fact sheet - cannabis and mandrax use in South Africa
Fact sheet by:
Alcohol & Drug Abuse Research Group
Medical Research Council

Supported by UNDCP Global Assessment Programme (GAP) on Drug Abuse
What are cannabis and mandrax?

• Cannabis (cannabis sativa) is a herbaceous plant containing more than 60 cannabinoid compounds, of which the main psychoactive constituent is delta-9-tetrahydrocannabinol (THC).
• The THC content of cannabis varies according to the part of the plant used, with THC levels ranging between 0.5% to 5% for marijuana (dried flowering tops and leaves), 5% to 20% for hashish (compressed cannabis resin), and 15% to 20% for hashish oil (extracted from the flowering tops and resin).
• Mandrax tablets typically consist of a mixture of Methaqualone (the active ingredient) and antihistamine.
• Methaqualone is a synthetic sedative-hypnotic which acts as a central nervous system (CNS) depressant.

Modes of administration

• The main mode of cannabis use is smoking (inhalation). Less frequently, cannabis is used orally.
• Although Mandrax can be used orally, this mode of use is rare in South Africa, with users preferring to smoke Mandrax with a mixture of cannabis and tobacco in a unique South African drug combination called a ‘white pipe'.
• Solvents are sometimes added to low grade cannabis to make it more combustible and to give the user a greater "high". This is known as ‘majat'.

Short-term effects

• Cannabis acts on specific cannabinoid receptors in the cerebral cortex, hippocampus, and cerebellum, resulting in feelings of euphoria and relaxation.
• The acute effects of cannabis include impaired attention and short-term memory, loss of coordination, distorted perceptual and sensory processes, a dry mouth, and increased appetite.
• Large doses of THC may result in anxiety and panic reactions, transitory hallucinations, thought disturbances, and paranoid delusions. These may be signs of a cannabis-induced psychotic episode.
• The initial effects of Mandrax may include feelings of euphoria, a brief loss of consciousness, nausea, and stupor. This may be followed by feelings of relaxation and drowsiness, dulled mental functions, and slowed breathing and cardiac functions. Other signs of intoxication include sensory distortions, impaired judgement, slurred speech, and loss of coordination.
• As Mandrax acts as a CNS depressant, large doses may suppress the rate and depth of respiration, resulting in seizures, coma, and potentially death.

Long-term effects

• Chronic users may become physically and psychologically dependent on Mandrax. Dependent users develop tolerance and craving for the effects of Mandrax and experience withdrawal symptoms on cessation of use. Mandrax-withdrawal is characterised by physical symptoms (such as insomnia, muscle tremors, seizures, delirium, vomiting) followed by psychological signs (e.g. anxiety, irritability, and depression.
• Chronic cannabis use may lead to psychological dependence, characterised by deterioration in psychosocial functioning, tolerance for the effects of cannabis, and mild withdrawal symptoms on cessation of use (e.g. depression, anxiety, headaches, diminished appetite, and insomnia).
• Chronic cannabis use may lead to subtle cognitive deficits, particularly in attention, learning, and executive functioning (organising and integrating of information).
• Respiratory problems from smoking cannabis and white pipes: precancerous changes in lung tissue, impaired lung function, increased vulnerability to respiratory illnesses, and more symptoms of chronic bronchitis than nonsmokers.
• Contaminants in Mandrax (e.g. talc) may act as pneumo-toxins.
• In immune-suppressed users, fungal spores contaminating cannabis may lead to aspergillosis (a pulmonary disease).
• Regular cannabis and Mandrax use have been associated with adverse psychological consequences such as impaired psychological development and social and occupational functioning.
• Cannabis may trigger the onset of schizophrenia in predisposed persons and may exacerbate symptoms in users with existing psychotic disorders.
• There is a link between the use of cannabis and Mandrax and crime, with cannabis and white pipe use being linked to violent and property crime. In South Africa, Mandrax use and trafficking is associated with vehicle theft, organised crime, and gang-related activities.

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