Cancer Assciatin f Suth Africa (CANSA) Fact Sheet and Psitin Statement n Cannabis in Suth Africa Intrductin Cannabis is a drug that cmes frm Indian hemp plants such as Cannabis sativa and Cannabis indica. Cannabis is a generic term used t dente the several preparatins f the plant Cannabis sativa. The Legal Status f Cannabis in Suth Africa The Drugs and Drug Trafficking Act, 1992 (Act N 140 f 1992) is the cntrlling legislatin n street drugs in Suth Africa including Cannabis. Cultivatin, pssessin, use, supply and dealing in Cannabis is illegal in Suth Africa. The afrementined Act allws charges t be brught under three separate prvisins: Sectin 3 f the Act - cultivatin, manufacture and supply Sectin 4 f the Act - use and pssessin Sectin 5 f the Act - dealing The Cancer Assciatin f Suth Africa (CANSA) has nted the inclusin f Cannabidil (CBD) under Schedule 6 in Regulatin N 748, prclaimed under the Medicines and Related Substances Act, 1965 (Act N 101 f 1965) in terms f Sectin 22A(2) by the Minister f Health, and published in Gvernment Gazette N 41009 f 28 July 2017. CANSA s Psitin n Cannabis and its Derivatives The Cancer Assciatin f Suth Africa (CANSA) is aware f the inclusin f Cannabidil (CBD) as a recgnised Schedule 6 medicine. It is expected that Gvernment will sn regulate ther aspects f medicinal cannabis fr prescribed health cnditins. Until such time as all the remaining legal prcesses have taken place, medicinal cannabis becmes available in Suth Africa, and valid clinical trials n Cannabidil has been successfully cncluded, CANSA maintains the fllwing psitin: CANSA cannt supprt the use f Cannabis (excluding medically prescribed Cannabidil) as lng as Cannabis is still illegal in Suth Africa. August 2017 Page 1
CANSA cannt supprt the smking f Cannabis as smking is dangerus t health whether ne speaks f tbacc prducts r Cannabis. CANSA cannt currently recmmend the use f Cannabidil fr use by cancer patients until such time as successful clinical trials have been cncluded indicating that the benefits f Cannabidil use utweigh any pssible assciated risks with the use f Cannabidil in the palliatin and/r treatment f cancer. CANSA, hwever, recgnises the right f any patient t request a prescriptin fr the use f Cannabidil frm his/her dctr and als recgnises the right f medical practitiners t prescribe Cannabidil t their patients. CANSA supprts the Wrld Health Organizatin in its guidelines fr the cntrl f cancer pain. T this end CANSA believes that there are medicines available fr the cntrl f pain. Mrphine is ne f the drugs f chice fr the cntrl f severe pain and is als available at a reasnable cst. CANSA is als f the pinin that there are currently medicines available fr use in Suth Africa fr the effective treatment f nausea, vmiting and ther cnditins related t cancer including palliative and end-f-life care until ther cmplimentary medicines may becme available. CANSA can als nt supprt the use f natural and/r synthetic cannabinids and/r THC and/r any ther pssible active substances (natural r synthetic) that can be derived frm Cannabis until such time as successful clinical trials have been cncluded and clear indicatins fr the specific use f Cannabidil in the palliatin and/r treatment f cancer has becme available. Whenever the legal prcesses have taken their curse, and a decisin is taken t allw the legal imprtatin and/r manufacture and/r distributin f medicines cntaining natural and/r synthetic cannabinids and/r THC and/r any ther pssible active substances (natural r synthetic) that can be derived frm Cannabis, and until such time as successful clinical trials have been cncluded and clear indicatins fr the specific use f Cannabidil in the palliatin and/r treatment f cancer has becme available, CANSA will investigate and recnsider its psitin with regard t medicinal cannabis. The Wrld Health Organizatin and Cancer Pain Relief The Wrld Health Organizatin (WHO) intrduced the 3-step WHO ladder apprach t cancer pain relief. If pain ccurs, there shuld be prmpt ral administratin f drugs in the fllwing rder: nn-piids (aspirin and paracetaml); then, as necessary, mild piids (cdeine); then strng piids such as mrphine, until the patient is free f pain. August 2017 Page 2
[Picture Credit: WHO 3-stel Ladder] In the case f cancer pain in children, WHO recmmends a tw step ladder apprach. Using a tw-step strategy fr pain relief in children - the WHO recmmends treating pain in tw steps, based n pain severity assessment: Step 1 is fr mild pain. The medicines used are nn-piid analgesics like paracetaml and ibuprfen. These substances have a fixed maximum dsage and can prvide nly limited analgesia. Step 2 is fr mderate and severe pain. Strng piids are used, e.g. mrphine, using a weight-apprpriate starting dse. The dsages recmmended by WHO are lwer than thse recmmended elsewhere. As lng as the pain is nt sufficiently addressed, the dsage needs t be increased in steps f n mre than 50% per 24 hurs. Accrding t Mercadante & Fulfar (2005) the WHO methd remains f paramunt imprtance and shuld cntinue t be encuraged when appraching advanced cancer patients with pain, fr the high chances f success, ranging between 70 and 90%. Despite the lack f strng evidence t prduce unbiased estimates f the prprtin f patients in whm the ladder prduces satisfactry results and the fact that n cntrlled studies with ther methds have been cnducted t assess its validity, there is the risk t underestimate the educatinal meaning f this simple apprach. Althugh these guidelines can be implemented, currently the crrect use f the WHO methd can lead t adequate lng-term pain cntrl in mst patients with advanced cancer disease. (Wrld Health Organizatin; Persisting Pain in Children; Mercadante & Fulfar). Medical Disclaimer This Fact Sheet and Psitin Statement is intended t prvide general infrmatin nly and, as such, shuld nt be cnsidered as a substitute fr advice, medically r therwise, cvering any specific situatin. Users shuld seek apprpriate advice befre taking r refraining frm taking any actin in reliance n any infrmatin cntained in this Fact Sheet and Psitin Statement. S far as permissible by law, the Cancer Assciatin f Suth Africa (CANSA) des nt accept any liability t any persn (r his/her dependants/estate/heirs) relating t the use f any infrmatin cntained in this Fact Sheet and Psitin Statement. Whilst the Cancer Assciatin f Suth Africa (CANSA) has taken every precautin in cmpiling this Fact Sheet and Psitin Statement, neither it, nr any cntributr(s) t this Fact Sheet and Psitin Statement can be held respnsible fr any actin (r the lack August 2017 Page 3
theref) taken by any persn r rganisatin wherever they shall be based, as a result, direct r therwise, f infrmatin cntained in, r accessed thrugh, this Fact Sheet and Psitin Statement. August 2017 Page 4
References and Surces Drugs and Drug Trafficking Act, 1992 (Act N 140 f 1992) Mercadante, S. & Fulfar, F. 2005. Wrld Health Organizatin guidelines fr cancer pain: a reappraisal. Annals f Onclgy 16 (Supplement 4): iv 132 iv 135, 2005. di:10.1093/annnc/mdi922. Persistent Pain in Children http://apps.wh.int/medicinedcs/dcuments/s19992en/s19992en.pdf Regulatin N 748 Regulatins issued under the Medicines and Related Substances Act, 1965 (Act N 101 f 1965) in terms f Sectin 22A(2) by the Minister f Health, and published in Gvernment Gazette N 41009 f 28 July 2017. Wrld Health Organizatin http://www.wh.int/cancer/palliative/painladder/en/ WHO 3-step Ladder https://www.uspharmacist.cm/article/verview-f-adult-utpatient-cancer-pain-management August 2017 Page 5