Could legalising cannabis see South Africans’ health going to pot?
THERE are certain expectations every individual has when visiting their doctor.
The first is for a diagnosis to be made, and the second, of course, is for the most suitable form of treatment to be prescribed.
A decision regarding any treatment has to consider the evidence supporting its efficacy, knowledge regarding how it compares to other treatments, and a reassurance that the benefits obtained will outweigh any potential harms.
Should any treatment carry a risk of severe harm, there is a legal obligation to be informed of this, allowing for an opportunity to make an informed decision regarding your health care.
I therefore find it quite interesting that in our country there appears to be an increasing sense of acceptability of the cannabis plant or oil for various ailments.
While I find this trend intriguing, I cannot say I am surprised. South Africans today find themselves being drawn into a constitutional court case discussing the possibility of cannabis being classified as a legal substance, as well as a Western Cape High Court judgment allowing for the growth of cannabis on one’s property, which is yet to be validated at the Constitutional Court.
At this point there are several countries that have decriminalised cannabis, which is an act to remove a criminal penalty associated with using it.
Anyone found to be using cannabis under this law would still face a penalty that ranged from paying a fine to being advised to enter a rehabilitation unit, while those found to be cultivating or selling it would face a criminal record.
Decriminalisation acts to protect any individual addicted to cannabis – it was not designed to convey a sense of safety or acceptability.
While the act to decriminalise a substance is accepted as being driven from a human rights perspective, protecting those addicted to a substance, there is to this day international concern about making cannabis accessible for either medicinal or recreational purposes.
Budney et al (2017) argues that the ease of accessing an intoxicating substance has an underestimated influence on the initiation, frequency and risk of developing an addiction later in life.
The perceived risk of cannabis has declined over the past 20 years (Pacek et al, 2015), and this has been associated with an increase in prevalence of cannabis use and addiction in the US (Hasin et al, 2015).
The State of Colorado on January1, 2014 became the first American state to allow for legal sales of non-medical marijuana for adults over the age of 21.
Youth perception of risk was found to decrease significantly, an increase in hospitalisations related to cannabis use increased by 70% between 2013 and 2015, poison centre calls related to children between the ages 0-8 increased by 63% in the first year after legalisation, and fatalities where drivers tested positive for cannabinoids increased by 80% between 2013 and 2015.
An editorial in the May 2017 edition of the Canadian Medical Association Journal condemned the decision by the Canadian government to legalise cannabis, pointing out that “cannabis is not a benign substance and its health harms increase with intensity of use”.
Federal Law in the US still classifies cannabis as a Scheduled 1 controlled substance.
An editorial in the Journal of the American Medical Association in 2015 argues that most of the qualifying conditions approved for medical marijuana in the US relied on low-quality scientific evidence, anecdotal reports, individual testimonials, legislative initiatives and public opinion, that the current evidence failed to meet the US Food and Drug Administration standards.
In South Africa, our Central Drug Authority published a position statement in 2016 stating “there is insufficient data to indicate that legalisation of cannabis will not be harmful, and that the immediate focus should be on the decriminalisation rather than the legalisation of cannabis”.
A position statement published in 2018 by the SA Society of Psychiatrists states that “any potential benefit obtained from cannabis must be weighed against its risk of addiction, risk of psychosis, cognitive impairments and a 2.6 times greater likelihood of causing a motor vehicle accident”.
While cannabis may have benefited or been safe to “someone you know who used it”, you simply cannot be reassured it will have the same effect on you.
Domingo is a specialist psychiatrist and senior lecturer at Stellenbosch University.