Abstract
According to the exogenous cannabinoid hypothesis, exposure to cannabis and cannabinoid receptor (CB1R) agonists (henceforth referred to as “cannabinoids”) is associated with a number of psychosis outcomes. The high rates and earlier onset of cannabis use, the legalization of “medical” marijuana (cannabis) and recreational cannabis use in some states, the increasing availability and use of edible cannabinoid products and highly potent synthetic cannabinoids (e.g., Spice and K-2), the increasing potency of cannabis, and the high rates of emergency department visits related to cannabinoids warrant the need to understand the relationship between cannabinoids and psychosis.
The relationship(s) between cannabinoids and psychosis may be categorized according to the temporal proximity of the onset of psychosis to cannabinoid exposure and the duration and clinical significance of psychosis. Cannabinoids are associated with psychosis that manifests soon after exposure, typically lasts only for the duration of intoxication (hours) and that typically does not involve significant clinical intervention. Cannabinoids are also associated with psychosis that manifests soon after exposure but lasts beyond the period of intoxication and often requires clinical intervention. Finally, exposure to cannabinoids has been associated with an increased risk for chronic psychotic disorders (e.g., schizophrenia) that emerges years later and that requires clinical intervention. The link between cannabinoids and chronic psychotic disorder is greater with earlier age of exposure, cumulative dose of exposure, childhood abuse, and genetic vulnerability. However, cannabinoids are neither necessary nor sufficient to cause a chronic psychotic disorder. More likely, cannabinoids are a “component cause” interacting with other known (family history) and unknown factors to result in psychosis outcomes. Further research is necessary to fully understand the mechanisms underlying these relationships between cannabinoids and psychosis.
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Tikka, S.K., D’Souza, D.C. (2019). The Association Between Cannabinoids and Psychosis. In: Montoya, I., Weiss, S. (eds) Cannabis Use Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-90365-1_14
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