Citation

Bantjes J, Myers B, Parry C. S. Afr. Med. J. 2022; 112(6): 393-394.

Copyright

(Copyright © 2022, South African Medical Association)

DOI

unavailable

PMID

36217866

Abstract

There is a global trend towards liberalising cannabis legislation amid recognition that previous restrictions caused social harm and impeded medical research on phytocannabinoids.[1,2] Liberal legislation and attitudes toward cannabis may create opportunities to harness the pharmacological benefits of cannabis for epilepsy,[3] chronic pain,[4] nausea and spasticity,[5] among other medical conditions. Nonetheless, laws that potentially increase access to cannabis could have public health consequences with regard to respiratory health, traffic-related injuries, and the mental health of vulnerable populations.[6] Rigorous debate about these public health concerns is needed as South Africa (SA) moves towards ratifying the Cannabis for Private Purposes Bill[7] introduced to Parliament in October 2020. The Bill, which is currently before the Portfolio Committee on Justice and Correctional Services, makes provision for adults to possess, cultivate and process a prescribed quantity of cannabis plants, and to use cannabis, while also explicitly acknowledging the need to protect citizens from potential harms. This prompts questions about who should be protected from cannabis harms. Drawing on recent systematic reviews and expert consensus, we argue that adolescents, pregnant mothers, and fetuses are three groups vulnerable to the harmful effects of cannabis, requiring special consideration as noted in recent Portfolio Committee hearings.

Cannabis exposure and adolescent development

The lack of well-designed longitudinal studies assessing the impact of cannabis on adolescent health makes it impossible to conclude that adolescent cannabis use is safe.[8] If anything, the evidence highlights safety concerns, with regular cannabis use during adolescence associated with persistent functional and structural neurological changes,[9] and cognitive and emotional deficits.[10] Adolescents are more vulnerable than adults to the negative effects of cannabidiol and tetrahydrocannabinol, with regular exposure during adolescence associated with more severe and persistent negative outcomes than use during adulthood.[11,12]

Cannabis use during adolescence causes structural, functional and histological alterations in the frontoparietal, frontolimbic, frontostriatal and cerebellar regions of the brain,[9] and also affects the endocannabinoid system, which is particularly susceptible to the harmful effects of cannabis as it undergoes profound developmental changes during adolescence.[10] Prolonged cannabis use during adolescence also disrupts the neuromaturation processes that occur during this period, with synaptic pruning and white matter development particularly affected...

Language: en

Keywords

Adolescent; Humans; Female; Public Health; Pregnancy; South Africa/epidemiology; *Cannabis/adverse effects; *Hallucinogens; Pregnant Women