MARIJUANA is unfairly demonised, say experts. It is no more a gateway drug than tobacco and alcohol are. It is a common plant with compounds that make it useful for pain control, and to treat illnesses ranging from cancer to neurological disease, eye disease (glaucoma), asthma and epilepsy. Here’s a look at the medical marijuana debate worldwide.
By Marika Sboros
In South Africa, it is known as “dagga”, “grass”, “dope” or pot” and grows widely – and wildly – like the weed it is. In other parts of the world it is commonly called marijuana or cannabis.
Whatever you like to call it, marijuana is medicine. You can smoke it just to get “high”, but this weed doesn’t just alter your consciousness. It has a host of other powerful pharmacologic effects on body and mind, all of which make it medicine by definition.
Depending on which side of the legalisation or criminalisation fence you sit on, you’ll see those effects in a good or bad light.
In South Africa, Julian Stobbs and Myrtle Clark sit firmly on the side of the fence bathed in the glow of a good light. The media have dubbed them the “dagga couple”. They are part of an influential legalisation campaign in the country that has spread faster than the weed grows, and now includes medical doctors, psychologists, lawyers, and other interested parties.
On the other side of the fence sit just as many committed health and legal professionals who say legalisation for recreational use is simply not an option, for various religious, cultural and economic reasons.
They also say that while compounds in dagga (commonly called cannabis or marijuana in other countries) may have medicinal use, more research is needed into efficacy and safety.
Stobbs and Clark say they only became “reluctant activists” for change after police arrived at their Johannesburg home at 2am in 2010, “trying to bash the door down”, and arrested them for “growing a little dagga for our own use”.
They spent a few hours in jail and were given three choices, says Stobbs: “Pay our way out of it, take our punishment, or fight our way out of it.”
They chose the latter, hired a lawyer, and have been fighting seven government departments and “unlawful laws” ever since, helping others to do the same. They are preparing to take their cause to the Constitutional Court if necessary, to fight for what they see as their right to use dagga for whatever reason they choose.
Dagga is a green or grey mixture of dried, shredded flowers and leaves of the Cannabis sativa hemp plant and has active ingredients. These include compounds known as cannabinoids, the most well-known of which is THC (delta-9 Tetrahydrocannabinol). The compounds work primarily by activating specific receptors in the body to produce their pharmacologic effects on the brain, immune system and other tissues.
Research supports efficacy and safety of cannabis compounds for pain control, illnesses ranging from cancer to neurological disease, eye disease (glaucoma), asthma and epilepsy. It is also used to reduce nausea and vomiting during cancer treatment, and to treat cachexia, a wasting syndrome present in cancer, HIV/Aids and TB patients.
Change to the law on medical use of dagga in South Africa received a boost after an impassioned plea to parliament in 2014 by IFP MP Italian constitutional lawyer Mario Oriani-Ambrosini, who tabled the Medical Innovation Bill he drafted to legalise use of cannabinoids for medical and industrial purposes.
Oriani-Ambrosini, who was terminally ill with lung cancer at the time, and admitted to using the drug, committed suicide in August 2014. Progress on the bill stalled temporarily.
After his death, the Cancer Association of South Africa (Cansa) produced a position statement in November 2014, researched and prepared by its head of health Prof Michael Herbst.
It is enough to frighten the wits out of anyone even thinking of smoking dagga recreationally, or using it medicinally to ease pain and suffering.
Apart from “possible endocrine disrupting effects”, the Cansa paper says risks include selective cognitive and memory impairment, airway injury, lung inflammation, bronchitic conditions from smoking it, exacerbation of schizophrenia in anyone affected with it, and rare forms of cancer in those whose mothers smoked it during pregnancy – though Herbst does say “more research is needed” in this area.
It also says dagga is addictive, and often a “gateway” or “portal” drug, leading to the use of harder illegal substances such as heroin, cocaine, methamphetamine, mandrax, etc.
Cape Town GP Dr Keith Scott says that’s just scaremongering: “Dagga has been demonised,” he says. “It is no more a gateway drug than tobacco and alcohol.
“People assume it is far more dangerous than alcohol and tobacco, but it is not as toxic, and is far, far safer – definitely safer than harder drugs such as heroin and morphine.”
South Africa is “lagging far behind the international trend towards dagga legalisation or decriminalisation”, Scott says.
Legalising it for medical use would be a “step in the right direction”, but wouldn’t solve all the other psycho-socio-economic and crime problems caused by drug criminalization, which are in effect public health issues.
Globally, the biggest problem with dagga, and drugs in general, says Scott, is that they are mired in politics and outdated international treaties formed in the wake of drug criminalization. These treaties are collectively known as the “War on Drugs”.
“The war has been lost, and it has exacerbated drug problems worldwide,” says Scott, “because drugs by themselves generally don’t make people addicts.
Research shows that social, psychological, political and economic factors are the primary causes of drug addiction. If you doubt it, he says read the well-referenced book, Chasing the Scream, The First and Last Days of the War on Drugs (Bloomsbury) by British journalist Johann Hari.
Early in 2015, South Africa’s Department of Social Development organised a two-day roundtable conference in partnership with the Central Drug Authority, held in Gauteng. It aimed to increase debate about the safety of medicinal use of dagga, and develop recommendations on policy.
The roundtable became farcical at times, Scott says, as vehement opponents of legalisation, including Doctors For Life, introduced “red-herring” arguments, such as the dangers of pilots flying aircraft while high on dagga.
The event “did not contribute to a real understanding of the issues”, he says.
There are few documented cases worldwide where dagga has killed someone, while tobacco kills 6-million people annually, and alcohol 3-million people, says Scott. There is no clear evidence linking dagga with an increased risk of schizophrenia in adults; in fact studies are under way using cannabis to treat schizophrenia.
Regular dagga use from childhood or adolescence could possibly increase the risk of schizophrenia and other long-term brain dysfunction, Scott says, “but, like alcohol and tobacco, no one is suggesting children should take dagga or any other drug”.
“No drug is free from harm,” Scott says, “but any harm must be seen in perspective”.
Johannesburg clinical psychologist Quentin Ferreira says there are mental-health risks, but says dagga is “relatively safe” compared to other drugs, including legal ones, for adults not generally predisposed to psychosis or schizophrenia.
“The youth using dagga is problematic,” says Ferreira, who has worked at Sterkfontein Hospital, and clinics in Ekurhuleni, and volunteered at the South African National Council on Drugs and Alcohol Abuse while completing a master’s degree.
The brain finishes developing only in the early 20s, Ferreira says. Adding chemicals to the mix from dagga use changes the way the brain works and can also make young people vulnerable to addiction.
If there is an underlying or genetic predisposition to psychosis or schizophrenia, any drug use can bring on the onset faster and worsen these conditions, he says, by mimicking some common symptoms of psychosis, such as paranoia or “disorganised thinking”, with cannabis specifically.
Addiction is “much more complicated than most people think”, says Ferreira. It is “a complex interaction between the substance, biological and psychological factors of the person and the environment”. All these factors “cohere towards addiction”, which is not simply the inevitable consequence of using an addictive substance, as most people assume.
People become addicted to all kinds of things, including shopping, sex and gambling, but “you wouldn’t say a pack of cards causes addiction in gambler”, Ferreira says.
Stobbs and Clark, who worked in the film industry, say they have smoked dagga every day for the past 50 years, 25 of them in South Africa, without any apparent adverse effects.
Stobbs says he is not a heavy user, and only smokes it to “get that shift you need at the end of the day — when you know you haven’t done everything you need to do. It helps me switch off, calm down, put my lights out… when my mind is whirling.
“Some people call that a sedative,” he says, “and would say I’m self-medicating.”
Many countries such as Canada, Finland, Germany, Israel, Italy, the Netherlands, Portugal, Austria and Spain, allow the use of cannabis for medical purposes. Clark attended a “Spannabis” conference in Spain earlier this year that included paraphernalia for both medical and recreation cannabis use.
In the US, 26 of the 50 states and the District of Columbia have enacted legislation to legalise or decriminalise it both for medical and recreational use.
Other countries have followed suit, creating some anomalies along the way.
Uruguay positioned itself as a world leader this year: the first country to license and regulate production, distribution and sale of cannabis for adult consumers. One of the stated aims is to combat organised drug-related crime.
One problem with the way they’ve gone about it, say critics, is that the drug could end up costing more for patients seeking simple pain relief than hippies who just want to get high.
Under current legislation in SA, medical practitioners are legally denied the right to prescribe cannabis or any of the commercially produced cannabinoids approved for the treatment of cancer-related side effects in the US, and have become available in SA. Among these are dronabinol (imported and sold under the trade name Marinol in this country) and nabilone.
Many people in South Africa have made a decision to take cannabis for various ailments such as cancer, arthritis, multiple sclerosis and other diseases. However, under the present, discriminatory and arbitrary laws, patients are breaking the law by doing so, says Scott.
He knows of many doctors monitoring seriously ill patients who have chosen to treat themselves with the plant.
Stobbs refers to the recent quirky case of Durbanite Sheldon Kramer, aka “Bobby Greenhash” and the “Robin Hood of cannabis of oil”, who makes and sells cannabis oil on a non-profit basis for anyone who it. Kramer went into hiding after a police raid on his home in October. He gave himself up, has yet to be charged, and continues to advertise his oil on social media.
“My concern is for patients who won’t get it,” Kramer says.
One reason opponents usually give for opposition to medical use of dagga is that cannabinoids don’t have the sufficient number of double-blind clinical studies required for full registration.
Such studies are considered “economically unviable”, says Scott, because profits in the pharmaceutical industry come from patents, and cannabis, a plant that’s in the public domain, can’t be patented.
The international criminalisation of cannabis over the past century has made it extremely difficult to carry out research on this plant
Ever resourceful, pharmaceutical companies are finding ways to “cash in on the legalisation of cannabis and corner the market with patents”, as one media report put it.
There are suggestions that the pharmaceutical industry is behind, or at least actively supporting, the medical cannabis movement precisely because it stands to make “trillions of dollars out of products”.
Scott says if there is to be any change, the dagga couple’s pending court cases, not the Medical Innovation Bill, will drive South Africa to more just drug laws.
“The Constitutional Court will probably compare dagga laws to those pertaining to tobacco and alcohol, and hopefully find the former unconstitutional.
“Laws that criminalise the use of one substance while allowing the use of far more toxic drugs are not only irrational, they are grossly unfair and discriminatory,” Scott says.
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