The real story on cannabis-induced psychosis
Media coverage of cannabis-induced psychosis is polarizing. There are careful tellings of studies and expert takes from cannabis media, paired with drastic sweeping anti-cannabis statements using psychosis as a shield. Now, there is a skewed understanding of the connection between smoking weed and developing conditions like bipolar disorder or schizophrenia.
There are cannabis consumers everywhere, even some that have been consuming quite a lot for a long time and haven’t experienced psychosis. But still, research continues to sound the alarm.
Even famed television personality and addiction specialist Dr. Drew Pinsky recently shared his views on the Fox News show The Bottom Line in a tempered statement about how he was surprised with the severity of how cannabis psychosis is presenting.
The conversation even went to court in a trial for Bryn Spejcher, who was given a comparably lenient sentence due to “acute psychosis” brought on by large quantities of THC. Some suggest this sets a dangerous precedent that smoking cannabis leads to murder, but like the topic of cannabis-induced psychosis, it’s complicated.
The cannabis psychosis connection
There are two camps on the edges of the issue of cannabis and psychosis. One side believes cannabis has no medicinal value and causes psychotic episodes, and others whose lives have likely been changed by the plant aren’t ready to see any negatives. The “right” place to be on this one is probably somewhere in the middle.
Dr. Cassandra Boduch, chief medical officer of mental health platform Psych+, shared insight on cannabis and psychosis with GreenState.
“The relationship between cannabis use and psychosis is complex and not fully understood. This is largely because although it has been studied extensively, different data leads us to different conclusions,” Boduch said.
Everyone has a unique endocannabinoid system, it makes sense that psychosis would be dependent on each person. The research supports this understanding—sometimes, it shows no connection, while others it signals that cannabis may trigger psychosis.
Research on cannabis and psychosis
There are many studies on the topic of cannabis and psychosis, and as Boduch mentioned, the results vary widely. One of the most recent is a cross-sectional analysis of psychosis-related care and health services provided in Ontario from January 2014 to March 2020.
Ontario cannabis sales started in 2018, so statisticians were hoping to see if there was a spike in psychosis-related treatment after the province went green. There was no indication of increased incidents of cannabis-induced psychosis in the short term (17 months) after legalization.
However, the full window saw an increase in health service use for weed-induced psychotic disorders. This suggests psychosis may present after long-time regular consumption.
Research published in October told an opposing tale. A cohort of 210 teens at risk for psychosis took part in the study, which tracked the cannabis-consuming participants over two years. Continuous cannabis consumption did not increase the presentation of psychotic events or episodes.
These results are duplicated on both sides, highlighting the perplexing relationship between cannabis and psychosis. The answer can probably be found in brain chemistry.
Upsides of cannabinoids and the brain
There are a few ways psychosis can present. One way is from the dysregulation of dopamine, and the other is a misfiring in the brain. Research shows how cannabis might help regulate the brain in some ways, these are often multi-cannabinoid formulations that don’t center on THC.
That isn’t the only positive correlation between cannabis and mental health. Another study explored how cannabis might help people with OCD, Tourette’s, and other neurological disorders. The results did indicate less compulsion when consuming cannabis.
A Frontiers in Psychology cannabis study cohort with clinical depression or anxiety had lower depression scores when using medical marijuana. These results and those related to depression and anxiety are double-edged, however. There is evidence that cannabis consumption may increase the risk of depression or aggravate anxiety. Again, the patient response depends on the person consuming, consumption method, and formulation or dose.
One theory: more THC equals more risk
Just as with psychosis and cannabis, the likelihood of a positive or negative experience is case by case. Many studies suggest that a cannabis-induced psychotic episode is a dose-dependent response when someone overconsumes THC. However, some medical cannabis patients need high milligram doses of THC to find relief from various symptoms or conditions.
Integrative mental health clinician and plant medicine formulator Shari B. Kaplan offered her take to GreenState about the relationship cannabinoids have with the brain.
“Having too much THC can induce psychosis due to overproduction of dopamine when done in high doses,” Kaplan said. “Therefore, if someone just keeps smoking THC or concentrates, that’s going to make their cerebellum produce more dopamine, which can then misfire into the temporal lobe and cause psychosis.”
Boduch shared Kaplan’s sentiments that high THC and regular, consistent consumption are contributing factors in cannabis-induced psychosis cases.
“Research is ongoing to better comprehend these connections. Understanding the effects and methods of cannabis consumption is crucial in evaluating its potential impact on mental health and exploring the connection between cannabis use and schizophrenia.”
Developing cannabis-induced psychosis
The risk of developing psychosis as a result of cannabis consumption seems to rise for young men, with seniors being at the lowest risk. Originally, it was thought that only those predisposed to schizophrenia were at risk of developing cannabis-induced psychosis, but recent findings have changed that.
Now, it seems that while those with a family history of psychotic disorders or previous psychosis were at risk, so is anyone who consumes an excess of THC all at once or regularly over a long period.
Those who experience an episode of psychosis brought on by cannabis are almost 50 percent more likely to develop schizophrenia. This highlights a need for cannabis harm reduction, including dose education to stifle overconsumption, especially among teens.
“The current state of research does not allow us to reach many definitive conclusions with regards to how the means of consumption affects the risks of psychosis,” Boduch said. “However, in addition to the theory that stronger strains of cannabis can be the cause of increased chance of mental illness…the more cannabis that is consumed, the higher the risk of mental health issues.”
Kaplan doubled down on this notion, sharing that some who rely on cannabis as a mental health tool might fall into a cyclical consumption pattern leading to psychosis.
“If your brain has a dysregulation of dopamine, you’ll just keep smoking more and more when you are at a deficit of dopamine, thinking it’s going to make it better. However, you will then overproduce, and then, when you produce enough, psychosis can occur,” Kaplan shared.
Does consuming cannabis cause psychosis?
Smoking weed doesn’t make people schizophrenic, but abusing it may increase the risk of psychotic episodes. Research continues to show that THC alone isn’t always a medical dose, but a full spectrum of cannabinoids, like that which is present in cannabis flower, is more effective in unlocking potential benefits.
Along that same vein, just because there may be cases of cannabis-induced psychosis, that doesn’t write off the potential therapeutic benefits of the plant as some media outlets suggest. Like the plant, those covering the cannabis beat should strike a balance when presenting both sides to the story.
That said, those in treatment for or with a predisposition for psychotic disorders should consult with a physician before consuming. That is especially true when planning to eat, vape, or smoke large amounts of THC. Boduch explained that developing psychosis from cannabis consumption is relative to every person; after all, patients respond differently to medications.
“For some people, they may run no increased risk of psychosis via the use of cannabis,” Boduch explained. “And indeed, many individuals do consume cannabis as a way of self-medicating a pre-existing condition, including psychosis. These two are not mutually exclusive.”
Until more research fine-tunes our understanding, the exact connections between cannabis and psychosis are unknown. But it’s safe to say that while all cannabis doesn’t cause psychosis, irresponsible consumption might. Until more research is done on the matter, that’s the best a regular patient or cannabis consumer can do.