There are over 20 000 medical cannabis patients in South Africa registered with SAHPRA, but this cannot be verified because the regulator won’t release the figures. However, what is clear is that the number is surging and that SAHPRA is upgrading its systems to cope with the anticipated workload.
Many, if not most, medical cannabis patients are active in the job market and although their medication use remains their personal issue, there are workplace implications.
The issue has surfaced in the UK, where legal firm Lewis Silken says the use of medical cannabis is raising new challenges for employers.
This report is taken from a legal note from Lewis Silken, UK published on 19 June 2025.
Key issues for employers
The use of medical cannabis is raising new challenges for employers. Here are some of the issues to consider:
- Drugs screening and fitness to work assessments. Routine or spot testing of employees for drugs is generally only permissible in safety critical roles. Employers should have clear policies requiring employees in such roles to disclose any medication which could impair their fitness to work and should establish a disclosure procedure for medical cannabis in advance of any drug testing.
- Where drug testing is carried out, and the presence of cannabis is detected, employers will need to investigate if a prescription is in place and take medical advice on the impact on the employee’s fitness to work. It is often a common assumption for an employer to believe that any cannabis use is for recreational purposes and that the employee is looking for an excuse for having been ‘caught’. Whilst undoubtedly this does happen employers would be wise to approach such assumptions with caution.
- In some situations, it may be advisable to obtain occupational health or GP advice. This can help employers to determine what impact the cannabis could have on any role and whether any adjustments are required (such as whether more regular breaks are needed). Medical advice will be particularly important when the use of cannabis at work could be a health and safety risk (for example, when working in manufacturing). If medical advice is required by an employer, it is recommended that any costs associated with obtaining the advice (e.g. time off work, appointment, letters) are paid for by the employer.
If a medical opinion is that the employee is unable to perform their role while using cannabis, the employer would need to consider whether there are any suitable alternative roles or whether parts of the role could be changed. If not, it may be necessary to engage in a capability process or in some situations, a termination for some other substantial reason as the employee is unable to perform the role. As with all situations, it is important not to respond with a knee-jerk reaction but to take a considered and proportionate view.
- Substance misuse policies.These may need to evolve to keep pace with the increase in medical cannabis prescriptions. Wording about possession of drugs in the workplace may need updating to reflect that employees may legitimately be prescribed cannabis. Employers may also want to consider what they require employees to disclose. Employers would not normally require employees to disclose all prescription medications and arguably medical cannabis should not be any different, but it would be legitimate (and potentially advisable) to include a positive requirement to disclose any prescription medication which can cause impairment.
- As with any other prescription, it would not be appropriate for an employee with a prescription for medical cannabis to share their prescription with others. Sharing a prescription could be a legitimate breach of policy as well as having potentially criminal consequences.
- Legitimacy of a medical cannabis prescription. Most employers would not question the legitimacy of a prescription for other medication, but medical cannabis may well feel different because of the prevalence (and criminality) of non-medical use, concerns over the impact on fitness to work and, in some instances, concerns about how some private prescriptions are obtained.
- This is a new and tricky area for employers to navigate. It is likely to be reasonable to check that any prescription for medical cannabis has been issued by a registered specialist. However, challenging the decision to issue that prescription or whether the employee is using the drug responsibly would be much more difficult. In many cases, the employer would already be aware of the employee’s underlying medical condition, decision to use medical cannabis as a treatment and any potential impact (both positive and negative) on the employee’s fitness to work. In cases where the employer has concerns, good occupational health support may be useful but is, of course, not always easy to obtain.
- Stigma, awareness and discrimination. One of the biggest challenges those taking medical cannabis face is the stigma attached to the drug. It is important for line managers and HR to understand that medical cannabis can be used legitimately like any other prescribed medication. Many – if not most – employees will be using medical cannabis to manage a health condition that could meet the legal definition of disability.
- Employers need to be careful to avoid unjustified discrimination for something arising from a disability or breaching their duty to make reasonable adjustments. For example, refusing to allow a disabled employee breaks to take their prescribed medical cannabis. It could also be a reasonable adjustment to enable a disabled employee to vaporise medical cannabis indoors with proper ventilation.
- Confidentiality. Medical information is treated as special personal data under the GDPR which brings with it additional conditions to satisfy for its processing. This means that employers need to handle information about medical cannabis use carefully and responsibly. Disclosure of information should be kept to a minimum and restricted to only those who need to know for clear business purposes.
- What else? Other role-specific issues can arise – such as the legality of possessing cannabis in other jurisdictions, placing an employee at risk if travelling on business. Ultimately, there is no blanket approach to medical cannabis in the workplace, and each use case needs to be assessed on a case-by-case basis with particular focus on the individual employee’s role.
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