Message from NSTF Executive Director

The ConCourt ruling and Cannabis sativa research

(There are many names for this plant, among others ‘marijuana’ in the United States and ‘dagga’ in South Africa. In this article, I prefer the term ‘cannabis’ as it is part of the scientific name of the plant).

The ruling by the Constitutional Court on 18 September 2018 that the Drug Trafficking Act and the Medicines Control Act should be amended, and cannabis should be legalised for private use, has elbowed out news about the major issues South Africa is struggling with – the economy, unemployment, crime, rooting out corruption, restoring public institutions, the 2019 election, etc. A brief respite from all these major headaches for the public and politicians perhaps? Yet it remains a controversial ruling. South Africa’s population probably associates cannabis with harder drugs, and a gateway drug to very harmful addictions. Elsewhere in the world it is classified with drugs like LSD and heroin.

There are good reasons to legalise private use of the drug (in my opinion):
*It possibly causes less social harm than alcohol, because people are less likely to adopt aggressive behaviour and violence when intoxicated. Rather it is reported that it has a relaxing effect. (Some people however, experience anxiety, fear or distrust, and using large amounts can lead to an experience of acute psychosis – NIDA article on drugabuse.gov)
*Used medicinally by the terminally ill or those in unbearable pain, it is reported to give substantial relief.
*Legalising cannabis removes one burden on an overstretched police force and justice system. This is a great benefit to a country battling to deal with serious and violent crime.
*It undermines the black market, where high prices are charged for cannabis and it is hard to regulate and monitor cannabis use when it is illegal.
*People who make a profit from cannabis sales will have to pay tax.

The late Inkatha Freedom Party (IFP) member of Parliament, Mario Oriani-Ambrosini, fought for legalisation of cannabis in Parliament. He suffered from lung cancer diagnosed in 2013, and argued that cannabis should be available in particular for pain relief. In 2014 he tabled a bill in Parliament, called the Medical Innovation Bill to legalise cannabis applied for medical purposes. His pleas fell on deaf ears and he eventually took his own life in 2014. The IFP has continued to campaign for the legalisation of cannabis use.

Decision making by Government should be informed by credible scientific research
People are rightly concerned about the health effects of regular use and the social impact. What does scientific research say about the effects and impact? What about restrictions on relevant research? Trawling the web for scientific advice, I have found the following and made brief summaries of the information:

There must be access to cannabis to enable research
In Scientific American, an article appeared 14 years ago called Marijuana Research – Current restrictions on marijuana research are absurd, by The Editors.

The human body naturally produces compounds similar to cannabis, namely endogenous cannabinoids or endocannabinoids. These play roles in pain management by the body, memory, neurodegeneration and inflammation.

Among others, cannabis may have clinical benefits like relieving nausea during chemotherapy. There are about 60 cannabinoids with potential for medical applications.

All cannabis cultivated for research in the United States is grown in one facility only, and the variety of the plant is less potent than others, making its research and exploration for applications very limited. In the United Kingdom by contrast, a pharmaceutical company is authorised to grow a variety of cannabis strains for medical research purposes.

The authors point out that the call for an enabling environment for research has nothing to do with legalising general use of the drug.

The (American) National Institute on Drug Abuse (NIDA) communicates summaries of scientific research to the public
The following samples are from pages on the NIDA website.
*Cannabis “impairs short-term memory and judgment and distorts perception, it can impair performance in school or at work and make it dangerous to drive.”
*“The main psychoactive(mind-altering) chemical in marijuana, responsible for most of the intoxicating effects that people seek, is delta-9-tetrahydrocannabinol (THC). “

Is there a link between marijuana use and psychiatric disorders?
A link between cannabis use and psychiatric disorders has been indicated by several studies. However, it remains difficult to prove and further research is needed.

“Research using longitudinal data from the National Epidemiological Survey on Alcohol and Related Conditions examined associations between marijuana use, mood and anxiety disorders, and substance use disorders. After adjusting for various confounding factors, no association between marijuana use and mood and anxiety disorders was found. The only significant associations were increased risk of alcohol use disorders, nicotine dependence, marijuana use disorder, and other drug use disorders.63

It has been found recently, that people who have the AKT1 gene, and specifically the C/C variant, are more susceptible to psychotic disorders if cannabis is used daily. The risk for this group of people is 7 times higher than for those with other variants of the gene, and those who use cannabis infrequently.

“The AKT1 gene governs an enzyme that affects brain signaling involving the neurotransmitter dopamine. Altered dopamine signaling is known to be involved in schizophrenia.”

For those who have a “variant of the gene for catechol-O-methyltransferase (COMT), an enzyme that degrades neurotransmitters such as dopamine and norepinephrine65 – and had used cannabis during adolescence, the risk of psychosis was higher in adulthood.

Cannabis use tends to worsen schizophrenia in patients who are already suffering from it.

Long-term effects of regular cannabis use include: “Impairments in learning and memory with potential loss of IQ” and “increased risk of chronic cough, [and] bronchitis” (This latter effect is thus similar to that of smoking tobacco).

Second-hand exposure to cannabis smoke
Studies showed that there is an effect on non-smokers in the company of smokers. The potency of the effect depends on the strength of the cannabis being smoked, the ventilation in the room they share, and the length of exposure. One study showed that non-smokers in a room with smokers using high THC cannabis, experienced mild effects of being less able to perform motor tasks.

Although little research has apparently been done on this topic, it would be logical if second-hand smoking of cannabis had similar harmful effects to second-hand smoking of tobacco. Preliminary studies seem to point to this conclusion. This raises concerns about the effect of smoke on children, asthma sufferers and other vulnerable people.

Pregnancy
More research is also needed on the effects of mothers using cannabis during pregnancy and on infants. If mothers are not aware of the possible risks, they will continue to smoke, and may even accept advice to use cannabis for nausea.

Research has shown that pregnant women who use cannabis have a 2.3 times greater risk of stillbirth.

“The American College of Obstetricians and Gynecologists recommends that obstetrician-gynaecologists counsel women against using marijuana while trying to get pregnant, during pregnancy, and while they are breastfeeding.104

Animal studies have shown that the active cannabis ingredient THC administered during pregnancy can have negative effects on their unborn young.

Conclusions:
The envisaged amendments to legislation should ensure that cannabis varieties are available for research, as there is still much that is unknown or uncertain.
*Existing research shows clear indications of harmful effects. It is thus essential to proceed with caution in the formulation of legislation legalising cannabis.
*At the very least, cannabis impairs judgement and performance on mental and motor coordination tasks.
*Psychiatric disorders can develop in those who have a specific genetic makeup and use the drug daily.
*There are serious warning signs regarding second-hand inhalation and cannabis use while pregnant and breastfeeding.
*The public, especially adolescents and their parents and teachers, need to be informed thoroughly of the risks of using cannabis. Legalising cannabis for private use sends a signal to the public that the drug is not harmful.
*The summaries above are but a small sample of the credible research findings that are publicly available on the internet. Rather than publicising conclusions based on hearsay and blogs, scientific results should be disseminated widely.

Sources
https://www.scientificamerican.com/article/marijuana-research/
https://www.drugabuse.gov/publications/research-reports/marijuana/there-link-between-marijuana-use-psychiatric-disorders
https://www.drugabuse.gov/publications/research-reports/marijuana/what-are-effects-secondhand-exposure-to-marijuana-smoke

The 118 sources for the information provided on the NIDA webpages are listed here: https://www.drugabuse.gov/publications/research-reports/marijuana/references

About Mario Ambrosini:
https://www.dailymaverick.co.za/opinionista/2013-11-01-the-politics-of-cancer-mario-oriani-ambrosinis-personal-odyssey/ Ambrosini writes about a group of ‘scientifically minded’ friends who supported him in trying alternative cures for cancer and trying to understand the disease. He comments on the restrictive environment in which pharmaceutical research is done and the nature of science, among other related insights. He writes: “In South Africa we have 225,000 licenced traditional healers, who may use the same muti to cure cancer, impotence, bad luck and unemployment. But we have stopped our doctors from prescribing effective cancer treatment or even acupuncture for pain control.” He pleads for “South Africa to become a world-renowned centre for cancer treatment”.
https://www.iol.co.za/dailynews/news/ifp-leader-confirms-suicide-of-ambrosini-1738005
https://www.iol.co.za/dailynews/news/ambrosinis-dagga-bill-revived-in-parliament-1748632