Across the included countries, legislative trends are not uniformly reflected in public attitudes towards cannabis. Variations were noted in responses towards user stereotypes, cannabis being a problem, comparisons with tobacco and alcohol use, preferred legislation, and strategies towards addressing users. Consistent with our hypothesis, countries with more liberal policies were associated with more positive sentiments. Dependent upon the question of focus, at the liberal end of the spectrum are Ghana, South Africa and Zimbabwe whilst Nigeria, Sierra Leone and Uganda were more conservative. Questions were marked consistency across countries were identified related to the accessibility, age limits for sales, comfortability with regulated medical use and sale, public use and associated risks and benefits. Participants were asked if they had ever used cannabis and if they were aware of a current user, to better contextualise interpretation of attitudinal differences between countries. There is a relationship between toleration of cannabis and its consumption and awareness of current users: countries that are more liberal tended to have higher rates of ever cannabis use (above 35%) whilst less liberal countries had higher rates of knowing a current user (above 56%). These results indicate that country differences in cannabis use experience and encounters with users can be reflective in collective attitudes.
Overall, participants from more conservative countries more greatly endorsed common gender (male) and negative typecasts of users (criminals, mentally ill) and disagreed with positive personality attributes (hardworking and trustworthy). Studies have shown that African cultures and religions tend to consider cannabis consumption as taboo (Carrier & Klantschnig, 2017; Mametja & Ross, 2020) and our study found higher levels of religiosity amongst countries considered more conservative– particularly Sierra Leone. Cannabis use is a stigmatized behaviour associated with devaluation of users(Skliamis et al., 2020). Amongst users this could be linked to the need of concealment to avoid prejudice and punishment, particularly in countries such as Nigeria with harsh penalties for users(Nelson, 2018) and Uganda where harsher repealed law provisions are used to charge and prosecute users((HRAPF), 2015).Moreover, such divisions of stereotypes can provide an explanatory basis for the fact that participants in more liberal countries mainly considered that users should be left alone whereas sending them to treatment (medical or religious) was more greatly associated with less liberal countries.
Risk (social, health and substance abuse) perceptions were similar across countries. However, participants from more liberal countries had an overall more favourable view towards social and health benefits of cannabis use. Cannabis is typically introduced to adolescents in social settings such as parties (Mehanović et al., 2020) and moderate use is linked to positive social attributes whereas abstinence is viewed negatively(Robertson et al., 2020). As most survey participants are considered young this may explain the endorsement of social benefits. However, pressure to conform to socializing norms and engage in risky behaviours(Mametja & Ross, 2020) equally explains why nearly similar proportions also believed cannabis to pose a social risk. The support of cannabis health benefits being greater than risks is consistent with previous research indicating a minimization in associated risk perception in European and American settings(Piontek et al., 2013; Steigerwald et al., 2020; Tamson et al., 2021). A possible explanation for perceived health benefits has been defined as “legitimacy-conferring process” whereby regardless of personal beliefs, medicinal cannabis is legitimized through expert backing from established health institutions(Sznitman & Bretteville-Jensen, 2015), as is the case with the Medicines and Control Authority of Zimbabwe(MCAZ) or the South African Health Products Regulatory Authority(SAPHRA).
Regarding smoking cannabis as more harmful to health than tobacco products and driving under the influence of cannabis as safer than under the influence of alcohol, a divide was seen in responses with Sierra Leonean and South African respondents being more likely to believe cannabis use as safer in both instances. Although considered to be on different sides of the policy spectrum, these responses may be connected to experiential encounters with cannabis and users, given the fact that South Africa reported the highest proportion of ever cannabis use and Sierra Leone had the large percentage of participants aware of current users. Similar to previous studies that found enhanced tolerance for cannabis when purposed for medical reasons(Mikos & Kam, 2019), majorities in all countries considered the sale and use of medicinal cannabis under doctor authorisation acceptable, safe and effective. This somewhat supports the assumption that public opinion toward cannabis is driven by deliberations related to medical effects, as opposed to current polices and concerns for detrimental public health effects(Sznitman & Bretteville-Jensen, 2015). Evidence suggests that exclusive cannabis smokers, while, exposed to lower levels of harmful constituents than exclusive tobacco smokers and co-users, are still exposed to higher toxicant levels than non-smokers(Meier et al., 2021). Associations have been found between blood tetrahydrocannabinol(THC) levels and impaired performance with cannabis intoxication related to a statistically significant increased risk of vehicular accidents(Jasmine Turna, 2020). As policies evolve, the perspective that cannabis use is safe and of low risk may become a more salient public health discussion requiring targeted campaigns against misconceptions.
Support for legalization of cannabis was mainly associated with medical use. Total legalisation was less supported which may be linked to the idea that full legalisation would increase crime and illicit use as majorly agreed upon in all countries. While the consequences of liberalised cannabis systems on crime trends are not fully understood, there have been reports of increased illicit use and poisoning in jurisdictions with commercialized medical cannabis(Sznitman & Bretteville-Jensen, 2015). This may explain why our participants, regardless of nationality, expressed the need for age restrictions and providing information on laws and safe use. Although contrasting to results from a similar Latin American study where support was largely associated with legalization of recreational use, our findings showcase the effect of territorial differences on public opinions and the importance of accurate assessments of current situations in respective countries.
Support for medical cannabis was further shown by most participants in agreement with legalization leading to greater medical options and employment opportunities. Countries are eyeing the socioeconomic prospect of legally regulating cannabis for medicinal, industrial and scientific purposes(Bizimungu, 2020; Bloomer, 2019; Partners, 2019). By 2023, a fully legal and regulated African cannabis industry, valued at over $US7.1b(Partners, 2019), is anticipated to boost regional employment particularly to the benefit of South Africa and Nigeria with the world’s highest and third highest unemployment rate(Naidoo, 2021). Endorsements for medical applicability may also stem from reported successes of locally sourced plant-based medicines such as African Potato (Hypoxis spp) and Moringa for HIV positive patients, for which reputation alone was sufficient to establish a significant industry in Zimbabwe(Chisaka, 2019; Onifade & Sciences, 2020; Salehi et al., 2018). Also, with imports comprising upwards of 70% of drugs consumed in most sub-Saharan Africa countries(Conway et al., 2020), patients typically lack access to locally manufactured and affordable drugs. Increased pharmaceutical activity can improve medicines availability resulting to better health(Abbott et al., 2021).
We examined perceptions of formal controls by investigating cannabis as a source of problems and its ease of accessibility. The reported apparent ease in more conservative countries affirms their problem belief statement. Interestingly, liberal countries expressed that although easy to access, the trade does not stand as a problem. Cannabis ease of acquisition and availability is not surprising since it is the most used psychoactive drugs(Chan et al., 2018; Gebremariam et al., 2018; Peltzer & Pengpid, 2018) and a United Nations report of ten surveyed African countries, highlighted its accessibility through findings of cannabis being considerably cheaper than bottled beer(Carrier & Klantschnig, 2017). Disparities in the problematic perception of cannabis align with our theory and may speak to cannabis’s ambiguity as a hard or soft drug, referred to as “quasilegality”, which allows laws to be leniently or strictly enforced(Carrier & Klantschnig, 2017). For instance, seizures and arrests are likely a means of extracting bribes, or increasing arrest quotas, than clear evidence of policy aligned prohibition(Eligh, 2019). Associations with narcotics may permeate into the cannabis trade. Data indicate growing heroin and cocaine trafficking networks linking South America to European markets via West Africa(United Nations Office on Drugs and Crime, 2019). Increase in trade activities and related arrests can feed into the perception of illegality and problematic among law enforcement as well as the general population.(Mendiburo-Seguel et al., 2017).
Policies have been concluded as crucial in the construction of cannabis perceptions and experiences (Skliamis et al., 2020). Furthermore, as public backing can impact and simultaneously be impacted by policies, it was imperative to conduct this study across different policy settings, to investigate whether public opinion differences were reflective of policy variations. Unlike other countries(Aliekperova et al., 2020; Resko et al., 2019), individuals in many African countries are unable to vote for their favoured policy and changes are made largely without public consideration. The significances of policy implementation without formulation of public consensus have not been explored and should stand as a key area for countries considering similar actions.