The study , From courtroom to clinic: How legal rulings shape cannabis use among adolescents and young adults in South Africa, was led by Professor Nadine Harker of the South African Medical Research Council (SAMRC) and published last month. Prof Harker is also the Health Department’s point person in drawing up regulations for cannabis edibles.
The bottom line is that a lot more people are seeking treatment for cannabis related issues since the Constitutional Court ruling in 2018 which legalized the private consumption of cannabis and heralded in a new era of widespread availability and an impetus towards destigmatization.
This was exacerbated by the effects of lockdown during the Covid 19 pandemic. Social disruption and anxiety, isolation, economic uncertainty all appear to be factors leading towards an increase in clinic admissions.
Prof Harker writes that “these findings are therefore significant since they provide nuanced information about the year-on-year changes observed in cannabis treatment, which allows for the monitoring of trends in use in the period following the 2018 ruling in South Africa, contributing to our limited evidence on the actual impact of the 2024 Cannabis Use Act.”
This is an edited version of Prof Harker’s paper summary:
“The study findings show interesting trends in substance use among adolescents and young adults, and more specifically for cannabis use. While initially there was an increase in substances other than cannabis, there was a shift in 2020, the starting point for a steady increase in cannabis treatment demand from 43.4 % in 2020 to 56.2 % in 2023 (an increase of 23%)
The gradual increase, specifically over the last 3 years, in treatment demand for AYAs as reported in our results is not dissimilar to data reported from other countries. For example, in Canada, since the legalization of cannabis, 5.5 % of those aged 16–19 and 49.8 % of 20–24-year-olds reported increased cannabis consumption.
Unsurprisingly, the study found that age of initiation and higher frequency of reported cannabis use among adolescents and young adults were associated with increased treatment demand over a greater number of time points, namely those who reported first use at age 14 or younger or used cannabis daily or weekly.
While a concern is that earlier initiation of use as well as higher frequency of use among adolescents and young people increases risk for faster progression to developing cannabis use disorder, the findings above indicate that it is not only frequency of use that should be considered.
Especially for adolescents and young people, who may use cannabis in various novel ways such as consuming of unknown potency, future research should look at capturing a comprehensive pattern of use including age of initiation and frequency, but also quantity of use and duration of periods under the influence of cannabis, as well as changes in use, for different cannabis products.
Of further interest in our study is that increases in cannabis treatment demand were only noticeable a few years after the ruling was made, suggesting that the effects of recreational cannabis use were not evident immediately.
Research suggests that there is often a lag time between the implementation of cannabis policy changes and observable changes in cannabis use, which may be due to lingering stigma or uncertainty around the legislation or other factors such as market stabilization.
However, the increase in cannabis treatment admissions among adolescents and young adults (AYAs) from 2021 onwards can also be understood within the context of the COVID-19 pandemic.
Firstly, the 2018 Constitutional Court ruling likely contributed to changes in cannabis use patterns, but the onset of the pandemic introduced a range of psychosocial stressors, including isolation, academic disruption, and economic insecurity, that may have exacerbated substance use among youth.
In addition to influencing patterns of use, the pandemic could also have disrupted access to health services, including substance use treatment particularly for adolescents who already face barriers to care.
This disruption may have contributed to delays in treatment-seeking behaviour, resulting in a lag in admissions observed after the legislative changes.
Research from other jurisdictions supports these findings, noting that cannabis use increased during the pandemic, especially among youth due to heightened stress and boredom, which may also have been the case in South Africa.
Overall, it is not unlikely that the combination of social isolation, service disruptions, and increased psychosocial stressors during the pandemic influenced both the patterns of cannabis use and the timing of treatment admissions among AYAs during this period.
These findings, therefore, underscore the importance of distinguishing between the effects of policy change and those of public health crises in further research.
Furthermore, the findings cement the need to monitor use, including recreational use, over time, especially changes following the actual legalization of cannabis use in 2024. While adults are legally permitted to consume cannabis privately, we also need to conduct further research on the effect that this may have on adolescent cannabis trends.
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