Much has been said and written about the “legalisation” of cannabis (or dagga) in South Africa. But there are, well, high and lows to consider…

Cannabis has been shown to have several valuable uses in medicine. There are many countries that have legalised the medical use of cannabis, but in South Africa this is, according to current legislation, still illegal. On November 23, 2016 Parliament’s Portfolio Committee on Health announced that the Department of Health will soon regulate access to medical cannabis for prescribed health conditions but under very strict guidelines – but remember the sale and use of cannabis in any form is illegal in South Africa.

Despite this there are many forms of cannabis available in South Africa. The use of cannabis in medicine relies on a pure compound. Clearly in an unregulated market, it is impossible to be assured that the compound you buy is indeed the correct cannabinoid and is safe and effective for medicinal use. The Medical Innovation Bill seeks to legalise innovative use specifically of cannabinoids for medical purposes. Neither this Bill nor the available scientific evidence advocates for the use of the whole cannabis plant, whether smoked or ingested. There are many varieties of the cannabis plant, each producing many active chemicals known as cannabinoids – some of these chemicals have greater psychoactive effects and hence the popularity of its recreational use. The most psychoactive cannabinoid found in the cannabis plant is tetrahydrocannabinol (THC) – the compound responsible for the “high” but not useful in medical terms. It has been shown that the ratio of THC to another well-studied cannabinoid (cannabideol or CBD) is important. The greater the THC ratio the poorer the medicinal effect and the greater the psychoactive effect.

Commonly, cannabis is available in distilled oil and this is the easiest way of medicating, but other forms such as vaporisers, aerosols, pills etc. are available in certain countries where its use is legal.

The demand for the medical use for cannabis is growing and available evidence shows that it helps in chronic pain (both cancer pain and neuropathic pain) and muscle spasms. Low-quality evidence suggests its use for reducing nausea during chemotherapy, improving appetite in HIV/AIDS, improving sleep, and easing tics in Tourette syndrome. When usual treatments are ineffective, cannabinoids have also been recommended for anorexia, arthritis, migraine, and glaucoma, but further medical studies are required to ensure long term use is safe.

The bottom line is that, until it is legalised, you cannot simply go out and buy it. Also, if and when it does become legal, you need to ensure that the quality of the compound you are buying is good.

Dr Ed Baalbergen is the medical officer at the Vincent Pallotti Rehabilitation Centre (Cape Town) and is a member of the International Spinal Cord Society and the Southern African Neurological Rehabilitation Association. email: ed.baalbergen@lifehealthcare.co.za