Expert opinion divided over health impacts as SA legalises dagga

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Woman smoking, close up on smoke and mouthFollowing the legalisation of cannabis for personal use in South Africa, the SA Society of Psychiatrists and the SA Medical Association warned of its addictive nature and the need for support measures to deal with dagga’s negatives effects. Meanwhile, The Witness cited US studies busting the myth that legalising cannabis causes more teens to use it.

In response to the recent legalisation of cannabis, the South African Society of Psychiatrists noted with concern a growing public perception of dagga as a ‘harmless’ plant, and that few measures have been instituted to address this, writes Dr Abdul Kader Domingo, a member of the society’s special group on addictions, in City Press.

Research has shown that 9% of individuals who experiment with dagga will become addicted to itThis number increases to one in six when use starts during adolescence.

Human brain development and maturation is a process that is guided by the body’s endogenous cannabinoid system and occurs until the early 20s.

Exposure to phyto-cannabinoids (cannabinoids obtained from the cannabis plant) during this vulnerable period may disrupt the process of brain maturation and affect aspects of memory, attention, processing speed and overall intelligence. Dagga use during the adolescent period may cause lasting cognitive deficits, even after sustained abstinence.

The South African Community Epidemiology Network on Drug Use reports that, during the second half of 2016, dagga was the most common primary substance of abuse for persons younger than 20 years presenting to treatment facilities in all areas across South Africa, except for the Free State, Northern Cape and North West.

A review article by the World Health Organisation in 2016 concluded that current evidence points to a modest contributory causal role for cannabis in schizophrenia and that a consistent dose-response relationship exists between cannabis use in adolescence and the risk of developing psychotic symptoms or schizophrenia.

Any change to the legislation regulating dagga use should have been undertaken in consultation with all the relevant stakeholders, be based on good quality scientific evidence and take into consideration the availability and accessibility of current drug addiction prevention and treatment resources in South Africa.

The Society of Psychiatrists concurs with the executive committee of the Central Drug Authority of South Africa that the approaches to combat the use and abuse of psychoactive substances should include harm reduction (interventions aimed at reducing the harmful consequences associated with substance use), supply reduction and demand reduction and preventative strategies.

We agree with the executive committee of the central drug authority that there is currently insufficient evidence to predict the long-term consequences of the legalisation of cannabis.

The ease of accessing an intoxicating substance may have an underestimated impact on the initiation, frequency and amount of use, and the subsequent risk of developing a substance use disorder. Legalisation should therefore not have been considered at this point.

The decriminalisation of cannabis removes the criminal penalty related to the use of cannabis; it allows for a distinction between a drug dealer and an individual experimenting with or addicted to a drug.

While the Society of Psychiatrists supports the human rights of all individuals, we argue that a decision to protect those addicted to substances should not be viewed as a simple binary decision based on criminal penalties.

In 2001 Portugal augmented the decriminalisation of illicit substances with drug dissuasion commissions, increased the number of facilities offering detoxification and therapeutic admissions, increased the number of drug education campaigns and refocused policing efforts on large scale trafficking operations.

The decriminalisation of dagga must be preceded by and augmented with similar socially responsible strategies for it to be successful in South Africa.

Available evidence does not support the strong positive public opinion and anecdotal reports favouring medicinal cannabis.

The exceptions are the moderate quality evidence of medicinal cannabis for treating chronic pain, spasticity due to Multiple Sclerosis and weight loss associated with HIV. This evidence includes trials investigating pharmaceutical medications based on phyto-cannibinoids.

Good quality evidence does however exist regarding the frequently occurring side effects of cannabis such as confusion, dizziness, diarrhoea, euphoria, fatigue and hallucinations.

Any potential benefit obtained from cannabis must therefore be weighed against its risk of causing addiction, psychosis, cognitive impairments and a 2.6 times greater likelihood of motor vehicle accidents.

The Society of Psychiatrists also notes with concern the growing evidence linking cannabis use with an increased risk of an acute myocardial infarction as well as an ischaemic stroke.

The Society of Psychiatrists commended the Medical Control Council’s decision to limit the use of cannabis for medicinal purposes to registered prescribers and for individuals in which an acceptable justification is provided.

We support ongoing research on the use of cannabis for medicinal purposes to ensure that its purported and potential benefits can be scientifically measured against medical and societal risks.

Dagga ruling will have side-effects – SA Medical Association

The South African Medical Association (Sama) also articulated issues, amid the excitement over the Constitutional Court rulinglegalising dagga possession for private use, writes Brian Sokutu for The Citizen.

Sama said support structures were needed to curb the drug’s negative effects on society and to assist addicts. It is to make a submission to parliament in this regard.

Sama president Mzukisi Grootboom said the ruling “comes as the country faces a big problem of abuse of alcohol and illegal drugs”.

In support of the SA Society of Psychiatrists’ concerns about the ruling, Grootboom said documented evidence showed cannabis had extensive personal and societal side-effects. Sasop claimed that 9% of those who tried cannabis would become addicted to it, increasing to one in six when use starts during adolescence.

Sasop member Dr Abdul Kader Domingo explained: “Human brain development and maturation is guided by the body’s endogenous cannabinoid system and occurs until the early 20s.

“Exposure to phyto-cannabinoids [in cannabis] during this vulnerable period may disrupt brain maturation and affect aspects of memory, attention, processing speed and overall intelligence.

“Cannabis use during adolescence may cause lasting cognitive deficits, even after sustained abstinence.”

Grootboom added: “The emphasis should be on what the Constitutional Court said in its ruling – that use should be restricted to adults and in private.

“Given the societal challenges South Africa faces, this ruling may have unintended consequences. We lack support structures for addicts, which we’re discussing with the Royal Dutch Medical Association.

“It’s the lack of these structures, which Holland has, that our submission will be based on.”

Two dagga myths busted

Some people assume that legalising the use of dagga will cause more teens to use it, and that legalising it will reduce the number of adults overdosing on opioids (pain medication), which is a critical problem in the US. Neither is true, according to research, writes The Witness.

Since medical marijuana first became legal in California in 1996, it’s been legalised or decriminalized across nearly three-fifths of the United States. However, that’s had virtually no impact on the rate of recreational marijuana use among teens, a broad review of published studies has found.

The results of both studies are published online in the journal Addiction.

‘Several years ago, before the group of papers we (analysed) started to be published, people thought that US medical marijuana laws would increase teen marijuana consumption by ‘sending the message’ to teens that marijuana was safe and acceptable to use,’ explained Deborah Hasin, a professor of epidemiology at Columbia University’s College of Physicians and Surgeons in New York City, and the new study’s lead author.

Hasin however said: ‘It doesn’t seem that teens were impacted much by this – perhaps because they didn’t find the legalisation of medical use very relevant to them or didn’t even know about the laws.’

The South African court ruling refers to the use of dagga in private, not to the drug used medically and obtained in marijuana pharmacies, as in the US.

The impact of marijuana legalisation also has been minimal on the risk for fatal overdosing among adult users of opioid pain medications, a separate study team has found.

American, Australian and British researchers found little to suggest that increased access to medical marijuana as an alternative way to manage chronic pain has led to any measurable drop in deaths from opioid abuse.

Despite the findings of both research teams, legalising medical marijuana is not consequence-free, Hasin said.

‘Passing laws legalising marijuana use has some social benefits – business and tax revenues, job creation, and reduction in unfair race-based arrests,’ she said. ‘And while not every marijuana user experiences harms, using marijuana does have some risks, including withdrawal, addiction and increased chances of vehicle crashes.’

Report on the City Press site
Full press release on the SA Societ of Psychiatrists site
Research: Adverse Health Effects of Marijuana Use, New England Journal of Medicine
Report on The Citizen site

Article on The Witness site

 


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