- @ SANCWG - Cannabis Position Paper 2013 - South African National Cannabis Working Group Cannabis Position Paper 2013 As presented by the South African National Cannabis Working Group to the Central Drug Authority at the Department of Social Development 20 November 2013 André du Plessis Imiël Visser Alwyn Smit { 1 } 20 November | 2013 TABLE OF CONTENTS For Public Distribution www . cannabis . reforms . co . za & Comment - @ SANCWG - Cannabis Position Paper 2013 - South African National Cannabis Working Group Attribution Creative Commons Share Alike You must attribute the work in If you alter, transform, or build the manner specified by the This license allows for upon this work, you may author or licensor (but not in any redistribution, commercial and distribute the resulting work way that suggests that they endorse non-commercial. only under the same or similar you or your use of the work). license to this one. You are free to: Share — to copy, distribute and transmit the work, to Remix — to adapt the work, to make commercial use of the work. { 2 } 20 November | 2013 TABLE OF CONTENTS For Public Distribution www . cannabis . reforms . co . za & Comment - @ SANCWG - Cannabis Position Paper 2013 - South African National Cannabis Working Group This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 Unported License for informational, educational and commercial purpose the like. This document is also licensed under a Free Culture License! https://creativecommons.org/freeworks { 3 } 20 November | 2013 TABLE OF CONTENTS For Public Distribution www . cannabis . reforms . co . za & Comment - @ SANCWG - Cannabis Position Paper 2013 - South African National Cannabis Working Group ABSTRACT The Cannabis Position Paper 2013 contains numerous quotes and references to peer-reviewed case studies detailing historical and modern accounts of cannabis prevalence within Southern Africa. The participation of civil society is an important part of the National Drug Master Plan’s implementation and consequently there is a need for an inclusive body to deal with public policy matters surrounding cannabis. This publication attempts to summarise current scientific literature about the dynamics of cannabis while providing a platform for an integrated approach that assists the Central Drug Authority in carrying out their mandate. This document will facilitate in creating an evidence-based public discussion for all interested and affected parties. { 4 } 20 November | 2013 TABLE OF CONTENTS For Public Distribution www . cannabis . reforms . co . za & Comment - @ SANCWG - Cannabis Position Paper 2013 - South African National Cannabis Working Group HOW TO USE THIS DOCUMENT This document can be used as a reference guide to contextual prohibitive measures throughout the South African history with references that include the latest peer reviewed science on cannabis. The table of contents is hyper-linked for easier navigation and there is a return link in the footer of each page called: 'TABLE OF CONTENTS' You are free to: Share — to copy, distribute and transmit the work, to Remix — to adapt the work, to make commercial use of the work as long as you attribute the work in the manner specified by the author or licensor (but not in any way that suggests that they endorse you or your use of the work). { 5 } 20 November | 2013 TABLE OF CONTENTS For Public Distribution www . cannabis . reforms . co . za & Comment - @ SANCWG - Cannabis Position Paper 2013 - South African National Cannabis Working Group TABLE OF CONTENTS Click on the headings to navigate between sections ABSTRACT 4 HOW TO USE THIS DOCUMENT 5 TABLE OF CONTENTS 6 EXECUTIVE SUMMARY 10 LIST OF TABLES 14 LIST OF FIGURES 15 PREFACE 16 HISTORY & DEFINITION OF CANNABIS 17 Cannabis Taxonomy 22 Practical anatomy of cannabis 25 The Cannabis Dichotomy - Correcting the ‘Rumor’ About Hemp 26 Ultraviolet Radiation 28 Cannabis Trials In South Africa 35 Therapeutic benefits of cannabis 39 MEDICAL CANNABIS 41 Medicinal History 42 The Endocannabinoid System 44 Cannabinoids 45 Medical Cannabis Table of Contents 46 THE HISTORY OF CANNABIS PROHIBITION 48 Setting the tone for debate 49 The Wragg Report 50 The Customs and Duties Amendment Act 35 of 1922 51 Committee on the Abuse of Dagga 52 Role of cannabis in the Apartheid regime 53 South Africa’s role in international prohibition 54 THE COST OF THE PROHIBITION 56 Processing of drug-related offences 57 The failure of the war on drugs on its own terms 58 Environmental impact of cannabis prohibition 64 SADC / UN PROTOCOL INTERVENTION 64 SADC / UN Historical drug trafficking related accounts 65 Undisclosed cannabis provisions within the treaties 68 OPTIONS FOR REFORM 70 Reforms through new international conventions 71 Possibilities for a country acting alone 72 Denunciation and re-accession with reservations 72 The Supra-national basis possibilitie 73 Denunciation of the treaties and replacement with alternatives 73 Adopting new alternative treaties 73 A new single convention 74 Important key principles when drafting a new Single Convention 75 THE CHANGING 76 INTERNATIONAL LANDSCAPE 76 TIMELINE FOR REFORM 78 { 6 } 20 November | 2013 TABLE OF CONTENTS For Public Distribution www . cannabis . reforms . co . za & Comment - @ SANCWG - Cannabis Position Paper 2013 - South African National Cannabis Working Group Global Drug Policy Change a rapidly changing landscape 79 Regulation and control 81 EXAMPLES OF CANNABIS REGULATION 83 The Netherlands 84 Canada, Germany, Israel 85 Cannabis decriminalisation and its impact on use 86 Europe 86 Australia 87 Great Britain 87 Decriminalisation in the United States 87 Medical Cannabis USA 88 Lowest law enforcement priority (LLEP) / de-prioritisation 88 Spanish Cannabis Clubs 89 North Korea 89 Existing Possibilities With the Current UN Treaties 90 HARM REDUCTION 91 SAFE ACCESS 92 A cost‐benefit analysis of cannabis 93 SOUTH AFRICAN SUPPORT FOR REFORM 94 CONCLUSION 95 ABOUT THE AUTHORS 97 ANNEXURE 1 - Industrial Cannabis 98 ANNEXURE 2 - Therapeutic benefits of cannabis 110 MEDICAL CANNABIS 111 Medicinal History 112 The Endocannabinoid System 114 Cannabinoids 115 History of cannabinoid research 116 Types of Cannabinoids 117 Types of Cannabinoids 118 Terpenoid Essential Oil Components of Cannabis 121 Flavonoid and Phytosterol Components of Cannabis 123 Cannabinoid Receptors 124 Cannabinoid receptor type 1 124 Cannabinoid receptor type 2 124 Cannabis Extracts and Synthetic Cannabinoids 125 Natural, synthetic pharmaceutical cannabinoid extracts 126 Nabilone (Cesamet) 126 Dronabinol (Marinol) 126 Nabiximols (Sativex) 126 Effects of Cannabinoids 128 Clinical Endocannabinoid Deficiency 129 IBS and the link between the brain and gut 131 Cannabinoid receptors in the enteric nervous system 132 Underlying condition 133 Promotion of Homeostasis 134 CANNABIS AS A PREVENTATIVE MEASURE 135 Neurodegeneration and Protection 137 { 7 } 20 November | 2013 TABLE OF CONTENTS For Public Distribution www . cannabis . reforms . co . za & Comment - @ SANCWG - Cannabis Position Paper 2013 - South African National Cannabis Working Group Cannabis Patents 138 South African Cannabis Related Registered Patents 142 Cannabis and Medical Conditions 143 1. Alzheimerʹ s Disease 144 2. Amyotrophic Lateral Sclerosis (ALS) 146 3. Chronic Pain 147 4. Charcot-Marie-Tooth disease (CMT) 150 Hereditary Motor and Sensory Neuropathy (HMSN) 150 5. Diabetes Mellitus 151 6. Dystonia 153 7. Fibromyalgia 155 8. Incontinence 157 9. Gastrointestinal Disorders 158 10. Cancer 161 a. Gliomas 161 b. Breast Cancer 165 c. Lung Cancer 166 d. Prostate Cancer 167 e. Blood Cancer 168 f. Oral Cancer 169 h. Liver Cancer 169 i. Pancreatic Cancer 170 11. Hepatitis C 171 12. Human Immunodeficiency Virus (HIV) 172 The Experience of Doctors Working With AIDS/HIV Patients 175 14. Hypertension 179 15. Methicillin‐resistant Staphylococcus aureus (MRSA) 180 16. Multiple Sclerosis 181 17. Osteoporosis 183 18. Phantom limb syndrome 184 19. Pruritus 184 20. Rheumatoid Arthritis 186 21. Sleep Apnea 188 22. Touretteʹ s Syndrome 189 Oncology and Palliative Care 191 Opioids versus Cannabinoids 193 Delivery methods 194 Smoking and Pulmonary function 195 Safety and Side Effects of Cannabis 197 Harm Scale 201 Medical ethics in South Africa 202 Base principles of the medical practice 204 GLOSSARY 205 DETAILED REFERENCE LIST 207 Other Health Organizations 209 Health Organizations Supporting Legal Access to Medical Cannabis 210 { 8 } 20 November | 2013 TABLE OF CONTENTS For Public Distribution www . cannabis . reforms . co . za & Comment - @ SANCWG - Cannabis Position Paper 2013 - South African National Cannabis Working Group { “I tried it,” } - Sanjay Gupta - { “So What?” } - Helen Suzman - { "Someone has to be the first..."} - José Mujica, President of Uruguay - “....in working with the hearts of people, and not locking them up ... we should treat cannabis the { way we treat beverage alcohol,” } - Mr. Pat Robertson, The 700 Club - { 9 } 20 November | 2013 TABLE OF CONTENTS For Public Distribution www . cannabis . reforms . co . za & Comment - @ SANCWG - Cannabis Position Paper 2013 - South African National Cannabis Working Group EXECUTIVE SUMMARY This document investigates a PESTEL1 viability of regulating cannabis in accordance with the spirit and purport of the Final Constitution of the Republic of South Africa. Both sides of the debate share many universal The cannabis plant is used for industrial goals: applications, inter alia, nutrition, fibre, rope and construction. Commercial trials in South Africa