MHM Magazine

Issue 6 | 2021 | MENTALHEALTHMATTERS | 21 MHM The rest of the world is seeing similar trends, with a global 18 percent growth in cannabis users over the last ten years (2010– 2019), owing in part to a 10% increase in global population over the same period, according to the WHO Drug Report, 2021. According to the UNODC, over 4% (range: 2.8–5.1%) of the global population aged 15–64 years used cannabis at least once in 2019, equating to roughly 200 million persons (range: 141 million–256 million). Similarly, the majority of patients treated for drug use disorders in South Africa who attended specialist drug treatment facilities in 2019 reported cannabis as their primary or secondary drug, particularly among those aged 20 or less. Cannabis was the most prevalent primary substance of use for persons younger than 20 years in all sites, except in the Western Cape, where methamphetamine was the most common primary substance of use, according to SACENDU (2021). Cannabis use is linked to decreased cognition in teenagers, with delayed effects on inhibitory control (e.g., self-control) and working memory, as well as concurrent effects on delayed memory recall and perceptual reasoning. In February 2014, the Medical Innovation Bill was introduced in Parliament. The bill, which legalised the use of cannabis in South Africa for medical, economic, and industrial purposes, was intended to allow for medical innovation. Depending on numerous growing parameters, cannabis contains varying levels of the cannabinoids delta-9- tetrahydrocannabinol (THC) and cannabidiol (CBD). The SA Health Products Regulatory Authority (SAHPRA) has not yet approved any commercial plant-derived cannabis products for medical use. As a result, such products are unregulated but widely available in South Africa, and they may be of poor quality, have an unknown composition, and are not guaranteed to be safe or effective. Only one synthetic medicinal cannabis medicine, dronabinol, has been approved by SAHPRA so far. For two drug-resistant childhood epilepsy types, Dravet syndrome and Lennox-Gastaut syndrome, there is evidence that medical cannabis can help. Adjuvant medical cannabis medication can lower seizure frequency by 18.8 percent and 22.8 percent for Lennox-Gastaut syndrome and Dravet syndrome, respectively, and may be effective for other rare forms of epilepsy. With synthetic cannabis, there is some evidence of chemotherapy- induced nausea and vomiting. When a purified version of THC/ CBD was introduced to existing medication for multiple sclerosis- associated spasticity, there was a slight clinical improvement in self-reported spasticity. Medical cannabis is currently used to treat chronic pain, sleep and weight issues, and neuropsychiatric diseases, however there is little or no convincing proof that it is effective. Cannabis has a higher risk of side effects than active and placebo controls, and it could be involved in clinically relevant drug- drug interactions. In the future years, the changing regulatory and legal framework surrounding the use of medicinal cannabis will guide prescription and recreational use. Here are some pointers for medical professionals: 1. Doctors must be cautious when prescribing CBD medications because research suggests that up to 60% of these products also contain THC. 2. Check and register with the Medical Control Council before prescribing cannabis to patients as a medical practitioner. 3. A comprehensive medical history should be taken to check for a family history of addiction or mental health 4. Patients must closely follow the dosage monitoring instructions. 5. Because THC is fat soluble and lingers in the bloodstream for weeks, urine screens could reveal it. 6. Refer a patient for detoxification or treatment if he or she is abusing the drug provided. All medical aid schemes consider SANCA Inpatient Treatment Centres to be preferred service providers. SANCA can be reached at 011 892-3829 (office hours) or by vis- iting www.sancanational.info for information on the nearest SANCA Centre. References available upon request