Members of several organisations, NGOs and growers clubs protest as part of the Cannabis Mass Action Gatherings at the Union Building on September 17, 2022 in Pretoria, South Africa. (Photo by Alet Pretorius/Gallo Images via Getty Images)
Cannabis legalisation has gained traction in several African countries, including South Africa, driven by the real and prospective economic benefits for local and Western markets. But this development is happening amid a surge in drug use and dependence, with cannabis emerging as the most widely used illicit substance worldwide.
The 2022 United Nations Office on Drugs and Crime report highlighted a significant rise in cannabis consumption following legalisation policies, leading to a higher prevalence of cannabis use disorder (CUD), characterised by the maladaptive behaviour akin to other forms of substance dependence, including cognitive deficits, loss of control and memory impairments.
Despite this awareness, there is a scarcity of data and conflicting scientific evidence regarding the safety of cannabis, coupled with the shortage of comprehensive population-based data on CUD prevalence in Africa and insufficient research on its pathophysiology, which can influence the exploration of novel therapeutics. This raises substantial concerns about the social and public health implications of increased cannabis accessibility and use on the continent.
Conversely, research on the medicinal applications of cannabis has gained prominence since the onset of legalisation trends and has received prioritised funding while studies examining vulnerability to cannabis use disorder have not.
The absence of comprehensive data regarding the prevalence of cannabis use, risk of CUD and associated health and social implications perpetuates a false sense of security. This data gap also provides fertile ground for the influence of large corporations on legalisation policies, while simultaneously impeding policymakers’ ability to prioritise public health needs and safety in African communities.
In countries such as South Africa, cannabis remains a prevalent substance among individuals seeking treatment for substance use disorders.
At the same time there are ongoing problems in accessing structured treatments, which is further exacerbated by resource limitation, inadequate facilities and income disparities, with many people in Africa unable to afford private medical aid. In South Africa, only 16.2% of the total population of about 60 million can afford private medical aid.
Reports analysing the effect of cannabis legalisation in sub-Saharan Africa consistently underscore the widespread use of cannabis among socioeconomically disadvantaged demographics. This prevalence of cannabis use is intertwined with the numerous problems confronting these communities, such as unaddressed mental health concerns and economic hardship. The heightened availability of cannabis within these contexts fosters a culture of increased usage, consequently increasing susceptibility to the adverse effects of cannabis use disorder. As a result, vulnerable people bear the greatest burden of the negative consequences associated with cannabis legalisation.
The purported immediate economic benefits of cannabis legalisation in South Africa, aimed at promoting local production, opportunities for small-scale producers and entry into the export market do not match the reality. Regulating the sale and use of cannabis presents similar difficulties to those encountered with alcohol and tobacco products, particularly among marginalised people.
The journey to achieving exports is fraught with barriers and complexities, including stringent regulations of Western markets, as well as the need for advanced techniques to characterise cannabis constituents and safe dosages for medicinal use.
National household surveys conducted in South Africa from 2002 to 2017 have shown that the prevalence of cannabis use in the country has doubled the global average since legalisation. This raises concerns about its potential negative effect on public health and exacerbation of existing social problems. Concerns include the anticipated decline in adherence to antiretroviral therapy among HIV-infected people with comorbid substance use disorder. Given South Africa’s high HIV prevalence, this issue is particularly worrying because of the potential effect of increased cannabis use on treatment adherence and high-risk behaviours.
Currently, there is a growing interest from multifaceted quarters, including medical experts and researchers as well as health/science regulatory actors, in fostering discussions about the safety of cannabis use while balancing economic benefits and national interests to inform evidence-based policy reform in the South African context.
Despite willingness to invest in validating the medicinal and recreational uses of cannabis, advocating for cannabis legalisation and establishing cannabis production industries, there is a significant lack of interest in funding research on cannabis use disorder in Africa. This discrepancy stifles parallel discussions that highlight the effect of cannabis legalisation policies on the continent.
Similarly, research efforts to explore novel pharmacotherapeutics for CUD treatment have been limited, resulting in very few and low-quality research outputs. Consequently, there are currently no effective pharmacological interventions for cannabis use disorder, despite the availability of treatments for other substance use disorders. Moreover, a progressive decline in the uptake of psychosocial interventions for CUD since the adoption of cannabis legalisation policies in Africa has been observed.
Most available data on cannabis use, CUD and the associated consequences are primarily from Canada and the US. Relying on this data to extrapolate to an African context may overlook cultural and country-specific nuances, significantly affecting the assessment of trends related to cannabis use, the prevalence of cannabis use disorder and the formulation of intervention strategies specific to Africa. Additionally, the limited data that comes from African research studies on CUD are often incomprehensive and heterogenous. Despite this, proponents of cannabis legalisation express confidence in the safety of cannabis use within African populations.
Navigating the complexities of cannabis legalisation in Africa requires a multidimensional approach that addresses the economic opportunities while mitigating the risks associated with increased cannabis use and cannabis use disorder. By prioritising comprehensive research on CUD prevalence, intervention strategies tailored to Africa’s needs, evidence-based policy reform and equitable funding allocation, the continent can harness the potential benefits of cannabis legalisation while safeguarding public health and promoting social equity in vulnerable people.
Musa Aminu is a second year PhD student in the Department of Human Physiology at Nelson Mandela University. Dr Duyilemi Chris Ajonijebu is a behavioural neuroscientist in the department.