(OPINION) The cannabis legalisation debate -By Lolu Ojo

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Arakunrin Oluwarotimi Odunayo Akeredolu, the Governor of Ondo State in South West Nigeria, has many things going for him. He is a male model. Tall and handsome, he carries a balanced gait with a characteristic shiny white beard. You cannot miss him in a gathering no matter the size of the crowd. Apart from the unique physical endowment, Governor Akeredolu is a genius in his own right. He became a law graduate at a young age of 21 years, and he was, at a time during his undergraduate days at the University of Ife, the Vice-President of the Student Union Government (SUG). He must have carried this ‘aluta’ spirit into his law practice clinching the Senior Advocate of Nigeria (SAN) title in 1998 and the Presidency of the Nigerian Bar Association (NBA) in 2008. He became the Governor of Ondo State in 2017 and dropped all pretences of over-lordship preferring to be addressed simply as ‘Mr. Governor’ rather than the usual ‘His Excellency’ and taking a prefix of ‘Arakunrin’ (or Gentleman) rather the popular ‘High Chief (Dr.) —-’ titles that we know.

Arakunrin Akeredolu is a man of strong conviction. He has been well known before becoming the governor for his strong view on social justice and the need to have an egalitarian society. Recently, he has spoken; loudly and very convincingly, about current issue of insecurity in the country and was the first governor in the South to order the ‘killer’ herdsmen out of his state. Many people have come to regard him as the voice of the people. Now, he has another project that may prove tougher to handle compared to the ‘killer’ herdsmen’s case. He wants the cultivation and medicinal use of cannabis to become legal in Nigeria. He knows how tough this proposition is and from all indications, he is prepared to tackle all oppositions to his pet project. As part of activities lined up to sell the cannabis legalisation project, the Ondo State Government organised a 2-day (7-8th June 2021) roundtable discussion involving diverse interest and professional groups. I think this was a good step taken to involve all stakeholders, including international bodies, to discuss and come to a common understanding on the subject.

I got a call from the President of the Pharmaceutical Society of Nigeria (PSN), Mazi Sam Ohuabunwa, to go to Akure and represent the PSN at the roundtable discussion. As a technocrat and statesman, Mazi Ohuabunwa stated clearly that we are not opposed to the governor’s call, but we have a responsibility to protect the health and interest of all Nigerians and that responsibility imposes on us, the duty of due diligence and deep scientific and social environment enquiries. I relished the opportunity of meeting the governor on this subject. As far as cannabis legalisation is concerned, Governor Akeredolu can be described as a hardliner. He believed that sooner or later, Nigerians will come to understand his position that we can separate the good aspect of cannabis from the bad ones and that Ondo State stands to reap immense benefits from the cultivation and export of cannabis. Certainly, the debate is on, and it is going to take the centre stage very soon as Arakunrin Akeredolu will not let go.

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The position canvassed by the Pharmaceutical Society of Nigeria (PSN) at the roundtable was to the effect that we couldn’t recommend the legalisation until we interrogate all available facts and positions on the subject, particularly the capacity of the regulatory agencies to handle the fallout. We also raised some questions, which we used to articulate our points of view.

What are the facts, as we know it on Cannabis?
Information about cannabis can be accessed easily on Google search and I am using the ‘Wikipedia’ compilation as a guide. Cannabis has a history that dates to the Neolithic age (New stone age, date: 10,000 – 4,500 BCE) when it was used for fabric and rope in China and Japan. It is indigenous to Central Asia and Indian subcontinent. Ancient Assyrians discovered the psychoactive property and this history include ritual use and is found in Pharmacological cults around the world. The modern history started in the 1840s when the French Physician, Jacques-Joseph Moreau wrote on the psychological effects of cannabis use.

Cannabis was criminalised in various countries as from the 19th century. The colonial government in Mauritius banned Cannabis in 1840 followed by Singapore in 1870, USA (1906, DC) and Canada (1923). Today, cannabis use for recreational and medical purposes is now legal in Canada (and since 2018). In Nigeria, the cultivation and dealings in cannabis is illegal.

Cannabis, also known as marijuana (among other names), contains Tetrahydrocannabinol (THC) as the main psychoactive constituent. There are 483 other known compounds in the cannabis plant, including about 65 cannabinoids like cannabidiol popularly known as CBD.

Cannabis is used as recreational or medicinal drug and for spiritual purposes (as popularised by the disciples of the Rastafari movement). In 2013, between 128 and 232 million people used cannabis (about five per cent of global population between the ages of 15 and 65). It is the most used illegal drug in the world with the highest use among adults, as of 2018, in Zambia, USA, Canada and Nigeria.

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In 2013, Uruguay became the first country to legalize recreational use of cannabis and other countries including Canada, Georgia, South Africa and USA (17 States, two territories and DC) followed at different times. However, medical use of cannabis, requiring a physician’s prescription has been legalised in a greater number of countries.

The medical use of cannabis (and its cannabinoids) to treat disease or improve symptoms includes reduction of nausea & vomiting during chemotherapy, improves appetite in people with HIV/AIDS and to treat chronic pain and muscle spasms. The common side effects are dizziness, fatigue and vomiting but there are concerns about memory and cognition problems, risk of addiction, risk of schizophrenia in young children and others.

Recreational use: Cannabis has psychoactive and physiological effects when consumed and it produces relaxation and euphoria (the ‘high’ or ‘stoned’ feeling), a general alteration of perception, increased awareness of sensation, increased libido and distortion in the perception of time and space. At higher doses, effects can include altered body image, auditory and visual illusions, pseudo-hallucinations and ataxia from selective impairment of polysynaptic reflexes. In some cases, cannabis can lead to dissociative states such as depersonalisation and derealisation. Some immediate undesired side effects include a decrease in short-term memory, dry mouth, impaired motor skills and reddening of the eyes. Short-term physical and neurological effects include increased heart rate, increased appetite and consumption of food, lowered blood pressure, impairment of psychomotor coordination and concentration. Some users may experience an episode of acute psychosis.

Economic benefits of legalisation of Cannabis
The potential of economic benefits is the driving force in the arguments in favour of legalisation of cannabis cultivation and medicinal use. These benefits include income and job, impact on tax revenue, investment opportunities, among others. Certainly, Nigeria economy will need opportunities of this nature as a panacea to recent upheavals, but we need to take things easy and avoid being penny wise and pound-foolish.

Should Cannabis cultivation and medicinal use be legalised in Nigeria?
Our considered opinion is that ‘there are many rivers to cross’ before we arrive at this destination. How will the cultivation ensure that we have only the useful cannabinoids and not the psychoactive THC? Are we going to have the genetically modified variants? If the plan is to discard the THC during extraction, how do we ensure that this will not find its way to the market?

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Do we have the capacity to handle the widespread availability and consumption of cannabis in Nigeria?
A 2018 survey indicates that 10.6 million people have used cannabis in Nigeria mainly for recreational purpose. We have serious challenges with drug abuse already particularly among the youths, do we need to add more to this challenge?

Alternative pathway to economic prosperity through the pharmaceutical sector
About 80 per cent of our national medicine consumption are imported. Is it not possible for us to change this profile for economic prosperity? In 2019, the top five pharmaceutical companies had a turnover of $239.58 billion (Pfizer, 51.75, Roche, 50, Norvatis, 47.45, Merck, 46.84, GSK, 43.54). Individually, they have turnover that is much bigger than our national budget. Nigeria does not exist in the world pharmaceutical map (perhaps only as a consuming nation). The pharmaceutical sectors, without the additional burden of abuse potential of cannabis legalisation, hold the promise for economic prosperity for Nigeria. Can we explore this opportunity?

If we talk about the medical benefits of cannabis use, we should also ask if there are no existing alternatives? Codeine is a powerful pain killer and antitussive whose use has become controversial and extremely restricted in Nigeria? Are we going to add cannabis to an already long list of drugs with abuse potential?
Do we have a tight regulatory control or rule enforcement practices that can handle the fallout that will surely follow the cannabis legalization?

Recommendations:
It is recommended that the state should continue the engagement and expand the scope to include many more stakeholders. It will be important to get the Federal Ministry of Health (and her agencies) involved in building a consensus on the subject. We know that scientific issues are never cast in concrete, and it will be good for all of us to continue to seek information and details that could make us to take a firm decision in the interest of all Nigerians. The Pharmaceutical Society of Nigeria (PSN) has just set up a committee of experts under the leadership of Prof. Chinedum Babalola FAS, FPSN, FNAPharm, the Vice-Chancellor of Chrisland University, Abeokuta, to interrogate all the available data, information, issues, etc., and advise the Society on the way forward.

Dr. Ojo is a consultant pharmacist and medical director of Merit Healthcare.

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