Could South Africans soon be self-medicating legally with cannabis, or dagga as it is more commonly known? This could flow from the latest position statements of the Central Drug Authority (CDA).

In the SAMJ (South African Medical Journal) in June, CDA executive committee member Dr Dan Stein says the authority favours "decriminalisation rather than the legalisation of cannabis" for personal use. And in the SAMJ in September, Stein says the CDA also accepts that globally, alcohol causes more harm than cannabis.

Cape Town GP Dr Keith Scott does not believe this is progress. He has a special interest in reforming drug laws to reflect drug use as a public health concern rather than a criminal issue. The CDA frustrates and irritates him in equal measure.

In the SAMJ, Scott describes the CDA’s recommendation on decriminalisation as "a welcome, if somewhat tentative and belated move" that it yet has to endorse fully.

It gives an indication of the state’s response to "the shifting sands of local and international public opinion and global drug policies", he says.

But the CDA continues to justify the illegal status of cannabis and other drugs by using "confirmation bias" — selective presentation of evidence.

Not surprisingly, Stein and other CDA executive members disagree that they show bias.

Stein says the agency has considered the totality of the evidence. But Scott says that if the CDA uses the same standards for alcohol and tobacco, it would have to ban those two drugs as well.

If the government accepts the CDA’s recommendation for the decriminalisation of cannabis, there would be an unintended consequence. Scott says that by decriminalising cannabis use by individuals, but not legalising its use for medical purposes, people would be able to self-medicate legally, while doctors wouldn’t be allowed to prescribe it.

This would be an "unintentional, illogical policy clash", he adds.

Scott and others who support legalisation point out that many countries including Australia, Jamaica and some US states, have decriminalised cannabis for personal use. Uruguay led the way by legalising cannabis in 2013. None of those countries have descended into anarchy and criminality.

In May, UK neurological and psychological researchers at Newcastle University and the Northumberland, Tyne & Wear NHS Foundation Trust issued a paper, Cannabis: The Evidence for Medical Use. Over 176 pages, 43 of them on references, the authors make a powerful case for legalisation.

They say that use of medical cannabis is "generally safe", with short-term effects that are mild and well-tolerated in the correctly prescribed dosages.

They say that there is good evidence for the efficacy of cannabis in chronic and neuropathic pain; spasticity — mainly in multiple sclerosis but also secondary to other neurological disorders; nausea and vomiting, particularly with chemotherapy; and anxiety.

The UK researchers say there is moderate evidence for efficacy in Parkinson’s, sleep disorders, fibromyalgia, post-traumatic stress disorder and appetite stimulation — mostly in cases of HIV infection.

They found a small dependency rate with cannabis use at about 9%, which compares well to a rate of about 32% in tobacco use and 15% with alcohol. The researchers say there is probably a link between cannabis use and schizophrenia at an early age and if there is a genetic predisposition to psychosis.

Dagga grows wild in SA, is easily available and has been used as medicine for millennia.

Scott attacks the CDA’s continued use of "stale arguments", such as the dangers of cannabis, to oppose its use as a medicinal herb.

Drug use should be primarily a public health issue, not a criminal one
Cape Town GP Dr Keith Scott

"We know all medicines, including potentially lethal over-the-counter drugs such as aspirin and paracetamol, have undesirable effects. Cannabis is no exception but it is far less harmful than alcohol and tobacco," Scott says.

Research shows that cannabis is far less toxic than alcohol, which is associated with many kinds of cancer, cardiovascular disease, and other diseases, he says.

Alcohol is also directly responsible for the deaths of more than 3-million people annually worldwide, according to the World Health Organisation, while deaths attributed to cannabis are "insignificant in comparison".

In a debate in the SAMJ in September, Stein agrees with Scott that various substances "differ in their associated costs and harms".

He also agrees that an approach to substances that "emphasises harm reduction and human rights is also key", and that new local policies and programmes are urgently needed.

In an editorial, acting SAMJ editor Dr Bridget Farham says her late father, a solicitor in England with a predominantly criminal practice, "always believed that the so-called drugs of abuse — including cannabis — should be legalised and subject to the same regulation as alcohol and tobacco".

Her father encountered substance abuse, in all its forms. "Like all sensible people", he could see that the war on drugs has not worked. It caused "untold misery to many while massively enriching the few".

Farham says her father’s opinion was "revolutionary for his time and not shared by many of his contemporaries" but she "always agreed with him".

Scott says he hopes that the CDA’s "increasingly progressive attitude to drug issues will give the medical profession a dominant role in policy making within its structures, in Parliament and other decision-making forums".

For too long, he says, the justice system has had an overriding influence on the way governments have created harmful drug laws and how these laws have been implemented.

"Drug use should be primarily a public health issue, not a criminal one," Scott says.

He sees the CDA’s call for more evidence before it will back the implementation of legal regulation as a block to progress. So too is its advocacy for continued adherence to "the harmful, irrational and outdated UN Single Convention on Drugs of 1961 (and related conventions)".

The CDA focuses entirely on direct harms of drugs to users, while ignoring the massive damage the implementation of drug prohibition and the drug laws do, Scott says.

He blames the usual suspects including global and local organised crime, corruption, contaminated and impure drugs, victimisation and discrimination.

Scott finds it especially frustrating that although the CDA calls for more action to reduce the enormous harms caused by alcohol, it never calls for alcohol to be banned.

That is because alcohol is "a culturally sanctioned drug", he says.

Whenever the CDA confronts alcohol in the arena of illicit drug policy discussion "political interests trump rational thought every time", Scott says.

 

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