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Ep. 432: Dr. Michael Segal, Shaar Menashe Hospital

Cannabis Economy Podcast
Ep. 432: Dr. Michael Segal, Shaar Menashe Hospital

Ep. 432: Dr. Michael Segal, Shaar Menashe Hospital

For eleven years, Dr. Michael Segal has been treating PTSD patients – mainly IDF veterans – with medical cannabis. Segal describes the incredible improvements he has seen in his patients: “If you see a post-traumatic patient before and after cannabis, you see two different persons.” Segal compares this type of success in Israel to the lack thereof in the United States in order to emphasize how important it is to prioritize our veterans’ mental health.

Transcript:

Seth: Dr. Michael Segal joins us. Welcome to Cannabis Economy. I'm your host, Seth Adler. Download episodes on caneconomy.com or wherever you currently get your podcasts. Caneconomy.com has a ton of direct insight these days, from science, policy, and business leaders in the space. First a word from Bedrocan and then Dr. Michael Segal.
Bedrocan is a patient-driven, global, pharmaceutical-minded cannabis company. Their entire end-to-end process is GMP certified through Dutch and ultimately European authorities. Bedrocan is the market leader in Europe for medical cannabis and has been the sole supplier to the Dutch government for 16 years. Through the Dutch government, Bedrocan provides product to 15 countries, currently. As a science-based company, Bedrocan invests in clinical research. The Leiden University conducted a double-blind, placebo-controlled clinical trial on fibromyalgia with Bedrocan products, which yielded promising results. They are now working on a follow-up to that study. Bedrocan is also working on the extent to which cannabis can reduce a reliability on opioids. Bedrocan believes that clinical research is key for the future of the company, standardized product, the industry, and the patient. Visit bedrocan.com for more information.

Dr. Segal: My name is Michael Segal. I am a psychiatrist. I am head of a department in the psychiatric hospital of Israel, its name is Sha'ar Menashe. I am also belong to the Technion Faculty of Medicine in Haifa, and I have my clinical practice in Haifa, and I treat a lot of patients, actually most of them, with post-trauma.

Seth: Okay.

Dr. Segal: A private practice.

Seth: So, let's dive in on your private practice with PTSD. How long have you associated cannabis with PTSD?

Dr. Segal: 11 years. This time, way before Pesach in 2008, this was my first patient, he convinced me that is something different that I knew.

Seth: He convinced you?

Dr. Segal: With the results of the treatment he received the approval to take cannabis and he changed dramatically from his previous condition that it was one of the worse that I saw.

Seth: Now, things have changed over the past 11 years of course. At the time, how did this all occur? You as the doctor, you as the physician, had to sign off on this, or he ... How did it occur?

Dr. Segal: I treated a lot of patients who were IDF veterans that were injured in the army. They were sent to me by the Ministry of Defense. I began to treat them, actually I treat in the private practice, and I saw that all of them, but moreso all those there that were post-traumatic, improved.

Seth: Improved. From cannabis use.

Dr. Segal: From cannabis use. All of them were treated with combination of treatment, medication that was accepted. Just know [inaudible 00:03:40] like mood stabilizer, like sleep pills, or anti-anxiety, but it was inefficient. Also psychotherapy was inefficient and so on.

Seth: When you say inefficient, how did we actually come to cannabis? I understand you have been convinced since then, but when you say inefficient, what were you seeing that wasn't working? That wasn't-

Dr. Segal: Inefficient? The main inefficiency was related to the traumatic memories, to the flashbacks, to the core symptoms of post-trauma. The depressive state probably was slightly influenced and maybe a little bit sleep, but the core symptoms that they suffered didn't improve with any treatment they received.

Seth: Dr. Michael Segal joins us. Welcome to Cannabis Economy. I'm your host, Seth Adler. Download episodes on caneconomy.com or wherever you currently get your podcasts. Caneconomy.com has a ton of direct insight these days, from science, policy, and business leaders in the space. First a word from Bedrocan and then Dr. Michael Segal.
Bedrocan is a patient-driven, global, pharmaceutical-minded cannabis company. Their entire end-to-end process is GMP certified through Dutch and ultimately European authorities. Bedrocan is the market leader in Europe for medical cannabis and has been the sole supplier to the Dutch government for 16 years. Through the Dutch government, Bedrocan provides product to 15 countries, currently. As a science-based company, Bedrocan invests in clinical research. The Leiden University conducted a double-blind, placebo-controlled clinical trial on fibromyalgia with Bedrocan products, which yielded promising results. They are now working on a follow-up to that study. Bedrocan is also working on the extent to which cannabis can reduce a reliability on opioids. Bedrocan believes that clinical research is key for the future of the company, standardized product, the industry, and the patient. Visit bedrocan.com for more information.

Dr. Segal: My name is Michael Segal. I am a psychiatrist. I am head of a department in the psychiatric hospital of Israel, its name is Sha'ar Menashe. I am also belong to the Technion Faculty of Medicine in Haifa, and I have my clinical practice in Haifa, and I treat a lot of patients, actually most of them, with post-trauma.

Seth: Okay.

Dr. Segal: A private practice.

Seth: So, let's dive in on your private practice with PTSD. How long have you associated cannabis with PTSD?

Dr. Segal: 11 years. This time, way before Pesach in 2008, this was my first patient, he convinced me that is something different that I knew.

Seth: He convinced you?

Dr. Segal: With the results of the treatment he received the approval to take cannabis and he changed dramatically from his previous condition that it was one of the worse that I saw.

Seth: Now, things have changed over the past 11 years of course. At the time, how did this all occur? You as the doctor, you as the physician, had to sign off on this, or he ... How did it occur?

Dr. Segal: I treated a lot of patients who were IDF veterans that were injured in the army. They were sent to me by the Ministry of Defense. I began to treat them, actually I treat in the private practice, and I saw that all of them, but moreso all those there that were post-traumatic, improved.

Seth: Improved. From cannabis use.

Dr. Segal: From cannabis use. All of them were treated with combination of treatment, medication that was accepted. Just know [inaudible 00:03:40] like mood stabilizer, like sleep pills, or anti-anxiety, but it was inefficient. Also psychotherapy was inefficient and so on.

Seth: When you say inefficient, how did we actually come to cannabis? I understand you have been convinced since then, but when you say inefficient, what were you seeing that wasn't working? That wasn't-

Dr. Segal: Inefficient? The main inefficiency was related to the traumatic memories, to the flashbacks, to the core symptoms of post-trauma. The depressive state probably was slightly influenced and maybe a little bit sleep, but the core symptoms that they suffered didn't improve with any treatment they received.

Seth: It was just smoked cannabis, I would imagine at the time, all the way back then, yes?

Dr. Segal: Yes.

Seth: Okay. How did they report a difference in ...

Dr. Segal: Huge difference. It was amazing-

Seth: How did they, if you could-

Dr. Segal: First of all, they begin to sleep without nightmares, without interruption of the sleep. The mood improved. The sex improved. The feelings, in psychiatry it's anhedonia, the impossibility to feel happiness or sadness, improved. The attention and memory improved. They finished school. They began to work in high-tech and other things. I can't get into ... to be able to understand, but I reported that from 29% they are occupied in studies or work, they improve to 70% of patients that work or learn or so ...

Seth: It was from under 30% to over 70%.

Dr. Segal: Yeah. Yeah, yeah, yeah, no, I wasn't able to make controlled research because it's difficult in Israel to receive the approval of the institutions, but I think that you can contest the improvement of occupations was amazing. And 75% of my patients interrupted any medical treatment, even against pain, not all psychiatric treatment, but anything, they are without treatment, only with cannabis.

Seth: No other medication.

Dr. Segal: No other medication.

Seth: 75%.

Dr. Segal: 75%.

Seth: Okay. Now, we say that obviously it's hard everywhere to get the approval to use cannabis for clinical trials, so that's some of the problem. But as far as the research that has been done, maybe not a double-blind, placebo-controlled study, but what have you seen that has been done that has been published?

Dr. Segal: Almost nothing. I know that actually there are trials that are ongoing.

Seth: Right now.

Dr. Segal: Right now in the United States. I met Sue Sisley.

Seth: Sue Sisley. Yes, she's been on.

Dr. Segal: I knew her. And I know that she made an announcement to the newspaper about her trials, and I know it was a trial about veterans that were also physically injured, that had injuries, traumatic brain injury and post-trauma also. I didn't see the results of the paper. And I know that everywhere in the world there are trials that are ongoing now.

Seth: Now they are ongoing. They weren't, certainly weren't going-

Dr. Segal: I didn't see the papers.

Seth: Yeah. But they certainly weren't happening 10 or 11 years ago and now they're starting to get done.

Dr. Segal: You know it's a very difficult challenge to change the mind to think about cannabis like it's a drug, and to understand that it's a treatment, a very efficient treatment, not all in post-trauma but also in other disabilities.

Seth: Okay. Now, how much do you focus on schizophrenia, understanding that you are in psychiatry?

Dr. Segal: I have a double life. In the hospital I treat most of the patients in the closed ward are schizophrenics, and in my private practice they are patients that I can treat in my clinic, actually most of them are post-traumatic. In schizophrenia, it's almost a contrary indication to treat because there is not a fine-tuning of the differences between type of schizophrenia. I can do it but I have not the approval to treat schizophrenia because there are patients that their condition is worsening with cannabis.

Seth: Right. This is what I have read as well. What does this make you think about cannabis? You are seeing obvious success from your perspective on PTSD's side, but then ...

Dr. Segal: You know, Seth, I have such a hard work with my post-traumatic that I haven't time to think seriously about schizophrenia or other ... it's OCD also, they respond very well with cannabis. There are rare syndromes that also improve, like alcoholic fetal syndrome, yes, and other ...

Seth: Alcoholic what was this?

Dr. Segal: In Israel are more than 1000 children that were adopt from the Eastern Europe, and their parents probably were alcoholic-dependent, and they suffer from disabilities due to the-

Seth: Substance abuse with alcohol.

Dr. Segal: [crosstalk 00:10:14] Yeah, like attention deficit, hyperactivity, all that and more. So our language is anecdotal, that I had one or two patients that improved dramatically with the cannabis. And I think that there are a lot of other diseases that can benefit a lot of cannabis. Schizophrenia's one of them and I didn't deny the possibility that we use but you need to find the type of schizophrenia this is relevant for the cannabis, not all of schizophrenia's ...

Seth: Whereas you might be convinced that PTSD, we're pretty well set.

Dr. Segal: Absolutely.

Seth: Yeah. But on schizophrenia we need to dive in and be a little bit more precise.

Dr. Segal: Right.

Seth: Okay. I wonder about your colleagues in academia. Your colleagues, your physicians on the street, so to speak. How have their opinions changed? How has their work changed over the past decade plus?

Dr. Segal: A lot. When I began I was almost alone. We are two or three psychiatrists with cannabis. Now there are more and there are a lot of psychiatrists that they can recommend cannabis in their clinics or in hospitals, but they recommend kind of another to [inaudible 00:11:49] to help these patients. There are a lot of psychiatrists that are convinced if you see a post-traumatic patient before cannabis and after cannabis you see two different persons.

Seth: And how do you mean two different people? Because I have seen the same thing, but, please, from your perspective.

Dr. Segal: From my perspective they are relaxed, they are with huge improvement of mood, they describe an improvement of sleep, and all things that I told you, and most important, that the traumatic memories almost disappear. Then they are able to speak about the traumatic events with being relaxed and something that's ... they give interviews, they write, they describe without special emotion about the ... that's amazing.

Seth: What was an inability to communicate becomes an ability to communicate.

Dr. Segal: Absolutely. Absolutely.

Seth: Okay. So we've got over a decade's worth of work. Obviously, we're looking for more research. That's number one. From your academic science brothers and sisters, we want more work, we want as many clinical trials as possible.

Dr. Segal: Correct. I think that's very important. The picture that you saw, it was about the American soldiers that were post-traumatic more than the 300000 veterans that are post-traumatic with a higher rate of suicide. It's very important to treat them.

Seth: As far as policymakers are concerned, whether it be in Israel or anywhere else, you know that it is difficult to research based on the way that the laws are written. What would be your advice, your suggestions, if you could sit next to someone? Because some of those folks listen. Folks that are legislators and regulators. What would you say to them from your physician standpoint?

Dr. Segal: I'm going to apply to begin to research with a hospital in northern Israel. I think that things will change. I hope that I be enough patient and strong to wait and to make things like grants for there are more and more persons and companies that are interested to investigate the post-trauma and the cannabis as well.

Seth: Regulations, at least in some countries, are getting easier to do some research. There's more and more grants from governments wherever they are. Am I hearing you correctly, or ...?

Dr. Segal: In Israel is difficult to begin research but I think that it's an issue of time until people will be convinced that it's not only a drug but a treatment.

Seth: You mentioned companies, you mentioned-

Dr. Segal: You can see this meeting that prominent that might change.

Seth: So, we're here at a meeting. There were roughly 250 people. Mostly physicians.

Dr. Segal: Correct.

Seth: Did you get the sense that this is welcome information? Because essentially we were talking all about cannabis.

Dr. Segal: Israel is a very new country and everybody knows everybody and I think that it's important to describe and to make the things free and-

Seth: At least the information.

Dr. Segal: The information. Scientific and clear and based on the data.

Seth: You mentioned businesses or companies, I think, earlier, and I wonder, if this was a room full of CEOs, chief executive officers from these companies, what would you tell them? What could they do to help you? Besides just put money into research? Obviously this is [crosstalk 00:16:16].

Dr. Segal: It's important. I'm not looking for money, but you need money to begin anything. To be convinced that it's something that is very important to a lot of people. To understand that what we did is inefficient. More than that, with the side effects of conventional medication, and that cannabis is something else, almost without side effects, it's amazing. The post-traumatic person are not sleeping, they improve the driving, they improve the cognitive-

Seth: Capability.

Dr. Segal: Capabilities, performance, and so on.

Seth: You say almost without side effects.

Dr. Segal: Without. Without side effects.

Seth: You're saying without side effects.

Dr. Segal: I didn't see ... I make generally a telephone interview to any person that want to make an appointment with me, and I focused only for the persons that are probably the best candidates to cannabis. 70% I don't receive in my clinic because I know that they have not the diagnosis to cope with my possibilities, or they didn't receive the medication or something that is preconditioned for cannabis apply.

Seth: Right. So they have to be approved before you can help them, almost.

Dr. Segal: Of course.

Seth: Okay. So we have to change a number of different things here.

Dr. Segal: A lot of things changed in this year.

Seth: So it has changed a lot in the recent past and it needs to change more as we go.

Dr. Segal: The most, in my mind.

Seth: Yeah. But we still have a long way to go, is what I'm saying.

Dr. Segal: Correct.

Seth: Or, I'm trying to make sure that I understand that that's what you're saying. So, just one more time, again, we go back 11 years to when a patient comes to you and you want to help the patient but not every doctor, not every physician, is going to do what you're going to do and say, "Okay, yes, let's try it." What do you think it is in your background? What is it about you?

Dr. Segal: I tell you. For years, almost 20 years, I treated the Israeli veterans from the IDF, they received a percentage of incapacity for being post-traumatic. A lot of them described problems with memory, with concentration, the incapacity to improve their cognitive performance in any reason, they are not able to watch television, to remember that they learned. So I edit the diagnosis of a kind of ADHD, attention deficit hyperactivity disorder, they received psychostimulants like methylphenidate, the medication that we give to the children with hyperactivity, and almost all of them improved. When one of the chief psychiatrists of Israel proposed let's send this guy, post-traumatic, very severe post-traumatic soldier to cannabis, I learned a lot.

Seth: You have to pay attention if almost all of a-

Dr. Segal: So the first one, this is the beginning of my speech about this very serious post-traumatic patient that was in the army, in the elite of the army. I saw him, this was the first one, he changed 180%. It was another man.

Seth: Night and day is what went, right?

Dr. Segal: In hours.

Seth: In hours. Okay. So we will get to work, we will do what we can to keep speaking to more people about making change, like we're speaking to you. In the meantime, I'll ask you three final questions. I'll tell you what they are, and ask you them in order. What's most surprised you in cannabis? You might've already answered it. What's most surprised you in life? And on the soundtrack of your life, one track, one song that's gotta be on there? We ask everybody that last. First thing's first, though. What has most surprised you in cannabis? You might've already answered it.

Dr. Segal: The improvement, the huge improvement, and the disappearance almost of any symptom of post-trauma. It was amazing. 11 years passed and I have the same-

Seth: You're still amazed.

Dr. Segal: Yeah. Not amazed but I'm very happy that I see a person improve. I know that if somebody is the correct patient for post-trauma and cannabis, I know that the next visit to me, he will be another person.

Seth: I see. So you already know-

Dr. Segal: I think this is my destiny of any physician, any psychiatrist, to look for improvement.

Seth: Right, that's what we're going for.

Dr. Segal: I'm very lucky to be in this issue.

Seth: Yeah, it's special.

Dr. Segal: I had ... Not in my more or less [inaudible 00:22:15] but I had a lot of success in my activities of psychiatrics in the hospital. This is different.

Seth: I understand. Well they're not going to send you the elite soldier that they sent you if you don't have success before, so we understand. What's most surprised you in life? It might be the same answer. What's most surprised you in life?

Dr. Segal: In life?

Seth: Yes.

Dr. Segal: Every day is a surprise for me. I have no idea what is the most surprised thing but these stories that I was able to write books about stories in psychiatry's also surprising.

Seth: Right. On the soundtrack of your life, one track, one song that's gotta be on there. A special song in your life.

Dr. Segal: There are a lot of thing, but in song is in Hebrew, it's translated "You and Me Will Change The World."

Seth: Okay.

Dr. Segal: Yes, a hit that's forty years in Israeli music and is very sensitive for me.

Seth: Perfect, and this is your wife chiming in as well.

Dr. Segal: Yeah, my wife [crosstalk 00:23:26] We are Romanians, born.

Seth: I see, I met another Romanian today as well. That's interesting.

Dr. Segal: Yeah, a lot. There are 400000 Romanians in Israel.

Seth: There we go. Alright, well, thank you very much for your time, and we'll check in with you down the line.

Dr. Segal: Thank you very much.

Seth: And there you have Dr. Michael Segal. 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.