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The CDA is a government advisory body which supports the decriminalisation of dagga. It switched its stance earlier this year, marking a major shift in drug policy.
Dagga is illegal for personal and medicinal use. But the CDA has gone further to say in the SAMJ article a “balanced and pragmatic” approach to dagga use and abuse was needed, especially in light of evidence to show decriminalisation could contribute to improved public health.
Its support for decriminalisation is part of a shift away from a “war on drugs” approach focused on policing, to a public health approach where harm reduction is key.
“Harm reduction refers to policies and interventions to reduce the harmful consequences of alcohol, tobacco, marijuana and other psychoactive substance use,” they said, arguing criminalisation of dagga hasn’t worked.
“There is little evidence that focusing on supply reduction via criminalisation is effective in reducing alcohol, tobacco, marijuana and other substance abuse.”
While they support decriminalisation, Stein and Manyedi also say legislation to make dagga commercially available would be a step too far.
“We are cognisant of not wanting policy to lead simply to Big Tobacco’ being joined by Big Marijuana’ – there is insufficient evidence this would be a gain for public health,” they said.
Stein and Manyedi voiced support for research on medicinal cannabis, as scientific studies found it to be harmful “for certain aspects of health”.
“Research on its health benefits remains sparse to date, with more research needed to establish safe dosages.”
The CDA’s policy statement was answered in the journal by Cape Town doctor Keith Scott, who said decriminalisation was not enough.
“Decriminalisation rarely provides for users to legally obtain their drugs, but implicitly directs them to continue sourcing drugs of unknown purity and potency.” .
Scott argued rather than legalising the drug, South Africa should take an approach of “legal regulation”, which he described as a strict policy control around its use.
“Any drug will be safer if its production and availability is regulated rather than in the hands of criminals,” he said.
SAMJ acting editor Dr Bridget Farham, meanwhile, noted that dagga would “almost certainly be legally available in the not-too-distant future”.
She argued that South Africa needed to get ahead of the curve by beginning to research the efficacy, safety and dose range of cannabis.
In January, the SA Medical Research Council published a policy brief on cannabinoids for medicinal use.
In a systematic review of scientific studies, the council concluded there was evidence “of moderate quality” to support the use of cannabinoids for the treatment of chronic pain and to reduce spasticity in multiple sclerosis sufferers.
The council noted there were some safety concerns about the drug, however. Short-term adverse effects ranged from dizziness and vomiting, to disorientation. There was not enough data to assess the long-term effects. The council concluded there was not enough detailed information about the appropriate dosage for medicinal use.
For many, the enduring image of legal marijuana is still that of a coffee house in Amsterdam, where patrons can select their dagga from a menu.
Under the Dutch policy of gedoogbeleid, marijuana is technically illegal, but authorities rarely choose to prosecute.
Since the Dutch embarked on their policy of de facto decriminalisation, the number of countries where marijuana is decriminalised or legalised has grown.
In Canada, for example, patients can buy medical marijuana from a licensed producer, when authorised by a doctor.
The Canadian government is also considering legalising the drug.
In the US, while the use and sale of marijuana remains illegal under federal law, half the 50 states have legalised it in some form.
In 25 US states patients can buy medical marijuana, it can only be smoked legally in four.
A number of South American and European countries have also decriminalised marijuana for personal use, leaving users alone if they have up to a specified amount.
Africa has been behind the curve, however. And while marijuana use is tolerated in some countries, it has not yet been been officially decriminalised anywhere on the continent.