Cannabis-Induced Psychosis: What Is It and Who Is at Risk?

With accessibility to cannabis increasing across North America due to varying levels of legalization, consumption has followed among both medicinal and recreational users.  For existing and potential users, though, it is important to recognize that while cannabis boasts various amazing properties, nothing is provided free of risk.  To that end, below, we will briefly look at one of these risks, who is susceptible, and what to look for.  This would be Cannabis-Induced Psychosis (CIP)

Understanding Cannabis-Induced Psychosis

While rare, cannabis-induced psychosis (CIP) is a potentially serious condition that can actually worsen or cause many of the very mental health issues people consume cannabis to help with.

Cannabis-induced psychosis refers to a temporary psychotic episode that can occur after consuming cannabis.  For those susceptible, it is more prevalent after consumption of especially high-potency forms with elevated THC levels – something to be mindful of, as modern cannabis is significantly more potent than it once was.

Symptoms of such episodes are varied and uncomfortable for the user.  These range from,

• Hallucinations: Seeing, hearing, or feeling things that aren’t present.
• Delusions: Strongly held false beliefs, such as feelings of grandiosity or paranoia.
• Paranoia: An irrational fear that others may be trying to harm or deceive you.
• Disorganized thinking: Difficulty in maintaining a coherent line of thought.
• Agitation and mood swings: Rapid shifts in mood, often toward anger or agitation.

If experienced, these symptoms may last anywhere from a few hours to several days in rare instances – it all depends on the individual and the amount and potency of cannabis used.  However, most symptoms resolve within a few days as the drug clears from the system.

However, there are rare cases that result in prolonged aftereffects, which may be an indicator of more serious underlying psychiatric conditions, such as schizophrenia.  For those with underlying conditions, cannabis-induced psychosis can mark the onset of longer-term mental health conditions.  Research suggests that users who experience psychosis triggered by cannabis are more likely to develop a recurrent psychotic disorder in the future.

As it stands, the underlying cause of cannabis-induced psychosis isn’t entirely understood.  It’s believed that THC, the primary psychoactive compound in cannabis, may interact with certain neurotransmitters or brain structures in a way that triggers psychotic symptoms in susceptible individuals.

The Connection Between Cannabis and Psychosis

A link between cannabis and psychosis has been supported by various studies over the years, with a focus on how cannabis affects the brain’s endocannabinoid system, which plays a role in regulating mood, memory, and perception.   It is important to understand that high doses of THC have the potential to negatively disrupt this system, which can lead to the previously mentioned altered mental states that can mimic psychosis.  As this is more likely to occur with high doses of THC, occurrences are typically more common when consuming concentrated forms like edibles, oils, or dabs.

It’s important to note that while cannabis can induce psychosis, it does not necessarily cause schizophrenia or other lasting psychotic disorders.  Rather, it is thought that cannabis may simply act as a trigger for individuals who already have a genetic predisposition or existing mental health vulnerability.

Risk Factors: Who Is at Greater Risk?

At the end of the day, while users should learn about the potential for cannabis-induced psychosis to occur, the reality is that it isn’t overly common.  Perhaps most important is understanding pre-existing risk factors before consumption to avoid putting oneself in such a situation.  Although we are still learning about these events, some of the current most well-known risk factors include:

1. Age of First Use

• Early initiation of cannabis use, especially in adolescence, is associated with a higher risk of developing psychotic symptoms.  Adolescence is a critical period of brain development, and cannabis use at this stage can have lasting impacts on the brain’s structure and function.

2. Frequency and Dosage

• The risk of psychosis increases with frequent and heavy cannabis use, especially when high-potency products are consumed.  Daily users and those who consume products with high THC content are at greater risk than occasional users.

3. Genetic Predisposition

• A family history of schizophrenia, bipolar disorder, or other psychiatric illnesses increases the likelihood that an individual may experience psychosis from cannabis use.  This suggests that genetic vulnerabilities may play a role in how cannabis impacts mental health.

4. Mental Health Background

• Those with a history of mental health issues, such as anxiety, depression, or bipolar disorder, may be more susceptible to cannabis-induced psychosis.  Cannabis may exacerbate existing mental health symptoms, leading to psychosis in some cases.

5. Co-occurring Substance Use

• Concurrent use of other substances, particularly hallucinogens or stimulants, can amplify the risk of psychosis when combined with cannabis.  Alcohol and certain prescription drugs may also interact with cannabis to increase psychotic symptoms.  Cannabis mixed with tobacco has also been linked to higher rates of occurrence.

6. Sleep Deprivation and Stress

• Lack of sleep and high levels of stress can both weaken mental resilience and potentially contribute to psychotic episodes.  When combined with cannabis use, these factors may lower the threshold for psychosis to occur.

Preventing and Treating Cannabis-Induced Psychosis

Cannabis-induced psychosis is something that, to an extent, can be avoided or minimized with a proper approach.  This means,

• Opting for cannabis products with lower THC levels, which are less likely to induce psychotic symptoms, and starting with a small dose to understand personal tolerance, especially for new users.
• Delaying cannabis use until after adolescence can also reduce the risk of long-term mental health issues like psychosis.
• Staying informed about potential side effects helps recognize issues before they become serious.

When treating cannabis-induced psychosis, severe episodes at times may require medical attention to manage symptoms.  Discontinuing cannabis is crucial for preventing recurrence, and support from counseling and support groups can aid in managing withdrawal and avoiding relapse.  Therapeutic approaches like Cognitive Behavioral Therapy (CBT) can help individuals cope with any residual anxiety or paranoia.  In cases of prolonged psychosis, healthcare providers may prescribe antipsychotic medications to stabilize symptoms and facilitate recovery.

By combining preventative practices with supportive treatment strategies, individuals can mitigate the risks and manage the impacts of cannabis-induced psychosis more effectively.

Final Thoughts

The purpose of this article is not to cultivate fear surrounding the use of cannabis, as the plant does offer many therapeutic benefits.  It is foolish, however, for anyone to consume such a drug without being aware of such a condition that has the potential for lasting detrimental effects.  So, while rare – a 2022 study showed that 0.5% of 230,000 users suffered serious incidents- consider the prevention methods outlined above and be mindful of your mental health and history before consumption.

Overall, cannabis-induced psychosis is a complex condition that affects a minority of users, but with increasing cannabis availability and potency, it’s an issue that warrants awareness.

Whether you’re a recreational user, a medicinal user, or simply curious about the effects of cannabis, being aware of cannabis-induced psychosis and knowing what to watch for can help in preventing unwanted issues.