Cannabis-induced psychosis is a possible side effect of excessive marijuana consumption. In those who face a high risk for someday developing a psychotic disorder, cannabis can act like a trigger, setting off symptoms of psychosis that are usually associated with conditions like schizophrenia. Cannabis-induced psychosis requires rapid medical intervention to stabilize its debilitating symptoms, followed by treatment for cannabis dependency if it that condition is diagnosed by a qualified physician or addiction specialist.
What Is Cannabis-Induced Psychosis?
Marijuana is known for producing milder effects than most intoxicating substances. But for a subgroup of cannabis users, this reputation departs from reality. These people are vulnerable to a mental health condition known as cannabis-induced psychosis, which can cause a frightening break or disconnection with reality.
Regardless of its source, psychosis is a debilitating and destructive mental health condition that usually requires rapid medical attention. People experiencing a psychotic episode can be a danger to themselves and others, and their symptoms may continue to worsen without intervention.
While frequent or heavy marijuana use can initiate an outbreak of psychotic symptoms, there is uncertainty about the true basis of cannabis-induced psychosis. Research suggests those who experience it were already at risk for developing psychotic disorders, and that without this predisposition cannabis use alone is unlikely to cause psychotic episodes.
Types of Substance-Induced Psychosis
Cannabis-induced psychosis is the most common form of substance-induced psychosis, a larger category that includes multiple intoxicants capable of producing psychotic symptoms in users. Other substances capable of causing psychotic symptoms include alcohol, opioids, sedatives, cocaine, amphetamines, methamphetamine, PCP, and hallucinogens like LSD.
While it is true that cannabis is consumed far more frequently than most drugs, even when adjusted for usage levels cannabis products are still more likely to cause psychotic symptoms than any other substance.
Facts and Statistics
In the United States, marijuana is the most widely used illicit substance, even accounting for the fact that it is legal and unrestricted in several states.
Statistics reveal high levels of marijuana use and a legitimate risk for cannabis-induced psychosis in those who abuse the drug:
- In 2017, 35 million American adults, or 14 percent of the adult population, were monthly recreational users of cannabis products, while another eight percent (20 million) had consumed marijuana within the previous year.
- Among adolescents, nearly 40 percent of 12th graders and about 25 percent of 10th graders reported past-year marijuana usage in 2017, and 5.9 percent of 12th graders reported daily usage.
- In 2016, about four million Americans aged 12 and over had a marijuana-use disorder, which represents about 1.5 percent of this population group.
- In one New Zealand study, 15 percent of regular cannabis users reported symptoms consistent with psychosis.
- In the years immediately after legalization of recreational marijuana in Colorado, the number of teen emergency room visits related to marijuana use quadrupled—and half of the adolescents admitted required psychiatric evaluations.
- In 2011, the most recent year for which comprehensive statistics are available, 36.4 percent of drug-related emergency room trips involved marijuana consumption, with cannabis-induced psychosis as a prime motivator for these visits.
Cannabis-Induced Psychosis Symptoms and Diagnosis
Psychotic episodes are bewildering for those who experience them and terrifying for their loved ones. The symptoms of cannabis-induced psychosis include:
- Delusions. Cannabis-induced psychosis is often associated with feelings of grandiosity and invincibility.
- Hallucinations. Auditory hallucinations (hearing voices) are especially common with cannabis-induced psychosis, and visual hallucinations are experienced frequently as well.
- Dissociation or depersonalization. People in a psychotic state often feel disconnected from the world and detached from their own minds and bodies.
- Anxiety and agitation. Psychotic symptoms of anxiety may start out as extreme restlessness or emotional disquiet, before degenerating into paranoia or hostility.
- Disorganized thoughts and speech. Normal patterns of thinking and speaking may become garbled and confused during a cannabis-induced psychotic episode.
Since cannabis-induced psychosis is associated with frequent or heavy marijuana consumption, there may be signs of drug use as well, which can help identify the cause of the psychotic symptoms. The symptoms of cannabis abuse include:
- Extreme drowsiness
- Altered perceptions
- Bloodshot eyes
- Excessive appetite
- Dry mouth
- Slowed reflexes and poor coordination
- Impaired memory and thinking processes
Symptoms of heavy drug use before or during a psychotic episode offer significant clues as to the nature of the condition.
Diagnosing Cannabis-Induced Psychosis and Cannabis Use Disorder
When psychotic symptoms are experienced, medical professionals may diagnose cannabis-induced psychosis if:
- The symptoms cannot be traced to an active, pre-existing mental health condition known to cause psychotic side effects (specifically bipolar disorder and schizophrenia).
- Psychotic symptoms must have manifested shortly after cannabis use, or within a month after withdrawal symptoms have abated if drug use has been halted.
- Strong hallucinations and delusions are experienced in connection with cannabis use and are not related to episodes of delirium caused by acute drug intoxication.
- Psychotic symptoms are not transitory but persist for an extended period and continue to cause serious life disruption.
If a person is judged to be suffering from cannabis-induced psychosis, they may be referred to an addiction specialist for an evaluation, assuming their symptoms of psychosis have been stabilized.
To diagnose a cannabis use disorder, medical professionals must identify at least two of the following symptoms in people who admit to using the drug continuously for one year or longer:
- Frequent overuse of cannabis, contrary to intentions
- Relapses after previous attempts to quit using cannabis products
- Use of cannabis and recovering from its effects occupies a significant amount of time
- Consumption continues despite adverse personal consequences (criminal charges, relationship problems, etc.)
- Cannabis use interferes with daily life responsibilities (parenting, working, attending school, etc.)
- Cannabis use has been implicated in dangerous or reckless behavior, such as driving under the influence
- Use of the drug continues despite it causing physical or mental health problems
- Cravings for cannabis are experienced frequently
- Tolerance for the drug has led to escalating usage
- Withdrawal symptoms are experienced when the drug is not used for a few hours or more
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Cannabis-Induced Psychosis Causes and Risk Factors
While any amount of marijuana consumption could conceivably cause a psychotic episode in a vulnerable person, chronic or heavy use of cannabis increases the risk dramatically. Those who abuse cannabis products during adolescence may be at greatest risk for future psychotic episodes and/or psychotic disorders, including but not limited to cannabis-induced psychosis.
In addition to frequent marijuana use, other risk factors for cannabis-induced psychosis include:
- Family history of substance use disorders or psychotic disorders
- Personal history of schizophrenia, bipolar disorder, or depression
- Previous head injuries
- Birth complications or poor maternal health during pregnancy
- Other types of drug abuse
- Physical, emotional, or sexual abuse in childhood
Research has confirmed the connection between cannabis use, cannabis-induced psychosis and later onset of schizophrenia, bipolar disorder (psychosis can occur during manic states), and other psychotic disorders:
- In one long-term study of more than 6,700 individuals with various forms of substance-induced psychosis, researchers discovered that 41 percent of those who’d experienced cannabis-induced psychosis later developed schizophrenia. Another six percent developed bipolar disorder, and the average time of onset for one of these two conditions was approximately 3-4 years.
- A separate 2017 study found that those with an established risk for psychotic disorders were far more likely than others to experience the temporary onset of psychotic symptoms following marijuana use. Study participants either came from families with a history of conditions like schizophrenia, or they were already showing the initial signs of a psychotic condition before consuming cannabis.
- In a 2010 meta-analysis, a team of Finnish researchers found that about 25 percent of people with schizophrenia also suffered from a cannabis use disorder.
- A 2017 study of more than 1,200 people diagnosed with schizophrenia revealed that those who’d consumed marijuana before the age of 18 developed their disorders 10 years earlier on average than those who had no such history.
This research reinforces the theory that cannabis-induced psychosis is a precursor to future incidence of non-substance-induced psychosis, based on pre-existing risk factors for such disorders. Researchers know that adolescents who use marijuana face a significantly elevated risk for future problems with psychotic disorders, since cannabis can cause structural changes in their still-forming brains that leave them vulnerable to mental health breakdown.
Heavy or regular cannabis use has also been linked to an increased vulnerability to anxiety and depression. Cannabis-induced psychosis will not cause anxiety or mood disorders but might occur alongside them, since those who abuse marijuana are at risk for all.
Any time a mental health disorder of any type has been diagnosed in a person who has experienced cannabis-induced psychosis, that condition will need to be addressed in treatment—and if a cannabis use disorder is diagnosed, that will require treatment as well.
Cannabis-Induced Psychosis Treatment and Prognosis
Episodes of cannabis-induced psychosis are usually indicative of other issues related to mental health and substance use. Consequently, treatment for this condition will likely progress beyond detox services or emergency medical procedures.
Detox following in incident of cannabis-induced psychosis is often just a matter of time and patience, and providing a safe, comfortable, and relaxed atmosphere for the person to recover from their psychotic symptoms and marijuana intoxication. But various combinations of medications—specifically, antipsychotics, anti-seizure drugs, and antiepileptics—have been found to hasten the decline of psychotic symptoms in people who’ve been abusing cannabis.
Detox may take place in hospitals, if emergency medical care was sought. But drug and alcohol treatment facilities are also prepared to manage detox for people with cannabis-induced psychosis and who are known or suspected of having a cannabis use disorder.
If a cannabis use disorder was not diagnosed before a psychotic episode, there is a good likelihood it will be afterward, and at that point enrollment in an outpatient or inpatient treatment program at a substance abuse rehab center offers the best chances for recovery. Through a combination of individual, group and family therapy, medication (if prescribed), holistic healing practices, life skills/coping skills training, and aftercare services, these treatment programs can help people with substance use disorders—plus accompanying mental health conditions if there’s a dual diagnosis—overcome their conditions and dramatically reduce their future risk for episodes of psychosis.
Because cannabis-induced psychosis is a risk factor for schizophrenia, bipolar disorder, and other similar conditions, people in recovery should be closely monitored during their aftercare programs for any signs of psychotic symptoms, which could manifest suddenly even if cannabis is no longer being used. Fortunately, early intervention for schizophrenia or bipolar disorder can be highly effective, so adherence to aftercare programs in this case is conducive to good long-term mental health.