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This study was compiled from surveys, data from specialised alcohol and drug treatment centres through the South African National Council on Alcoholism and Drug Dependence (SANCA) and the South African Community Epidemiology Network on Drug Use (SACENDU), cannabis-related trauma unit admissions and studies on people arrested for cannabisrelated offences over the past 12 years in South Africa. Results indicate that cannabis is the most common illicit substance used in South Africa, and second to alcohol, the most extensively used substance.  Use is particularly high among the youth (ranging from adolescents to university students) and much higher for young males than for young females. From 1993 to 2002, lifetime cannabis use for young females (7%) remained the same, whereas there has been an increase among young males from 13% to 20% over the same period. Cannabis use among young males is much higher than that of young females, as is seen in Table 1. Current self-reported cannabis use was 5–10% among adolescents and 2% among adults. Annual cannabis prevalence rates are lower in South America (2.6%), Asia (2.1%) and higher in West and Central Europe (7.4%), Africa (8.1%), the USA and Canada combined (10.3%), and the USA-only (31%). Among adults in South Africa, higher current cannabis-use rates were found in urban (2.3%) than in rural (1.0%) areas in 2005. Among youth, current cannabis use was highest among coloureds and current cannabis use was found highest in the provinces of Gauteng, Western Cape, Mpumalanga, Free State and Limpopo. It was found highest among adults in the Western Cape, Gauteng and North West provinces (Figure 1). Various studies in trauma units show high levels of cannabis use preceding an injury. Cannabis is commonly misused by trauma patients (29–59%) and is often associated with crime (39%). The demand for treatment in South Africa indicates that cannabis abuse increased from 14% in 1999 to 17% in 2005, while cannabis mixed with mandrax has remained stable (from 7% in 1999 to 7% in 2005). Whether the slight treatment increase is due to the increased potency of cannabis is unknown, as in South Africa cannabis is rarely tested for its active chemical agent, delta-9 tetrahydrocannabinol (THC), levels. In a recent HSRC study at drug treatment centres, key informants reported an increase in cannabis psychosis due to the high quality of cannabis now available as a result of hydroponic cultivation. In conclusion, this study has found that the increase in cannabis production, improved production technology and treatment demands has implications for service delivery, especially considering the lack of treatment facilities in South Africa. More substance abuse treatment centres are needed and that youth, especially young men, need a targeted intervention to reduce their cannabis use. In considering effective ways of reducing cannabis-related problems, routine screening and brief intervention of substance (including cannabis) use in primary- and emergencycare settings should also be considered. 
Shandir Ramlagan is a senior researcher in the Social Aspects of HIV/AIDS and Health (SAHA) programme and Professor Karl Peltzer is a research director in the same programme. The article is based on a paper, Cannabis use trends in South Africa, published in the South African Journal of Psychiatry; 13(4): 126–131, by Peltzer, K., & Ramlagan, S. (2007).
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