Introduction
People have been using cannabis since the beginning of civilization. It has become the most widely used illegal drug in the world; its euphoric effects came first, followed by its medical uses (Millar et al., 2021). Cannabis usage has become more and more common as a result of more countries permitting its use and loosening their laws against its use.
Users of cannabis report a variety of effects from the drug itself, including medical benefits, such as controlling diabetes, treating glaucoma, relieving chronic pain, and even curing some conditions (Millar et al., 2021). In South Africa, cannabis use is constantly linked to issues such as Cannabis Use Disorder (CUD), and the court has heard several cases about this topic (Feingold et al., 2020). This article will critically evaluate the implications of marijuana legalization in South Africa, examining its legal, social, economic, and public health impacts.
Clinical Characteristics and Risk Factors of Cannabis Use Disorder
Clinical Characteristics
Some cannabis users struggle to stop using the substance even when it is the cause of their social problems and health problems. This condition is known as cannabis use disorder. A cannabis use disorder, as defined in the DSM-5, involves a problematic pattern of marijuana use that leads to clinically significant impairment, indicated by the presence of at least two specified symptoms within 12 months (American Psychiatric Association, 2000). People frequently use cannabis for a long time or in larger amounts than they are supposed to. There is a persistent goal to control or limit cannabis use, which should focus on spending much of the time on the actions necessary to obtain, use, or recover from cannabis use.
One CUD characteristic is significant craving—the urge to consume cannabis. Long-term cannabis use has been linked to a decline in focus on objective behaviors, which may result in poor performance in the workplace or educational setting (Feingold et al., 2020). Cannabis-related intoxication-related safety accidents may be dangerous. According to Feingold et al. (2020), there is also continuous cannabis use despite persistent or recurrent social or personal problems worsened by the drug’s side effects.
Significant interpersonal, professional, or pleasure activities are curtailed or stopped as a result of cannabis use. There are regular cannabis uses in physically dangerous situations. Another feature of a cannabis user is that they continue to take the drug even after realizing they have a chronic or recurring medical or psychological ailment that the drug may have aggravated or caused (Feingold et al., 2020). This continued usage of cannabis, despite its drawbacks, highlights how addictive marijuana is.
Risk Factors
Numerous risk factors have been linked to the emergence of cannabis use disorder. These include frequent marijuana use, oppositional behaviors, early start of cannabis consumption, parental substance use, low academic success, antisocial behavior, and childhood sexual assault. Reduced birth weight, premature birth, stillbirth, and a higher chance of cognitive and behavioral issues are all associated with it (Bako et al., 2023).
A client attempting to recover from cannabis misuse is equally vulnerable to relapse if there is continuous substance abuse among the immediate family of the client. Peer pressure, stress or traumatic experiences, socioeconomic status, and exposure to marijuana in the environment can all have an impact on the beginning of CUD (Bako et al., 2023). Effective preventative and treatment techniques depend on identifying and resolving these issues.
Other mental health conditions, such as anxiety, depression, or attention-deficit, can cause CUD. It affects an individual with ADHD because they may behave without fully realizing the consequences of their behaviors, which can result in worry and sadness (Millar et al., 2021). The chance of getting CUD rises with early cannabis usage, especially throughout adolescence, when the brain continues to grow.
Early and consistent use can alter the shape of the developing brain, especially the areas responsible for recall, making decisions, and time management (Millar et al., 2021). Frequent cannabis usage increases the risk of developing CUD by causing addiction, tolerance, and signs of withdrawal. These people exhibit many of the characteristics of more widely recognized substance use disorders, such as tolerance and signs of withdrawal.
Implications of the Ruling for South Africa
Legal Implications
It is anticipated that the legalization of cannabis will negatively affect South Africans’ physical and social well-being, especially focusing on the impacts of CUD. The Constitutional Court gave the parliament two years to amend the Drugs and Drug Trafficking Act to reflect the new policy after deciding in favor of legalizing cannabis (Dugas et al., 2018). The decision significantly modifies the application and interpretation of current drug laws by legalizing individuals’ personal use, ownership, and growing of marijuana in private settings (Dugas et al., 2018).
The reading-in meant that cultivating cannabis for personal enjoyment in a private setting or using it for personal use behind closed doors was no longer illegal. People with CUD are known to break the law regardless of what they are supposed to do (Dugas et al., 2018). Therefore, laws and regulations must be updated to conform to the new legal structure, and law enforcement goals and practices must be reevaluated to accommodate people with CUD.
Social Implications
The legalization of marijuana has a significant impact on societal norms, attitudes, and behaviors related to cannabis usage. Literature found mixed results for changes in attitudes toward cannabis and inadequate proof for minimal effects, such as a small decrease in adolescent marijuana consumption rates and drug consumption rates (Bogais et al., 2022). Increased usage among young individuals, CUD medical care visits, and impaired driving were among the negative impacts of legalization (Bogais et al., 2022).
It could help change people’s opinions on cannabis from one that is illegal and stigmatized to a perspective that is acceptable or even normalized in some situations. This normalization affected cannabis consumption trends, particularly in vulnerable populations like teens who could perceive the substance as less harmful or forbidden (Bogais et al., 2022). Numerous studies demonstrated the links between the regular use of cannabis and an increased likelihood of higher cases of CUD (Jenkins et al., 2023). Indeed, these relationships got stronger even after accounting for potential confounders like personality traits and substance abuse history.
Economic Implications
From an economic perspective, legalization may offer new ways for the state to collect revenue and save money, while creating more jobs and opportunities for entrepreneurs in the legalized cannabis sector. The legalization of marijuana has financial benefits, including increased tax revenue, economic growth, and fostering innovation (Raihan & Bijoy, 2023). From the perspective of the economy, it is not surprising that following legalization, tax receipts from the direct sales of marijuana increased while those from the sales of tobacco and alcoholic drinks declined (Raihan & Bijoy, 2023). This change highlights the possible financial effects of legalizing cannabis on other sectors of the economy.
Legalized cannabis production, distribution, and sales might contribute to funding for drug education and treatment initiatives. It may boost tax revenue for government organizations and reduce the burden on the legal system and law enforcement organizations enforcing marijuana-related laws (Rotering & Apollonio, 2022). States collected around R56,120,100 from marijuana sales in 2022 (Rotering & Apollonio, 2022). Legalization across the country may bring in R152 billion per state per year (Rotering & Apollonio, 2022).
Potency-based taxation is great, but if commerce between states is authorized, tax uniformity between jurisdictions will be crucial. Legalization may also encourage the development of cannabis-related industries, including manufacturing, processing, retail, and auxiliary services, thereby strengthening the economy and creating jobs (Rotering & Apollonio, 2022). However, the legalization of cannabis can also negatively impact the economy, as some people will not be earning (Rotering & Apollonio, 2022). People with CUD are known to avoid working and concentrate on getting cannabis, hence affecting the tax that they should pay.
Public Health and Safety Implications
The legalization of marijuana also brings up significant issues related to public safety and health. While ingesting marijuana might have delayed, perhaps unforeseen effects, marijuana consumption produces quick and predictable indications and symptoms (Manu et al., 2021). The possible rise in marijuana-related medical conditions like addiction, respiratory disorders, and psychosis disorders is one of the societal issues that has recently received increased attention.
Proponents argue that regulation can mitigate the adverse effects of cannabis use, such as shrinking the black market and ensuring product safety, but concerns persist about potential health risks (Manu et al., 2021). These might include a rise in CUD illnesses, diminished cognitive function, and a worsening of already-existing health inequities.
The most substantial evidence of risk can be traced to early and continuous use in youth and children, which is associated with the onset of their CUD issues. Enforcement, education, and prevention activities regulating drunk driving, party accidents, and marijuana intoxication-based workplace accidents should also be implemented for public safety. According to Crocker et al. (2021), a loss of an average of six to eight IQ points, as tested in mid-adulthood, was linked to a persistent CUD with regular use beginning in youth. The chances of deadly motor vehicle collisions are significantly increased to the point where one could die when driving under the influence of marijuana.
Intervention Strategies for Managing Cannabis Use Disorder
It is true to say that, aside from rehabilitation facilities, there are no intervention techniques available in South Africa. Furthermore, there is a lack of effective preventive measures to address the growing problem of Cannabis Use Disorder. As a result, it becomes imperative to analyze past decisions, including the decision to create rehabilitation facilities (Choi & DiNitto, 2019). These clinics may offer intensive treatment and support those with CUD. Rehab involves an individualized treatment approach, enabling clients to identify and combat the root causes of their addiction (Choi & DiNitto, 2019). The ultimate aim of any rehab is to help people beat the addiction, but the therapy is not limited to this.
Therapy program organization is also an intervention method. The disorder is mainly treated in South Africa with behavioral methods, including cognitive-behavioral therapy (CBT), motivational interviews, and medication for contingency management (Granholm et al., 2020). One of the main goals of CBT is to change individual negative thoughts and attitudes associated with CUD people (Granholm et al., 2020). The goals of such programs are to take care of the underlying conditions, educate the users to quit use or reduce cannabis use, and familiarize them with coping mechanisms so they do not relapse. CBT provides relapse prevention skills, helping them to determine the triggers and how to deal with them when the problems reappear.
Many groups and governmental bodies run educational initiatives to increase public knowledge of the dangers of cannabis usage, such as the possibility of addiction and unfavorable health outcomes. Their goal is to raise awareness of Drug Aware as a reliable, accurate resource for information on marijuana use (Fagan et al., 2019). Become more knowledgeable about the possible negative effects of using illegal drugs on one’s health, relationships, and legal status.
These initiatives aim to reach both the broader public and particular at-risk demographics, such as young people and young adults. It is due to these educational programs that stakeholders are aware of the hazards linked with cannabis consumption (Fagan et al., 2019). They might support health authorities in launching efforts to raise awareness of the negative consequences of cannabis usage among teenagers and young people.
Effectiveness Evaluation
Although these intervention measures may be useful in managing CUD, several factors may limit their effectiveness in South Africa. Accessing treatment programs and rehabilitation facilities may not be simple, particularly in rural or undeveloped areas of the country. Some people are forced to walk long distances looking for treatment (Budney et al., 2019).
There are frequently fewer rehabilitation options available and easily accessible within low-income nations, especially in rural locations. For instance, a country’s largest metropolis might have only one rehabilitation facility, or therapists might work only in big clinics and hospitals. It may make it more difficult for people to get the right therapies and seek assistance for CUD.
The stigma associated with drug use disorders, such as CUD, may prevent people from getting treatment or from talking about their problems using cannabis. It is plausible that patients would not consistently ask for it. Patient forgetfulness, fear of side effects from therapy, low motivation from perceived ineffectiveness, inadequate health literacy, distaste for the health concept model, and stigmatization are the main causes of low adherence (Budney et al., 2019).
Especially in medical settings, those who struggle with substance misuse issues may face prejudice, harassment, and negative public perceptions. These challenges may lead people to delay seeking medical attention. Fear of bias or judgment may make it difficult to get help and medical attention.
Cultural perspectives and attitudes on drug abuse and addiction may have an impact on people’s willingness to participate in treatment plans or seek expert assistance for CUD. For example, some ethnic groups may be less likely to seek treatment or to report their substance use to medical or mental health professionals. Compared to the general population, individuals who identify as immigrants and who have mental illness or drug use disorders are less likely to get treatment (Budney et al., 2019). The cultural stigma associated with seeking medical care for mental health conditions, including drug use disorders, may be the cause of this treatment barrier.
Alternative Preventive Measures and Intervention Strategies
Developing focused preventive programs in schools and communities is one strategy that other nations have employed to inform young people about the dangers of cannabis use and help them build the resilience and coping mechanisms they need to withstand peer pressure. Culturally sensitive interventions are based on recognizing and validating the target population’s inherent cultural knowledge (Budney et al., 2019).
Understanding which principles to uphold and what suffering to avoid or endure from their perspective is necessary for culturally sensitive involvement with individuals from various cultures (Budney et al., 2019). For instance, encouraging people to abstain from severe or early use of cannabis as well as other drug use might help lessen the need for complicated interventions involving the legal, well-being, and judicial systems, as well as personal and societal dysfunction.
Enhancing Primary Healthcare Services is an additional action. To identify people at risk for CUD and offer early intervention, including support, primary healthcare facilities should incorporate screening, short intervention, and referral to treatment (SBIRT) for drug use disorders (Thoele et al., 2021). It has been demonstrated that SBIRT is accurate and trustworthy for detecting drug users and improving their outcomes. This strategy can assist in reaching a larger audience and lessening the stigma attached to getting treatment for drug use disorders.
Establishing peer support groups, counseling services, and harm reduction programs as community-based support services to offer people with CUD and their families continuous support and aid. Community-based therapy is the most affordable means of supporting those affected by the misuse and dependence on illegal substances. Contacting local social services can determine whether to set up an assessment if someone feels they are in grave danger and won’t ask for assistance (Budney et al., 2019). These services ought to be easily available, accepting, and sensitive to cultural differences to encourage participation and adherence to therapy. They aim to raise protective variables and lower risk factors in addition to giving vulnerable youth alternatives to substance misuse, crime, and gang involvement (Budney et al., 2019).
Personal Reflections and Opinions
It is clear from evaluating the state of CUD intervention options in South Africa today that a multimodal strategy is required to address the many elements influencing cannabis use and addiction. Several demographic factors have been connected to adolescent drug use, according to research conducted in South Africa: the major sociodemographic risk variables for drug use were employment, degree of education, marital status, and sex (Budney et al., 2019). Even while current awareness efforts and treatment programs are beneficial in helping people with CUD, their efficacy has to be increased due to gaps, inconvenience, stigma, and cultural significance. Unwillingness to seek out assistance or therapy, uncompassionate treatment from friends, relatives, or other people, and a lack of work or social engagement possibilities.
In my opinion, reducing the overall incidence of CUD and mitigating its detrimental effects requires early intervention and preventive measures. By focusing on at-risk groups, like teenagers, and providing them with information, tools, and support systems, we can enable people to make responsible decisions regarding cannabis use and fend off peer pressure. Moreover, addressing people who would not otherwise seek treatment for CUD through the integration of drug use screening along with intervention into basic healthcare settings shows potential. Many individuals are caught in a vicious cycle whereby being exposed to traumatic events increases alcohol and drug usage, which in turn causes more traumatic incident experiences, which worsen substance abuse (Budney et al., 2019). Healthcare practitioners can greatly aid early detection and treatment of CUD by normalizing conversations about drug use and offering nonjudgmental support.
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. (5th ed., text revision). American Psychiatric Publishing.
Bako, R. R. A., Ramalepe, L. M., & Nwogwugwu, N. C. (2023). Cannabis Use and Cannabis Use Disorders in South Africa: A Narrative Review. Journal of Drug Issues.
Bogais, J., Garbuio, M., Groutsis, D., Peter, S., Riemer, K., Seno‐Alday, S., Shields, J., Sutton‐Brady, C., & Voola, R. (2022). Conquering ‘the tyranny of distance‘: Australian–European economic and geopolitical relationships past, present and future. European Management Journal, 40(3), 310–319.
Budney, A. J., Sofis, M. J., & Borodovsky, J. T. (2019). An update on cannabis use disorder with comment on the impact of policy related to therapeutic and recreational cannabis use. European archives of psychiatry and clinical neuroscience, 269, 73-86.
Choi, N. G., & DiNitto, D. M. (2019). Older marijuana users in substance abuse treatment: treatment settings for marijuana-only versus polysubstance use admissions. Journal of Substance Abuse Treatment, 105, 28-36.
Crocker, C. E., Carter, A. J., Emsley, J. G., Magee, K., Atkinson, P., & Tibbo, P. G. (2021). When cannabis use goes wrong: mental health side effects of cannabis use that present to emergency services. Frontiers in psychiatry, 12.
Dugas, E. N., Sylvestre, M., Ewusi-Boisvert, E., Chaiton, M., Montreuil, A., & O’Loughlin, J. (2018). Early risk factors for daily cannabis use in young adults. Canadian Journal of Psychiatry, 64(5), 329–337.
Fagan, A. A., Bumbarger, B. K., Barth, R. P., Bradshaw, C. P., Cooper, B. R., Supplee, L. H., & Walker, D. K. (2019). Scaling up evidence-based interventions in US public systems to prevent behavioral health problems: Challenges and opportunities. Prevention Science, 20, 1147-1168.
Feingold, D., Livne, O., Rehm, J., & Lev‐Ran, S. (2020). Probability and correlates of transition from cannabis use to DSM‐5 cannabis use disorder: Results from a large‐scale nationally representative study. Drug and alcohol review, 39(2), 142-151.
Granholm, E., Holden, J., Dwyer, K., Mikhael, T., Link, P., & Depp, C. (2020). Mobile-assisted cognitive behavioral therapy for negative symptoms: open single-arm trial with schizophrenia patients. JMIR mental health, 7(12).
Jenkins, E., Dearden, T., Figueras, A., McGuinness, L., Ewert, A., & Haines-Saah, R. (2023). Cannabis education resources for parents: an environmental scan and critical content analysis in the context of legalization. Drugs: Education, Prevention and Policy, 30(2), 124-140.
Manu, E., Douglas, M., & Ntsaba, M. J. (2021). Contextual influences of illicit adolescent marijuana cultivation and trading in the Inqguza Hill local municipality of South Africa: implications for public health policy. Substance abuse treatment, prevention, and policy, 16, 1-15.
Millar, S., Mongan, D., Smyth, B. P., Perry, I. J., & Galvin, B. (2021). Relationships between age at first substance use and persistence of cannabis use and cannabis use disorder. BMC Public Health (Online), 21(1).
Raihan, A., & Bijoy, T. R. (2023). A review of the industrial use and global sustainability of Cannabis sativa. Global Sustainability Research, 2(4), 1-29.
Rotering, T., & Apollonio, D. E. (2022). Cannabis industry lobbying in the Colorado state legislature in fiscal years 2010–2021. International Journal of Drug Policy, 102.
Thoele, K., Moffat, L., Konicek, S., Lam-Chi, M., Newkirk, E., Fulton, J., & Newhouse, R. (2021). Strategies to promote the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in healthcare settings: a scoping review. Substance Abuse Treatment, Prevention, and Policy, 16(1), 42.