A technical committee at the health ministry has weighed in on the cannabis debate, urging for the introduction of its medicinal use. The report comes as the fulfilment of one recommendation of the drug commission headed by former Supreme Court Judge Paul Lam Shang Leen in 2018. With the health ministry now advocating for medicinal cannabis, the government’s hostility to marijuana in general is becoming harder to sustain.

1. The technical report

This week, a ministry of health (MOH) technical committee released a report looking into the use of medicinal cannabis in Mauritius. Amongst its recommendations were allowing of the use of medicines containing either or both of the most active ingredients in cannabis, cannabidiol (CBD), tetrahydrocannabinol (THC) – the main psychoactive agent in cannabis – to treat a range of conditions, including multiple sclerosis, chemotherapyinduced nausea, vomiting, chronic pains and certain forms of epilepsy. The report concluded that initially, such medicines – approved by the US Food and Drug Administration – would be given out through the public health system (or a board of private and public health professionals in case of private healthcare use) in line with treatment regulations in the UK and France. “This is a major milestone,” Imran Dhanoo, director of the Idrice Goomany Treatment Centre in the capital Port-Louis, tells l’express. 

The technical report itself stems from one of the recommendations made in the 2018 report of the drug commission headed by former Supreme Court judge Paul Lam Shang Leen. One of its assessors, Sam Lauthan, says that the MOH report proposes broadly what the commission wanted to see: “Generally I would say that a study along these lines was what the commission was talking about. But here we must be careful not to confuse what the technical report says with the broader demand to decriminalise cannabis,” Lauthan says. In many ways, the MOH technical report is merely following an emerging consensus elsewhere about the medicinal potential of marijuana; back in January 2019, the World Health Organization (WHO) recommended changing the international drug categorization of cannabis leading the UN Commission on Narcotic Drugs (CND) at its meeting in Vienna in December 2020 voting to take cannabis off of schedule IV of its 1961 UN Single Convention on Narcotic Drugs; , which for the past 59 years had blocked the international recognition of cannabis as having therapeutic value, while maintaining it on schedule 1 of the convention, still listing it as a drug liable to be abused and illegal for non-medical and non-scientific purposes. It is based on this WHO and CND reclassification, as well as the development of cannabis-based medicine in other countries, that the MOH technical committee has cautiously given its support to the use of medicinal cannabis. Like Lauthan, Dhanoo is careful to recognize the limitations of this recommendation. “It may help some patients suffering from some pathologies and is a good first step, but the problem of cannabis is much wider than medicinal cannabis.”

2. What is really driving this change…

That the health ministry has for the first time given its support to the medicinal use of cannabis and some of its derivatives is in itself an indication of how perceptions among the political elite within Mauritius seem to be changing on the issue of cannabis. And this has less to do with what happens at the UN, and more to do with the invasion of synthetic drugs currently ravaging the country. 

Synthetic cannabinoids first appeared in Mauritius between 2011 and 2013 and has have quickly become the second biggest local problem drug in the country after heroin. This, of course, had everything to do with the long-standing hard-line approach towards cannabis. Aggressive crackdowns on cannabis within the country have meant that Mauritius has seen a double whammy: a shortage of local cannabis led to a surge in prices while making the cannabis local market dependent on imports from Madagascar and Reunion Island, driving the price of cannabis up still further. para 

In fact, cannabis street prices rose fourfold between 2015 and 2020, with cannabis being more expensive in Mauritius than anywhere else in the Indian Ocean. This forced younger and poorer users to switch from more expensive cannabis to cheaper synthetics that could be cooked up in a lab. At one time, where a dose of cannabis could cost Rs300, a single dose of synthetics could be bought for as little as Rs100. Now Mauritius has a synthetics problem on its hands. The government’s National Drug Observatory 2020 report noted that 41 percent of all drugrelated arrests involved synthetics. 

This is something that NGOs working in the field noticed too: “Only a handful of people come in because of serious problems involving cannabis use, and that too, only because they have been convicted for possession and coming into a treatment centre is part of their probation,” explains Dhanoo. The real problems, he insists, are the cases coming in for addiction to heroin and synthetics. “These are the biggest issues,” he adds. Back in 2020, he estimated that 60 percent of people attending the treatment centre came for heroin, and the remaining 40 percent for synthetics. The latter category made up of much younger people, mostly under 24s, driven to take up synthetics by the rising prices of cannabis. 

For long-term observers of the Mauritian drug market, it comes as no surprise: A according to a 2015 report by PILS, between 2011 and 2014, there was a 78 percent spike in convictions of cannabis users. This was precisely the time when in 2013 the first cases of synthetics use were being detected by the local authorities. Such factors caused the drugs commission in 2018 to lament that when it came to cannabis, “repression has not really eliminated drug use; at best, it has moved the users on to other drugs, including new synthetics”. It seemed that Mauritius was looking to repeat an earlier error: a crackdown on cannabis in the 1980s led to the emergence of heroin, transforming Mauritius into a state with one of the highest heroin use rates in Africa by 1996.

3. The political elite has come around… mostly

The conclusions of the drug commission report and the emergence of the synthetics problem forced a rethink within the political elite in Mauritius, softening their stance on cannabis use. And the question is medicinal cannabis is a key part of that. “The fact that the drug commission in 2018 called for a dispassionate debate on cannabis was a paradigm shift politically,” recalls Dhanoo. Although parties outside parliament such as Lalit or the MR led by Rama Valayden had long pushed for cannabis decriminalisation, the drug commission allowed the traditional parties to take it up too. By the time the 2019 elections rolled around, the PMSD was calling for decriminalisation of cannabis and allowing its medical use. Its ally at the time, the Labour Party, called for the medical use of cannabis. In their manifesto in 2019, the two parties proposed “an amendment to the law to allow the use of medicinal products derived from cannabidiol under strict medical supervision and under conditions approved by a board of doctors”. Quite similar to the proposal of the MOH technical committee. 

By November 2020, the MMM too had come around, calling for the medicinal use of cannabis and the dropping of prison sentences for cannabis possession. It did so at a meeting organized by its youth and women’s commission on the problem of synthetics. The problem is that not all parties have softened their approach. Most notably, the ruling MSM party, which has traditionally taken a hard-line on the issue. When the Labour-PMSD bloc came out with its proposal for the use of medicinal cannabis and its derivatives, for example, the prime minister Pravind Jugnauth ridiculed the idea. 

One of the big problems is that there has just been no research into cannabis in Mauritius. “There are no official figures for Mauritius regarding cannabis use,” Lauthan points out. The drugs commission during its hearings saw NGOs come and put the number of cannabis users as high as 200,000, but the commission did not endorse it. In this vacuum, resistance to cannabis has thrived, allowing for real contradictions to emerge. Dhanoo laments that this year, the government has halted the supply of codeine (used to treat heroin addiction) to treatment centres. In his own centre, up to one-third of heroin users were put on codeine treatment, particularly in the initial stages of heroin addiction. “The health ministry argued that they were discontinuing it because of scientific evidence that showed that it was less effective as compared to methadone and suboxone,” he points out.

However, that same scientific rigour seemed to be absent when on July 9, 2019, then opposition leader Xavier-Luc Duval asked then-health minister Anwar Husnoo whether, after the drugs commission, the health ministry would commission research and trials into the use of medicinal cannabis and its derivatives, such as cannabidiol in Mauritius. Husnoo responded, “Now as far as research is concerned, a lot of countries are doing it. Do you think Mauritius is such a big country to do large scale research? No!”. If Husnoo thought that such research was impossible in Mauritius in 2019, the current health ministry does not seem to think so. 

One of the technical committee’s ancillary recommendations is a four-week trial use of cannabidiol to treat multiple sclerosis. Precisely the type of research that the government was saying was impossible just a couple of years ago. Nor is the issue as clear-cut within the medical profession as the government would like to portray; in fact, one of the reasons for the technical committee’s endorsement of the use of medicinal cannabis is that when it called for comments on the issue in December 2020, “a significant proportion of the email respondents were health professionals who wanted to share their views. Some were patients who had had prior treatment with cannabisbased medicinal products abroad…” Out of the 77 emails that the technical committee received, 76 backed the use of medicinal cannabis in Mauritius. “This shows that this is a complex issue and that we must be humble enough to learn,” says Lauthan. 

So, if it’s not the healthcare profession, nor any scientific data from within Mauritius that is driving resistance to cannabis, whether general or medicinal, what is? The answer can be summed up in two words: chasing votes. While specialists within the health ministry, NGOs working in the field and a significant chunk of the political elite seem to be revisiting their views on cannabis – using medicinal cannabis as a half-way house to soften their positions – resistance to cannabis seems to be driven primarily by public opinion, with cannabis opponents taking heart from numbers such as those of a poll by AfroBarometer in 2017 that showed that 66 percent of the public were opposed to decriminalising cannabis. “What we need is a dispassionate debate and not merely follow public opinion,” Lauthan concludes. “What I find good about this technical report is how it speaks about properly regulating and standardising the medicinal use of cannabis. The emphasis should be to make sure this is done by credible people without strong feelings about the issue either way.”

4. Is this a first step?

Whether the health ministry’s endorsement of medicinal cannabis will lead to a genuine softening of attitudes towards cannabis generally across the political spectrum is an important question. Firstly, because although opposition parties have softened their positions on the issue, the ruling MSM hasn’t. And until it does, the attitude of the legal system towards cannabis will remain the same. The year the drug commission came out with its report in 2018 calling for a national re-think on cannabis and how cracking down on it was fuelling the rise of synthetics, 50 percent of all drug prosecutions in the courts were cannabis-related. 

The following year, the government came out with its National Drug Control Master Plan 2019-2023 that continued to list the crackdown on cannabis and seizures of cannabis and plants as key deliverables when it came to the government’s drug policy. “There is a need for some kind of decriminalisation, our prisons are full,” says Lauthan. For Dhanoo, the question of cannabis and synthetics are linked, “the priority for me is addressing the problem of synthetics. Medicinal cannabis is a good step, but unless we use it as a first step towards decriminalisation, we cannot solve the problem of synthetics”. 

The second consideration is spelled out in the MOH report itself when it lists the number of African countries that seem to have taken a more benign view of cannabis: Lesotho issuing licences in 2017 to grow cannabis for medical purposes; South Africa authorising in 2017 the use of medicinal cannabis – paving the way for the entry of companies such as Aphria, Aurora and Canopy Growth, with its court ruling that South African adults had the right to grow and use cannabis privately; Zimbabwe, Zambia, Ghana and Eswatini, each introducing between 2018 and 2020, their own licences to grow cannabis for medicine; Malawi establishing a Cannabis Regulatory Authority in 2020; and Morocco legalising in May 2021cannabis use in medicine, cosmetics and industry. 

In other words, by continuing to eschew cannabis, Mauritius risks becoming a laggard, not just globally, but even within Africa. The question that remains is: now that the health ministry itself seems to have given its endorsement to the medicinal use of cannabis, will it lead to a political U-turn on cannabis?