Does Cannabis Cause Psychosis?

Psychosis is characterized as a break from reality, which can manifest as delusions, hallucinations, and disordered thinking. These episodes can last for days, months, or even years. Even a brief psychotic episode can mark the onset of long-term psychiatric disorders like bipolar disorder or schizophrenia.

Over decades of clinical observation, many cases of psychosis have been reported in individuals who use cannabis. This is not surprising, as many people begin using cannabis during their teens or twenties—the same age range where they might experience their first episode of psychosis. However, there are too many instances where the timing between cannabis use and the onset of psychosis is too close to dismiss as mere coincidence.

While some may argue that cannabis directly causes psychosis or schizophrenia, this view oversimplifies the situation. There are several other plausible explanations to consider.

For example, individuals who are at risk for psychosis may self-medicate with cannabis to alleviate anxiety prior to the onset of the disorder. In these cases, cannabis may not help, but it is unlikely to cause psychosis. Conversely, the symptoms of an emerging psychosis might drive individuals to use cannabis, suggesting that psychosis could be the reason for cannabis use, rather than the reverse.

Additionally, cannabis may trigger or worsen psychosis without being the direct cause. Other substances, including psychostimulants, steroids, alcohol, and psychedelics, can lead to temporary substance-induced psychosis, lasting from days to months. Among these substances, cannabis is the most frequently associated with this form of psychosis.

Research shows that individuals experiencing substance-induced psychosis while using cannabis are more likely to develop schizophrenia over time. This indicates that cannabis may not only cause transient psychosis but could also be linked to the long-term development of schizophrenia.

Moreover, studies reveal that individuals with a history of cannabis use and psychosis often have a higher genetic predisposition for schizophrenia. Thus, cannabis might trigger a condition that the individual is already predisposed to experience later in life.

Complicating the matter further, evidence suggests that certain genetic factors may predispose individuals to both cannabis use and psychosis.

Should You Be Concerned About Using Cannabis?

It is unlikely that cannabis use alone causes schizophrenia. In fact, rates of schizophrenia have not increased in the past 70 years, even as global cannabis use has skyrocketed—from hundreds of thousands of users in the 1950s to hundreds of millions today. If cannabis caused schizophrenia, we would expect to see a corresponding rise in schizophrenia rates, which we have not observed.

However, if cannabis can accelerate the onset of schizophrenia in vulnerable individuals, this is still a significant public health concern. An earlier onset of schizophrenia can hinder an individual's biological and psychological growth, potentially leading to worse outcomes and more severe symptoms, such as paranoia and delusions.

Given this information, individuals with a family history of schizophrenia or other psychotic disorders should exercise caution when considering cannabis use. This also applies to those with blood relatives suffering from severe mental illnesses. Furthermore, while we do not yet fully understand whether high-THC cannabis is more likely to trigger psychosis, there is a possibility that it could.

As cannabis becomes increasingly normalized and accepted worldwide, it is crucial to understand the real benefits and risks that come with its use. Cannabis is often used to alleviate chronic pain, stress, nausea, insomnia, and other conditions.

It’s important to remember that no medication is completely safe for everyone, and all medications can have potential side effects. We should encourage everyone, particularly teens and young adults who are at risk for psychosis, to delay cannabis use until they are older and past the age when the initial onset of schizophrenia and other psychotic conditions is most likely to occur. While it is essential not to propagate the idea that cannabis outright causes psychosis, understanding the associated risks is critical.

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