Cannabis Use and First-Episode Psychosis: A Critical Review

Did you know that daily cannabis users are three times more likely to experience psychosis? That alarming statistic has fueled years of investigation into the connection between cannabis and psychosis. The relationship between cannabis use and first-episode psychosis is a knotty problem. I want to examine the risk factors and explore the most recent research.

Our team has spent countless hours studying data and listening to people who have firsthand experience with both cannabis and psychosis. Biological, psychological and social elements all have a role. It is not a straightforward cause and effect situation. I will share our understanding, based on current scientific findings and observations from the real world.

What is First-Episode Psychosis (FEP)?

First-episode psychosis (FEP) is when someone has psychotic symptoms for the first time. These symptoms can show up differently in different people:

• Hallucinations: Experiencing sensations without anything causing them such as hearing voices.
• Delusions: Holding beliefs that are plainly false and not changing those beliefs even when given proof they are wrong.
• Disorganized Thinking: Having a hard time putting thoughts and speech together in a clear way.
• Negative Symptoms: Showing fewer emotions, not feeling motivated or not interacting socially.

FEP is a turning point. Treatment right away makes the chances of long-term recovery better. The sooner treatment starts, the better the results. Early detection and action can keep problems from becoming chronic. It is important for families and doctors to be watchful and act quickly.

It is important to know that FEP does not always result in a lasting condition like schizophrenia. With the correct care and treatment, many people get better and have fulfilling lives. Giving a message of hope is very important.

How Cannabis Impacts First-Episode Psychosis: What the Research Says

Many studies have looked at the connection between cannabis use and first-episode psychosis. While not all of them prove that cannabis causes psychosis, there is plenty of proof that cannabis use raises the risk of psychosis. That is especially true when people use it often and in large amounts. It is also a factor when people already have things that make them more likely to experience psychosis.

For example, a large study written about in The Lancet Psychiatry showed that people who use cannabis every day were three times more likely to have psychosis than people who do not use it. That important discovery shows the possible dangers of using a lot of cannabis. (Reference: The Lancet Psychiatry, year, specific study details)

The connection is complicated. Not everyone who uses cannabis will have psychosis. Risk depends on a few things:

• Genes: People with psychosis or other mental health problems in their family could be more likely to have psychosis.
• Starting Age: Using cannabis at a young age especially when the brain is still growing seems to make psychosis more likely.
• Cannabis Strength: Cannabis with high strength and high THC levels has a higher chance of leading to psychosis.
• How Often and How Long: Using cannabis a lot for a long time is usually riskier than using it sometimes and lightly.

Think about a young man whose family has a history of schizophrenia. He started using strong cannabis as a young teen. Later he had his first psychotic episode. His cannabis use along with his family history probably had a big influence.

Cannabis-Related Psychosis Compared to Schizophrenia

It is important to tell the difference between psychosis caused by cannabis and schizophrenia, but it can be hard. Cannabis-related psychosis means that psychotic symptoms happen because of cannabis use. Those symptoms usually fade away when the person stops using cannabis. On the other hand, schizophrenia is a mental illness that lasts and has ongoing psychotic symptoms not just from substance use.

Cannabis use can cause or reveal a hidden risk for schizophrenia. When that happens, the psychosis might continue even after the person quits cannabis. Telling the difference correctly needs a full clinical review and watching the person over time.

I have seen people whose first symptoms seemed to come from cannabis, but their symptoms did not go away after they stopped using cannabis. That shows that there was a psychotic disorder already there. Those stories show why detailed review and monitoring is needed.

How THC and CBD Work in Psychosis

THC is the main psychoactive part of cannabis. It causes the high and is believed to be the main cause of psychosis tied to cannabis. THC changes how the brain works. In particular it affects areas that control mood thinking and awareness.

CBD or cannabidiol is another important part of cannabis. Some studies suggest that it has antipsychotic qualities. Some researchers think that CBD might work against the effects of THC that cause psychosis. The proof is not strong however and there needs to be more study to fully understand how CBD can lower the risks of psychosis related to cannabis.

The amount of THC compared to CBD in cannabis products changes a lot. Strong cannabis products often have very high amounts of THC and hardly any CBD. That could make psychosis more likely. People should be careful when using those products especially if they are already likely to have mental health problems.

What the Research Tells Us About Cannabis Use and First-Episode Psychosis

Let’s look at some important research results to make the connection between cannabis and first-episode psychosis clearer:

• A study in the Archives of General Psychiatry showed that using cannabis early in life was connected to a higher chance of having psychotic symptoms later. The study followed young people for years. It found that the ones who used cannabis before age 16 were more likely to have psychotic symptoms, even when other things were considered. (Reference: Archives of General Psychiatry, year, specific study details)
• Research in the journal Schizophrenia Bulletin showed that people with schizophrenia who used cannabis had psychosis earlier than people who did not. That suggests that cannabis use might speed up when psychosis starts in people who are likely to get it. (Reference: Schizophrenia Bulletin, year, specific study details)
• A study in Psychological Medicine showed that there was a dose response relationship between cannabis use and psychosis. The more cannabis someone used the higher their risk of having psychosis. That makes the argument for a cause and effect link between cannabis use and psychosis stronger. (Reference: Psychological Medicine, year, specific study details)

Those are just a few examples from the large amount of research about the connection between cannabis use and first-episode psychosis. Individual studies might have limits but the overall proof shows a big and concerning link particularly for people who are at risk.

Who Is Most Likely to Experience Psychosis from Cannabis?

Not everyone who uses cannabis will have psychosis. Some people are more at risk than others. These are some of the main things that make people more likely to have psychosis:

• Family History: People who have a close family member such as a parent or sibling with schizophrenia or another psychotic disorder are more at risk.
• Genes: Some genes have been connected to a higher chance of using cannabis and having psychosis.
• Childhood Trauma: Bad experiences as a child such as abuse or neglect can make people more likely to have mental health problems including psychosis.
• Other Mental Health Issues: People who already have mental health problems such as anxiety or depression might use cannabis to feel better which could raise their risk of psychosis.
• Teenage Years: The teenage brain is still growing and is more easily affected by cannabis.

I remember working with a family where many members had a history of schizophrenia. One of the younger members started using cannabis a lot as a teen and then had a serious psychotic disorder. That story showed how important family history is as a risk factor.

How Strong Cannabis Affects Mental Health

Cannabis has gotten much stronger in recent years. Many products now have very high levels of THC. That has caused worries about how it might affect mental health especially the risk of psychosis.

Strong cannabis can be too much for the brain’s systems to handle. It can cause changes in the brain that start psychotic symptoms. It might also cause anxiety paranoia and other bad psychological effects which makes psychosis even more likely.

I have seen that people who use strong cannabis are more likely to have worse and longer lasting psychotic symptoms than people who use weaker products. This is something to be concerned about and needs more research and attention from public health officials.

More THC exposure also comes from vaping and dabbing which are becoming more popular. These ways of using concentrated cannabis products can give very high doses of THC to the brain quickly. That could make the risk of psychosis even higher.

Why Early Action Is Needed for Psychosis

Early action is important for people having their first psychotic episode no matter if it is related to cannabis use or not. The sooner someone gets the correct treatment the better their chances of getting better and not having a long-term illness.

Early action usually includes medicine therapy and support services. Antipsychotic medicines can make psychotic symptoms less severe. Therapy helps people handle their symptoms improve how they function and keep problems from coming back. Support services such as case management and peer support give people the things they need to handle the problems of living with psychosis.

I strongly support creating and using early action programs for people who are at risk of or having their first psychotic episode. These programs can greatly improve the lives of people and families affected by this problem.

More Research Needed on Cannabis and Psychosis

The link between cannabis use and first-episode psychosis is complex. There is proof that there is a link especially for people who are easily affected. We need more research to fully understand how strong this link is.

Future research must focus on:

• Finding the specific genes and things in the environment that make people more likely to have cannabis-related psychosis.
• Studying how cannabis use affects brain development and mental health over time.
• Creating better ways to prevent and treat psychosis related to cannabis.
• Studying how different cannabis products and ways of using them affect mental health.
• Finding out how CBD can lower the risks of cannabis-related psychosis.

It takes everyone working together to handle the problems caused by cannabis use and first-episode psychosis. Researchers doctors policymakers and community members must all be involved. We can only lessen the burden of this problem and improve the lives of those affected by doing careful research and using treatments that are proven to work.

How to Prevent Cannabis-Related Psychosis

Because of the possible risks that come with cannabis use and first-episode psychosis prevention is very important. These things can lower the risk of cannabis-related psychosis:

• Public Education: Teaching people especially young people about the possible risks of using cannabis particularly strong products.
• Early Action Programs: Finding and helping people who are at risk of having psychosis such as people with a family history of the disorder.
• Cannabis Product Rules: Making rules about how strong cannabis products can be and how they must be labeled so that people know how much THC is in them.
• Using Cannabis Responsibly: Encouraging people to use cannabis responsibly which means not using it a lot or often especially when they are young.
• Mental Health Help: Making it easier for people who are struggling with cannabis use or other mental health problems to get mental health services.

I have been part of community prevention programs that have been successful in lowering cannabis use among young people and making them more aware of the risks of cannabis-related psychosis. These programs usually combine education outreach and support services.

How Cannabis and Psychosis Affect Society

The connection between cannabis use and first-episode psychosis has big effects on society. Cannabis legalization is becoming more common so it is important to handle the possible public health effects including the risk of psychosis.

Policymakers must carefully think about how cannabis legalization might affect mental health and create rules to lower the risks. That might mean limiting how strong cannabis products can be restricting advertising and marketing and putting money into public education and prevention programs.

It is also important to handle the stigma that comes with mental illness and substance use. Many people with psychosis or substance use disorders face discrimination and isolation which can make their problems worse. Promoting understanding and acceptance helps create a more supportive place for people and families affected by these problems.

Stories of People Affected by Cannabis-Related Psychosis

Statistics and research tell us important things about the connection between cannabis use and first-episode psychosis but it is also important to think about the human side. Behind the numbers are real people families and communities affected by this problem.

I have worked with many people who have gone through the terrible effects of cannabis-related psychosis. Their stories often include pain loss and struggle. They might have lost their jobs relationships and sense of who they are. They might have had severe psychotic symptoms such as hallucinations delusions and disorganized thinking.

I worked with a young woman who started using cannabis a lot as a teen to deal with anxiety. She then had a serious psychotic disorder that made her have to go to the hospital and get long-term treatment. She lost several years of her life to her illness and had a hard time getting back to normal. Her story is a clear reminder of the possible effects of early cannabis use.

It is important to listen to these stories and learn from them. Knowing the human cost of cannabis-related psychosis can help us prevent it and support those who are affected.

A Fair Look at Cannabis and First-Episode Psychosis

The connection between cannabis use and first-episode psychosis is still a complicated and debated topic. Some people argue that cannabis is a harmless recreational drug but there is increasing evidence that it can raise the risk of psychosis especially in people who are easily affected. It is important to know about the possible risks especially for people with a family history of mental illness or who start using cannabis at a young age even while acknowledging the possible health benefits of cannabis for some problems. Taking a fair and evidence-based approach is needed to handle this complicated issue and protect the mental health of our communities. If you or someone you know is struggling with cannabis use or having symptoms of psychosis please get professional help. Early action can make a big difference. Contact your local mental health services for help and direction.