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Medical cannabis: What practitioners need to know.

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South Africa has decriminalized adult cannabis use. While some medical benefits exist for specific epilepsies and nausea, evidence for other conditions is limited, and unregulated products pose safety risks.

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Area of Science:

  • Pharmacology
  • Cannabinoid Science
  • Public Health Policy

Background:

  • South Africa's Constitutional Court decriminalized private adult cannabis use.
  • Cannabis contains delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), with varying compositions.
  • Unregulated, plant-derived medical cannabis products are available but lack quality assurance.

Purpose of the Study:

  • To review the current evidence for medical cannabis efficacy and safety.
  • To examine the regulatory status of medical cannabis in South Africa.
  • To inform the evolving legal and prescription landscape.

Main Methods:

  • Literature review of clinical evidence for medical cannabis.
  • Analysis of South African Health Products Regulatory Authority (SAHPRA) approvals.
  • Assessment of product quality, safety, and drug-drug interactions.

Main Results:

  • Medical cannabis shows benefit for specific drug-resistant epilepsies (Lennox-Gastaut, Dravet syndromes) and chemotherapy-induced nausea.
  • Moderate evidence supports use for multiple sclerosis-associated spasticity.
  • Limited evidence exists for chronic pain, sleep, weight, and neuropsychiatric disorders.

Conclusions:

  • Medical cannabis has demonstrated efficacy in limited conditions, primarily epilepsy.
  • Unregulated products present significant quality and safety concerns.
  • The legal framework will shape future medical and recreational cannabis use in South Africa.