Substance Abuse

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:

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.

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.

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.