A recent webinar hosted by the Cannabis Organisation of the University of Pretoria (COUP) highlighted the potential risks and benefits of medical cannabis use for mental health, with experts shedding light on the key scientific factors that have an impact.

The webinar tackled the topic 'Cannabis and Mental Health – Navigating the Highs and Lows'. Isaac Mokgaolo, Senior Lecturer in the School of Nursing at North-West University, gave a background to cannabis use, particularly within the South African context, noting that South Africa is the highest cannabis producer in Africa, contributing 28% of the continent's total production. This is according to the United Nations Office on Drug and Crime, which also states that Africa is the highest producer globally, contributing 25% to worldwide production.

Most users in South Africa are adolescents and male, and cannabis use is more prevalent in urban than rural areas.

Mokgaolo laid out the health risks associated with cannabis, which include intoxication (and the associated withdrawal and addiction response), psychotic disorders, personality disorders, anxiety and stressor-related disorders, and increased respiratory conditions.

When it comes to the health benefits, he said there is good evidence for cannabis in treating epilepsy, Dravet Syndrome and Lennox-Gastaut syndrome.

For other conditions, the evidence is less clear. "There is limited evidence for its effectiveness related to reducing nausea and increasing appetite; pain relief (across various conditions); mental disorders such as anxiety, dementia, schizophrenia, and Attention Deficit Hyperactivity Disorder (ADHD); and glaucoma," he said.

Additionally, he said, there are risks associated with a rapidly changing social and legislative context. "It's important for health professionals to know that the changed legislative landscape for cannabis makes discussing its use more complex, and it might be a sensitive issue," he explained. "There is a lot of misinformation regarding the product and practitioners need to be equipped with evidence-based information and do thorough research before prescribing it to patients."

Regulatory hurdles

Werner Breedt, who is part of the strategic management team for the Southern Centre for Indigenous Psycho-Pharma (SCIPP), an inter-disciplinary research centre at UP positioned to conduct research and development of indigenous medicines and traditions, addressed the consequences of illegality for drugs, which are similar to those witnessed during the alcohol prohibition era in the United States.

"Firstly, the drug concentration increases, for many reasons, one of which is that there is a higher profit involved for the person selling it.

"Secondly, the illegal market is sustained, no matter how many controls are put in place. As a result, access is unregulated, and limited to the population at the highest risk (youth and adolescents), while access is not provided to those who have serious ailments and treatments needed.

"While more research is needed in this area, studies suggest that legalising cannabis does not have a significant impact on increasing its use among youth and adolescents," he said. Breedt then showed the audience videos with anecdotal evidence of how cannabis, when accessed correctly and in the right dosage and form, can assist patients struggling with diseases such as Parkinson's and epilepsy.

Psychiatric risks

The third presenter for the webinar, Gerhard Grobler, Head of Clinical Unit: Psychiatry, at Steve Biko Academic Hospital, addressed the potential psychiatric consequences of cannabis use. "In addition to the many positive benefits spoken about, I want to just highlight that for some users there are these negative psychiatric effects.

"The first relate to Cannabis Use Disorders (CUD) and include Cannabis Use Disorder (previously called cannabis addiction), cannabis intoxication and cannabis withdrawal. The second relate to Cannabis Induced Psychiatric Disorders (CIPD), which impact heavy users who are in the vulnerable group, six times more than irregular users.

"The question of whether or not cannabis use causes schizophrenia is a moot point, with the current thinking being that it does not cause schizophrenia per se, but if you are vulnerable to develop it, then cannabis use will unmask and activate that illness," he said. "If you do suffer from schizophrenia, it's not a good idea to continue using cannabis.

"In addition to an earlier onset and exacerbation of symptoms, there is evidence of higher relapse rates and longer hospitalisations."

Grobler highlighted a number of other cannabis-used effects, such as insomnia and delirium, sometimes called acute confusional state or acute brain failure, which leads to symptoms like disorientation, an altered sleep-wake cycle, and memory impairment, among others.

Tracy Muwanga, a postdoctoral transdisciplinary researcher at UP, facilitated the webinar, which included a question and answer session that sparked further dialogue. At the end of the discussion she thanked the presenters for sharing their expertise, and the audience for attending, and encouraged them to continue their conversations, as well as to engage and keep up to date with the work that COUP is doing.