Cannabis and Cannabinoid Research

Volume 7, Number 3, 2022

ª Mary Ann Liebert, Inc.
DOI: 10.1089/can.2021.0110

REVIEWS

Status and Impacts of Recreational and Medicinal

Cannabis Policies in Africa:
A Systematic Review and Thematic Analysis
of Published and ‘‘Gray’’ Literature
Chenai Kitchen,1–4 John Alimamy Kabba,1–4 and Yu Fang1–4,*

Abstract
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Background: Despite cannabis’s societal ubiquity, several African states remain traditional prohibitionists. However,
cannabis is becoming a more explored frontier from a health, human rights, and monetary perspective. A number of
African countries have taken to tailoring their policies to better engage in emerging global dialogs. Nevertheless, the
focus is majorly on the crop’s financial appeal with less consideration on impacts of policies. This review aimed to
specifically focus on the identification of existing or pending policies, indicating national positioning in terms of rec-
reational and medicinal cannabis use and summarizing publications addressing related impacts in Africa.
Methods: We systematically searched six academic research databases (including Google Scholar), Google,
country specific websites, and websites of relevant organizations. Included publications were in English and pub-
lished between January 1, 2000, and November 31, 2020 (with exception granted to official legislation not in
English and/or published earlier than 2000, but still in effect). Reference lists of included publications were
screened for potentially relevant publications. Results were synthesized thematically and descriptively.
Results: Cannabis is Africa’s most consumed illegal substance, its use entrenched in social, political, historical,
economic, and medicinal ties. African users constitute a third of the worldly total and cultivation is a major ac-
tivity. Policies have led to prison overcrowding, accelerated environmental damage, and sourced regional insta-
bility. South Africa, Seychelles, and Ghana have decriminalized personal use with Egypt and Mozambique
exploring similar legislation. Eleven countries have existing or pending medicinal cannabis-specific provisions.
South Africa and Seychelles stand out as having regulations for patients to access medicinal cannabis. Other
countries have made provisions geared toward creating export markets and economic diversification.
Conclusion: Cannabis policy is a composite and complex issue. Official stances taken are based on long with-
standing narratives and characterized by a range of contributing factors. Policy changes based on modern trends
should include larger studies of previous policy impacts and future-oriented analysis of country-level goals incor-
porated with a greater understanding of public opinion.
Keywords: cannabis; policy; Africa; recreational cannabis; medicinal cannabis

Introduction and traded illegal drug.2 Originating over 12,000 years

Cannabis is defined as ‘‘all parts of the plant Cannabis ago from Asia, years of intracontinental trade and its
sativa L. (Cannabaceae); the seeds; extracted resin; and many properties led to ubiquity.3
every compound, manufacture, salt, derivative, mix- Indigenous use dates back to 14th century Ethiopia,4
ture, or preparation of such plant, its seeds or resin.’’1 with its arrival as a commodity.5 Use garnered popular-
By weight and value, it is the most widely consumed ity in, inter alia, cultural and medicinal practices,
1
Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China.
2
Centre for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China.
3
Shaanxi Center for Health Reform and Development Research, Xi’an, China.
4
Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China.

*Address correspondence to: Yu Fang, PhD, Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, No. 76 Yanta
West Road, Xi’an 710061, China, E-mail: yufang@mail.xjtu.edu.cn

239
 240
including by Congo’s Aka forest-forager group as a hel-
minthic (worm infection) protectant,6,7 by Sierra Leo-
nean midwives as anesthesia,4 and by warriors and
Southern African healers (Sangomas).2
During the introduction of colonialism (1870s–
1890s), cannabis was legal. However, colonial gov-
ernments reduced production8 to curb diversion from
state generating activities (e.g., copal production) and
promote the European mission of ‘‘civilizing’’ natives,6,9
leading to enactment of racialized policies to strengthen
authoritarianism.5 In the early 20th century, medicinal
use also began to fall out of favor as Western medicine
began to focus on isolated chemical entities and interna-
tional prohibitions soon followed.10
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The Geneva Convention on Opium and Other
Drugs (1925) first outlawed cannabis in many colo-
nies.7 By the mid-20th century, liberation movements
brought about new governments, but independent na-
tions inherited colonial-era laws, due to international
agreements and elitist control,8 and in some instances,
more stringent measures have been enacted.11 Govern-
ments have shown varying levels of tolerance, notably,
Morocco’s lax position draws from past contexts.12
Cannabis is restricted to medical and scientific use
under Schedule I and IV of the United Nations’ Single
Convention on Narcotic Drugs (1961).13 However, af-
fairs concerning cannabis are nationally regulated.
Drug policies include supply reduction, access, cultiva-
tion, and treatment aspects. African nations are tradi-
tionally prohibitionists; however, the wave of global
shifting sentiments has been influential. Emphasizing
on policy redefinition, cannabis is becoming a more
explored frontier from a health and human rights per-
spective and as a pharmaceutical entity.
There exists a gap in research on African cannabis
policies, thereby making implementation of future
evidence-based policy regulating use challenging. This
study did not aim to provide insight of all afore-
mentioned aspects, but specifically focus on the iden-
tification of existing or pending policies, indicating
national positioning in terms of recreational and me-
dicinal cannabis use and summarizing publications
addressing related impacts in Africa.
Methods
This review follows the Preferred Reporting Items
for Systematic Reviews and Meta-Analyses guide-
lines. The protocol is uploaded on the International
Prospective Register of Systematic Reviews
(CRD42020211723).
KITCHEN ET AL.
Search strategy
Academic research database search. Publication re-
trieval included structured queries in five literature da-
tabases (African Journals Online, EBSCO, ProQuest,
Scopus, and Web of Science) from 2000 up to and
including November 2020. Google Scholar was addi-
tionally searched for the first 100 references as sorted
by relevance. Free-text key terms and medical subject
headings (MeSH terms) were incorporated and tailored
to each database (Supplementary File S1). To ensure
inclusivity of up-to-date results, searching was conduc-
ted first in July 2020 and rerun in November 2020.
Gray literature search
Google extraction. We used customized searches and
relevancy ranking to identify publications. The first
10 pages of each search (representing 100 results) were
reviewed, using title and short-text underneath (Sup-
plementary File S2).
Targeted browsing of relevant organizations. Using a
variety of keywords, we searched websites of country-
specific organizations (government, health organiza-
tions, universities, etc.) for relevant works. Google
search was first conducted to identify relevant orga-
nizations, including the United Nations Office on
Drugs and Crime (UNODC), The World Health
Organization (List of Globally identified Websites of
Medicines Regulatory Authorities14), and International
Drug Policy Consortium.
This process was conducted through (1) Website-
Searching: using search bars and keywords, (2) Website-
Browsing: homepages were searched for information
using selection menus, directories, and links, and (3)
Country specific website-browsing: browsing of official
websites of national authorities (Supplementary File S3).
Definition of legislation
For a more comprehensive review, a liberal definition
of legislation was adopted, which we defined as any
government documentation making reference to the
status of cannabis for a defined region.
Eligibility criteria
Inclusion extended to United Nations (UN) fully rec-
ognized sovereign African states, with nonsovereign
states and disputed territories excluded. Publication
inclusion applied to peer-reviewed materials (articles,
chapters, etc.) and gray literature works (reports, policy
literature, web articles, dissertations, etc.) exploring
 AFRICA CANNABIS POLICY STATUS AND IMPACT
policies or impact. Results were restricted to English
language works published between January 1, 2000,
and November 31, 2020, with exceptions made for
non-English legislation (whereby in such cases, the
Google Translate feature was used to extract informa-
tion) and/or in effect legislation published before
2000. A snowball strategy was also employed to further
identify material.
Data extraction and synthesis
Search terms and number of results retrieved and
screened from each search strategy were recorded. Pub-
lications meeting the preliminary inclusion criteria
were indexed in a citation manager. Two authors in-
dependently reviewed titles and abstracts to identify
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relevant articles following duplicates removal. In the
event of unavailable or inadequately detailed abstracts,
publications were screened in their entirety. We used
a fit-for-purpose quality criteria to select meaning-
ful gray materials.15
Using Tyndall’s ‘‘Checklist of Appraising Grey Liter-
ature’’ principles, each reviewer scrutinized gray litera-
ture in terms of Reputability: website domain and
content creator information (individual or organiza-
FIG. 1. Analytical framework.
241
tion credentials); Accuracy: spelling or grammatical er-
rors; Currency: date of creation or last updated;
Objectivity: factual information presentation; Signifi-
cance: existing relevance of information; and Credibil-
ity: references given to support information.16
Inclusion disputes concerning a source were moder-
ated by a second evaluation by reviewers or, if neces-
sary, through a third reviewer.
Data retrieval and analysis were undertaken con-
comitantly during data extraction and further refined
during the inclusion process. Data were pooled by way
of thematic narrative analysis into broad groupings.
A meta-analysis was out of this study’s capacity
due to limited quantitative data and the diversity of
publications.
Analytical framework
The main study question, that is, ‘‘What is the current
status of formal cannabis policy and their impacts in
Africa?’’ was approached through identification of can-
nabis policies and related impacts. A framework, adap-
ted by van het Loo et al.,17 was expanded and adjusted
to the study focus (Fig. 1). The original framework pre-
sented the primary goal of cannabis policy as
 242
‘‘controlling consumption and channeling conse-
quences’’; to this, we included ‘‘providing regulated ac-
cess to medicinal products.’’ This is because some
policies do not solely aim to reduce use, but also create
regulated markets for cultivation and sale. Our restruc-
turing presents medicinal and recreational policies as
subcategories to enable us to cover the entire debate.
We also focused on providing an overview of direct
(seizures, arrests, health effects, etc.18) and indirect im-
pacts. Given the intricacies of assessing health effects,
we did not provide in-depth analysis of such content.
Indirect consequences range from political to social.
In this study, we focused on social aspects, with refer-
ences made to the environment due to Africa’s
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agrarian-based image.
Results
Description of search results
Fifty-four fully recognized states (according to UN
membership) were eligible to have their cannabis poli-
cies researched, while two disputed territories, Sahrawi
FIG. 2. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.
KITCHEN ET AL.
Arab Democratic Republic and Somaliland, were ex-
cluded due to no UN recognition. We retrieved 1183
records (740 from literature databases and 443 from
gray literature searches). After removal of 231 dupli-
cates, 952 records were initially screened. Texts of
305 records were fully screened.
Totally, 208 records (20 from academic research da-
tabases, 163 from gray literature searches, and 25 from
snowballing) fulfilled the eligibility criteria for inclu-
sion (Fig. 2). Scholarly databases identified 20 publica-
tions, suggesting reliance on a singular strategy would
have led to a less comprehensive review. A total of 14
non-English documents (all government documents)
were found to be relevant and translated.
The majority of publications were web articles
and legislation documents, both nearly constituting
a third of all publications (n = 63 [30%]). The most thor-
ough strategy was Google extraction, identifying 116
(55%) publications. East Africa was represented by
62 publications (29.8%) from 18 countries, West Africa
54 (26.0%) from 16, Southern Africa 38 (18.3%) from 5,
 AFRICA CANNABIS POLICY STATUS AND IMPACT
North Africa 28 (13.5%) from 6, Central Africa 12
(5.8%) from 9 and 14 (6.7%) composite publications
(Supplementary File S4).
Mapping of existing and pending policies
All included countries are UN and African Group
members. The drug control realm is governed by the
UN Single Convention on Narcotic Drugs (1961), the
Convention on Psychotropic Substances (1971), and
the Convention against Illicit Traffic in Narcotic Drugs
and Psychotropic Substances (1988).19 Cannabis-related
activities are prohibited in all Single Convention signa-
tories states.20 Fifty-two African states are signatories
to all conventions.13 As of 2019, 22 countries were
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reported to have National Drug Control Plans or Strat-
egies21 to address local use, including Ethiopia,22 South
Africa,5,23 Mauritius,24 The Gambia,24 and Nigeria.25
Cannabis policies were grouped as illegal (may refer
to illegal; illegal, but decriminalized and unregulated;
or illegal consumption, but legal cultivation), decrimi-
nalized (systems in which possession or use of any
amount is noncriminal or depending on amount pun-
ishable by civil penalties), or legal (ranging from tech-
nically legal, but not legally available; legal, but no
formal access; or fully regulated with formal access)17,26
(Table 1). In all cases, reference is to personal con-
sumption, unless otherwise stated. All data are current
to end of November 2020.
Recreational policies. Of the 54 countries, we identified
provisions for 46 countries. Provisions for Burundi,
Chad, Comoros, Congo, Democratic Republic of
Congo (DRC), Equatorial Guinea, and Gabon and
Sao Tome and Principe were not made accessible
through our method. Continentally, cannabis is illegal
with the major differences seen in the degree of im-
posed sanctions, which, dependent upon country and
circumstance, can be a fine and/or sentencing ranging
from 2 months to death penalties. Ghana, Seychelles,
and South Africa have decriminalized personal use,
with South Africa allowing private cultivation. Egypt
and Mozambique have pending decriminalization leg-
islature.
Most countries lack independent bodies tasked with
policy implementation and data collection.25 Enforce-
ment efforts are undertaken by a combination of
authorities, including health departments, inter-
ministerial committees,27 civil society organizations
(CSOs),28 prison services, and community-based initia-
tives.29 The extent to which imprisonment alternatives
243
(fines and treatment) are used is limited. Arrested indi-
viduals face lengthy detentions and are often neglec-
ted following conviction.30
Treatment, education, and rehabilitation facilities
are scarce, underfinanced, and non-existent in countries
such as Sierra Leone and Liberia.30 In the former, 32
mentally ill youths were arrested and sentenced to
prison in 2015 for possession due to the absence of fa-
cilities.30 Malian law grants treatment to convicted
users, but fails to detail treatment guidelines.31 Burkina
Faso’s Drug Code references therapeutic injunctions for
users, but fails to assign accountable entities.32 The
Gambian government revealed construction plans in
2020 for a cannabis rehabilitation center to fulfill legis-
lative provisions.33 Guinea,31 Eritrea,34 Ethiopia,35
Liberia,36 Morocco, Rwanda,29 Senegal,37 South
Sudan, and Zimbabwe include regulations into penal
legislation, setting precedence to criminalize users.
Medicinal policies. According to the literature, seven
countries (Lesotho, Malawi, Rwanda, Seychelles, Sierra
Leone, Zambia, and Zimbabwe) have made official me-
dicinal cannabis-specific provisions and 4 countries
(Eswatini, Cameroon, Morocco, and South Africa)
have pending legislation. Of the official legislation,
provisions are mainly for medicinal cultivation for
export. South Africa, Seychelles, and Malawi have
established medicinal cannabis programs for patients
to access medicinal cannabis.
In 2017, Pharmaceutical Development Company
Ltd. became the first company in Lesotho and Africa,
licensed to carry out legal cannabis activities.38,39 In
Eswatini, American company, Profile Solutions, stands
to become licensed to operate a medical cannabis facil-
ity for a 10 year minimum.8
In Zimbabwe (March 2019), Precision Cannabis
Therapeutics was approved for a USD$46,000 cultiva-
tion license along with water rights to a dam40 and
partner companies Eco Equity, DutchGreenhouses,
and Australian Delta Tetra were approved to construct
a medicinal cannabis greenhouse.41 Malawian compa-
nies, Invegrow and IKAROS, are licensed producers
of ‘‘organic’’ essential oils42 and hemp extracts.43 Holis-
tic Relief Wellness and Pain Management Centre be-
came the continent’s first dispensary offering infused
Cannabidiol products,44 including Dronabinol.45
Although no official announcement from the Dem-
ocratic Republic of the Congo government has been
made, in 2017, Canadian company, EXMceuticals,
became licensed to grow psychotropic cannabis.8 A
 Table 1. Mapping of Existing and Pending Recreational and Medicinal Cannabis Policies

Country Legislation Recreational Medicinal Regulatory authority Notes

Algeria Law No. 04-18 of December Illegal98 (Article 12) Illegal National Anti-Drugs The basis of the legal response
25, 2004, on prevention and Drug to drug use is preventive and
and repression of illicit Addiction Office, treatment measures.84
use and trafficking of Algerian Ministry Sanctions only enforced upon
narcotics and of Justice the refusal of treatment
psychotropic substances97 (Article 9)99
Angola Law on trafficking and Illegal101 (Article 18) Illegal National Directorate
consumption of narcotic for Medicines
drugs, psychotropic
substances, and
precursors—Law No. 3/99,
of 6 August100
Benin Act No. 97-025 on the Illegal (Article 8) Illegal Central Office for No formal alternatives to
control of drugs and Repression of Illicit incarceration, exemptions
precursors, 1997102 Trafficking of maybe granted for minors or
Drugs and first time offenders103
18
Precursors
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Botswana Illicit traffic in narcotic drugs Illegal (Sections 4–6 Illegal Medicines Regulatory
and psychotropic of narcotic drugs Authority105
substances bill, 2018.104 and psychotropic
Medicines and Related substances bill)
Substances Act, 2013105
Burkina Faso Law No. 017/99/AN, 1999106 Illegal Illegal National Committee Inter-ministerial committees are
to Combat Drug designated to oversee and
Abuse (CNLD) support implementation103
Burundi No framework found Illegal28,26 Illegal26 ˚
Cabo Verde Law No. 78/IV/93 (1993) and Illegal (Article 1 of Illegal Coordinating Defendants may seek treatment
Law No. 92/92 Law No. 92/92) Commission to and a financial penalty in
(1992)103,107 Combat Drugs18 exchange for incarceration103
Cameroona Law No. 97-August 19, 1997, Illegal Illegal Anti-Drug National
relative to the control of Committee
drugs, psychotropic
substances, and
precursors and on mutual
assistance in material
traffic of narcotic drugs,
psychotropic substances,
and precursors108
PENDING: Framework not In 2001, reports of the intention
found to import Canadian medicinal
cannabis for HIV/AIDS
patients were made.109 The
government registered an
official request in 2002 to
become a medicinal cannabis
producer and exporter110
Central Law No. 01.011 adopting the Illegal Illegal National Police
African harmonized law relating to (Sûreté Nationale)
Republic the control of drugs,
extradition, and mutual
legal assistance in the
matter of illicit trafficking
in narcotic drugs and
psychotropic substances111
Chad No framework found Illegal26 Illegal ˚
Comoros No framework found Illegal112 Illegal ˚
Côte D’ivoire Law No. 88-686, 1988, on the Illegal (Article 8) Illegal Police Directorate on The Inter-ministerial Committee
suppression of trafficking Narcotics and for the Fight against Drugs
and illicit use of narcotic Drugs (CILAD) monitors impacts of
drugs103 legislation113
Democratic No framework found Illegal Illegal Capital punishment is applied to
Republic of certain offences28
the Congo

(continued)

244
 Table 1. Continued

Country Legislation Recreational Medicinal Regulatory authority Notes

Djibouti Law No. 171/AN/81 on Illegal Illegal Directorate of Drugs The drug law system makes use
psychotropic and Pharmacy of constitutional and Sharia
substances114 law. Under Sharia law,
cannabis is categorized as
‘mukhaddirat,’ referring to a
substance that numbs the
senses and slows the user, but
use is justifiable for medicinal
purposes115
Egypt Act No. 122 of 1989 Illegal117 Illegal Egyptian ANGA118,119 Punishment for possession, use,
amending Law No. 182 of or cultivation for any reason is
1960, control of trade of imprisonment of between 3
narcotics and regulation and 15 years and a
of substances116 fine.116,118,119
Alternatives to prison include
voluntary treatment served
for at least 6 months and no
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longer than 3 years or the

sentenced sanction period—
whichever is less (Article 37)120
PENDING: framework not Decriminalized ˚ ˚ In 2018, legislation was put
found forward, proposing that
repeat offenders be referred
to 3–6 months of treatment121
Equatorial No framework found Illegal26 ˚ ˚
Guinea
Eritrea Penal Code of the State of Illegal (Article 395) Illegal ˚ Differences made between
Eritrea, 201534 selling and buying for
personal use, with possession
being considered a ‘‘less
serious’’ offence122
Ethiopia Drug Administration and Illegal124,125 Illegal ˚
Control Proclamation No.
176/1999123
The Criminal Code of the
Federal Democratic
Republic of Ethiopia,
2004123
Eswatinia The Opium and Habit— Illegal126 Illegal Medicines Regulatory Currently, cannabis use and
Forming Drug Act 192226 Authority in cultivation for any purpose
Medicines and Related conjunction with are illegal and there is no
Substances Control Act, the Royal medical cannabis regulatory
2016 (Act 9 of 2016)26 Swaziland Police framework26
Service’s Drug Unit
PENDING: The production of ˚ Legal Drug Administration Pending legislation aims to
cannabis for medicinal and Control decriminalize medicinal
and scientific use Authority, cannabis use and
regulations, 2019127 Ethiopian Federal cultivation127
Police ANS
Gabon No framework found Illegal26 ˚ ˚
The Republic Drug Control Act, 2003 Illegal Illegal DLEAG Government plans are
of Gambia (as amended)103 underway integrate
Medicines and Related treatment programs into the
Products Act, 2014128 existing legislature.103
Drug Control (Amendment) Act
2014, Section 35, in relation to
first-time offenders offers
leniency according to amount
 0.1–150 g: fine and/or
imprisonment of between
6 months and 1 year
 151–500 g: fine and/or
imprisonment of between
one and 2 years
 above 500 g: fine and/or
imprisonment of between
2 and 3 years129

(continued)

245

Country Legislation
Ghana Narcotics Control Decriminalized
Commission Bill of 2017
(NCC)130
Guinea Criminal Code of the Illegal
Republic of Guinea132;
Decree D/2011/016/
PRG/SSG, 2011.103
Decree No. 066/PRG/SSG/94
on the creation, powers
and functions of the
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Central Anti-Narcotics
Office.
Decree No. 067/PRG/SGG
(1994) on the Creation and
Functions of the Inter-
Ministerial Committee
responsible for the fight
against drugs
Guinea- Legislation on narcotic drugs Illegal (Article 20)
Bissau (Decree-Law No. 2-B, of 28
October 1993103,133
Kenya The Narcotic Drugs And Illegal135
Psychotropic Substances
(Control) Act No. 4,
1994134
Lesothoa Drugs of Abuse Act 2008136; Illegal138
The Medicines Control and
Medical Devices Control
Bill 2018 Act No. 5
Drug of Abuse (Cannabis)
Regulations Act of 2018137
Liberia Controlled Drugs and Illegal36
Substances Act/Drugs
Enforcement Agency Act,
2014, in conjunction with
Penal Law36;
Table 1. Continued
Recreational Medicinal Regulatory authority Notes
Illegal Narcotics Control Civil penalties, i.e., fines will be
Commission issued to offenders or if
(NACOC) in necessary, treatment referrals.
collaboration with Failure to pay fines, translates
the Prosecuting into a 15-month jail
Unit of the Ghana sentence131,27
Police Service and
the Attorney
General
Department131,27
Illegal Central Anti- Provisions for related offences
Narcotics Office are made in a number of
(OCAD)18 decrees in the Penal
Code27,132
Inter-ministerial committees are
involved in the overseeing of
current policy.103
There are no protocols
regarding treatment27
Illegal NDLEA18 According to substance,
distinctions are made
concerning sentencing:
 cannabis oil, sentencing of 2
months to a year
 derivative other than
cannabis oil, a sentencing of
1–6 months133
Illegal ANU Cannabis for personal
consumption punishable
by 10–20 years of
imprisonment and cultivation
punishable by a pre-
determined fine or three
times the cannabis market
value and/or 20 years of
imprisonment134
Illegal Narcotics Bureau Any mode of use is punishable
by a minimum of 5 years in
prison or a fine (Section 9,
Drugs of Abuse Act)
The Drug of Abuse (Cannabis)
Regulations Act of 2018 allows
for medicinal cannabis
cultivation Lesotho Narcotics
Bureau approved permit
holders can
cultivate flowerings, extract
active pharmaceutical
ingredients, and produce
medicines; Export
and import
medicinal cannabis
products38
Illegal NDLEA18,36 Security and health
parliamentary committees
serve as proximal
mechanisms for drug
control.103
(continued)
246
 Table 1. Continued

Country Legislation Recreational Medicinal Regulatory authority Notes

Medicines and Health Use is chargeable with 1-year

Products Regulatory imprisonment and/or a fine.
Authority Act, 2010139 Aggravating circumstances,
e.g., use in a public institution
may incur greater
penalties.140 Courts can
request an individual to
submit to treatment9
Libya Law No. 7 of 1990 on Drugs Illegal Illegal Libyan Anti-Narcotics Offenders maybe remanded to
and Psychotropic and Psychotropic a treatment facility for 6
Substances Substances months to 1 year
(as amended)120 Agency A distinction is indicated
between possession and
actual use, although both are
punishable with a 2-year
prison sentence84
Madagascar Law No. 97-039 on The Illegal (Article 140) Illegal The National Article 411:
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Control of Narcotic Drugs, Gendarmerie’s Unlawful purchase, possession,

Psychotropic Substances,
and Precursors141
Malawia Dangerous Drugs Act
(1994)144
Cannabis Regulation Act,
2020145
Mali Law No. 01-078, 2001 on the Illegal
control of drugs and
precursors103
Mauritania Law No. 93-37, 1993103
Anti-narcotics or growing for personal
Office142
consumption are punished as
follows:
 cannabis plant, including oil: 3
months to a year
imprisonment and a fine
 derivatives other than oil: 2–6
months of imprisonment
and/or a fine
Exemptions made in cases of
minors or first-time
offenders142,143
Illegal146 Legal Pharmacy, Medicines The law excludes the use of any
and Poisons Board seed crushed or processed to
prevent germination; or the
fixed oil obtained from the
seed.
Medicinal cannabis products are
available to ‘‘Qualified
patients’’ (individuals with
specific medical conditions
and recommendation for use)
with Valid rIC obtained from
the CRA.42
Cannabis Regulation Act, 2020,
also legalizes medicinal
cannabis cultivation
Illegal Central Office of Illegal use and cultivation are
Narcotics- sanctioned by 6 months to 3
(OCS)55,31 years and 5–10 years of
imprisonment, respectively,
and/or a fine.27 Sentences
maybe forgone for
detoxification
programs.103
A specialized committee
monitors drug control,
policies, and proposed
legislation27
Illegal Illegal147 National Office for Use is punishable with a 2-year
the Fight Against maximum prison sentence
Drugs and and a fine. Standard
Psychotropic penalties will not be applied
18
Substances when a user has been
‘‘successfully subjected to a
cure’’103

(continued)

247

Country Legislation
Mauritius The Dangerous Drugs Act,
1986 (as amended)64
Moroccoa Law No. 1-73-282 of May 21, Illegal
1974, on the suppression
of drug use and drug
prevention47
The Criminal Code of
Morocco
PENDING51: Framework not
found
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Mozambique Regulations for the Practice
of Pharmacy, 1941,151
PENDING: Anteprojecto de
Revisão da Lei No. 3/9728
Namibia Combating of the Abuse of
Drugs Bill, 2006,153
Medicines and Related
Substances Control Act,
2003154
Niger Ordinance No. 99-42,
1999103
Nigeria The Dangerous Drugs
Ordinance of 1935157
The Indian Hemp Decree
No. 19 of 1966
(as amended)158
Table 1. Continued
Recreational Medicinal Regulatory authority Notes
Illegal Illegal Pharmacy Board, The 2000 Dangerous Drugs Act
Ministry of Health, sanctions drug use with
and Quality of Life, maximum 2 years of
Mauritius Police imprisonment and/or a
Force’s Anti-Drug fine148
and Smuggling
Unit
Illegal Central Unit to Fight Possession or use is liable to
Drugs (UCLAD) imprisonment of between 2
months and 1 year and/or a
fine.60 Article 8 of the Law on
the Suppression of Drug use
sets out the possibility of
treatment,149 i.e., mandated
medical detoxification (with a
15-day follow-up drug
screening)103
National Commission on
Narcotic Drugs addresses
policy and coordination
matters150
The Parti Authenticité et
Modernité (PAM) and Rifan
Deputies of the Istiqlal Party in
2013 formally proposed
medical cannabis use
legislation, but hashish
production is not
mentioned.4,61 A national
agency is to be established to
oversee supplying of
pharmaceutical companies,
seed importation, and
distribution51
Illegal151,152 Illegal Pharmaceutical
Department,
Ministry of Health
Decriminalized Legal ˚ Would allow only authorized
(Article 36) (Article 34) possession and cultivation of
small amounts
Illegal155 Illegal Medicines Regulatory Section 17 of the Medicines and
Council Related Substances Control
Act, 2003, applications can be
made to have cannabis or
extracts of such registered as
medicine.156
Use and possession are
punishable with between
20 and 40 years of
imprisonment and/or a
fine. Cultivation is punishable
with 20 years for a first
conviction and at least 30
years for subsequent
convictions153
Illegal Illegal Coordination Centre Addicts maybe court ordered to
to Combat Drugs undergo treatment,
(CCLAD) education, or rehabilitation.
(Article 115)103
Illegal157,160 Illegal158 NDLEA161 Possession and cultivation are
punishable under the Indian
Hemp Act with the later
receiving imprisonment for at
least 21 years158
(continued)
248
 Table 1. Continued

Country Legislation Recreational Medicinal Regulatory authority Notes

NDLEA Act No. 48 of 1989 The Indian Hemp Act of 1975

(as amended)159
Republic of No framework found
Congo
Rwandaa Law No. 03/2012 of February Illegal
15, 2012, governing
narcotic drugs,
psychotropic substances,
and precursors in
Rwanda,164
in conjunction with the N
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abolished the death penalty
and reduced use and
possession charges to 6
months of prison and/or a
fine.19 Minors can undergo
court-ordered treatment as an
alternative103,161,162
Illegal26,163 Illegal26 ˚
Illegal RNP, ANU As of October 2020, guidelines
for cultivating, processing,
and export of medicinal
cannabis solely for foreign
markets were approved165

01/2012/OL of 02/05/2012
Organic Law instituting
the penal code
São Tomé No framework found Illegal26,166 Illegal26,166 ˚
and
Prı́ncipe
Senegal Law No. 97-18, 1997,103 Illegal Illegal Central Office for the
Drug Code (Code des Suppression of
Drogues)37 Illicit Drug
Trafficking
(OCRTIS)
Seychellesa Misuse of Drugs Act, 2016167 Decriminalized Legal NDEA The law makes a distinction
Misuse of Drugs between a user and a
(Cannabidiol-based dependent person with the
products for medical latter the objective being to
purposes) Regulations, make treatment accessible.
2020168 Patients must present the
following:
 a ‘‘qualifying medical
condition
 a prescription issued by
medical practitioner; as
approved by Public Health
Authority, Seychelles Medical
and Dental Council and the
Health Care Agency.169
Unsanctioned use of medicinal
cannabis, is punishable by
imprisonment no longer than
6 months and a fine
Sierra Leonea The National Drugs Control Illegal172 Illegal NDLEA Section 50 of the Pharmacy and
Act, 2008,103 Drugs Act, 2001, legalizes
Pharmacy and Drugs Act, cultivation of cannabis for
2001,170 medicinal purposes
Guideline for the Cultivation
and Processing of Medical
Cannabis (2019)171
Somalia Act No. 46 of March 3, 1970, Illegal Illegal Central Narcotics
concerning the Bureau
production of, trade in,
and use of narcotic
drugs173
South Africaa Medicines and Related Decriminalized Legal South African Police A 2018 Constitutional Court
Substances Act (Act 101 of Service’s Narcotics ruling decriminalized adult
174
1965) Bureau (SANAB) use, possession, or cultivation
Guidelines on the Cultivation of cannabis in private for
of Cannabis and personal
Manufacture of Cannabis- consumption,175,44,176

(continued)

249
 Table 1. Continued

Country Legislation Recreational Medicinal Regulatory authority Notes

Related Pharmaceutical allowing the amendment of

Products for Medicinal provisions of Medicines and
and Research Purposes Related Substances Act No.
101 of 1965 and the Drugs
and Drug Trafficking Act No.
140 of 199260
PENDING: Cannabis for South Africa Health The Cannabis for Private
private purposes bill, Products Purposes Bill, 2020, proposes
2020177 Regulatory as follows:
Authority Public consumption is illegal and
liable to 2 years of
imprisonment.178,179
Patients require valid
prescriptions from a licensed
practitioner to access
medicinal products for the
following eligible conditions:
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 Severe muscle spasms or pain

in patients with multiple
sclerosis;
 Severe nausea, vomiting, or
wasting arising from cancer,
HIV/AIDS;
 Severe epileptic seizures
where other treatment
options have failed or have
intolerable side effects;
 Severe chronic pain
conditions45,94,180–182
South Sudan Drug and Food Control Illegal Illegal SSNPS
Authority Act, 2012183
184
The Penal Code Act, 2008
Sudan Narcotic Drugs and Illegal Illegal. SPF Use and cultivation are
Psychotropic Substances (Article 20-1) punished by no longer than 5
Act, 1994 years of imprisonment and a
fine;
charges are terminated for
undergoing voluntarily
treatment (between 6 months
and 2 years)84
Togo Drug Control Law No. 98- Illegal Illegal Central Office for the Possession and cultivation of
008, 1998103 Suppression of small quantities are
Illicit Drug punishable with lesser
Trafficking and penalties. The penalty for
Money cultivation and production of
Laundering18 cannabis oil is 2 months to 1
year; 6 months for any other
plant derivative and/or a
fine.185
Treatment is alternatively
offered instead of prison103
Tunisia Law No. 92-52 of May 18, Illegal Illegal National Narcotics Actual or attempted
1992 on Narcotic drugs Bureau (Bureau consumption or possession
84
(as amended) National des sanctioned by imprisonment
Law No. 2017-39 dated May Stupéfiants)95 of between 1 and 5 years and
8, 2017, amending Law a fine.84 Cultivation can
No. 92-52 dated May 18, receive a 6–10-year sentence
1992, related to with a fine9
narcotics186 Law No. 2017-39 states article 53
of the penal code is not
implemented regarding
narcotics infringements,186
giving judges the right to
reduce related
penalties.147,187,188

(continued)

250
 Table 1. Continued

Country Legislation Recreational Medicinal Regulatory authority Notes

The Narcotics Commission, an

Uganda The Narcotic Drugs and
Psychotropic Substances
(Control) Act, 2015189
United The Drug Control and
Republic of Enforcement Act (CAP.
Tanzania 95), 2016,190
The Tanzania Food, Drugs
And Cosmetics Act (CAP.
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auxiliary body in policy
implementation, has the
authority to compel
addicts to undergo
treatment95
Illegal116 Illegal NDA Possession and use are liable to
a fine and/or 1–5 years of
imprisonment.26
The Act empowers the Minister
of Health to establish
rehabilitation centers83
Illegal Illegal DCEA Possession or use is punishable
with 1–5 years of
imprisonment, or a hefty fine
for small amounts.
Small quantities are classified as

219)191
Zambiaa Narcotic Drugs and
Psychotropic Substances
Act, 1993,193
The Dangerous Drugs Act,
1965194
Zimbabwea Chapter 15:02 Dangerous Illegal.41,199
Drugs Act (as amended)
in conjunction with
the Criminal Law
(Codification and Reform)
Act [Chapter 9:23]
Act 23/2004
Statutory Instrument 62 of
2018. [CAP. 15:02]
Dangerous Drugs
(Production of Cannabis
for Medicinal and
Scientific Use)
Regulations, 2018196,197
follows:
 cannabis plant < 50 g
 cannabis resin or oil < 5 g
The onus falls on the individual
to prove intent not being for
sale or distribution for larger
quantities190
Engagement in cultivation
(which includes gathering) is
liable to imprisonment of not
< 30 years.
Related activities may be
conducted only on the
account of government192
Illegal123 Legal (Section 18 Drug Enforcement Use is recognized in cases of
Narcotic Drugs Commission chronic pain, nausea caused
and Psychotropic by treatments such as
Substances Act chemotherapy, epilepsy,
Cap 96) glaucoma, and sclerosis
symptoms.87
Cultivation is legal solely on the
basis of medicinal use and not
on a commercial scale195
Illegal Ministry of Health Statutory Instrument 62 of 2018:
and Child Welfare Authorized individuals can
and the ZRP41,199 cultivate and produce
medicinal cannabis
products40

˚ Information not available.

a
Countries with medicinal cannabis-specific provisions.
ANGA, Anti-Narcotics General Administration; ANS, Anti-Narcotics Service; ANU, Anti-Narcotics Unit; CCLAD, Coordination Centre to Combat Drugs;
CILAD, Committee for the Fight against Drugs; CNLD, National Committee to Combat Drug Abuse; CRA, Cannabis Regulatory Authority; DCEA, Drug
Control and Enforcement Authority; DLEAG, Drug Law Enforcement Agency of the Gambia; NACOC, Nation Control Commission; NCC, Narcotics Con-
trol Commission; NDA, National Drug Authority; NDEA, National Drugs Enforcement Agency; NDLEA, National Drug Law Enforcement Agency; OCAD,
Central Anti-Narcotics Office; OCRTIS, Central Office for the Suppression of Illicit Drug Trafficking; OCS, Central Office of Narcotics; PAM, Modernity and
Authenticity Party; rIC, registry Identification Cards; RNP, Rwanda National Police; SANAB, South African Police Service’s Narcotics Bureau; SPF, Sudan
Police Force; SSNPS, South Sudan National Police Service; UCLAD, Central Unit to Fight Drugs; ZRP, Zimbabwe Republic Police.

251
 252
similar occurrence is presented in Uganda where, de-
spite no published regulations, companies have re-
ceived approval to conduct related operations,8 but
government representatives announced, in 2019, offi-
cial plans to issue licenses.46
Policy impacts
Direct. The following are in reference to recreational
policies, as African medicinal policies are developing.
Gauges of drug policy effectiveness47 include planta-
tion eradication, facilities closures, seizures and arrests,
use trends, and health effects.18
Continentally, between 2010 and 2018, cannabis sei-
zures increased by 53%.48 However, the Nigerian
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NDLEA Annual Report (2016) showed a decline in re-
lated arrests and seizures, despite cannabis topping the
list of drugs seized (187,394 kg from a 267,591.49 kg
drug total) and 718 ha of plantations eradicated.25 In
Senegal, quantities seized from 2000 to 2009 included
45.08 t cannabis and 13.78 t hashish.49 Rwanda reported
tracking 2890.179 kg and arresting 1671 people in 2009,
and in January of the following year, 563,988 kg had
been seized and 999 people arrested.50 Algerian secu-
rity services seized 56,548 plants between 2003 and
2018, primarily from multihectare plantations.51
Morocco’s resin industry still produces similar quanti-
ties as it did decades ago.51
An American research institute’s regional report on
the state of the continent’s cannabis market produced
the following statistics as of 2019: 83 million or nearly
a third of the world’s 263 million users are in Africa;
Nigeria has the highest number of users at 20.1 million
followed by Ethiopia (7.1 million); Africa’s estimated
market accounts for 11% of the total global market;
and the continental consumption rate (11.4%) is twice
that of the global rate (6%).26
The 2020 UNODC World Drug Report identified
West and Central Africa as Africa’s ‘‘epicenter of can-
nabis use,’’ with a 9.3% estimated annual prevalence
among adults compared to the global and continental
average of 3.9% and 6.3% respectively; North Africa’s
annual prevalence was 5.1% (Morocco’s numbers are
rising with 600,000–800,000 users, Algeria and Tunisia
have roughly 200,00051); East and Southern Africa sur-
vey data were unavailable, but countries within the re-
gions reported increased use between 2009 and 2018;
and between 2010 and 2018, the following had compara-
bly significant cultivation and/or production: Morocco
(47,500 ha), Nigeria, Eswatini, Sudan, South Africa,
Malawi, Zambia, DRC, Lesotho, and Ghana.48
KITCHEN ET AL.
Cannabis is commonly smoked, processed into a
paste, or distilled into oil for incorporation into foods
and beverages or mixed with cocaine, crack cocaine,
heroin, and methaqualone.52 In West Africa cannabis,
alcohol and diazepam/trihexyphenidyl are typically
combined.49 Synthetic cannabinoids are gaining popu-
larity, particularly in Mauritius53 where they are avail-
able as a powder mixable with tobacco for smoking or
dissolved in a solvent (thinner or acetone) sprayed on
low-quality cannabis.28
In terms of health consequences, 12–40% of youths in
psychiatric hospitals across Africa were diagnosed with
cannabis or drug-induced psychosis.52 Ghanaian health
providers expressed belief in the ‘‘gateway theory’’ (can-
nabis consumption leads to harder drugs).54 Drug use
disorders were highest among people between 15 and
44 years of age, with primary or secondary education,
and who were unemployed, with cannabis the primary
drug of choice for treatment seekers according to
the West African Epidemiology Network55 and the
Pan-African Epidemiology Network.56
According to research, 50% of Zimbabwean mental
institutions’ admissions have been attributed to sub-
stance misuse, with 80% of those patients primarily
being male between 16 and 40 years of age.57 In South
Africa, indicators associated with disorders in males in-
cluded younger age, mixed race, urban area residency,
and violent crime victims, while for females, younger
age, being white or mixed race, being unemployed, and
psychological distress were associated factors.58
Indirect.
Environmental. A UN resolution suggested increased
cultivation has accelerated soil erosion, primarily due
to excessive fertilization, soil overexploitation, forest
destruction, and eradication efforts.59 In 2015, South
African Police Services used helicopters to spray herbi-
cides on rural cannabis subsistence farms with no
regard to crops, livestock, or rivers, potentially expos-
ing people to contamination.60 Increased cultivation
and poor soil conservation have taken a toll on the
Rif,61 posing a severe ecological and social risk.12 Anec-
dotal evidence suggests declining yields and size are
likely a result of limited crop rotation and continual
monocropping as seen in 17% and 36% of fields in
Botsoapa, Lesotho, respectively.59
Soil infertility has a corresponding impact on licit
crops yields leading to greater demands for larger
land areas to maintain output.62 Environmental over-
exploitation by a rapidly expanding population and
 AFRICA CANNABIS POLICY STATUS AND IMPACT
increased cannabis production can led to decreased
food production and subsequently poorer nutrition
due to increased food costs.12,59 New hybrid varieties
requiring more water to reach maturity pose a risk to
water resources and their increased use in Morocco
risks the future of licit and illicit economic develop-
ment due to depleting aquifers.51
Economic and socioeconomic stability. South Africa’s
war on cannabis cost tax payers over USD$223.7 mil-
lion in 2014 and 2015 through arrests and other reduc-
tion activities.60 Africa’s agrarian-based image and
donor reliance within and out of drug control dialogs
influence policy execution.59,63 Aid directed at illegal
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drugs, shaped by individualized plans, often tries to ex-
tend enforcement,2 for example, internationally backed
West-African strategies have overlooked domestic use,
concentrating on preventing exportation.54 Western-
funded eradication campaigns in Morocco cost 75
million Euros between 2003 and 2013.47
Cost–benefit analysis of Mauritius’s drug policy
found, in 2014, government expenditure on repression
and health services took up 78% and 22% respectively,
of the Rs300,909,835 budget for combating drugs.64
Ethiopia’s 2017 national drug control budget was
USD$980, 000, of which 34.2% (USD$335,000) was for
demand and harm reduction.65
In Lesotho, the crop is the only source of livelihood
for some because of high unemployment.66 In the Rif,
the situation is similar and some producers who have
even been able to gain wealth far exceeding expectations,
continually fight for their right to cultivate.67 Moroccans
view production differently from organized crime due to
little associated violence and authorities not focusing on
the issue.51 Northern Nigeria wholesalers credited their
financial successes to cannabis’s profitability and capac-
ity to withstand economic downfalls.68 Poor government
services can influence public demand as illustrated by
Zimbabwean rural farmers who unsuccessfully attemp-
ted to legalize cannabis they grew for traditional medic-
inal uses due to frequent medication shortages.8
The Rif region depends on hashish for socioeconomic
and political stabilization,12 with profits considered im-
portant to maintain social balance.61 Industry revenues
are reinvested in uncontrolled housing development,
particularly in northern Morocco.61 The growing num-
ber of drug users in Ghana is partly a reason behind
the expansion of ghettoes.49 Stricter policies could
cause more illegal immigration of Africa’s youth, weak-
ening communities and delaying development. The can-
253
nabis economy, in this sense, regulates employment and
emigration.12,51 Young Rif farmers driven by poverty
have left areas that are frequently targeted by law en-
forcement for other Moroccan regions and Europe.12
Associated crimes. Trafficking is mainly intraregional,
with the most frequently reported countries of origin,
departure, and transit, between 2014 and 2018, by re-
gion and in order of importance being as follows:
West and Central Africa: Ghana and Nigeria; South-
ern Africa: Mozambique, Eswatini, and Malawi; East
Africa: Tanzania, Uganda, and Kenya; and North Africa:
Morocco.48 Even so, in Ghana, low arrests and convic-
tions are attributed to legal corruption.49 Contrastingly,
in 2009, the Moroccan Court of Appeal for the first
time convicted 109 people, charged with arranging a
criminal group and international drug trafficking.61
Despite this, it is understood by producers who engage
local officials with payments as bribes to ignore their
activities that this relationship is fundamental to sus-
taining the trade.51
By weight and value, cannabis is the most trafficked
drug from and through the Maghreb with small
streams of product entering from West Africa or the
Levant.51 Globally, Morocco is the most frequently men-
tioned resin primary source as identified in more than a
fifth of all instances between 2014 and 2018.48 Traffick-
ing has introduced foreign elements, that is, Afghani
and Lebanese opium-laced hashish have reportedly be-
come available for purchase to Libya’s smokers.69
West-Africa is labeled as an emerging transiting sta-
tion, as proven reinforced by a causal relationship be-
tween international trafficking and terrorism.18,70 In
Mali, trafficking has been found to be involved within
governing structures, militarizing Sahel forces, under-
mining peacekeeping efforts, and official governance le-
gitimacy.31 Congolese social narratives have redefined
cannabis into a rebel tool for encouraging killings and
sexualized violence.6 In Benin, the trade is considered
a growing threat, believed to finance political corrup-
tion.49 Southern Africa’s forecasted cannabis market ex-
pansion maybe affected by actions taken against and in
response to organized crime, for example, Nigerian net-
works trafficking cannabis from the region.71
Despite being nonperishable, fear of being caught
with cannabis and failure to take advantage of the trad-
ing season cause farmers to oversupply markets,
devaluing their commodity.7 This forces Congolese
traders to cross dangerous terrains like the Ruzizi’s
crocodile-infested waters to reach Burundi markets,
 254
the greatest danger often occurring during encounters
with soldiers.7 As traders and growers are operating il-
legally, they are unable to appeal for protection in cases
of abuse from local enforcement.
The illegality of the trade, the need to conceal activi-
ties, and demand can lead to black market creation; ‘‘pol-
icy displacement,’’ through redirecting resources to law
enforcement; the ‘‘balloon-effect,’’ whereby enforcement
shifts drug production and supply elsewhere; ‘‘substance
displacement,’’ whereby enforcement measures lead
users to consuming other substances, for example, in
Mauritius, increased actions against cannabis have
made it scarce and expensive (USD$35–USD$75/g),
making more hazardous synthetic cannabinoids a more
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accessible alternative at USD$15/g; and stigmatization
discouraging users from accessing treatment.28
Enforcement and incarceration. Users are depicted as
criminals and wayward,72 as in Gambia, cannabis is
considered responsible for most drug-related crimes.73
In South Africa, this perception is fueled by car hijack-
ings by smugglers and crimes by users to fund their
consumption.59 Fear and insecurity were common
themes mentioned, explaining individuals’ experiences
when in the presence of users.74 Perceptions of users
are based upon sociocultural norms, with religiosity
cited as the greatest deterrent to cannabis engagement.6
Nigerian reports indicate high degrees of public con-
cern, with use identified as a loss of morality leading
to psychosis.75 Similar generalizations are made in
Ghana, as users are perceived as defective and unlikely
to regain a state of normalcy.54
Structural violence (beatings and unwarranted
arrests) was indicated as the most common form
of enforcement, with persistent surveillance and
crackdowns also used by authorities as means to
generate income through bribery and fulfill arrest
quotas.20 Congolese Pygmies are constantly chal-
lenged by such because of cultivation in an area
once considered their hunting grounds until state
backed evictions.76
Nigerian users described a consequential sense of fear
from enforcement tactics considered personal infringe-
ments.20 Users defend cannabis as an aid for ailments,
focus, and sexual potency,2 nonetheless, reported the im-
portance of concealment.72 Post-conflict Liberians re-
ferred to use for performance enhancement during
conflict, but more so to deal with psychological trauma.77
Nigerian health professionals acknowledged the ex-
istence of government institutions, but stated cost
KITCHEN ET AL.
and limited facilities as the biggest impediments to re-
ceiving help.78 Users in Dodoma, Tanzania, reported
unawareness of treatment options.79
Due to limited facilities and perceptions that drug
disorders are religious manifestations, pseudo-
treatments are common.32 Churches, traditional doc-
tors, and prayer camps are typical first-line treatment
in Ghana, with most users at government institutions
previously having undergone a form of religious treat-
ment.30,54 Psychiatric hospitals and faith-based facili-
ties are overcrowded and underfunded, and lack
qualified personnel.31 Critics of Ghana’s drug decrimi-
nalization consider the inability to provide quality
treatment disadvantageous to the measure.54
West Africa’s drug-related arrests increased during
2014–2017, with *16,000 arrests in 2017 with Cabo
Verde, Gambia, and Nigeria reporting the highest num-
bers.32 Between 2011 and 2014, Mauritius witnessed a
78% increase of cannabis-related convictions, despite
prison services reporting a 48% drop in drug detainees
from 2005 to 2013.64 In Senegal, it is estimated that a
quarter of the overcrowded prison population are drug
users.49 Tunisian prison system’s official capacity is
roughly 18,000, but estimates note that facilities are oper-
ating at 150–200% capacity.9,80 Roughly one-third of the
population are facing or serving drug-related sentences,
and in 2016, over 56% of drug use detainees were caught
in possession of cannabis,62,81 but following policy
amendments, prisoners have reportedly decreased.82 Gha-
naian overcrowded prisons are characterized by a consid-
erable segment of convicts on drug-related charges.49
Incarcerated users are often exposed to more lethal
drugs as proven by emerging drug injecting trends in
Ugandan prisons.83 In Côte d’Ivoire, correctional facil-
ities’ requests for rehabilitation have increased, as con-
victs admit to consuming varieties of drugs, although
admittedly before imprisonment solely used canna-
bis.32 Imprisonment has been related to high economic
expenditure, social stigmatization, expansion of ex-
tremist gangs, and smuggling networks.9,83
Prospects for change. West Africa Commission on
Drugs and West Africa Drug Policy Network advocate
for drug policy reform in West Africa, with the former
carrying out policy training in collaboration with local
institutions,28 and the latter, in calls for drug decriminal-
ization,84 focuses on local CSOs capacity building to ad-
dress impacts on governance and health.26
Fields of Green for All, a South Africa-based organi-
zation, hosts conferences, notably Clinical Cannabis
 AFRICA CANNABIS POLICY STATUS AND IMPACT
Convention Conference, addressing drugs in relation
to rights and reform.28 Kenya’s Africa Cannabis Asso-
ciation actively seeks to pressurize the government by
encouraging the National Assembly to legalize canna-
bis, protect farmers, and change attitudes.26 Human
rights groups have endorsed further reformation of
the modified Tunisia’s Law 52, currently seen as an in-
terim solution.9 Industries with potential stakes, such
as tobacco companies with technical skills and finances,
may possess the greatest policy-influencing ability.43
The global legal and illicit cannabis market is val-
ued at USD$344.4b, with Africa’s share at 11%
(USD$37.7b).85 Based on the markets of South Africa,
Zimbabwe, Lesotho, Nigeria, Morocco, Malawi, Ghana,
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Eswatini, and Zambia, Africa’s legal market could, by
2023, be worth over USD$7.1b.26 Nigeria ranks first
in terms of market potential (USD$15.3b), and then
Ethiopia (USD$9.8b).85
Legalization may lead to government gains.74
Income from previously decentralized and undocu-
mented transactions in countries such as Morocco,
with about 800,000 growers and cultivators in the
trade, could possibly generate annual sales estimated
at USD$10b, as the current illicit industry accounts
for nearly 10% of its gross domestic product.5 Huge op-
portunities exist along the value chain, for example,
equipment supplying for industrialization and employ-
ment creation.86 Increased European demand, which is
driving licit markets, could lead to foreign currency in-
flux.47 Decriminalization alleviates pressures on the
penal system and related costs. Nigeria’s underutilized
pharmaceutical sector currently operates at roughly
40% and could be a key industry for medical cannabis
due to its reliance on imported pharmaceuticals.26
Sustainability of ‘‘alternative development’’ relies on
programs being of comparable economic value to dis-
courage illicit trading.35 Licit cash crops’ prices are con-
siderably lower than those of cannabis.12 In Congo,
100 kg cannabis sells for up to USD$128, far more
than USD$54 for maize.26 Year-round cultivation in
Eswatini can yield a domestic retail price/mt return
of USD$43,300 compared to USD$400 for sugar and
USD$175 for maize.5
Financial challenges, value imbalances, and favor-
able production climate mean that Africa could be-
come economically reliant on cannabis as a main
financial source.68 Since 2013, pressures from Zambia’s
financial debt (USD$10.5b in 2018)87 have encouraged
major political party, the Green Party, to promote can-
nabis exportation.88 Malawi is one of the most tobacco-
255
dependent countries,89 estimating half of all foreign
earnings generated from sales.43 Declining productivity
has motivated officials to believe cannabis legalization
will lead to diversification.42
Discussion
Prohibitive measures aiming to minimize availability
are the norm.65 Related activities are subject to crimi-
nalization, partly due to policies shadowed by outdated
research and colonialism. Ghana, Seychelles, and South
Africa have taken into consideration the human rights
violations imposed by policies and decriminalized per-
sonal use.
Continentally, drug use is becoming increasingly
common and a greater health-related problem.90
Trends indicate that negative impacts are on a conti-
nental rise; however, because of a lack of population-
based data, most is sourced externally and may not
represent the true situation.18 As of 2019, there are an es-
timated 263 million users, largely young males without
regular income. This may be explained by cannabis’s
comparatively low selling price, being locally sourced,
early-age initiation,91 and low quit rate.74,92 Poverty, un-
employment, and unfavorable social conditions also favor
use, particularly among a increasing youth population.
Reported seizures have been declining. This may be
due to mainly intraregional trafficking. Regional secu-
rity forces may be more willing to ignore illegal activi-
ties and lack appropriate resources. Benin security
services suggested that the decrease could be down to
better skilled traffickers assisted by corrupt officials.49
Declining seizures have not translated into a de-
crease in users and growers as evidenced by an increas-
ing prison population of drug-related convicts (mostly
charged with cannabis possession) and growing treat-
ment demands.49 Even so, Morocco has maintained
resin production levels owing to unwillingness to en-
force policy, a dynamic created by eradication attempts
that contributed to social unrest, leading authorities to
instead choose to use containment strategies.61 Despite
decades of prohibition, intentions to limit access have
remained elusive. Corruption, lack of control bodies,
and poor regional dialog have been reported as causes
for reporting inconsistencies.31,51
Medicinal cannabis interests have resurged in the
past decades. African countries have created provi-
sions for access and cultivation. A commonality exists,
most laws appear directed toward foreign export mar-
kets rather than providing health and financial alterna-
tives.93 Licensing fees and international operating
 256
standards are beyond the reach of locals88 and likely
only achievable for foreign investors.94 This can lead
to criminal syndicate development to participate in ac-
tivities such as money laundering.88
South Africa and Seychelles stand out by having reg-
ulations for patients to access cannabis. We can only
infer impacts of medicinal policies, given limited
data. These may range from job creation and health re-
search sector development to further increasing the
wealth gap and local market underdevelopment.
Implications for future policies
By contrast with tobacco and alcohol, cannabis use and
associated outcomes tend to be undervalued due to the
lack of reliable documentation studies95 as well as the
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largely ignored, misunderstood, and generally taboo na-
ture of use, usually due to political and social denial.96
For instance, in Ghana, the result of this underreporting
is that the number of female users has been vastly under-
represented, which means that their treatment needs are
largely unmet.54 Studies have suggested a connection be-
tween prevalence of cannabis use and of existing policies.
Prevalence is typically measured in three ways: ever used,
used last year, and used last month.
Figures currently indicate an increase in prevalence
of cannabis use and associated psychosis in Africa.
However, longitudinal and internationally comparable
information on these measures are lacking for African
countries. Given so, establishing comparable data
across many African countries complicates the analysis
process of the policy-prevalence relationship. Within
Africa, most data are provided by international studies
that do not provide in-depth situational analysis and
may therefore be misleading or underreported. There-
fore, interpreting differences and similarities across
policy regimes must be done understanding the ununi-
form nature of data backing the policies. The African
Union’s Specialised Technical Committee on Health,
Population and Drug Control may devise coherent
strategies to monitor indicators.
Variations exist in formal policy among nations.
A great distinction exists between formal policy and ac-
tual implementation in a number of countries or juris-
diction, for instance, in Morocco’s Rif region. Several
influences contribute to the discrepancy of uniform pol-
icy implementation, one of particular relevance to the
African context is the allocation of enforcement. This
study revealed that most regulatory authorities, when
they do exist, operate under discretionary authority of
the law and judiciary system, which often relies on puni-
KITCHEN ET AL.
tive approaches of enforcement. Independent autono-
mous bodies are more practical; however, human and
monetary resources often limit their capacities.
Greater punitively designed policies are linked to
greater criminalization; however, be it from evasion,
to bribery, to corruption, the two do not linearly corre-
late. Nonetheless, users and growers who are criminal-
ized bear the burden of experiencing the penal system
even after release. Social consequences faced by actors
in the trade include stigmatization, loss of employment,
loss of civil privileges, and relationships. Government
expenditure on law enforcement, creation of black
markets, and crime negatively impact the community
at large. The full extent of these consequences has not
been fully examined in an African setting in terms of
their impacts on economic and social development
and effectiveness of deterring others.
Limitations
Results are to be interpreted with the understanding
that findings were largely dependent upon the meth-
odology used, which extensively relied on the accessi-
ble electronic databases and resources. In this way,
the reporting of impacts may be biased and demon-
strate more negative outcomes owing largely to long
existing prohibitive nature of policies. Although
most reported impacts of cannabis policies are pre-
sented negatively, positive impacts are heavily reliant
on anecdotal evidence typically stemming from en-
gagement in the extralegal cannabis economy (i.e., a
criminalized network that stretches between formal
political actors and those engaged directly in the can-
nabis trade59). Key examples of this include Lesotho
and Morocco.
As policies are changing, it will be important to in-
vestigate how more liberal regulations benefit or disadvan-
tage locals particularly in the aforementioned settings,
where the plant is de-facto decriminalized and acts as a
medical panacea as well as a major source of household in-
come, even considered more reliable than the prospect of
waged work.
This method was also unable to identify regulatory
provisions for all-inclusive countries; therefore, to be
able to provide more comprehensive and current infor-
mation, further research may require incorporation
of regionally and locally available unpublished resour-
ces not indexed on commonly used databases (e.g.,
books, dissertations, anecdotes, and nonelectronic gov-
ernment reports often only available in the relevant
countries). Results cannot be generalized to all nations,
 AFRICA CANNABIS POLICY STATUS AND IMPACT
but they stand as an identifiable point for further re-
search, and policy information can be continually
updated as more information is made accessible.
Conclusion
Cannabis framework is a complex issue handled under a
series of policies and characterized by a range of contrib-
uting factors. Our study was able to identify information
on policies’ statuses for most countries, but even so, most
information did not provide a full picture of regulatory
environments (e.g., regulatory authorities and measures,
prevalence measures, and society impacts). Countries
with long standing cannabis histories or recent changes
in policies were mainly reported upon and provided
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the bulk of information for this study.
Investigation of underrepresented nations and com-
munities may help better explain the current signifi-
cance of cannabis and the societal benefits and
constraints that policies place on its usage, and more
importantly on the general public. Policy changes
based on modern trends should include larger study
of previous policy impacts and future-oriented analy-
sis of country-level goals incorporated with a greater
understanding of public opinion.
Acknowledgments
We express gratitude to our technical support team.
Author Disclosure Statement
No competing financial interests exist.
Funding Information
This research did not receive any specific grant from
funding agencies in the public, commercial, or not-
for-profit sectors.
Supplementary Material
Supplementary File S1
Supplementary File S2
Supplementary File S3
Supplementary File S4
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 AFRICA CANNABIS POLICY STATUS AND IMPACT 261

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