This report from Business Day on 5 December 2022

Anyone who attended the recent Cannabis Expo would have noticed that the crowd was rather niche. Dreadlocks and man buns were well in evidence, as well as piercings and hippie clothing printed with leaf motifs.

In the open area at the Sandton Convention Centre, where the exhibition and talks were held, there was an open area where musicians performed and the weed could be smoked.

But on the speakers’ platform was a cohort of people on the other side of the cannabis divide, exhorting us to take the herb more seriously, to acknowledge its tremendous medical benefits and potential for entrepreneurship and trade. These were business people, members of the medical and legal establishments, government bodies such as the Industrial Development Corporation and various non-governmental organisations.

This year’s expo was a further demonstration of how the loose confederation that is the cannabis industry is edging into the mainstream business scene via professionalisation and regulation.

However, though the CBD (cannabidiol oil) products are dose-specific and becoming specialised and sophisticated, the business may never shake off its past associations with illegal spliff-smoking. Not least because it still has the image of an alternative industry, with its shops and stalls peopled by visionaries and hipsters. Take the Johannesburg outlets, Canna Kingdom in Parkhurst, with its logo of a shaggy-maned lion smoking a joint, and The Green Monk in Linden, manned by the gentle, sandy-haired Christoff B.

The speakers on the expo podium, however, had a serious message, urging the public to think outside received conventions, and for medical professionals to break out of the mould and the hold of mainstream allopathic medicine and pharmaceuticals to offer to treat patients with a more efficient and user-friendly cannabis regimen. The business-focused speakers emphasised how to maximise profit and production in the burgeoning local industry so as to glean the full benefit from the tsunami of world trade that is approaching.

The global cannabis industry is projected to reach $148.9bn by 2031.

According to Globe Newswire, the global cannabis industry is projected to reach $148.9bn by 2031. Citing an Allied Market Research report, Globe says the drivers of the growth of the global cannabis market are a “significant surge in the legalisation of cannabis, increase in the use of cannabis for therapeutic purposes, extensive applications of cannabis products for treating chemotherapy-induced nausea and epilepsy seizures”.

The global cannabis market generated $25.7bn in 2021, presumably affected by Covid-19 closures of manufacturing facilities and the subsequent effects on sales, as well as inadequate funding for research and academic institutes.

There is strong evidence that the cannabis industry is flourishing in pockets of SA. On the sides of the talks I met Lynette Zwane, of the Lynette & Peter Zwane Foundation, who teaches youngsters in rural KwaZulu-Natal to farm cannabis. The foundation works with the National Student Financial Aid Scheme and the education department to conduct youth outreach projects in the Umtentweni area.

Several lively young adults dressed in dark green T-shirts attending the expo turned out to be students and staff at the Cheeba Africa Cannabis Academy based in Rivonia, Johannesburg. The academy offers a medical cannabis professional development course, a cannabis consultant certification course, a commercial cannabis cultivation course, and various growing courses and workshops.

Cheeba CEO Trenton Birch said from the podium that SA needed to wake up to the potential of the cannabis revolution. “SA is too shy. The medical approach is too soft. In the US, the approach to business is brash, and Germany has a more open attitude.” A proponent of including tetrahydrocannabinol (THC), the principal psychoactive constituent of cannabis, in products for sale, Birch said there would be a strong adult use market over the next few years.

He said what the industry calls “edibles” will feature strongly in the over-the-counter (OTC) market, as many consumers do not want to smoke. These include “gummies” fruit-flavoured pastilles containing 10mg of CBD and help with pain relief, anxiety, inflammation and sleep. The gummies can be formulated with fruit flavourings as well as terpenes such as lavender and valerian, known to aid sleep and relaxation.

The future, he said, is fast-acting lozenges that will deliver a dose quickly and effectively, as well as CBD drinks.

At present for OTC products, the SA Health Products Regulatory Authority (Sahpra) recommends not exceeding a dose of 20mg of CBD a day, but Birch says this is “a joke”. It is clear though that in SA at the moment, the legislation and protocols around CBD are in limbo as the government debates the issue.

There is more leeway in the recommended dosage for medical cannabis dispensed at a pharmacy. 

Pharmacist Jacques Rossouw of the Compounding Pharmacy in Bryanston, which stocks CBD drops, creams and capsules, said: “The OTC remedy contains a maximum inclusion of 600mg per 10ml bottle (as per Sahpra regulations for OTC medicines), but this is interchangeable based on individual patient needs.”

He said the range of conditions for which CBD has been assessed is diverse, “consistent with its neuroprotective, anti-epileptic, anxiolytic, analgesic, anti-inflammatory, anti-asthmatic and anti-tumour properties”.

For patients experiencing pain while undergoing chemotherapy, Rossouw said studies had shown that 50mg-60mg per day was effective. “This dosage has however been increased to 600mg per day in severe cases.”

CBD has anticonvulsant, antipsychotic, and neuroprotective effects without the severe side effects of orthodox drugs

He added that CBD also has anticonvulsant, antipsychotic, neuroprotective and sleep-promoting effects without the severe side effects that orthodox drugs have treating these disorders. It is also safe. “Research indicates that CBD has a desirable safety profile and numerous studies substantiated its efficacy in treating the latter mentioned disorders.”

A passionate advocate and pioneer for medical treatment with the herb is cannabis clinician Dr Shiksha Gallow from East London.

An extraordinarily qualified, self-confessed seeker who progressed through mainstream medicine, completing degrees in biomedicine, qualifying in Clinical Pathology Cum Laude, with a master’s in Medical Science, a master’s in Medicine Public Health Medicine, an MBA, Ayurvedic Medicine and a PhD, she is completing a second PhD in medical cannabinoid research.

Dr Gallow is affiliated with the Cannabis Research Council and serves on the board of directors for the Society of Cannabis Clinicians in the US and UK. Deftly crossing the divide between the conservative, traditional medical establishment and this new green wave that offers the hope of treatment without negative side effects, Gallow pleaded for more understanding and investment in the industry. 

However, she had praise for SA because, she said, “You are allowed to do stuff here.”

In an interview on the sides of the conference, Dr Gallow spoke of her own journey with the medical uses of cannabis. While doing studies on autoimmune diseases at Wits, she felt frustrated with the limitations of drug therapy: when one drug was prescribed it appeared to cause various effects that needed treatment, with the patient then having to take several medications, each with its own negative side effects.

“I wondered, how do I really heal my patients? You need to empower patients. Cannabis is a catalyst for healing. For centuries people have been using it — boiling the leaves, inhaling it, drinking it. We need to bring all this together to control it.”

Studies have shown that there can be a rare toxicity in the CBD preparations. However, Dr Gallow says there is a danger in cannabis being grown without proper controls where there are toxins in the soil and water, and patient dosages leave a margin for error. Whereas dosages for pharmaceuticals are measured depending on body mass, administering CBD remedies is different. “Every patient is different; it depends on your endocannabinoid level.”

The subject of new international research & development, the body’s endocannabinoid system is critical for almost every aspect of daily functioning, as it regulates and controls many of our most critical bodily functions, such as learning, memory, emotional processing, sleep, temperature control, pain control, inflammatory and immune responses, and eating.

Dr Gallow says achieving balance is the aim: the CBD oil activates receptors in the body that help to detect imbalances, helping the body to naturally readjust and correct the imbalances and leading to a state of homeostasis.

For people experiencing chronic pain, there is hope in the first clinical cannabis trial to be held in SA next year. Dr Gallow says patients experiencing chronic pain are encouraged to participate in the study, which is being conducted in association with the Cannabis Research Institute SA and Releaf Cannabis Clinics. Qualifying patients will receive treatment free of charge for the duration of the trial expected to be a year.

The trial will examine the effectiveness of medical cannabis as an alternative to opioids for pain management, and is looking for 300 participants. Beginning in the new year, it will no doubt introduce a new cohort of people to the benefits of cannabis and aid in chipping away at the edifice of stigma that still seems to surround the plant.

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