“Behold, I have given you every herb, yielding seed…”

Perhaps it should be no surprise that Ichilov Hospital in holy Tel Aviv is attempting to use the re-emerging herbal medicine, cannabis, to treat the deadly scourge of COVID-19. We clinicians, treating the coronavirus patients on a daily basis, are struggling to find answers while throwing large chapters of the pharmacopeia at the virus and seeing what will stick safely. There is no cure yet, only therapies that may shorten the disease course or ease the symptoms. So it is by no means a stretch for Israeli researchers to attempt novel and experimental therapies like cannabis. Medical cannabis is far from the joke it used to be, possessing over 120 compounds unique to the plant, many of which have underexplored medical properties, only now re-emerging on the medical scene.

Indeed it has been found in 11 out of 12 studies from 1966-2005 that cannabinoids have significant short-term bronchodilating properties, similar if not more potent than several typical metered-dose inhalers. (Archives of Internal Medicine. 2007 Feb 12; 167 (3): 221-228). Thus, if medically vaporized, not smoked, legally qualified patients may potentially open up their bronchioles and improve oxygenation in this pulmonary menace.

Additionally, according to Dr. Yehoshua Maor of Jerusalem, a well-known researcher in the field of cannabinoids, “The effects of cannabinoids on the immune system and the inflammatory response is well established.” Cannabinoids have novel anti-inflammatory properties, particularly CBD. (Future Med Chem 2009 Oct 1(7): 1333-1349). Additionally, THC has been found to have 20 times the anti-inflammatory potency of aspirin and twice that of hydrocortisone. (Planta Med 1991; 57 (Suppl 1): S60-S67). Given that the immune system has a large amount of cannabinoid receptors (CB2) that can be regulated by medically administered cannabinoids, exploring their utility is surely not a shot in the dark.The novel coronavirus (SARS CoV2) attacks patients’ red blood cells and lung cells themselves, leading to what can be severe lung disease. With this deadly disease, a war ensues in the blood vessels, particularly in the lungs, where red blood cells are competing with the virus for oxygen. This war tragically and often spills over into the lung tissue itself, leaving excess iron to build up and an overwhelmed pulmonary and immune system attempting to rid the lungs of debris and restore oxygen exchange. Combined with a surge in cytokines (inflammatory chemo-mediators) the body’s own immune system can overwhelm the lungs. Blood clots often complicate this battle for the patient to survive. Thus, cannabis, having both bronchodilatory and anti inflammatory properties, could prove beneficial.

Yet prior to self-experimenting with cannabis during the COVID-19 crisis, it is important to know that the plant is not legally designated for this purpose in New Jersey unless one is actively dying, chas v’shalom. That said, CBD oil (the non-psychoactive component of cannabis) is fully legal over the counter in all 50 states, but it is too early to say whether it can be used in COVID-19-related lung disease—thus the Tel Aviv trial underway. Given that Israel’s regulatory atmosphere around cannabis research is more flexible than the U.S., the trials are thus efficient to conduct. Ichilov Hospital is testing CBD extracts, which may limit the applicability to the use of the herb’s full power against the disease, but Dr. Barak Cohen, the head of corona management at the medical center, says, “This is a novel approach to treating some of the symptoms, using a component of the plant that is considered safe and non-addictive.”

Patients cannot yet follow the Rambam’s prescription of “cannabis oil provides benefit for respiratory disease…” without modern scientific testing, but Maimonides did have extensive empiric success treating patients in Egypt and beyond. And even prior to the COVID-19 crisis, cannabis extracts were gaining serious exploration in the treatment of hepatitis C and Kaposi’s sarcoma associated herpesvirus (KSHV) (Maor, et al. Genes Cancer. 2012; 3:512-520), lending more scientific credence to the idea that viral illness may indeed have a nemesis in medical cannabinoids.

In tandem with modern medical research, the cure for the current plague must exist in Torah as well, as the Gemara states (Shabbat 89a), “… Moses told Aaron how to stop the plague, as it is stated: ‘And he placed the incense, and he atoned for the people’ (Bamidbar 17:12).” And while the current pandemic was likely far different than what faced the Jews in the desert, medicinal incense was and has remained a staple in Torah for curing disease, as Chizkuni comments on Bamidbar 17:11: “‘…and make atonement for them,’ the smoke of the incense will act as a barrier against the plague.” After all, the incense in the Torah is referred to as “ketoret hasamim” or “incense of medicaments,” which formed a pillar of smoke that was present during communications between Hashem and Moshe Rabbeinu. In parallel, the clouds of smoke that protected the Jewish people would roll into a pillar. This same pillar of smoke would blossom like a palm tree at all Israelite encampments, was that of the ketoret hasamim and served as the means by which the Shechina dwelled amongst the Jewish people.

There is no doubt that the end of the world’s current scourge will accompany the lighting of the ketoret hasamim in the Beit Hamikdash and pillar of smoke to rise, as the secret of the “ma’aleh ashan” is revealed. And while no one claims wholeheartedly that Onkelos’ mention of “k’neh busma” in the holy anointing oil of Moshiach Tzidkeinu is a reference to cannabis, one must know that the answer for the diseased state of the world will emerge from Torah, as it says in the Mishna 5:26, “Turn it [Torah] over and over, for everything is in it.”

Rabbi Dr. Yosef P. Glassman, MD, licensed as a geriatrician in Israel and New Jersey, is the CEO of Hadarta.org, which encourages seniors to make aliya. He is currently treating COVID-19 patients in Lakewood and beyond.