible 00:01:36] where I used to work at the time. I was one of the pioneers who asked for minister of health to give approval for the very very few patients at that time to be treated of medical cannabis.

Seth Adler: You said you were looking for options, before we turned on these microphones. You were looking for options, give us a sense of what you were dealing with with the patients that you had that made you say "Okay, actually, minister, I need another option."

Silviu Brill: I'm dealing with chronic pain, a very difficult condition to treat and to understand. We used, at the beginning and also these days, not cannabis, not as a fertile second line of treatments. When you failed to help your patients, helping reducing pain, improving quality of life, improving sleep, you try to have more things in your arsenal. At that time, cannabis show up as a new option. Very strange, we didn't know how to deal with them, as also in these days.

Silviu Brill: We start to have a new and nice option to treat our patient who've been in large doses of opioids or after medical procedure or surgery. And it worked.

Seth Adler: It worked. Now, you're a physician, how did you know it worked?

Silviu Brill: I... in pain... treating pain, you have only subjective things to ask. Does it help you? Is it reducing your pain? Is it improving? Nothing that I can measure, like blood pressure or temperature. So everything we are doing in my profession is asking and speaking and understanding your patients. That's the way I can say "work", "not work". And again, the side-effects of any kind of treatment.

Seth Adler: So this is... as far as it working, you take their... what they say, however, there is a certain kind of patient that will be okay with taking cannabis, whereas there will be a certain kind of a patient that won't be okay with taking cannabis. Is that what you've found?

Silviu Brill: Definitely. Patients who haven't tried anything is not the first kind of treatment. Patient with contraindication, different psychiatric condition or very young “I'm not happy to start treating with cannabis” without being treated together, multi-disciplinarian with other professions.

Seth Adler: Dr. Silviu Brill joins us. Welcome to Cannabis Economy, I'm your host, Seth Adler. Download episodes on canneconomy.com, that's two n's and the word "economy", or wherever you currently get your podcasts. Canneconomy.com has a ton of direct insight these days from scientists, policy makers, and business leaders in the space. First a word from MedMen and then Dr. Silviu Brill

MedMen: MedMen continues to expand its footprint on the cannabis landscape, opening new stores in Los Angeles, Las Vegas, and the iconic 5th Avenue in Manhattan. They've also opened a 45,000 ft high-tech cannabis cultivation and manufacturing facility in Nevada. The company has reached a one-million-dollar valuation, making it the country's first cannabis unicorn, and it's just the beginning.

MedMen: Learn how MedMen is building the future of cannabis today at MedMen.com.

Silviu Brill: Hi, my name is Silviu Brill, I'm director of the pain institute of Tel-Aviv Medical Center in Tel-Aviv. Past president of Israeli Pain Association, and for the last few months, Honorary Secretary of European Pain Federation.

Seth Adler: And so.

Silviu Brill: And so.

Seth Adler: You are one of these people, one of these physicians that has helped kind of bring cannabis forward. Especially here in Israel.

Silviu Brill: Yeah, I start use cannabis for medical reasons long time ago, twelve, thirteen years ago. In the medical clinic in Tel [inaudible 00:01:36] where I used to work at the time. I was one of the pioneers who asked for minister of health to give approval for the very very few patients at that time to be treated of medical cannabis.

Seth Adler: You said you were looking for options, before we turned on these microphones. You were looking for options, give us a sense of what you were dealing with with the patients that you had that made you say "Okay, actually, minister, I need another option."

Silviu Brill: I'm dealing with chronic pain, a very difficult condition to treat and to understand. We used, at the beginning and also these days, not cannabis, not as a fertile second line of treatments. When you failed to help your patients, helping reducing pain, improving quality of life, improving sleep, you try to have more things in your arsenal. At that time, cannabis show up as a new option. Very strange, we didn't know how to deal with them, as also in these days.

Silviu Brill: We start to have a new and nice option to treat our patient who've been in large doses of opioids or after medical procedure or surgery. And it worked.

Seth Adler: It worked. Now, you're a physician, how did you know it worked?

Silviu Brill: I... in pain... treating pain, you have only subjective things to ask. Does it help you? Is it reducing your pain? Is it improving? Nothing that I can measure, like blood pressure or temperature. So everything we are doing in my profession is asking and speaking and understanding your patients. That's the way I can say "work", "not work". And again, the side-effects of any kind of treatment.

Seth Adler: So this is... as far as it working, you take their... what they say, however, there is a certain kind of patient that will be okay with taking cannabis, whereas there will be a certain kind of a patient that won't be okay with taking cannabis. Is that what you've found?

Silviu Brill: Definitely. Patients who haven't tried anything is not the first kind of treatment. Patient with contraindication, different psychiatric condition or very young “I'm not happy to start treating with cannabis” without being treated together, multi-disciplinarian with other professions.

Seth Adler: Okay, so you are checking in on psychosis before you prescribe cannabis?

Silviu Brill: I do.

Seth Adler: This is a very serious thing, of course. What, how do you stay up to date with what information is actually out there? Other than the information that your patient is providing you directly.

Silviu Brill: First of all, I have to ask the patient. Second, we have, in Israel, a system we can go to see all the patient history, so nothing is not there. Psychiatric, this is part of... we can see directly the treatment that they get. And usually the patients are telling us in hand, and the other hand I'm asking, I'm speaking with my patient. Not the first, nothing is the first meeting I'm giving... to give him all the treatment. You need to build up a sort of... in my profession, in chronic pain... an area to build up the relation of the patient to a sort of chemistry, to be each other on the same wave in order to understand and to build up a treatment.

Seth Adler: So this is personalized medicine?

Silviu Brill: Definitely.

Seth Adler: Okay. Now I here from physicians, I hear from scientists, I hear from, certainly, business folks want to kind of make things standard, make things systemic. When you hear about calls for that type of behavior and that kind of outcome, what do you think, as a physician who is interested in personalized medicine?

Silviu Brill: I'm completely agree, you need to work on standards. Personally, medicine is coming out of the standards, but you need to have standards in order to go over, you can't do personalized medicine in desert without having nothing behind you. You need to have standards in any kind of treatment, it doesn't matter the name of the treatment. You need to have [inaudible 00:05:58] rates of treatment and you are going to personalize your treatment based on the [inaudible 00:06:04] rates.

Seth Adler: How has what you are working with in cannabis changed over these dozen years? Early on, I'm sure it was flower?

Silviu Brill: Yeah, well understand, I think. We are thinking, I'm not sure that is... we are right [inaudible 00:06:19] much more than the early days. We have much more options. It's starting to be, in Israel and all over the world, more standardized and more clear what the patient is getting. Not only flower, it's also drugs as a sort of [inaudible 00:06:35], clinical trials, and there are... thinking we know much more than earlier days.

Silviu Brill: I have in my unit, my institute, I'm treating around two thousand patients, so we have some experience already, for... they are already more than ten years, part of them.

Seth Adler: As far as what you are prescribing, is it in pill form? Is it in spray form? Is it in tincture form?

Silviu Brill: Well, mainly two forms: Flowers for smoking or vaporizing, and oils for oral use. That is the main issue. There are very simple cookies for very young children with epilepsy, but that is the idea: that we are treating this way.

Seth Adler: And as far as the cannabinoids and the oils, how specific are you getting?

Silviu Brill: Nowadays we are getting very specific. In the new wave that is going is Israel, are getting very specific nowadays.

Seth Adler: Can you give us some examples? I know that you have over two thousand patients, you have patient/client privilege.

Silviu Brill: Part of them are the new regulation that are getting very clear, let's say THC 8% and CBD 2% oil, or THC 15% and CBD 8%. The patients who are getting flower are in all way there's less specific, but there's the way that we are getting close to the specificity.

Seth Adler: As far as chronic pain is concerned, and the ratios, do you have thoughts on THC vs CBD, and what works and what doesn't?

Silviu Brill: Just thoughts, not something that needs to go away. Probably... no definitely, we need to have a synergy to... both to get, not only a single [inaudible 00:08:14] but I can say that this is much better for headache, and it is much better for abdominal pain.

Seth Adler: You are seeing the need for somewhat of an entourage effect.

Silviu Brill: Yeah I definitely see the need for an entourage effect.

Seth Adler: More than one cannabinoid.

Silviu Brill: Yes.

Seth Adler: Okay. Alright, so we've spoken about Israel, and now... also you have this position in the EU. Can you share?

Silviu Brill: Yeah I am the honorary secretary of the European Pain Federation, the biggest pain federation in Europe, and we start up a few years ago. I'm leading the task force for the use of cannabis for pain conditions. We are... we, all of us, published a survey that was going on in Europe, we are redoing the survey in this year, until the end of the year. Also, we'll show up some guidelines from how to treat chronic pain in Europe.

Seth Adler: Okay, in that initial survey, what findings can you share, generally?

Silviu Brill: It's a very dynamic and a very growing process. A very fast changing situation in all the countries of Europe. We in Israel are much in front of all the countries, we and Holland. They are moving fast to catch up.

Seth Adler: Yeah, so there is an open-mindedness that you hadn't seen before in Europe?

Silviu Brill: Definitely there is an open mind, and also they put in parliament... they published a motion this month to say "we want you to try, it's okay to use cannabis for medical purposes in Europe”.

Seth Adler: Okay, so there's some policy. For other policy makers that are listening, what would you say from your physician point of view? What should they be looking for? What should they be hearing?

Silviu Brill: What I'm saying, that we need to understand and to treat our patient, doesn't matter in which way, and to do the best for their well-being.

Seth Adler: What do business owners need to take into account as we create an economy around this medicine?

Silviu Brill: To understand what's the best strain for the specific patients and for specific disease. This the way... and to make it more easy to the patient to get it. Also in the way of money, or policy makers.

Seth Adler: Safe patient access, but sensible regulations. I have three final questions for you, I'll tell you what they are, I'll ask you them in order: What's most surprised you in cannabis? What's most surprised you in life? And on the soundtrack of your life, one track, one song that's got to be on there. That's always the last question we ask.

Seth Adler: First thing's first: what has most surprised you in cannabis?

Silviu Brill: That it works. Yeah.

Seth Adler: That is a very simple answer.

Silviu Brill: For different condition, even you can treat a patient with high dose of opioids and can reduce the dose.

Seth Adler: It's... to come off of opioids?

Silviu Brill: Come off or reduce.

Seth Adler: Yeah. Understood, because we have an addiction problem specifically in the U.S. and so there's... what's most surprised you in life? That you're here?

Silviu Brill: That I'm here? I'm enjoying every day, every second. So I-

Seth Adler: You have to, right?

Silviu Brill: Yeah, I have to, and I'm happy being here with my family.

Seth Adler: On the soundtrack of your life, one track, one song that's got to be on there.

Silviu Brill: I'm weak on songs.

Seth Adler: You're weak on songs? Well where... are you from here? Are you from Israel?

Silviu Brill: Yeah.

Seth Adler: Okay, you grew up here?

Silviu Brill: No, I was born in Romania, and grow up in Israel.

Seth Adler: Okay, well what is the... maybe do the Romanian national anthem?

Silviu Brill: No.

Seth Adler: Nadia Comaneci? Do you know her?

Silviu Brill: I heard about, yeah. Don't know her personally.

Seth Adler: Thank you very much, we will check in with you down the line, okay?

Silviu Brill: Thank you very much, bye-bye?

Seth Adler: And there you have Dr. Silviu Brill, very much appreciate his time, very much appreciate your time, stay tuned.

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Cannabis Economy is a real-time history of legal cannabis. We chronicle how personal and industry histories have combined to provide our current reality.