Closing the Loophole on Hemp(Press Release)

Media Release

 Embargo: Immediate release                                  Enquiries:    Doctors For Life

Date:       2 November 2024                                        Telephone:   032 4815550

USA –  Closing the Loophole on Hemp-Derived Cannabis Products

Article contributors: Alyssa F. Harlow, Adam M. Leventhal, Jessica L. Barrington-Trimis, Keck School of Medicine, University of Southern California, Los Angeles.

A recent authoritative article from the USA has exposed a loophole in the American legislation concerning hemp. The general public in South Africa, and to a certain extent medical practitioners, also consider hemp as an innocent drug.  DFL would like to make the South African public aware of this loophole that is becoming very relevant to South Africa. The following is a shorted version of the original article (link at bottom)

The USA federal policy loophole allows psychotropic ie, mind-altering or intoxicating, cannabis products to be commercially marketed and sold across the US-including in states where recreational cannabis is not legal.

The Agriculture Improvement Act of 2018, commonly known as the 2018 Farm Bill,1 legalized the growth and sale of hemp. Hemp is defined as a botanical class of the cannabis sativa plant that contains low concentrations of Δ9-tetrahydrocannabinol (Δ9-THC, which is the most well-studied psychotropic cannabis-specific compound [ie, cannabinoid]) and high concentrations of non-psychotropic cannabidiol (CBD).1

However, hemp also contains low concentrations of hundreds of other cannabinoids besides CBD and THC,2 which, until recently, were believed to be present in amounts too small to produce psychotropic effects.

Under the protection of the Farm Bill,1manufacturers can synthesize and sell hemp-derived cannabis products with psychotropic doses of cannabinoids, such as Δ8-THC, ΔO-THC, Δ10-THC, and hexahydrocannabinol, and others.

These hemp-derived cannabis products produce similar psychotropic effects as Δ9-THC and are being sold across the US as vape cartridges, edibles, concentrates (eg, potent extracts), and tinctures (eg, infused liquids). Hemp-derived cannabis products are also being marketed and sold widely in South Africa, all largely unregulated. Clinicians and policy makers should be aware of public health concerns of widely available, psychotropic, hemp-derived cannabis products that are being manufactured and sold with little regulation, leading to potential health and safety risks. There are 6 main concerns:

1) First, unlike traditional state-regulated Δ9-THC cannabis that is sold in medical or recreational dispensaries for adult use, psychotropic, hemp-derived cannabis products are sold online and by retailers (eg, vape and smoke shops, convenience stores, and gas stations). Retailers selling these products do not have the same safeguards in place that state-run cannabis control bureaus have developed to reduce potential harm to consumers.3 For example, there is no established minimum purchasing age for hemp-derived cannabis products. In addition, there are no requirements for hemp-derived products to include warning labels for the presence of THC, or instructions on their packaging regarding appropriate doses. Retailers that sell psychotropic, hemp-derived cannabis products may also sell alcohol and tobacco products like e-cigarettes and cigarettes; this increases the potential for co-use of multiple substances, which can lead to excessive impairment and greater risk of drug dependence.

2) Second, hemp-derived cannabis products have marketing features that may appeal to youth. For example, such products are available as chocolates, gummies, cookies, and brownies and the packaging and advertisements often use bright and colorful designs. In addition, hemp-derived cannabis vape cartridges come in a wide range of sweet and fruity flavors, which increase appeal among youth and young adults. Because of their similarity to candy and food products, accidental exposure by children, adults, and animals is a concern. Between January 1, 2021, and February 28, 2022, national poison control centers received reports of 2362 cases of Δ8-THC exposures, of which 40% involved accidental exposure to Δ8-THC (82% among youth), 70% required evaluation at a health care facility, 8% were admitted to a critical care unit, and 1 pediatric death was reported. 2 Animal poison control centers have also seen an increase in reports of accidental pet exposure to Δ8-THC.2

3)Third, there is no standardized approach or certification process  to synthesizing psychotropic, hemp-derived cannabinoids, and such products could contain dangerous and toxic byproducts. Hemp plants naturally contain low concentrations of psychotropic cannabinoids; manufacturers must first extract CBD from hemp, which they then convert to psychotropic cannabinoids through a series of chemical reactions. Independent laboratory tests of legally purchased hemp-derived cannabis products have revealed the presence of toxic heavy metals (eg, lead), residual solvents (eg, acetone), and multiple unidentified compounds with unknown toxicological harms.4 Inhalation of contaminated cannabis vaping products can lead to serious lung injury, as evidenced by the 2019 EVALI (e-cigarette, or vaping, product use-associated lung injury) outbreak.5

4) Fourth, the psychotropic properties of some hemp-derived cannabis products may be less potent than Δ9THC. Because of lower potency, individuals may consume higher volumes of hemp-derived cannabis products than traditional Δ9-THC products, leading to adverse effects such as hallucinations, vomiting, tremor, anxiety, dizziness, confusion, and loss of consciousness.2 It is not uncommon to see gummies with 50 mg of Δ8-THC per serving (compared with 5-10 mg of Δ9-THC in a standard product sold in a dispensary).

In addition, other synthesized THC isomers may be more potent than Δ9-THC. For example, at the same dose, ΔO-THC is considered 3 times stronger6 than traditional Δ9-THC, and products often contain a blend of different hemp-derived THC isomers. Consumers may not be aware of such differences and may be at risk for adverse effects from receiving a dose of a hemp-derived cannabinoid with higher potency than anticipated.

6) Under the Federal Food, Drug, and Cosmetic Act,7 hemp-derived cannabis products cannot be sold as dietary supplements, food products, or marketed with medical claims. However, beyond issuing a health alert and several warning letters to a small number of companies, there has been little action by the FDA to regulate hemp-derived cannabis products. In the absence of federal regulatory action, 21 states have enacted legislation to restrict or ban the sale of psychotropic, hemp-derived cannabis products.8

However, the sale of psychotropic, hemp-derived cannabis products remains legal in 29 states and in Washington DC, and online sales may render state regulations ineffective.

In conclusion, many of the potential harms of hemp-derived cannabis products stem from a lack of regulation, including the potential for harmful contaminants, accidental exposure, cross-product sale with tobacco and alcohol, and youth appeal. This we believe contributes to the public perception, especially our youth, that all hemp-derived cannabis producs are safe. Government regulators should prioritize new hemp policies that ensure prohibition of sale to minors; set requirements for testing, packaging, and labeling; and place limits on potency and concentration of psychotropic products.

Footnotes

Doctors For Life International is not the author of the above article. This is a shortened version of the original article that can be found here: https://pmc.ncbi.nlm.nih.gov/articles/PMC10406389/

 No Conflict of Interest Disclosures were reported

Contributor Information

Alyssa F. Harlow, Department of Population and Public Health Sciences and Institute for Addiction Science, Keck School of Medicine, University of Southern California, Los Angeles..

Adam M. Leventhal, Department of Population and Public Health Sciences and Institute for Addiction Science, Keck School of Medicine, University of Southern California, Los Angeles..

Jessica L. Barrington-Trimis, Department of Population and Public Health Sciences and Institute for Addiction Science, Keck School of Medicine, University of Southern California, Los Angeles..

Doctors for Life International represents more than 1500 medical doctors and specialists, three-quarters of whom practice in South Africa. Since 1991 DFL has been actively promoting sound science in the medical profession and health care that is safe and efficient for all South Africans. For more information visit: http://www.doctorsforlife.co.za

REFERENCES

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Africa Health and Medlab 2024 Conference

DFL was invited to present its stance on abortion at the recent Africa Health Conference and Medlab, held at the ICC in Cape Town. In addition, DFL was provided with a complimentary exhibitor's table to showcase its work.
Nearly 500 exhibitors of medical products from over 50 nations were expected at this international conference, with more than 7,000 visitors anticipated over the course of three days, including approximately 3,000 delegates. DFL had the opportunity to engage with many exhibitors and attendees.
Dr. Monica Molatlegi represented DFL during the ethical session and participated in the debate on abortion. She laid the foundation for the pro-life stance by explaining that life begins at fertilization, referencing the Carnegie stages of embryonic development, which is considered the gold standard in embryology. Her insights received enthusiastic support from several delegates.

The Africa Health Conference also invited DFL to participate in a debate and open Q&A session on abortion during one of the ethical panels. Dr. Monica Molatlegi represented DFL, effectively presented the organization’s stance on abortion.

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Here are additional photos of the other exhibitors at the conference.

Johan Claassen and Francois Williams were manning the DFL exhibit table and engaging with visitors.

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Proposed Legislation to Decriminalise Prostitution is Withdrawn (Press Release)

Prostitution Illegal

Doctors for Life International (DFL) is pleased to announce the withdrawal of the proposed Criminal Law (Sexual Offences and Related Matters) Draft Amendment Bill, which aimed to decriminalise prostitution. DFL’s diligent efforts and well-received written submissions have played a significant role in this decision by the Deputy Minister of Justice.

DFL’s comprehensive and well-reasoned submissions presented a compelling argument against the decriminalisation of prostitution. It included testimonies from individuals with experience in the industry, both as ex prostitutes and pimps, providing valuable insights into the realities and exploitation within the trade.

Furthermore, DFL incorporated expert evidence from esteemed medical professionals and academics across various disciplines. Their contributions provided a thorough analysis and presented the latest research findings on the inherent harm associated with the prostitution industry. By highlighting the physical, emotional, and psychological consequences experienced by prostitutes and clients, DFL effectively emphasised the importance of maintaining legislation that criminalises prostitution to prevent exploitation and protect individuals.

DFL’s submissions also underscored the broader societal impact of decriminalising prostitution. By referencing comprehensive studies, the organisation highlighted the adverse outcomes that persist regardless of whether prostitution is decriminalised, criminalised, or legalised. Including increased human trafficking, the spread of sexually transmitted infections, and the erosion of social norms. These considerations highlighted the necessity of protecting society as a whole from the effects of such legislation.

This victory demonstrates DFL’s continued commitment to help individuals exit the sex trade and uphold the principles of human dignity. By successfully advocating against the proposed amendment bill, and running an exit program, DFL ensures the continued protection of vulnerable individuals and safeguards society from adverse consequences associated with the decriminalisation of prostitution.

Cannabis for Private Purposes Bill: Public Hearings (Press Release)

Cannabis Committee

Doctors for Life International (DFL) submitted their stance to the Parliamentary Portfolio Committee on Justice and Correctional Services, expressing their opposition to the inclusion of hemp commercialisation in the contentious cannabis bill. Despite receiving resistance from some stakeholders who dismissed DFL’s right to be heard, Dr WL Sieling delivered an outstanding presentation, grounded in medical science.

During the discussion, Dr Sieling warned that the passage of the United States Agriculture Improvement Act of 2018 legalised hemp cultivation for commercial purposes. However, this legalisation inadvertently created a legal loophole that certain American businesses exploited to market and sell Delta-8 THC. Delta-8 THC is an isomer of Delta-9 THC with comparable adverse effects.

In addition to newly discovered THC isomers like delta-8 THC, there is an increasing concern surrounding hemp derived CBD. Consumer products containing CBD are being falsely marketed, making claims about their supposed health benefits and overall wellness effects. A recent article authored by researchers from the United States Food and Drug Administration (FDA) provides insight into the potential risks of CBD, including developmental and reproductive toxicity, hepatotoxicity, and interference with essential metabolic pathways and liver enzyme functions. The toxicological profile of CBD raises concerns regarding its safety, particularly when consumed by the general population over an extended period.

The South African Government’s optimism about hemp as a source of job creation and revenue may also be misguided. The United States Department of Agriculture’s latest National Hemp Report indicates significant declines in the value and cultivation of hemp crops across various metrics. The report states that the value of hemp production in the United States decreased by 71 percent compared to 2021. This decline reflects a market correction, as the exaggerated publicity surrounding hemp as a miraculous cure-all substance begins to fade away.

The video to DFL’s submission before the committee can be viewed here:

Legalising cannabis fails to address health risks: UN drugs control board (Press Release)

United Nations International Narcotics Control Board

The United Nations International Narcotics Control Board (INCB) warns in its most recent annual report, that cannabis legalisation causes “negative health effects and psychotic disorders” among some recreational users. It also warned legalisation contravenes the UN 1961 Single Convention on Narcotic Drugs.

“In all jurisdictions where cannabis has been legalised, data show that cannabis-related health problems have increased,” the INCB said. It pointed out that between 2000 and 2018, “global medical admissions related to cannabis dependence and withdrawal increased 800%. Admissions for cannabis-related psychotic disorders have increased 400% worldwide.” Statistical evidence from Colorado (United States) shows that fatal traffic accidents with drivers under the influence of cannabis nearly doubled from 2013 to 2020.

Regarding the recreational use of cannabis, the UN panel expressed concern that the “growing” industry was fuelling the shift to even greater use of the drug, by advertising their products “particularly to young people, in ways that lower the perception of risk”.

In the United States, it has been shown that adolescents and young adults consume significantly more cannabis in federal states where cannabis has been legalised compared to other states where recreational use remains illegal.

New cannabis-based products, including “edibles”, or vaping products marketed in eye-catching packaging have increased the trend, the report’s authors continued, warning that these tactics have contributed to a “trivialisation” of the impacts of cannabis use in the public eye, especially among a younger demographic. “This is a major cause for concern, because the harms associated with using high-potency cannabis products are being played down,” said INCB President Jagjit Pavadia.

The main objective stated by Governments for legalising cannabis has been to reduce criminal activities and increase public health and safety. In its report, the INCB highlights that this objective has not been achieved.

Generating tax income has been listed as another important goal by Governments which promoted legalizing cannabis. The INCB finds that, although tax income from cannabis sales has increased year over year in Canada and the United States, tax revenue has been lower than expected, making up only 1 per cent of the budget in legalising states.

Doctors for Life International notes that these tax benefits are further nullified when considering the added burden and expenses on the heath sector e.g., mental health care, traffic accidents.

The President of the INCB, Jagjit Pavadia said: “Evidence suggests that cannabis legalization has not been successful in dissuading young people from using cannabis, and illicit markets persist.” Data show that illegal cannabis supply continues at high levels in all legalising jurisdictions, reaching 40 per cent in Canada, nearly 50 per cent in Uruguay and even 75 per cent in California.

Cannabis Use Disorder (CUD) in individuals using cannabis for medical purposes (Media Release)

Cannabis disorder

The most common conditions for which individuals obtain medical cannabis are pain, insomnia, anxiety, and depressed mood, but evidence for the efficacy of cannabis to treat these symptoms has been mixed.

A follow-up study of a 12-week randomised clinical trial of medical cannabis users, found an association between frequent cannabis use and increased Cannabis Use Disorder (CUD) risk, with no significant improvement in pain, anxiety, insomnia, or depression symptom severity. These findings call into question the use of cannabis as an effective tool in relieving clinical symptoms.

The study was conducted by a team of researchers from Harvard University, one of the world’s most respected medical research institutes. Harvard Medical School consistently ranks as the number one medical school around the globe.

Cannabis use disorder (CUD), also known as cannabis addiction, is defined in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and ICD-10 as the continued use of cannabis despite clinically significant impairment. Those who used cannabis 3 or more days per week were 269% more likely to develop CUD.

The study found an association between greater cannabis use and greater pain, indicating that cannabis is not adequately treating pain symptoms. This viewpoint is supported by a recent position paper from the International Association for the Study of Pain (IASP) that found, after a comprehensive review of research on the use of cannabinoids to treat pain, there was a lack of sufficient evidence to endorse the general use of cannabinoids for the treatment of pain.

The lack of improvement in symptoms of anxiety after 12 months of cannabis use adds to a growing body of literature that does not endorse cannabis as a treatment for these conditions. The lack of benefit from cannabis indicates that individuals with chronic conditions should consider evidence-based treatments.

The Netherlands is backtracking on its prostitution legalisation (Press Release)

prostitution laws amsterdam

Sex work in the Netherlands got out of control. After more than 20 years of experiencing legal prostitution, it is now obvious that the rules and regulations, and even restrictions, do not work. Despite the legislation in place which is attempting to create a safe environment for sex work, there is a great lack of safety, protection and regulation in the Red-Light District, admitted by Femke Halsema, the mayor of Amsterdam.

Crime is escalating, clients are becoming increasingly disrespectful towards prostitutes and residents are complaining about the swelling nuisance caused by drug addicts. It is proven that prostitutes are one of the most vulnerable populations in the Netherlands. 71% has been physically assaulted and 63% has been raped while working as prostitutes. Most struggle with Post Traumatic Stress Syndrome (PTSD). The Netherlands has been listed as one of the top destinations for human trafficking victims.

Since the start of the Red-Light District, gradual restrictions have been put in place. The previous mayor, Job Cohen, planned to close half of the city’s 400 prostitution windows because of the criminal activity going on there.

As a proposed solution, Amsterdam now wants to move prostitutes from the Red-Light District, creating an erotic centre at another place in Amsterdam. However, the suggested locations are in neighbourhoods with families, schools and parks. Parents are concerned about their children’s safety would a sex centre be launched in their vicinity. The European Medical Agency’s head office is located in Amsterdam, due to the proposed safety of the city. They are concerned that putting up an erotic centre will endanger their employees, as they have to work late night shifts and have accommodations in hotels in the area. The Dutch government has guaranteed that the neighbourhood will be kept safe, and no unrest will occur. However, being incapable to control the Red-Light District as it is, they will not be able to control an erotic centre.

The city’s mayor confesses, “Unacceptable situations have arisen, and the council is ready to consider far-reaching solutions.” She has already put even stricter regulations in place concerning the district, including earlier closing times and a cannabis smoking ban. Moving prostitutes to a sex work centre will not remove the crime related to prostitution, it will just relocate the crime scene causing nuisance to a different neighbourhood. It will also cause many prostitutes to go underground, because they do not want to register.

Doctors For Life believes that the solution to the various problems related to prostitution is not to move the prostitution to an erotic centre, but to criminalise  prostitution completely. Prostitution is a basis for criminal exploitation and a state should not participate in it, but rather warn and protect its society against it. The continuous restrictions put in place in the Netherlands are proof of the failure of decriminalising prostitution and should serve as a warning to the South African government as it seeks to legalise prostitution and the use of cannabis

The Medical Opinion on Gender Dysphoria on Minors (Press Release)

Gender Dysphoria

Gender dysphoria refers to persistent, significant distress that an individual experiences due to a perceived difference between their gender identity and their biological sex.
Normalising gender fluidity causes psychological trauma to those suffering from Gender Dysphoria and even more so to those who are not confused about their gender identity. In various countries in America and Europe, this ideology is already promoted at schools and kindergarten.
The claim that a child with gender dysphoria is born with a brain that is of the opposite sex is simplistic, biologically impossible and therefore scientifically incorrect. Every cell in an individual contains identical sex chromosomes, either XX for female or XY for male. There is little supportive evidence for the different opinions about prenatal hormone exposure and structural brain differences that cause gender dysphoria. Infants’ brains are already exposed to their own sex hormones within a few weeks of conception.
The concept of transgender identity is based purely on subjective experience, and the so-called “gender affirmative” approach to gender dysphoria (i.e., supporting social, medical, and surgical transition to a transgender identity) is based on very low certainty evidence – therefore many experts do not agree that it is appropriate.
Doctors for Life is convinced that teaching the prepubertal child about gender dysphoria and then affirming its belief that their gender differs from their biological sex and playing along with a child’s imprinted confusion, leads them to psychological and social dysfunction.
Children who “feel like the opposite sex” or “somewhere in between” do not comprise a third sex; they remain biological boys or girls. Gender ideology has little basis in science and causes more harm than good, especially in minors. Unquestioningly affirming gender dysphoric students’ social transition, harms them by impairing their chances of aligning their gender identity with physical reality; it may propel them down the dismal path of medical transition, firstly puberty blockers are prescribed to prepubertal children with gender dysphoria. The so-called aim of puberty blockers is to arrest the process of puberty. This is supposed to allow the child enough time to explore their gender without the “distress” of onsetting secondary sex characteristics. It is supposed to help the child to decide, whether it should grow into an adult according to their biological sex or according to the imaginary gender, for which they will need cross-sex hormones. However, as their peers grow into normal young men and young women, firstly these children stay stagnant and secondly start feeling more psychosocially isolated and left out.
This approach is not supported by solid scientific research results. Medical professors state that confused children get chemically castrated through the treatment of puberty blockers and will be sterile for life having to consume cross-sex hormones permanently. Taking it to the extreme, sex reassignment surgeries (SRS) are performed on children as young as 13 years. This means that these adolescents can have their healthy breasts cut off or their penises transformed into look-alike vaginas. Clearly, such surgeries cause permanent sterility and transform the child to a patient for the rest of its life.
Neuroscience shows that the development of the brain is not completed until the mid-twenties. This should immediately bring up the question why children under the age of 18 years are allowed to decide on life-changing procedures that are harmful and dangerous.
It is proven, that the general population’s health is better than that of transitioned people’s health. Moreover, it shows that the suicide rate amongst post-operative transgender adults is 20 times greater compared to the general population.
The vast majority of pre-pubertal youth with gender dysphoria will accept their biological sex by late adolescence, even without medical intervention. It is unlawful and unconstitutional to push an ideology onto children through the school system. If this is not child abuse, then what is? Our children need to be protected and given the opportunity for a prosperous future.
(Sources available on request)

New South African Studies on cannabis/dagga (Press Release)

Cannabis studies

New South African Studies done on cannabis/dagga since the legalisation for private use by the Constitutional Courts ruling in 2018

A recent study published in the South African Medical Journal found Cannabis use during adolescence affects the endocannabinoid system, which is particularly susceptible to the harmful effects of cannabis as it undergoes profound developmental changes.

The study states that adolescent cannabis use causes structural, functional, and histological alterations in the frontoparietal, cerebellar and other regions of the brain with some evidence suggesting that cannabis related neurocognitive impairments persist into adulthood, even after prolonged abstinence. Adolescent cannabis use should be actively discouraged, and pregnant women should be advised to avoid cannabis use.

Thirdly According to another study published in the South African Journal of Psychiatry, ADHD is common amongst cannabis users seeking substance abuse treatment and advises that cannabis prevention activities be strengthened.

Also, an observational study by the University of Witwatersrand on cannabis exposures reported to the Poisons Information Helpline of the Western Cape (PIHWC) noted there was a threefold increase in cases reported during the period June 2018 to June 2019 compared to the period June 2015 to June 2016. This coincides with the South Africa Constitutional Court ruling in favour of decriminalising cannabis for private cultivation and consumption.

Accidental ingestion of edible cannabis products was a common occurrence in patients aged 12 years and younger.

The introduction of the Cannabis for Private Purposes Bill in 2020 further clarified how consumers can legally use cannabis.

The expectation of many is that changing legislation will lead to the increased use of cannabis products.

In general, there has been an increase in reports made to health care facilities of acute cannabis intoxication and other adverse effects in countries when cannabis was legalised.

The same study warned that Cannabis use is not without consequences, and it is important for all health care practitioners involved in acute patient care to be aware of the various adverse effects associated with its use.

Prolonged cannabis use during adolescence also disrupts the neuromaturation processes of the brain that occur during this period, with synaptic pruning and white matter development particularly affected. Adolescent cannabis use is also associated with cognitive deficits and interference in logical thinking processes.

Cannabis use during pregnancy increases the risk of adverse outcomes for women and their neonates, to the extent that the American College of Obstetricians and Gynaecologists advised physicians to discourage use of cannabis during preconception, pregnancy, and lactation.

Cannabis use during pregnancy and breastfeeding alters the development of multiple brain regions and may result in lasting functional consequences, including impaired higher-order executive functioning (i.e., impulse control, visual memory, and attention). As a result, attention deficit hyperactivity disorder (ADHD) during childhood affects academic performance and social adjustment.

Prenatal cannabis exposure is associated with an increased risk of foetal growth retardation and childhood behavioural disturbances. Infants exposed to cannabis in utero tend to have lower birthweights and are more likely to need placement in the neonatal intensive care unit compared with infants without exposure. Cannabis may be toxic to human chromosomes, with chromosomal changes caused by in utero cannabis exposure contributing to the lower fertility and higher miscarriage rates known to occur among women who use cannabis.

Doctors For Life International would like to caution the South African government on whether they want to continue to experiment with the approximately 60 million people of South Africa as it moves towards ratifying the Cannabis for Private Purposes Bill introduced to Parliament in October 2020.

Submission for Road Accidents SA (Press Release)

To whom it may concern

Reason for this presentation

This presentation has been compiled by Doctors for Life International out of concern regarding ramifications arising from the legalisation of Cannabis. The concern is founded on the scientific and medical fact that most drugs active in the central nervous system, including cannabis, have an impairment potential and therefore pose a road safety threat. It is essential that regulations are drafted, and parameters placed before the legislature for deliberation, to avoid a spike in intoxication-related traffic incidents and ensure that our roads remain safe.

DISCUSSION:

Drug levels and their effects on different tissue types:

Cannabis blood drug levels in occasional users and chronic users (Toennes et al., 2008) showed an initial cannabis half-life of 30 minutes. The half-life of Cannabis has a complex overlay of different clearance rates, but after 8 hours, the clearance is considerably slower, particularly in heavy users of Cannabis.

Cannabis is absorbed from the lungs. It is redistributed and diluted into the entire blood pool. Simultaneously all other elimination routes start working. Kidney elimination is the fastest initial elimination route and is blood level dependant. Such elimination decreases. Liver and other routes become more important. Because heavy usage damages the liver, elimination slows and consequently drug levels are considerably higher after eight hours in heavy users than in casual, intermittent users.

Brain levels of cannabis are 2-3 times higher than blood levels (Heustis et al., 1992). This is due to accumulation in fat. The brain fatty substance is responsible for insulation around the nerve cell fibres as myelin sheaths. It may then have a profound effect on brain function. This means that blood levels may approximate, but do not accurately reflect brain levels. These levels may therefore still be high enough to cause impairment whilst the blood levels may seem safe.

When cannabis damages the liver, elimination will inevitably become slower and this affects elimination negatively, including in the brain.  For most drugs that redistribute to fat, elimination is slow due to the relative lack of blood flow to fat. This accumulation is not limited to the fat in the brain but occurs in the entire body.

The effect in each patient is drug level dependant. The higher the levels, the more effect it has.

Effects of legalisation of cannabis in other countries

In an address delivered (February 2022) before the Virginia General Assembly, by Prof Bertha Madras (MD), Professor of Psychobiology, Department of Psychiatry, Harvard Medical School she stated that in states where cannabis is legal, an increase in traffic deaths was observed. Her literature review found that cannabis is the most identified drug in deadly vehicle accidents, and it doubles drivers’ chances of being involved in an accident. The reason is that cannabis impairs judgement and many other skills needed for safe driving, e. g., alertness, concentration, coordination, and reaction time. cannabis makes it difficult to judge distances and to react timeously.