CANNABIS, long derided as a “gateway drug”, is increasingly prescribed as an “exit drug” for pharmaceutical drug addictions tripped by chronic pain, anxiety and insomnia medications routinely used by millions of South Africans to create a market worth billions of rands.
But five years since the Constitutional Court gave the government a two-year deadline to reform and dismantle cannabis’s longstanding prohibition laws, the plant’s myriad medical applications remain in the twilight zone.
Commonly prescribed pharmacy drugs are “highly addictive”, says Dr Anton van Rensburg, an allopathic (Western) physician. For three years, the Midrand doctor has used medicinal cannabis to wean addicts off pharmaceutical drugs while at the same time addressing their illnesses and complaints. “Medicinal cannabis is less addictive than caffeine,” he says, and it doesn't have “stoned" side-effects.
Van Rensburg says he rehabilitates pharmacy junkies with “ridiculously low cannabis doses … they literally take a single drop for the first few nights and then you go to two drops for a few more and then (maintain at) three drops”. Breaking addictions to “toxic" medications can take between three and six months, he says, and a monthly supply of medical-grade cannabis costs about R1,200.
Medicinal cannabis is unregistered, and doctors' prescriptions are sanctioned after payment of a R350 administration fee for individual vetting by the South African Health Products Regulatory Authority (Sahpra). This is done under section 21 of the Medicines Act, which provides access to medicines on an exceptional basis when approved therapies have been ruled out, have failed or are unavailable.
Factors that constrict demand are a 12-page application, the exclusion of cannabis from medical aid refunds, as well as most allopathic professionals being unschooled in its ways — all underwritten by the stubborn fake-news legacy that dagga is dangerous.
About 4.6 million South Africans have insomnia and one in five adults manage chronic pain with prescription drugs. Zolpidem tartrate is the active ingredient for treating insomnia, trading sleep for a heightened risk of clinical depression and loss of libido loss. It is available in a variety of guises, including Stilnox.
Addicted to profits
In1996, chronic pain medication started the US opioid crisis after OxyContin was aggressively marketed as “rarely addictive”. OxyContin is a registered Sahpra drug.
Ground zero for the carnage was West Virginia’s Cabell County. Big Pharma shipped 81 million opioid doses, or 28,000 daily, over eight years to satisfy demand from the county’s 90,000 population, according to legal records. By 2017, more than 210,000 Americans had fatally overdosed on prescription opioids including Fentanyl, used to numb cancer pain.
Benzodiazepines, a class of drugs often lumped under Valium, are prescribed for the anxious, and withdrawal symptoms include panic attacks and deep anxiety. They're distributed in more than 20 brand offerings, including Xanax and Urbanol.
Humanity’s intimacy with cannabis over many thousands of years has yet to produce a clinically documented overdose fatality. The corporate gold rush to monetise cannabis was the 1990s easing of prohibition’s medical research restrictions, seeded nearly 60 years earlier when the US criminalised a flower for immorality.
Endocannabinoid system unravelled
Technology’s phenomenal advances since the 1937 Marihuana Tax Act have unplugged scientific inquiry from criminal sanction and allowed a comprehensive gaze at the plant’s molecular structures, also revealing more about ourselves. .
Lifting scientific censorship unveiled the endocannabinoid system (ECS), a previously unrecognised and intricate biological network critical for our movement, learning, memory, appetite regulation, sleep and modulating pain and addictions, among a few other tricks.
Cannabinoid receptors are dotted throughout the body, with heavy concentrations in the central and peripheral nervous systems and among immune cells.
Sista Vee Nohombile, author of the holistic guide Cannabis is the Human Companion Plant and arrested 11 times for possession during her 40 years as a healer, says the ECS remains excluded from allopathic medical schools' seven-year doctor qualification regimes.
She says most South Africans consult traditional healers and are prescribed cannabis for asthma, cancer, diabetes, mental, gut and bone health, and other conditions. An August 2023 South African Police Service directive acknowledged a patient’s right to “legally obtain small (cannabis) amounts” without healers risking “drug dealing” prosecutions or exposure to lavish cop bribes, Nohombile said.
Sahpra's medicinal cannabis has quality controls, whereas medicines dispensed by healers or apothecaries are unregulated, opening a window to pesticides and other shortcut growing and processing practices polluting the medicine. “There are a lot of dodgy products masquerading as (cannabis) medicine these days,” Nohombile says.
“The only truly safe way of getting this medicine is to make your own, because the truth is that anyone can make this medicine.”
Prohibition in a cheap suit
The yet-to-be gazetted Cannabis for Private Purposes Bill effectively bans home-produced plant-based remedies by restricting households to eight female plants and making provision for severe, escalating criminal charges for those not holding the line.
The US-inspired global prohibition removed cannabis from the food chain and “that is exactly when we started to see an increase in cancer cases and mental health conditions”, says Nohombile.
Industrial cannabis or hemp, with a growth rate second only to bamboo, is planted at densities of up to 200 seeds a square metre and the biomass is harvested within six months when it reaches nearly five metres tall.
Before the drug war’s cluttered security furniture, hemp’s widescale use in food products — from vegetable oils to staple livestock fodder — unwittingly added non-psychoactive cannabinoids to dairy, poultry, red meat and other edibles, guaranteeing cannabis compounds were integral to diet.
“There is enough research to show that cannabis does have a cancer- suppressive effect,” says Van Rensburg. “We just don’t know which cancer, which strain, which dose. Without a shadow of a doubt, this plant has anti-cancer properties.”
Every month, Sahpra approves about 200 cannabis scripts but rejects one in three, says the regulator's spokesperson, Yuven Gounden.
Red tape two-step
Cannabis clubs have become an alternative avenue for those chasing relief from chronic pain and other decay.
Anneke Vrey, a founding member of Hartbeespoort’s Die Joint, says up to 40% of its hundreds of members use recreational marijuana for “self-medicating reasons”.
Angel Louise*, a qualified nurse with a side-hustle in the KwaZulu-Natal wellness industry from her business management day job, uses IntroCann, a web-based service fast-tracking Sahpra Section 21 authorisations. This gives patients peace of mind, because without a prescription, workplace drug-testing can threaten jobs.
IntroCann’s Craig Ludwig says the platform caters for patients and “time-starved” doctors, while offering allopathic professionals medicinal cannabis education. Sahpra's quickest turnaround for a standard six-month prescription is a day, Ludwig says. The service’s youngest patient so far was a 10-year-old prescribed the medicine for palliative care.
“Substituting morphine is becoming more open with the oncologists I deal with,” says Van Rensburg. “You want the patient to have as much quality time as possible in their last days, and high-dose opioids or morphine cause them to become zonked-out zombies. Cannabis medication allows them to spend quality time with their family.”
The registration of cannabis would remove barriers barring medical aids refunding the costs of unregistered medicine, but dagga’s intrigue is its Achilles heel. Multi-million rand registration fees are imposed, and even the slightest deviation from a recipe requires a separate Sahpra listing.
Medicinal cannabis’s broad reach alleviates a host of fragilities, and much of its power lies in its trichomes, the flowers' crystal glazing that manufactures terpenes, cannabinoids and flavonoids.
Cannabis contains about 550 diverse chemical compounds, including hundreds of cannabinoids. The most infamous, and the one that causes all the fuss, is the psychotropic element delta-9-tetrahydrocannabinol (THC). Less stigmatised is the sleep-inducing anti-inflammatory cannabidiol (CBD).
Adding to Sahpra's cannabis registration maze, there are between 700 and 2,300 strains of cannabis, each with unique cannabinoid concentrations.
Allopathic research shares common ground with cannabis healers in attributing the plant's efficacy to “the entourage effect”, where compounds act in concert, although the combinations and codes are yet to be cracked by clinical investigators.
Science’s THC buzz
THC, the compound propelling the “moral” prohibition sideshow of many religious people, is seducing researchers with its possibilities; and endangering Big Pharma's annual global “happy pill” anti-depressant and anti-anxiety sales forecasts, which are expected to breach $18 billion (R346 billion) by 2027.
This year, the scientific journal Cell Reports published the results of a Northwestern University study in which laboratory technicians stressed mice then used real-time protein sensors to monitor cannabinoid activity in the amygdala.
It discovered the brain’s default stress compensation setting was to release THC-type cannabinoids, a result stoners have been banging on about for a millennium.
In a comparative trial, brain cannabinoid release was prohibited, resulting in anhedonia — a psychological condition extinguishing desire and joie de vivre that is common among sufferers of post-traumatic stress disorder and clinical depression.
Allopathic investigations are seeking a cannabis-based formula for pills, patches, capsules and vape medications that appease insomnia, pain, anxiety and stress — all while carrying lower addiction threats than Checkers instant coffee.
* Not her real name
♦ VWB ♦
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