Does marijuana cause psychosis? The answer is complicated

[Simple Jack]

Does marijuana cause psychosis? The answer is complicated

 

Of the many harms attributed to cannabis use, few have garnered as much attention as the frightening association of cannabis with psychosis. From the 1936 exploitation film “Reefer Madness” to a recent article in the Wall Street Journal, the media has covered the topic extensively and, at times, hyperbolically. Still, the question remains: Does cannabis truly cause psychosis and related diseases such as schizophrenia — or is this another overblown claim?

The link between cannabis use and psychosis is well-established through research. This association is not in doubt. However, as we all learn in high school science, correlation does not imply causation. Take a common example: Ice cream consumption and drownings both increase in the summer months. They are unquestionably associated. But no one believes that one of these causes the other. It is especially important for us, as doctors, to untangle whether cannabis actually causes psychosis.

Let’s begin by defining “psychosis,” which is a break with reality, encompassing delusions, hallucinations and/or disordered thinking. Delusions can be of a paranoid or frightening nature. Psychotic episodes can persist from days to months or even years. Even a brief psychotic episode can indicate the beginning of a lifelong psychiatric condition such as bipolar disorder or schizophrenia.

Over the decades of our clinical work, we have seen numerous cases of psychosis that first emerged in the context of cannabis use. On one hand, this isn’t surprising, as people are more likely to start using cannabis at the same age that they’re at greatest risk for a first episode of psychosis — in their teens or 20s. However, we’ve seen too many cases in which the timing was just too close to dismiss as a mere coincidence.

It may be easy to assert that cannabis use causes psychosis or schizophrenia without looking more closely at the correlation between the two, especially for those who want to stigmatize cannabis use. However, available evidence doesn’t support such a simplistic view, as there are several other plausible connections.

For example, people at risk for psychosis may self-medicate with cannabis before they develop a psychotic disorder. In this scenario, before the onset of psychosis, the patient may experience anxiety and use cannabis to try to feel better. While cannabis might not help, it often doesn’t actually cause the psychosis. Paradoxically, symptoms of emergent psychosis could lead people to self-medicate with cannabis meaning that, in some cases, the psychosis is the cause of the cannabis use, not the other way around.

Secondly, cannabis could trigger or worsen psychosis without being a primary cause. We know that other drugs, including psychostimulants, steroids, psychedelics and alcohol can trigger a brief substance-induced psychosis, which can last for days to months. Still, of all the drugs associated with this uncommon kind of psychosis, cannabis is the most common culprit.

Among people with substance-induced psychosis, those who use cannabis are most likely to eventually progress to schizophrenia. So, it appears as if the cannabis is causing not just the transient psychosis, but schizophrenia as well. At the same time, studies show that these patients have a higher genetic risk for schizophrenia, meaning that cannabis may simply trigger what the patient is predisposed to suffer from eventually.

To make things even more complicated, there is a third explanation of the relationship between cannabis and psychosis. There is some evidence that certain genes can predispose a person to both cannabis use and psychosis, a shared genetic basis.

So, where does all of this leave us?

It is unlikely that cannabis use by itself causes schizophrenia. The rates of schizophrenia have been stable for the last 70 years, while the rates of worldwide cannabis use have gone up from the hundreds of thousands in the 1950s to the hundreds of millions today. If cannabis caused schizophrenia, the rates of schizophrenia would have risen alongside the thousand-fold increase in cannabis use, and they haven’t.

Still, if cannabis can precipitate the onset of schizophrenia earlier in vulnerable individuals, that by itself is a public health issue. An earlier onset of schizophrenia means that patients have fewer years of biological and psychological growth before mental illness adversely affects brain development and adult coping skills. That could lead to worse outcomes, including more positive symptoms of schizophrenia such as paranoia and delusions.

Given the ongoing uncertainty around this issue, it would be wise for people with a personal history of schizophrenia or another psychotic disorder to avoid cannabis completely, unless there is a compelling medical reason to use it under close clinical supervision. Even people who have blood relatives with psychotic disorders or other severe mental illness should think twice and exercise a lot of caution before using cannabis. Also, while we don’t know whether potent forms of cannabis with very high THC (tetrahydrocannabinol) levels are more likely to trigger or worsen psychosis, they might be.

Interestingly, there is some evidence that CBD, the second most common cannabinoid molecule, has mild anti-psychotic activity. So, cannabis that has higher levels of CBD might have a lower risk of triggering psychosis, and cannabis that has CBD without any THC could actually benefit people with schizophrenia in combination with other antipsychotic medications. Here again the consumer should beware. The US Food and Drug Administration has not yet regulated CBD products, so untested products might contain more THC than the 0.3% limit that the law allows. CBD products should only be purchased from reputable companies that test their products through independent labs and share the results.

Given society’s growing normalization and acceptance of cannabis, it is as important as ever to understand the actual benefits and risks that can accompany its use. People use cannabis to alleviate chronic pain, nausea and insomnia, among many other conditions.

Of course, no medications are entirely safe for everyone and all have potential side effects. We can make cannabis use safer by encouraging people to consume products with lower THC levels and higher CBD levels. Perhaps most importantly, we should encourage teens and young adults with risk factors of psychosis to delay their use of cannabis until they pass the age when the initial onset of psychotic disorders like schizophrenia is most likely. We shouldn’t jump to the conclusion that cannabis causes psychosis, but anyone who plans to use cannabis should know their personal risk factors and exercise caution accordingly.

 

https://edition.cnn.com/2024/02/08/opinions/marijuana-cannabis-psychosis-nathan-grinspoon/index.html

 

See original article for embedded references.

[darXound]

The answer is no.....

 

As with schizophrenia, there is nothing to suggest cannabis causes any of these. From all the literature i've read, including Peter Grinspoons book, it seems cannabis is a crutch for people with these problems rather than a cause. Due to the nature of modern, prohibition cannabis with it's high THC content and 0 CBD however, it is prone to trigger episodes in people with these conditions.

 

This shouldn't be a negative against cannabis, except maybe for the state prohibition has left it in, but a positive thing. I imagine using THC in a controlled environment that can bring these traits out in people, could prove very beneficial therapeutically in the future.

 

Also important to note that full spectrum flower, complete with CBD, tends not to have these side effects and in fact, has a protective function in the brain

[v12xjs]

Peter Grinspoon LOL.
It was Lester Grinspoon that earned a reputation as an expert on cannabis, not Peter. Peter is the son who was addicted to pretty much anything and everything he could get hold of. Did you read his first book?

 

Free Refills: A Doctor Confronts His Addiction
Dr. Peter Grinspoon seemed to be a total success: a Harvard-educated M.D. with a thriving practice; married with two great kids and a gorgeous wife; a pillar of his community. But lurking beneath the thin veneer of having it all was an addict fueled on a daily boatload of prescription meds. When the police finally came calling – after a tip from a sharp-eyed pharmacist – Grinspoon’s house of cards came tumbling down fast.

 

If anything, the fact that a successful doctor and family man is addicted to pretty much every drug he can get his hands on would suggest he has mental health issues in abundance.

[darXound]

Do you think having mental health issues makes a person inferior in some way?

 

This isn't his research anyway, it's just mentioned in his book. It was David Nutt where I first heard it.

[catweazle1]

@Bulldogbill91 Yep, know your limits.

[The Green Manalishi]

On 19/02/2024 at 15:29, Bulldogbill91 said:

he used to say there was ghost in the bushes, he used to say the ghost basically used to wank him off and touches him

Where exactly is this bush…… 

[mikeydoughnut]

Never seen it cause full blown psychosis but I’ve seen folk go under and never touch it again. Walking home in the dark is one I remember from my childhood. It’d be nerve jangling but never put me off. Some lads would leg it home. One lad in particular never touched it again after being ‘followed’ home  

[bushdoc]

Someone I hung around with developed schizophrenia around the age of 15. Hearing voices thinking we were doing voodoo on them.  They put her on drugs and said it was the cannabis but got to say she was doing loads of class a at the time and the psychosis was obviously there and seemed to be brought out by the drugs.

 

She was messed up for a while but last time I saw her she's had a kid and looked well. 

 

Drugs might not be for everyone. 

Edited February 21 by bushdoc
Specially at that age when your perception of reality is shifting anyway

[The Green Manalishi]

Ganja does not agree with my mate, and he likes a toke, but It does send him off his tits, and in such a way that I don’t toke with him anymore…. he scares me.

[ratdog]

weed definitely brings on the unwanted thoughts, like a paranoid depression if i don't have a drink beforehand, so i've given it a rest for a while, i think i'm about just over three weeks in now. will give it a few more weeks to see what else i'm missing, but my dreams are getting back to some kind of normality. i've certainly had a few weird dreams, last night i was dreaming about being on the lash with @Joolz

[j.o.i.n.t]

51 minutes ago, ratdog said:

paranoid depression

 

Yeah, If I go hard (which is my natural way when confronted with a drug stockpile, despite knowing I shouldn't) I get a mild form of this....more sullen introspection, with a self concious edge. One of the reason I force breaks.

 

That being said, best thing about breaks is getting mashed again. Smoking too often dulls that. Just becomes another norm.

 

....And, ratty, I'm a bit envious of those like you who get the dreams back. I don't.

[ratdog]

28 minutes ago, j.o.i.n.t said:

And, ratty, I'm a bit envious of those like you who get the dreams back. I don't.

 

 

not at all? tbh they are not all nice, some are real head fucks and leave a "bad taste in the mouth" for the rest of the night

 

i find the best ones are usually the week after stopping

[cypo74]

When i was a kid i wouldnt go anywhere without at least 10 rolled joints in a box, used to carry a double chambered bong on my back in a tube everywhere, at about 26-27 i moved to thailand for a few years, didnt smoke at all through the trip, came home and couldnt handle the weed anymore, made me super paranoid, unless id had a few beers, then id be fine.

 

Id nip out at lunch for a joint and come back and not want to answer the phone at work, if i did i wouldnt listen to what the client was saying and just be thinking about something else. Then i printed 20,000 brochures with a whole article missing out of it.......... expensive mistake . things had to change

Stopped for about 15 years, then started having sleep issues........ started vaping weed again in the evenings and i sleep like a baby again, certain strains have the opposite effect though, too racy and make me parra again. 

 

Prefer starins around 17-20% thc

I dont smoke every day now and still have crazy arse dreams every night  

[j.o.i.n.t]

@ratdog Nope, not at all. Not had one for about 20 years, or so. If no weed smoked/ingested at all, after ~day 3 wake up every two hours like clockwork (and need naps) - don't enter rem sleep at all, unless it's right at the beginning in the form of sleep paralysis.... That doesn't leave a nice taste either

 

Not a medical user, cos fuck simpering to some acceptable usage frame, but can't deny weed masks that shit very well. Even 'on a break', if it starts to do my head in a few drags shuts that crap down for a while and I'll sleep through again, with no 'visits' or waking up all the time. 

 

Waking up permanently every two hours is no good for the mental health either, so it's a balancing act...tilted firmly on the side of getting mashed, cos It's nicer way to be a bit fucked up

[ratdog]

@j.o.i.n.t no wonder you are up silly o'clock getting stoned.

 

last time i had sleep issues was coming off benzos about 8 years ago, man that was harsh, most nights i only had 1 hour sleep for months, nodding off at midnight, only to wake at one am , man i read a lot of books back then

 

i've never used the med thing either, if this is the case then (all drugs are) booze is medicine!