Cannabis debate at Portfolio of Health

There has been a lot of discussion in the news recently about the use of cannabis – or legal marijuana – as an alternative treatment for a number of medical conditions.

At the end of last month, the Portfolio Committee on Health heard submission from legal and medical researchers from the Medical Research Council (MRC) and three clinicians. They were addressing issues raised by the Private Member’s Medical Innovation Bill.

The Bill – better known as the Dagga Bill – was originally tabled by IFP MP Mario Ambrosini, who died of cancer in August 2014. ANC Chief Whip Stone Sizani tabled the motion to revive the Bill, partly because of the huge support for the Bill from the public. When Ambrosini was still alive, he announced that 1902 public submissions had been receivedThis Bill essentially proposed the legalisation of alternative treatments, specifically cannabis, for medical use. The first submission highlighted a few problems with the definitions, specifically the definitions for treatment, and medical practitioner and cure. The Bill was proposing the establishment of pilot health centres, but this would need considerable consideration into how and where to create them, and how powers and functions would align, and testing of patients.

Generally speaking, the Committee would have to work closely with legal advisers to sort out the several points of ambiguity and possible constitutional implications of the Bill.

All submissions recognised that the topic was complex, and said that in general there was very little empirical scientific research into the use of medicinal cannabis and cannabinoids to support the Bill and there was also some uncertainty whether the Bill wanted to propose only legalisation for medicinal use or for general use. There were concerns about the inclusion of provisions that would promote the industrial production and commercialisation of medicinal cannabis. It was also pointed out that there were numerous conditions which could be treated using cannabis and cannabinoids, and more clarity was needed on which would be legally accepted for treatment in this way.

Both presenters and Members raised concerns that there could be a public perception that if medicinal cannabis was legalised, this would then open up the possibility of legalising also for recreational use.

Other points raised were which medical practitioners, general or specialist, would be recognised in South Africa as allowed to prescribe the cannabis. It would be important to discuss and understand how this Bill would function in the health system, especially in relation to the mental health system, and whether other legislation would need to be amended as well. It was pointed out that South Africa was a signatory to international treaties that had to be respected, whilst many people questioned whether, given that some form of special application was available already, there was actually a need for a new specialist Bill.

Clinicians pointed to the effect of addiction and drugs on the mental health care system, saying that this would be added to if drug induced mental conditions were also added to the general situation. However, there were divided views on whether cannabis was necessarily addictive, whether it had a lower deleterious effect than other substances such as alcohol, whether use of cannabis necessarily led on to use of other drugs, and whether medical use of cannabis would stimulate a desire to use it recreationally.

Different examples were cited of other countries who had legalised it from a medical or general perspective. Other important points raised related to the cost of the research, the cost of introducing the Bill, the cost of setting up regulatory systems, and whether this would be possible, decisions on who must regulate, and the form which the medical cannabis would take, which then also meant that how it was acquired or synthetics manufactured would need to be considered.

Some Members were concerned that this Bill sought to introduce cannabis through a “Trojan Horse” approach. Some felt that it could lead to pressure for general legalisation. The motives behind the Bill were questioned, as well as noting the emergence of strong lobby groups. Through all the different views, however, there seemed to be a common concern that more research was needed in a number of areas.

The MRC pushed strongly that if research was to be done, then it should be done by the MRC, who supported a number of other research methods and organisations, and was already engaged in considerable research on cancer.

The social and political implications would also need careful consideration and it was pointed out that although information from other countries was useful, it was not necessarily directly translatable to the South African situation.

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