From courtroom to clinic: How legal rulings shape cannabis use among adolescents and young adults in South Africa.

BACKGROUND

Substance use, including cannabis (marijuana/dagga), is a major global public health concern. In South Africa, the Cannabis for Private Purposes Bill decriminalised, the use, possession, and cultivation of cannabis by adults in private for personal use, but it remains illegal for those under 18. This study aimed to determine the impact of the cannabis decriminalisation bill on treatment demand among South African adolescents and young adults for cannabis use. A secondary aim was to examine trends in cannabis-related admissions post-legislation.

METHODS

We used retrospective, inpatient and outpatient treatment demand data to assess time trends for cannabis t admissions among South African adolescents aged ≤18 years and young adults aged 19-25 years for the period 2015 to 2023. Basic descriptive statistics and logistic regression were employed to assess changes in cannabis-related admissions over time (2015-2023), adjusting for various sociodemographic and treatment-specific variables. Adjusted odds ratios (ORs) were reported at a 95% confidence interval and significance p-value of<0.05.

RESULTS

The results do not support an immediate increase in treatment demand for cannabis-related problems among adolescents and young adults following the 2018 decriminalisation ruling. Instead, a significant increase in admissions was observed after 2021 onwards, with significantly higher odds observed in 2022 (AOR=1.50, 1.38-1.63, p < 0.001) and 2023 (AOR=1.48, 1.37-1.59, p < 0.001) compared to 2019. Treatment demand also varied by age category, gender, and educational attainment, with higher odds among adolescents, males, and those with primary or secondary education.

CONCLUSION

The decriminalisation of cannabis for private use has impacted treatment demand for cannabis use and the need for specialist substance use treatment among adolescents in South Africa. Legislation and amendments thereof must consider the specific vulnerabilities associated with this population, and the recent decriminalisation of cannabis should also be further explored.