A motley crew of eccentric activists, some garbed in tie-dye shirts and wearing peace signs, are waging a headline-grabbing battle in court to legalise the recreational use of dagga in South Africa.

But the real power to decide the plant’s fate may lie with the country’s scientists who will have to weed out fact from fiction when it comes to its true medicinal worth, and how it will move from field to pharmacy.

Self-proclaimed “reluctant activists” Julian Stobbs and Myrtle Clark were arrested for possession of and dealing in marijuana in 2010 after police raided their home in Lanseria, north of Johannesburg. Since then, they have been working to have the courts declare the ban on the adult recreational use of marijuana unconstitutional.

Currently, dagga is a schedule seven drug, meaning the Medicines Control Council (MCC) has deemed it highly addictive and not suitable for medical use. But doctors can apply for special permission from the national drug regulator to prescribe it, according to the MCC’s law enforcement manager, Griffith Molewa.

Stobbs and Clark argue that the regulation of dagga is scientifically unfounded and based on outdated colonial laws. The pair suggests that, given evidence of dagga’s medicinal benefits, South Africans should have the right to self-medicate with it. Their battle is expected to resume in the Johannesburg high court next year.

In March, the Cape Town high court ruled that banning adults from smoking or growing dagga in their homes infringed on their constitutional right to privacy. The director of healthcare and life sciences practice at Werksmans Attorneys, Neil Kirby, says this means South Africans can legally use cannabis at home.

But the ruling does not apply to marijuana use in public, something that Stobbs and Clark advocate for in their court bid. Their ongoing court battle has delayed their criminal prosecution.

While the couple’s attorneys continue to pore through reams of state evidence submitted in August, researchers and regulators warn that the trial may be conflating issues. Ultimately, whether South Africans have a right to get high is a very different matter to whether it has any medical benefits.

The promised land? A sign in the United States city of Los Angeles advertises medical marijuana. Although dagga isn’t registered for medicinal use in South Africa, doctors can apply for special permission to prescribe it. (Lucy Nicholson, Reuters)

The constitutional and medical arguments for legalising marijuana should be kept separate, according to Charles Parry, the director of the alcohol, tobacco and other drug research unit at the South African Medical Research Council (SAMRC).

He says: “Medicinal use of cannabis is already legal [provided you have special permission] and access for medicinal use should be increased, but we should follow normal procedures for testing as you would any other medication before opening it up for medicinal use for a broad range of conditions.”

Dagga’s defenders have claimed the weed can help with ailments such as incontinence, diabetes and lung cancer. But the question remains whether there is any evidence to prove this.

Parry says the benefits of cannabis are often exaggerated, and its reported medical benefits have not been backed up by studies based on trustworthy evidence.

“There’s a lot of anecdotal evidence. You’ll see people with Parkinson’s disease on TV, smoking and claiming to feel better, but that’s just one person.”

Marijuana, or Cannabis sativa, contains at least 100 active pharmacological substances.

Last year, a SAMRC review only discovered sufficient evidence globally to support the use of one of these, cannabidiol, to treat two conditions prevalent in South Africa — chronic pain and multiple sclerosis. In a 2016 policy brief, the medical body found that cannabidiol provided some relief for sufferers of persistent pain. It was also associated with decreased muscle spasms in patients with multiple sclerosis, a degenerative condition that affects the brain and spinal cord and causes nerve damage.

The brief was based on a systematic review published in the Journal of the American Medical Association in 2015.

“Cannabis could be useful for other conditions as well, but we have to do the proper trials,” he says.

One of them could be Aids wasting syndrome in which HIV-positive people suffer extreme weight loss as well as chronic diarrhoea, weakness or fever.

There is some evidence to support this, but more is needed, according to a 2013 systematic review by the Cochrane research network.

Parry admits legalising marijuana could make it easier to research the plant’s benefits and the SAMRC is currently raising funds to study dagga’s potential for treating the Aids-related illness.

Cannabis-based products line the shelves of a story in Oregon, United States. While only about 9% of users develop dependence in the US, the herb accounts for between 24 and 36% of admissions into local rehabilitation centres in SA. (Steve Dipaola, Reuters) 

But Molewa and Parry warn that marijuana is not without its risks. A 2009 research review published in The Lancet medical journal unearthed an association between smoking weed and lung cancer. The study also found that using dagga put people at an increased risk of motor vehicle crashes, heart disease and lung damage.

But alcohol and tobacco caused more harm at a community level than cannabis, such as increased motor accidents, lower educational attainment in adolescents and dependence, the review revealed.

In Canada, Australia and the United States, the lifetime risk of developing a dependence on cannabis is about 9%, or almost three times less than that linked to cigarette smoking.

But, in South Africa, between 24% and 36% of patients attending specialist treatment centres list cannabis as their main drug of abuse, according to the most recent data from the SAMRC’s alcohol and drug surveillance project. The project captures data from drug treatment centres every six months.

International research shows that legalising cannabis isn’t necessarily linked to an increase in use, but the SAMRC’s data suggest that there could be at least 8 000 people who need support to fight dagga-related problems, such as dependence, annually.

Parry says the harms of marijuana use should not be overstated, cautioning that everyone reacts differently to the plant. However, he warns the country’s health system may not be equipped to deal with any increase in cannabis-related health problems — but we need more data to know this.

“Cannabis has been shown to affect your driving ability so we might expect more motor vehicle issues. We would need to be collecting data from emergency rooms, conducting better household surveys to study the effect of legislated changes, and increase funding for education on safe use.

“In an ideal world, we would probably legalise it, but we would need safety nets, and there is no guarantee we’d have the capacity to establish them,” he says.

The nonprofit advocacy group Anti Drug Alliance estimates that decriminalising dagga could save the country about R3.5-billion, which is spent, for instance, on policing its use, prosecution and incarceration. But Parry says it’s unlikely these savings would find their way into public health coffers.

A woman smokes a joint in the Netherlands. SA is expected to regulate aspects of medical cannabis including the quality of seeds and soil used as well as the geographic area in which it is grown. (Michael Kooren, Reuters)

Meanwhile, the days in which South Africans take to the fields to cultivate medical marijuana may not be far off.

Molewa says South Africa’s research community is trying to better understand cannabis’s medical potential and the MCC has already begun to regulate medical marijuana.

In July, the MCC declared cannabidiol — the substance that has been found to help patients with chronic pain and multiple sclerosis — a schedule 6 drug. The decision means doctors can now legally prescribe the compound.

In a statement, the MCC says it expects to release regulations for the cultivation of medical marijuana for public comment by the end of the year. These criteria are expected to cover aspects of growing such as soil and seed quality as well as preferred varieties and geographical areas for growth.

Cape Town-based company Verve Dynamics, which specialises in “vegan-friendly” botanical extracts, is ready to begin growing medicinal weed in Lesotho after its government granted the firm a licence two weeks ago.

Once the MCC’s regulation is adopted, South Africans will be able to apply for permits to grow the plant, following in the footsteps of the mountain kingdom.

Have something to say? Tweet or Facebook us on @Bhekisisa_MG

daggamedical marijuana