South Africa is presently confronted with a deepening mental health crisis. Rising rates of depression, anxiety, trauma, substance dependency, and suicide are placing unprecedented strain on our health system. Current resources are insufficient to meet demand, particularly within rural and under-served communities.
Against this backdrop, it is concerning that cannabis, a plant with centuries of traditional use and a growing body of modern clinical evidence supporting its therapeutic value remains administratively restricted. Access to cannabinoid therapies is limited by complex licensing systems, bureaucratic delays, and a regulatory framework situated primarily within agriculture and commerce rather than public health.
Constitutional Obligations
The Constitution of the Republic of South Africa places a direct duty on government to address this imbalance:
• Section 27(1)(a): “Everyone has the right to have access to health care services, including reproductive health care.” Restricting safe, evidence-based access to cannabis as a therapeutic option undermines this right, particularly where conventional services are unavailable.
• Section 27(2): “The state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.” The current regulatory framework fails to take reasonable measures to integrate cannabis into the mental health system, despite overwhelming evidence of benefit.
• Section 30: “Everyone has the right to use the language and to participate in the cultural life of their choice.” For many South African communities, cannabis use forms part of traditional healing and cultural practices. Excluding traditional and rural growers from the regulatory framework directly infringes this constitutional right.
• Section 39(1)(b): In interpreting the Bill of Rights, courts “must consider international law.” International precedents (Canada, Germany, Israel, Australia) show that integrating cannabis into mental health care is consistent with human rights and public health obligations.
Thus, failure to align cannabis policy with constitutional protections is not only cannabis poor administration; it represents a breach of the state’s constitutional duties.
International and Domestic Evidence
• Reviews by the World Health Organization (WHO) and the U.S. National Academies of Sciences confirm cannabis and cannabinoids demonstrate therapeutic potential for conditions such as chronic pain, insomnia, anxiety, PTSD, and epilepsy.
• More than 1,000 international clinical trials have been completed, with favourable outcomes across psychiatric, neurological, and palliative care domains.
• In South Africa, the Chris Hani Baragwanath Hospital study (2025) documented widespread cannabis use among psychiatric patients, underscoring its embedded role in mental health.
Cannabis-Related Mental Health Risks
A balanced approach also requires recognition of risks:
• Psychosis & Schizophrenia: High-potency THC, particularly in early or heavy use, may increase risk in vulnerable individuals.
• Cognitive Impairment: Heavy adolescent use may affect memory and concentration.
• Anxiety & Paranoia: Excessive THC can worsen anxiety in some patients.
• Dependence: Approximately 9–10% of users may develop cannabis use disorder.
• Bipolar Disorder & Suicidality: Heavy use may exacerbate symptoms or correlate with suicidal ideation.
These risks justify regulated, evidence-based access overseen by clinicians, not prohibition and criminalization.
Policy Shortcomings
South Africa’s current approach to cannabis regulation is characterised by fragmentation, institutional misalignment, and a lack of public health prioritisation. The following areas illustrate the depth of the problem:
1. Regulatory Placement under Agriculture and Industry Cannabis is administratively located within agricultural and industrial frameworks, treating it primarily as a commodity or cash crop. This approach overlooks its recognised therapeutic applications, which fall squarely within the ambit of health care. By divorcing cannabis from the Department of Health, the state has effectively excluded it from national health strategies, mental health policies, and essential medicines discussions — contrary to the obligations set out in Section 27 of the Constitution.
2. Licensing Priorities Favouring Export and Commerce Current licensing systems have been designed with an emphasis on large-scale commercial cultivation and international export markets. These licences are costly, complex, and inaccessible to the majority of South Africans, particularly patients in need of affordable local access. Critically, there are no requirements for licence-holders to supply the domestic public health system, to contribute to clinical trials, or to provide affordable therapeutic access. This design entrenches inequality, making cannabis legally available to foreign consumers while South African patients continue to suffer without access.
3. Exclusion of Traditional Healers and Rural Communities South Africa has a centuries-long history of cannabis use in traditional medicine and rural wellness practices. Yet current frameworks explicitly exclude traditional healers, small-scale cultivators, and rural growers from participating in the regulated market. This exclusion is inconsistent with Section 30 of the Constitution, which guarantees the right of all persons to participate in the cultural life of their choice. It also undermines equity, erases indigenous knowledge systems, and perpetuates the marginalisation of communities historically criminalised for cannabis.
4. Absence of Clinical Protocols and Practitioner Training Despite growing international evidence of cannabis’s therapeutic value, the Department of Health has not issued clinical guidelines for mental health practitioners on safe and appropriate use. There are no standardised protocols for dosage, cannabinoid profiles, or patient monitoring Moreover, doctors, psychologists, psychiatrists, and nurses receive no structured training in cannabinoid medicine as part of their professional development. This results in patients self-medicating without guidance, clinicians reluctant or unprepared to prescribe, and a widening gap between evidence and practice.
5. Lack of Integration with Mental Health Services
Cannabis is not integrated into South Africa’s public mental health strategy, despite strong evidence supporting its use as an adjunct therapy for conditions such as PTSD, anxiety, insomnia, and depression. Mental health clinics do not have access pathways for cannabinoid therapies, and no budgets are allocated for such interventions. As a result, cannabis remains siloed as an economic product, disconnected from the urgent realities of the mental health crisis.
6. Failure to Ensure Transparency and Accountability
Licensing and regulatory processes for cannabis are frequently criticised for lack of transparency. There is no public disclosure of criteria used to issue licences, nor any audit of political or commercial interests linked to the sector. This undermines public confidence, fosters perceptions of corruption, and diverts cannabis away from its potential role in improving health outcomes.
Recommendations for Government Action
To bring cannabis regulation in line with constitutional, scientific, and public health imperatives, government should:
1. Decriminalise and enable access to cannabis for medicinal, mental health, and traditional use in a constitutionally compliant manner.
2. Transfer oversight of medical cannabis to the Department of Health, ensuring public health imperatives take precedence.
3. Develop inclusive access models incorporating traditional healers and rural communities, giving effect to Section 30 cultural rights.
4. Invest in local research and clinical trials, supporting practitioner training in cannabinoid therapies.
5. Reform licensing frameworks to include therapeutic delivery, clinical monitoring, and equity requirements.
6. Ensure transparency in licensing and policy, in line with constitutional principles of accountability.
South Africa cannot continue to treat cannabis as an agricultural commodity while millions suffer untreated mental illness. The constitutional right to healthcare (Section 27), the right to cultural participation (Section 30), and the duty to interpret rights consistent with international law (Section 39) collectively require urgent reform.
Cannabis must be integrated into the national mental health response — responsibly, transparently, and in line with both science and constitutional values.
This is a copy of Botha’s letter to the President on Integrating Cannabis Into South Africa’s Response to a Growing Mental Health Crisis.
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