Marijuana is the most widely used illicit drug in the United States and across the world—and cannabis’ changing legal status has heightened the need for an increased understanding of its potential impact on your mental health.[1] While not everyone who uses cannabis will experience psychotic symptoms or cannabis-induced psychosis, certain factors can amplify the risk, underscoring the need to make informed decisions about your decisions around cannabis product consumption.

Today, Clear Behavioral Health will explore the emerging news and the nuances of cannabis potency and its potential to cause psychotic symptoms and disorders. We aim to empower you with knowledge about the changing and sometimes confusing landscape of cannabis use, along with gaining a better understanding of the best options for treatment for any mental health and substance use-related issues that can arise.

The Legalization of Cannabis in the US

The legal status of cannabis and cannabis-related products in the United States has undergone significant changes in recent decades. As of this writing, several states have legalized cannabis for recreational use, allowing adults to use and possess cannabis for personal use (within specific legal limits).

As of this writing, 26 total states, districts, and territories have approved recreational cannabis usage, each with its own regulatory framework:[2]

• Arizona
• Alaska
• California
• Colorado
• Connecticut
• Delaware
• Guam
• Illinois
• Maine
• Maryland
• Massachusetts
• Michigan
• Minnesota
• Missouri
• Montana
• Nevada
• New Jersey
• New Mexico
• New York
• Ohio
• Oregon
• Rhode Island
• Vermont
• Virginia
• Washington
• Washington DC

In terms of medicinal cannabis, an even larger number of states and territories have established programs that permit the use of cannabis for medical purposes.[3] Patients with qualifying medical conditions can access cannabis products with a prescription from a licensed healthcare professional.

However, cannabis remains illegal at the federal level. Federal laws classify cannabis as a Schedule I controlled substance, but states also have the authority to enact their own cannabis policies. Furthermore, there is discussion to reclassify cannabis as a Schedule III drug, meaning there is likely to be ongoing debate and legislative efforts to address the legal status of cannabis at both the state and federal levels in the months and years to come.[4]

Have Cannabis Products Increased in Potency?

Concurrent with its legal status, there has also been a noticeable increase in the potency of cannabis products as well. Cannabis potency is primarily measured by the concentration of delta-9-tetrahydrocannabinol (THC), the main psychoactive compound in cannabis.[5]

In 1995, the Drug Enforcement Administration reported an average THC content of approximately four percent in seized cannabis products (primarily marijuana). By 2017, the average THC content had grown to 17 percent. Moreover, various cannabis products available in the market today, including dabs, oils, concentrates, and edibles, exhibit even higher levels of THC content, with some as high as 90 percent.[6]

Selective breeding and hybridization techniques have been employed to enhance THC content, with growers focusing on creating strains with increasing levels of THC. Advancements in cultivation practices, such as hydroponics and optimized lighting, have further contributed to maximizing THC production to meet the growing demand.[7]

Cultural shifts and market trends—along with the growing framework of legalization—have influenced the demand for high-THC products, raising several potential concerns for teenagers. The wide availability of cannabis products with elevated THC levels poses a particular concern for adolescents and young adults, as their developing brains may be more susceptible to the effects of high-THC cannabis. The increased potency, coupled with the accessibility of these products, raises the risk of adverse mental health outcomes.

Young individuals experimenting with cannabis, especially those unaware of the potential potency, may be at a heightened risk of experiencing cannabis-induced psychosis or exacerbating underlying mental disorders. Additionally, the rising potency of cannabis contributes to other adverse side effects such as greening out which consists of intense physical and psychological discomfort.

What is Drug-Induced Psychosis?

Drug-induced psychosis refers to a condition where the use of certain substances, such as drugs or medications, can lead to symptoms similar to those seen in psychotic disorders. Psychosis is a mental health condition characterized by a disconnection from reality, leading to disturbances in thinking, emotions, and perceptions.[8]

The duration and severity of substance-induced psychosis can vary, and in many cases, symptoms may subside once the substance is out of the individual’s system. However, in some instances, prolonged or recurrent drug use may lead to more persistent psychotic symptoms.

What are the Symptoms of Drug-Induced Psychosis?

The symptoms of substance-induced psychosis can vary depending on the substance involved, the dosage, and the individual’s sensitivity to the drug, along with their potential predisposition for psychotic disorders.

Common symptoms may include:[8]

• Hallucinations: Perceptions of things that are not present, such as hearing voices, seeing images, or feeling sensations that others do not
• Delusions: Strongly held and false beliefs not based in reality
• Disorganized thinking: Difficulty organizing one’s thoughts and expressing them coherently. Speech patterns can also become incoherent or illogical
• Impaired judgment: Difficulty making sound decisions and accurately assessing reality
• Extreme anxiety or agitation: Individuals may experience intense fear, anxiety, or restlessness
• Mood swings: Rapid changes in mood, from extreme euphoria to deep depression
• Sleep disturbances: Disruptions in sleep patterns, such as insomnia or increased need for sleep
• Paranoia: Feeling suspicious, fearful, or believing that others are plotting against them
• Lack of insight: Individuals may not be aware that their experiences and perceptions are distorted, leading to a lack of insight into their current condition

It’s important to note that these symptoms can occur during the intoxication phase of drug use or persist during the withdrawal period. The severity and duration of drug-induced psychosis can vary, and getting immediate assistance can be key to achieving the best outcomes.

Are Some People Predisposed to Developing Drug-Induced Psychosis?

Yes, some individuals may be more predisposed to developing drug-induced psychosis, owing to several potential factors:[9]

Genetics

Genetic predisposition can play a role in determining an individual’s vulnerability to psychosis. Some people may have a genetic susceptibility that makes them more prone to experiencing psychotic symptoms when exposed to certain substances.

Family History

A family history of psychiatric disorders, including psychosis, can increase the risk for an individual. Genetic factors that contribute to mental health conditions may be shared among family members.

Underlying or Co-Occurring Mental Health Conditions

Individuals with pre-existing mental illness, such as schizophrenic patients, individuals with bipolar disorder, or other psychotic disorders, may be more susceptible to drug-induced psychosis. Substance use can exacerbate existing psychiatric vulnerabilities.

Neurobiological Factors

Variations in brain structure and function may influence an individual’s response to drugs and increase the likelihood of experiencing psychosis. Neurotransmitter imbalances and abnormalities in brain circuits associated with psychosis can contribute.

Psychosocial Factors

Environmental factors, such as stress, trauma, and adverse life events, can contribute to an increased vulnerability to psychosis. These factors may interact with genetic predispositions, further influencing an individual’s susceptibility.

Substance Sensitivity

Some individuals may be more sensitive to the effects of certain substances than others. Factors such as the dosage, frequency of use, and the specific type of drug can influence the likelihood of developing cannabis-induced psychotic symptoms.

It’s important to recognize that drug-induced psychosis can occur in individuals without a prior history of mental health issues. Additionally, not everyone with the above-mentioned risk factors will necessarily develop drug-induced psychosis. Substance use can have different effects on different individuals, and the interplay of various factors makes it a complex, individualized phenomenon.

Is There a Link Between Cannabis Products and Psychotic Disorders?

There is evidence suggesting a link between cannabis use and an increased risk of psychotic disorders. The relationship between cannabis and psychosis is complex, and various factors contribute to this association.

Cannabis with higher levels of THC has been associated with a greater risk of inducing psychotic symptoms. THC acts on cannabinoid receptors in the brain, influencing neurotransmitter systems and potentially contributing to the development of psychosis. The risk of psychosis appears to be dose-dependent, meaning that higher doses of THC may increase the likelihood of psychotic experiences—which is particularly relevant in light of the increasing potency of many cannabis products.[10]

Cannabis use, especially when initiated during adolescence, has been linked to an increased risk of developing psychotic disorders later in life.[10] The developing brain during adolescence may be more vulnerable to the effects of cannabis, and individuals with a genetic predisposition to psychosis or a family history of psychotic disorders may be more susceptible to developing psychotic-related disorders later on.

It’s important to note that while there is an association, not all cannabis users will develop psychotic symptoms. Individual responses vary, and other factors, such as genetic predisposition, mental health history, and environmental influences, contribute to the overall risk.

For individuals with a history of psychotic disorders or those at risk, avoiding or carefully managing cannabis use is advisable.

Cannabis, Psychosis, and Co-Occurring Disorders

The relationship between cannabis and psychotic disorders becomes particularly significant when considering the potential effect of co-occurring mental health disorders. For individuals already diagnosed with conditions like schizophrenia or bipolar disorder, cannabis use may contribute to an increased frequency and severity of psychotic episodes.[11] The use of cannabis may complicate treatment strategies and hinder the effectiveness of any prescribed medications.

Furthermore, individuals with co-occurring substance use disorders and psychosis face unique challenges. Cannabis use may serve as a form of self-medication, as individuals attempt to alleviate symptoms of their mental health condition. However, this coping mechanism can contribute to a cycle of dependency and cannabis abuse, making it difficult to address both the drug abuse and the underlying psychiatric disorder simultaneously.

What are the Treatment Options for Cannabis-Induced Psychosis (and Co-Occurring Substance Use and Mental Health Concerns?)

The treatment of cannabis-induced psychotic disorder involves a comprehensive and individualized approach, considering factors such as symptom severity, underlying issues, and unique needs. As such, a full continuum of care is typically employed to address all aspects of your well-being. This includes inpatient and outpatient treatment as well as ongoing therapy.

Residential Mental Health Treatment

After a thorough assessment is conducted to determine the extent of cannabis-associated psychosis and to rule out other potential causes of psychotic symptoms, a supervised stabilization process may be necessary.

For individuals with severe symptoms or other co-occurring disorders, residential mental health treatment may be advisable to begin treatment. This level of care provides a structured environment, 24-hour supervision, and intensive therapeutic interventions. Medication management may be considered, with antipsychotic medication prescribed based on the individual’s specific symptoms.

The Power of Therapy

Using cannabis is a symptom of a bigger problem. Consuming cannabis products daily to alleviate mental health symptoms can quickly develop into cannabis use disorder, increasing the risk of experiencing adverse side effects. At Clear Behavioral Health, we treat cannabis-induced psychosis as a mental health issue. What needs to be treated is self-esteem, anxiety, PTSD, depression, and other underlying mental health conditions that lead individuals to seek out cannabis for relief.

Psychotherapy and counseling are crucial components of treatment, including individual and group therapy sessions. Cognitive-behavioral therapy (CBT) and other evidence-based approaches help individuals address distorted thought patterns and develop healthier and more adaptable coping strategies. Once an individual’s mood, anxiety, and sleep are under control, the desire to use cannabis will begin to subside. This empowers people to convert unhealthy coping mechanisms to more healthy and sustainable coping skills.

Outpatient Programs

Individuals attending inpatient care may transition to outpatient care upon its completion, which offers continued therapy, support, and monitoring while allowing them to reintegrate back into daily life. Relapse prevention strategies are emphasized to help you maintain your recovery practices, and regular follow-up appointments and ongoing support monitor progress and address any emerging challenges.

Providing a full continuum of care recognizes the varying levels of intensity needed at different stages of the treatment and recovery process. Tailoring the approach to your specific needs ensures a comprehensive and effective response to cannabis-induced psychosis, with regular reassessment and adjustment of the substance abuse treatment plan contributing to better long-term recovery and well-being.

The Choice is Clear for Effective, Evidence-Based Treatment

Clear Behavioral Health offers a comprehensive and effective continuum of care for mental health and substance abuse challenges. Our approach encompasses a range of therapeutic interventions tailored to individual needs, ensuring a holistic and personalized recovery journey.

Our commitment to high-quality care extends beyond your initial phases of treatment as well, which is why we offer several step-down and aftercare options to keep you engaged with your recovery community. If you or a loved one is struggling with mental health or cannabis-induced psychosis, reach out to Clear Behavioral Health to learn more about our residential mental health treatment for stabilization and outpatient programs for ongoing therapy and support. Our expert care team is readily available to help guide you through treatment options and help you on your journey to mental wellness.

The choice for effective, evidence-based treatment is clear—give us a call to start your recovery journey today.

 References:

1. ElSohly, M. A., Mehmedic, Z., Foster, S., Gon, C., Chandra, S., & Church, J. C. (2016). Changes in Cannabis Potency Over the Last 2 Decades (1995–2014): Analysis of Current Data in the United States. Biological Psychiatry, 79(7), 613–619. https://doi.org/10.1016/j.biopsych.2016.01.004 on January 22, 2024
2. Ohio legalizes marijuana, joining nearly half the US: See the states where weed is legal. (n.d.). USA TODAY. https://www.usatoday.com/story/news/nation/2023/11/08/legal-weed-states/71500355007/ on January 22, 2024
3. National Conference of State Legislatures. (2023, June 22). State Medical Cannabis Laws. Www.ncsl.org. https://www.ncsl.org/health/state-medical-cannabis-laws on January 22, 2024
4. 2023-01171 – Supplemental Release (1).pdf. (n.d.). Dropbox. Retrieved January 22, 2024, from https://www.dropbox.com/scl/fi/pw3rfs9gm6lg80ij9tja6/2023-01171-Supplemental-Release-1.pdf?rlkey=v5atj0tcnhxhnszyyzcwdcvvt&dl=0 on January 22, 2024
5. Freeman, T. P., Craft, S., Wilson, J., Stylianou, S., ElSohly, M., Di Forti, M., & Lynskey, M. T. (2020). Changes in delta‐9‐tetrahydrocannabinol (THC) and cannabidiol (CBD) concentrations in cannabis over time: systematic review and meta‐analysis. Addiction, 116(5), 1000–1010. https://doi.org/10.1111/add.15253 on January 22, 2024
6. Backman, I. (2023, August 30). Not Your Grandmother’s Marijuana: Rising THC Concentrations in Cannabis Can Pose Devastating Health Risks. Medicine.yale.edu. https://medicine.yale.edu/news-article/not-your-grandmothers-marijuana-rising-thc-concentrations-in-cannabis-can-pose-devastating-health-risks/ on January 22, 2024
7. Barcaccia, G., Palumbo, F., Scariolo, F., Vannozzi, A., Borin, M., & Bona, S. (2020). Potentials and Challenges of Genomics for Breeding Cannabis Cultivars. Frontiers in Plant Science, 11. https://doi.org/10.3389/fpls.2020.573299 on January 22, 2024
8. Fiorentini, A., Cantù, F., Crisanti, C., Cereda, G., Oldani, L., & Brambilla, P. (2021). Substance-Induced Psychoses: An Updated Literature Review. Frontiers in Psychiatry, 12(12). https://doi.org/10.3389/fpsyt.2021.694863 on January 22, 2024
9. Beckmann, D., Lowman, K. L., Nargiso, J., McKowen, J., Watt, L., & Yule, A. M. (2020). Substance-induced Psychosis in Youth. Child and Adolescent Psychiatric Clinics of North America, 29(1), 131–143. https://doi.org/10.1016/j.chc.2019.08.006 on January 22, 2024
10. Di Forti, M., Quattrone, D., Freeman, T. P., Tripoli, G., Gayer-Anderson, C., Quigley, H., Rodriguez, V., Jongsma, H. E., Ferraro, L., La Cascia, C., La Barbera, D., Tarricone, I., Berardi, D., Szöke, A., Arango, C., Tortelli, A., Velthorst, E., Bernardo, M., Del-Ben, C. M., & Menezes, P. R. (2019). The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. The Lancet Psychiatry, 6(5), 427–436. https://doi.org/10.1016/s2215-0366(19)30048-3 on January 22, 2024
11. Khan, M. A., & Akella, S. (2009). Cannabis-Induced Bipolar Disorder with Psychotic Features. Psychiatry (Edgmont), 6(12), 44–48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811144/ on January 22, 2024