Cannabis Treatment Demand Among South African Youth Rose Years After Decriminalization
South Africa's 2018 cannabis decriminalization did not immediately increase treatment demand among youth, but significant increases emerged from 2021 onward, with 50% higher odds of admission by 2022-2023 compared to 2019.
Quick Facts
What This Study Found
Cannabis-related treatment admissions did not increase immediately after the 2018 decriminalization, but rose significantly from 2021 onward with higher odds in 2022 (AOR=1.50, 95% CI=1.38-1.63, p<0.001) and 2023 (AOR=1.48, 95% CI=1.37-1.59, p<0.001) compared to 2019, with higher rates among adolescents, males, and those with lower education.
Key Numbers
2015-2023 data; 2018 decriminalization; no immediate increase; significant rise from 2021; 2022 AOR=1.50 (p<0.001); 2023 AOR=1.48 (p<0.001) vs 2019; higher odds among adolescents, males, lower education
How They Did This
Retrospective analysis of inpatient and outpatient treatment demand data from South African adolescents (≤18) and young adults (19-25) from 2015-2023, using descriptive statistics and logistic regression adjusted for sociodemographic and treatment variables.
Why This Research Matters
This is one of the first studies to examine cannabis decriminalization effects in an African context, revealing a delayed impact that may reflect gradual normalization of use and increased availability.
The Bigger Picture
The delayed increase in treatment demand suggests decriminalization's effects unfold over years, not immediately — which is important for countries planning cannabis reform to anticipate gradual treatment system needs.
What This Study Doesn't Tell Us
Treatment data may reflect help-seeking patterns rather than actual use changes; 2021+ increase coincides with COVID-19 aftermath; no direct cannabis use prevalence data; South African context may not generalize; observational design.
Questions This Raises
- ?Is the delayed increase due to gradual normalization, increased availability, or post-COVID mental health effects?
- ?How does the private treatment market data compare?
- ?Would decriminalization with age-restricted access better protect youth?
Trust & Context
- Key Stat:
- Evidence Grade:
- Comprehensive national treatment data with appropriate statistical adjustment, though unable to separate decriminalization effects from COVID-19 pandemic impacts.
- Study Age:
- Published 2026; covers 2015-2023 spanning pre- and post-decriminalization.
- Original Title:
- From courtroom to clinic: How legal rulings shape cannabis use among adolescents and young adults in South Africa.
- Published In:
- The International journal on drug policy, 149, 105151 (2026)
- Database ID:
- RTHC-08322
Evidence Hierarchy
Frequently Asked Questions
Does cannabis decriminalization increase youth drug problems?
In South Africa, treatment demand didn't rise immediately after 2018 decriminalization, but significant increases appeared 3-5 years later — though COVID-19 effects make it hard to isolate the decriminalization impact.
Who is most affected by cannabis decriminalization in South Africa?
Adolescents (under 18), males, and those with lower educational attainment showed the highest increases in cannabis-related treatment admissions after decriminalization.
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Cite This Study
https://rethinkthc.com/research/RTHC-08322APA
Harker, Nadine; Hornsby, Nancy; Londani, Mukhethwa; Parry, Charles; Carney, Tara. (2026). From courtroom to clinic: How legal rulings shape cannabis use among adolescents and young adults in South Africa.. The International journal on drug policy, 149, 105151. https://doi.org/10.1016/j.drugpo.2026.105151
MLA
Harker, Nadine, et al. "From courtroom to clinic: How legal rulings shape cannabis use among adolescents and young adults in South Africa.." The International journal on drug policy, 2026. https://doi.org/10.1016/j.drugpo.2026.105151
RethinkTHC
RethinkTHC Research Database. "From courtroom to clinic: How legal rulings shape cannabis u..." RTHC-08322. Retrieved from https://rethinkthc.com/research/harker-2026-from-courtroom-to-clinic
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.