Even though cannabis is commonly used in many African nations as a recreational drug illegally, the potential medicinal use is often neglected and generally perceived that legalizing it can normalize aggressive recreational use. Pharmacists in African nations need to know the legal structure surrounding medical marijuana for them to serve their patients better at the heart of health promotion without contravening the law. Arguments continue to arise on the need for removal of cannabis from schedule I of the controlled substances act. The most tightly restricted category reserved for drugs with ‘no currently accepted medicinal use’. The current scheduling of cannabis is as strict as that of heroin. This has inevitably restricted progress on research for the potential therapies derived from this drug use.⁹ There has been progress in cannabis use legislation in some African countries for medicinal use.¹⁰ Table 1 revealed the African countries that legalize cannabis and the status of use.

The World Health Organization (WHO) has recently proposed the rescheduling of cannabis within international laws, considering the past and present evidence for medical application of cannabis hereby reversing its position as to restrict the use of the drug in legitimate medical practices.¹¹ This proposition in some developed countries has received warm reception.¹² However, African countries can only foster the adoption of WHO’s reschedule proposition by increasing the participation of medical practitioners and legal drug experts i.e., pharmacists in the law making and amendment process. Some African countries are plagued with ineffective policies and implementation processes.¹³ This occurrence can only be salvaged by the active and consistent participation of experts in policy making and implementation processes.

Marijuana is prohibited under federal law in many countries, and health authorities has no role in the production, prescription, dispensing, labeling, or purity assessment of the final product.¹⁴ This implies that patient can only purchase or possess marijuana from unauthorized sources, which raises additional concern about the product’s safety and possibility of pervasive abuse.¹⁴ With increasing media awareness on the potential benefits of cannabis in pharmacotherapy, it is only a matter of time before patients start seeking illegal means to access and use cannabis for their medical concerns. Increasing awareness will in the long run increase threat posed by cannabis use to public health in Africa. Cases of adverse effect, abuse potential will increase with increasing number of patients missing out on proper counselling and advice from a healthcare professional. It therefore becomes imperative to assess the emerging roles of pharmacists in successful use of cannabis in pharmacotherapy in Africa.

Pharmacists in the African countries need to be aware of the increasing trend towards growing public recognition of medical cannabis as a pharmacotherapy option. Pharmacists can engage the patient in thorough medical and social histories and inquire about the use of illicit drug, including medical/recreational use of marijuana. Pharmacists should take up the active role to provide adequate unbiased information on the benefits and risks of cannabis use.¹⁵ This is important because the health-seeking behavior of many patients make for self-medication and the possibilities of coming across the information on potential roles of medicinal cannabis in their ailment and this can facilitate abuse. Pharmacists need to have a broad knowledge of the risks and benefits of medical marijuana and take the active role in health promotion and enlightenment of the general public.¹⁶ In Table 2, we highlighted the possible roles pharmacists across various sector in Africa can play in medicinal use of cannabis. However, until there is policy reform towards legalizing medical cannabis, pharmacists may not routinely advocate marijuana use or assist patients in obtaining the drug but should provide honest information on its risks and benefits to the patient.

Research is also important to better aid the understanding of how integrating medicinal cannabis can be more useful to the healthcare systems and the overall need of the patients.^17,18 The research interest of drug policy researchers in African countries need to shift in order to bridge the knowledge gaps in the opportunities, benefits and risks associated with medicinal cannabis. Cannabis plant is indigenous to many African countries and it is interesting to note that vast majority of research in this field are not carried out by researchers in Africa. This is to be seen as an opportunity for pharmacists in academia to venture into this field because there are still many unanswered questions on cannabis use and the knowledge gaps need to be bridged. Even though cannabis is a drug of abuse, the fact that it is a potential pharmacotherapy agent cannot be overemphasized and pharmacists, together with other stakeholders’, in Africa need to take the ownership to safeguard the health of the populace at the large interest of public health.¹⁹

Currently, there is a lack of knowledge on the perception, attitude and beliefs of healthcare professionals including pharmacists on the use of medical cannabis in Africa. To the best of our knowledge, there are no published articles in any of the African countries on this topic. However, in a systematic review which included 26 studies, with no reference from developing countries, it was revealed that health professionals concur with the use of medicinal cannabis, notwithstanding, there was a common dearth of self-perceived professional knowledge about the entire characteristics of medicinal cannabis.²⁰ Thus, it becomes imperative to consider the emerging roles of cannabis in pharmacotherapy and the roles of pharmacists in its successful application from legalization down to use in pharmacotherapy.²¹

In conclusion, despite the fact that cannabis use and cultivation are illegal in most of the developing countries^22,23,24, it is still one of the most abuse drugs in this region. It is essential to pursue restriction lifting to allow the use of cannabis for medical purposes and empower the pharmacists on their roles in maximizing therapeutic outcomes in patient who actually needs the drug. This will not just contribute to the revenue of the developing countries but ensure maximization of the potential health benefits of cannabis. However, there is a need to bridge the knowledge gaps of healthcare professionals including the pharmacists on the potential use and dispensing practice of medical cannabis²⁵ in Africa. In addition, further research should be implemented on the knowledge, attitude, awareness of role, perception, and beliefs of pharmacists and other healthcare professionals in Africa as regards cannabis use. This will provide the necessary information to support for tailor-made policies aimed at pharmacy school curriculum review and training of pharmacists in Africa on ethical issues and uses of the medical cannabis in order to balance the real potential of cannabis with their limitations and adverse effects.

Ethics approval and consent to participate: Not applicable.

Consent for publication: All authors agreed on the publication of this manuscript.

Availability of data and materials: Not applicable.

Funding: None

Authors’ contributions: This commentary was conceptualized by Yusuff Adebayo Adebisi. Yusuff Adebayo Adebisi wrote the first draft of the manuscript with support from Damilola Quazeem Olaoye. All the authors read and approved the final manuscript.

The opinions expressed in this paper are those of the author(s).