South Africa decriminalised the use of cannabis for private use in a Constitutional court ruling during September 2018.
An observational study, of cannabis exposures reported to the Poison Information Helpline in the Western Cape. the University of Witwatersrand found that coinciding with the court ruling there was a threefold increase in cases reported to the Poison Information Helpline.
Accidental ingestion of edible cannabis products was a common occurrence in patients aged 12 years and younger, leading to neurological symptoms.
In general, there has been an increase in reports made to health care facilities of cannabis intoxication and other adverse effects in countries where cannabis has been legalised.
Cannabis use is not without consequences, health care practitioners should take note of the various adverse effects associated with its use.
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.
Highlighted in the 2022 World Drug Report by the U.N. Office on Drugs and Crime, cannabis remains the most widely used drug worldwide, with roughly 209 million people having used cannabis in 2020, a 23% increase from the 170 million people in 2010. As cannabis use and THC potencies increase, there has been a “notable increase” in related treatment admissions and psychiatric comorbidities. Cannabis was the most common substance reported in emergency rooms, where it was present in 26% of acute drug toxicity cases. In a study involving patients presenting first episode psychosis, cannabis use was associated with a three times greater likelihood of psychotic disorder. Daily use of high-potency cannabis increased the risk of psychotic disorder more than fourfold.
An employee who was fired after repeatedly testing positive for cannabis, in breach of company rules, has failed in their bid to be reinstated. The company had a zero-tolerance policy towards alcohol and drugs requiring employees to undergo regular tests. After failing several weekly tests the employee was charged with breaching the company’s Alcohol and Substance Abuse Policy and was fired. Johannesburg Labour Court Acting Judge Makosho Ntsoane held that the employee was at all times aware of the policy which had been applied consistently to all employees. He said in light of the dangerous environment, the company was entitled to its zero-tolerance policy and the Constitutional Court judgment on cannabis did not offer protection to employees who breach company policies.
Six children suffered from cannabis side effects between June 21 and 26, 2022, Dr Opass Putcharoen, head of Chulalongkorn University’s Emerging Infectious Diseases Clinical Centre, reveals. People have bought food, beverages and products with cannabis as an additive after the plant was legalised for medical and commercial use on June 9. “The legalization of cannabis has caused medical staff to work harder, especially psychiatrists and neurosurgeons, as many children and teenagers have begun to suffer from side effects,” Opass said. Citing the Royal College of Paediatricians of Thailand, cases included a 3-year-old girl suffering from “dizziness” after consuming cannabis cookies and a 16-year-old male who suffered from “confusion and tried to use a knife to harm himself” after smoking cannabis.
Cannabis use increases the risk for cardiovascular disease. Tetrahydrocannabinol (THC) (the psychoactive substance of cannabis) binds the CB1 receptors in blood vessels causing the release of pro-inflammatory cytokines involved in the development of atherosclerotic plaques and cardiovascular disease. This has been showed in plasma concentrations of patients smoking cannabis, cell lines and mice models. Genistein, a component of soybean, acts as a CB1-receptor antagonist and reduces and partially reverses the pro-inflammatory effects of THC, reducing atherosclerotic plaques in both cell lines and mice models. Genistein, however, does not cross the blood-brain barrier and has no influence on the neurobehavioral effects of THC.
Legalization of marijuana for medical purposes/recreational use coincides with a decrease in perceived harmfulness of the drug and increases adolescent use. 9% of children in grade 9-12 use marijuana daily/almost every day. Marijuana exposure in adolescence is associated with use of other illicit drugs and increased emergency unit visits in the pediatric population. 17% of youth using marijuana develop a cannabis use disorder, recognized in the DSM-V as physical dependence. 68% of youth presenting for treatment report dependence, tolerance and withdrawal. Marijuana intoxication may cause acute psychosis and adolescent exposure predicts a twofold increased risk of developing psychosis and schizophrenia in adulthood. There is also an association between chronic use and suicidal ideation/attempt. Adolescent use causes cognitive impairment and decreases academic performance. Pediatricians must be aware of the problem and incorporate questions about substance abuse and education/intervention in their consultations.
In November 2020, Oregon voters elected to decriminalize the possession of small amounts of drugs, including heroin and cocaine. State-wide treatment centres would enable addiction to be handled as a healthcare, rather than a law enforcement issue. Law enforcement officers now report a drug-driven increase in criminality including assaults, possession of illegal firearms and prostitution on Oregon streets. Officers report a single arrest during which 500 fentanyl pills, 44 firearms, two of which were machine guns, and 1,000 grams of methamphetamine were seized. Further, criminal organizations operating in these areas have been largely legitimized through the adopted measures and gun violence has increased, with drug legalization having created an environment in which criminality is tolerated and is able to flourish.
In 2021 there were over 76,975 overdose deaths attributed to opioids (CDC) in the United States. Opioid deaths have increased nationwide in recent years the CDC reports that “…increases in synthetic opioid-involved deaths are being driven by increases in fentanyl-involved overdose deaths.” Fentanyl deaths are now on the rise among teens. According to a study conducted by JAMA, adolescent drug rates didn’t change much over the last decade (+ 0.2 percent between 2010 and 2020). Yet, overdose deaths among teens grew exponentially, with the overdose mortality increasing by 94.03% from 2019 to 2020 and then again by 20.05% from 2020 to 2021. The study found that fentanyl use among adolescents was “identified in 77.14% of adolescent overdose deaths.”.
In 2020 cannabis use among college students reached its highest level during the 21st Century. The National Institute on Drug Abuse’s 2020, Monitoring the Future study, tracking substance use in adults between the ages of 19 and 22, revealed that in 2020 44% of college students used cannabis in the last year, compared with 38% in 2015. Of that number 8% admitted to “heavy” usage. Cannabis use is likely to increase among this and younger age groups, as it has become legal in many states. Nearly half of people 12 years old or older in the United States have used cannabis at least once in their lives, according to NIDA statistics, and almost 17% of all adults are current users.
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