Perceptions of Cannabis in sub-Saharan Africa: Findings from a general population survey in six African countries with different Cannabis policies.

Background: Recently, legislative shifts in cannabis regulation away from exclusively prohibitionist controls have been seen in sub-Saharan African countries. However, the extent to which public perceptions are aligned with policy trends is unclear. Given that views concerning cannabis may be influenced by associated legislation we aimed to compare public opinion towards cannabis amongst countries with legislatively different cannabis policies. Methods We conducted an online survey of the general adult population in six purposively selected countries representative of maximum policy variation across sub-Saharan Africa i.e., Ghana, Nigeria, Sierra Leone, South Africa and Zimbabwe. Survey questions covered perceptions towards users, risks and benefits, regulations and public health impacts as well as sociodemographic characteristics. Chi square tests were used to analyse the association between categorical variables and explore country level differences. Results Totally 1216 responses were received. Large variations were noted in responses towards user stereotypes, risks and preferred legislation. In relation to users being honest (X 2 =43.316, P<0.0001 ), most in Sierra Leone(52.9%), Nigeria (45.6%) and Uganda(48.6%) disagreed whereas in Ghana(39.4%), South Africa(43.3%) and Zimbabwe(40.1%) most agreed. Differences in smoking cannabis and smoking tobacco products(X 2 = 27.712, P=0.002 ) saw respondents from Ghana(51.4%), Nigeria(58.8%), Uganda(50.9%) and Zimbabwe(46.8%) agreeing that smoking cannabis is more harmful to health, whereas majorities in Sierra Leone(45.7%) and South Africa(49.8%) disagreed. Apart from South Africa were the greater proportion opted to allow cannabis for all purposes(28.8%), majorities in other countries supported only medicinal legalisation(X 2 = 96.631, P<0.0001 ). Conclusion Dependent upon the question of focus, at the liberal end of the policy spectrum are Ghana, South Africa and Zimbabwe whilst Nigeria, Sierra Leone and Uganda were more conservative. Responses tended to reflect the policy position of respective countries, however our findings suggest overall increasing medicinal cannabis support. Greater understanding of policy dynamics may help create frameworks for countries contemplating reforms.