• Title: Rates and correlates of cannabis-associated psychotic symptoms in over 230,000 people who use cannabis
• Journal of Translational Psychiatry 2022, Nature publishing group (Pubmed)
• Authors: Tabea Schoeler, Jason Ferris, and Adam R. Winstock
• Citation: Schoeler, T., Ferris, J., & Winstock, A. R. (2022). Rates and correlates of cannabis-associated psychotic symptoms in over 230,000 people who use cannabis. Translational psychiatry, 12(1), 369. https://doi.org/10.1038/s41398-022-02112-8
• Study type: retrospective statistical analysis

The purpose of this study was to analyze how using cannabis statistically correlates to psychosis. I chose this article because my patient met the criteria for schizophrenia however, he also had cannabis use disorder. Therefore, I was curious to read up on what the recent research data shows for how cannabis impacts psychosis. The authors acknowledged that the reason why individuals use recreational cannabis is for the psychoactive pleasurable effects of euphoria, relaxation or sociability. Adverse effects include anxiety, panic, paranoia, and psychosis experiences including hallucinations. There is evidence that those who experience psychosis with cannabis use are more likely to develop a psychiatric disorder therefore, the authors sought to define the risk factors for this occurrence.

The methods that the authors used were as follows: They collected data from 233,475 people who use cannabis to see what percentage required at least one instance of emergency medical treatment due to cannabis associated psychotic symptoms. They acquired the data from the Global Drug Survey (GDS) over 5 years from 2014-2019. They assessed a number of factors by survey questions including age, mental health history, type and frequency of cannabis use, route of administration and others.

Key findings from the study included: 148,109 people who had cannabis associated psychotic symptoms in the last year and 85,366 with lifetime occurrence. The authors estimated that the rate of needing emergency treatment for cannabis associated adverse effects were .19% in the last year and .47% in a lifetime. The most common symptoms were paranoia and then paranoia in addition to hallucinations. Risks were higher in people under age 21. Rates were higher in Denmark where higher potency cannabis is used and lower in the United States. Those with a concurrent psychotic disorder were more likely to experience cannabis associated psychotic symptoms. 56% of the people who sought medical treatment had a prolonged psychosis >4 weeks. And 36% of those who sought treatment were admitted to the hospital.

Limitations: this study only included patients who sought medical attention for their symptoms. There is a possibility of recall bias due to the retrospective nature of the study. People who developed prolonged psychosis after the occurrence of cannabis associated psychosis were not included in the study therefore the numbers may really be higher.

In conclusion, this article had useful data about how cannabis use is related to psychosis. Since cannabis likely exacerbated my patient’s schizophrenia, educating him about cessation of using cannabis can help minimize his schizophrenia exacerbations.

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