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.
Drug policy researchers, South African health officials, international policy makers considering decriminalization, and treatment service planners.
What the researchers 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.
Why it 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 numbers in context
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 the study worked
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.
What this study cannot 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.
How to read the evidence
Comprehensive national treatment data with appropriate statistical adjustment, though unable to separate decriminalization effects from COVID-19 pandemic impacts.
When this study was published
Published 2026; covers 2015-2023 spanning pre- and post-decriminalization.
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.
Questions still open
- 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?
Common questions
Does cannabis decriminalization increase youth drug problems?
Who is most affected by cannabis decriminalization in South Africa?
Read the original research
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
Citation
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