A decision regarding any treatment has to consider the evidence supporting its efficacy and knowledge regarding how it compares to other treatments, and a reassurance that the benefits obtained outweigh potential harm.
Hence, I find it interesting, though not surprised, that in South Africa there appears to be an increasing sense of acceptability of the cannabis plant or oil for various ailments.
South Africans 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 your property, which is yet to be validated by the Constitutional Court.
There are several countries that have decriminalised cannabis, which is an act to remove a criminal penalty associated with using it. Anyone found using cannabis under this law would still face a penalty ranging from a fine to being advised to enter a rehabilitation unit, while those found to be cultivating or selling it would face a criminal record.
While the act to decriminalise a substance is accepted as being driven from a human rights perspective, there is to this day international concern about making cannabis accessible for either medicinal or recreational purposes.
Budney et al (2017) argue 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 (Hasin et al, 2015).
On January 1, the State of Colorado 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 70% between 2013 and 2015, poison-centre calls related to children between the ages 0-8 increased 63% in the first year after legalisation and fatalities where drivers tested positive for cannabinoids increased 80% between 2013 and 2015.
An editorial published 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”.
In 2016, the Drug Enforcement Agency in the US denied a petition to loosen the federal law regulating cannabis accessibility. The federal law still classifies cannabis as a schedule 1 controlled substance, which means it's considered to have "no currently accepted medical use" and a "high potential for abuse". An editorial published 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, and that the current evidence failed to meet the US Food and Drug Administration standards.
In South Africa, the 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 South African 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”.
This position statement further states that “any change to legislation regulating cannabis use should include the views of appropriate regulatory bodies, be based on good-quality evidence, and take into consideration the availability and accessibility of current drug addiction treatment resources in South Africa”.
While we are yet to discover the outcome in the Constitutional Court, one can likely assume it has affected public opinion. A combination of perceived safety, myth, facts and ongoing legal debate has proved to be dangerous.
In terms of the medicinal benefit, it is highly likely that at least one of the chemicals found within the plant will be of future benefit. The plant itself has more than 100 different chemicals capable of activating the brain’s receptors and exerting some effect, but it is not fully understood and is being investigated.
At this point there is no evidence comparing these chemicals to medications known to be effective.
A recent published outcome of a four-year prospective study investigating the use of cannabis for people with chronic non-cancer pain found that those who used it had greater pain, lower self-efficacy in managing pain, greater generalised anxiety disorder severity score and no evidence of cannabis reducing prescribed opioid use.
No doctor will prescribe a medication that contains over 100 different chemicals, many of which we still know little of.
Further, it is estimated that 9% of those who experiment with cannabis become addicted. The South African Community Epidemiological Network on Drug Use reports that between January and June last year cannabis was the most common primary substance of abuse for teens admitted to a rehab unit. Cannabis is known to impair attention, learning, memory and inability to switch between ideas. There is now evidence that these impairments may persist if initiation of cannabis use occurred during adolescence.
Heavy use during the adolescent period also places one at greater risk of schizophrenia. Studies have found an increased risk of motor vehicle accidents while intoxicated. There is growing evidence linking cannabis use with sudden cardiac death, myocardial infarction and strokes.
I firmly believe that every individual should have the right to choose the form of healthcare they feel most comfortable with, but be sure to make an informed decision.
While cannabis may have benefited someone you know, you cannot assume it will have the same effect on you.
* Dr Abdul Kader Domingo is a specialist psychiatrist and senior lecturer at Stellenbosch University.
** The views expressed here are not necessarily those of Independent Newspapers.