Cannabis and mental illness: a review

Abstract

With the increasing push to legalize cannabis in Western nations, there is a need to gage the potential impact of this policy change on vulnerable populations, such as those with mental illness, including schizophrenia, mood, and anxiety disorders. This is particularly important as there are strong motives in these individuals to seek short-term reward (e.g., “getting high”). Nonetheless, data to support the beneficial effects of cannabis use in psychiatric populations are limited, and potential harms in patients with psychotic and mood disorders have been increasingly documented. This article reviews the effects of cannabis in people with mental illness. Then, we provide a reconciliation of the addiction vulnerability and allostatic hypotheses to explain co-morbidity addiction in mentally ill cannabis users, as well as to further aid in developing a rational framework for the assessment and treatment of problematic cannabis use in these patients.

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References

  1. 1.

    Agrawal A, Pergadia ML, Lynskey MT (2008) Is there evidence for symptoms of cannabis withdrawal in the national epidemiologic survey of alcohol and related conditions? Am J Addict 17:199–208

    Article  PubMed  Google Scholar 

  2. 2.

    Andréasson S, Engström A, Allebeck P, Rydberg U (1987) Cannabis and schizophrenia a longitudinal study of swedish conscripts. Lancet 330:1483–1486

    Article  Google Scholar 

  3. 3.

    APA (2013) Diagnostic and statistical manual of mental disorders. APA, Washington, DC

    Google Scholar 

  4. 4.

    Baggio S, N’goran AA, Deline S, Studer J, Dupuis M, Henchoz Y, Mohler-Kuo M, Daeppen JB, Gmel G (2014) Patterns of cannabis use and prospective associations with health issues among young males. Addiction 109:937–945

    Article  PubMed  Google Scholar 

  5. 5.

    Bahorik AL, Leibowitz A, Sterling SA, Travis A, Weisner C, Satre DD (2017) Patterns of marijuana use among psychiatry patients with depression and its impact on recovery. J Affect Disord 213:168–171

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Barrus DG, Capogrossi KL, Cates SC, Gourdet CK, Peiper NC, Novak SP, Lefever TW, Wiley JL (2016) Tasty thc: promises and challenges of cannabis edibles. Methods report. RTI Press, Research Triangle

    Google Scholar 

  7. 7.

    Bergamaschi MM, Queiroz RHC, Chagas MHN, De Oliveira DCG, De Martinis BS, Kapczinski F, Quevedo J, Roesler R, Schröder N, Nardi AE (2011) Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naive social phobia patients. Neuropsychopharmacology 36:1219

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Boden MT, Babson KA, Vujanovic AA, Short NA, Bonn-Miller MO (2013) Posttraumatic stress disorder and cannabis use characteristics among military veterans with cannabis dependence. Am J Addict 22:277–284

    Article  PubMed  Google Scholar 

  9. 9.

    Boggs DL, Surti T, Gupta A, Gupta S, Niciu M, Pittman B, Martin AMS, Thurnauer H, Davies A, D’Souza DC (2018) The effects of cannabidiol (CBD) on cognition and symptoms in outpatients with chronic schizophrenia a randomized placebo controlled trial. Psychopharmacology 235:1923–1932

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Bonn-Miller MO, Babson KA, Vandrey R (2014) Using cannabis to help you sleep: Heightened frequency of medical cannabis use among those with ptsd. Drug Alcohol Depend 136:162–165

    Article  PubMed  Google Scholar 

  11. 11.

    Bonn-Miller MO, Boden MT, Bucossi MM, Babson KA (2014) Self-reported cannabis use characteristics, patterns and helpfulness among medical cannabis users. Am J Drug Alcohol Abuse 40:23–30

    Article  PubMed  Google Scholar 

  12. 12.

    Bossong MG, Jansma JM, van Hell HH, Jager G, Oudman E, Saliasi E, Kahn RS, Ramsey NF (2012) Effects of δ9-tetrahydrocannabinol on human working memory function. Biol Psychiatry 71:693–699

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Brown AS, Lau FS (2016) A review of the epidemiology of schizophrenia. In: Pletnikov MV, Waddington JL (eds) Modeling the psychopathological dimensions of schizophrenia: from molecules to behavior, vol 359. Academic Press, San Diego, pp 1555–1564

    Google Scholar 

  14. 14.

    Buckner JD, Schmidt NB, Lang AR, Small JW, Schlauch RC, Lewinsohn PM (2008) Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence. J Psychiatr Res 42:230–239

    Article  Google Scholar 

  15. 15.

    Buckner JD, Zvolensky MJ, Ecker AH, Jeffries ER (2016) Cannabis craving in response to laboratory-induced social stress among racially diverse cannabis users: the impact of social anxiety disorder. J Psychopharmacol 30:363–369

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Budney AJ, Hughes JR, Moore BA, Vandrey R (2004) Review of the validity and significance of cannabis withdrawal syndrome. Am J Psychiatry 161:1967–1977

    Article  PubMed  Google Scholar 

  17. 17.

    Bujarski SJ, Galang JN, Short NA, Trafton JA, Gifford EV, Kimerling R, Vujanovic AA, McKee LG, Bonn-Miller MO (2016) Cannabis use disorder treatment barriers and facilitators among veterans with ptsd. Psychol Addict Behav 30:73

    Article  PubMed  Google Scholar 

  18. 18.

    Cameron C, Watson D, Robinson J (2014) Use of a synthetic cannabinoid in a correctional population for posttraumatic stress disorder-related insomnia and nightmares, chronic pain, harm reduction, and other indications: a retrospective evaluation. J Clin Psychopharmacol 34:559

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Government of Canada (2017) Canadian cannabis survey 2017—summary. https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/canadian-cannabissurvey-2017-summary.html. Accessed 10 June 2018

  20. 20.

    Carey CE, Agrawal A, Bucholz KK, Hartz SM, Lynskey MT, Nelson EC, Bierut LJ, Bogdan R (2016) Associations between polygenic risk for psychiatric disorders and substance involvement. Front Genet 7:149

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Chambers RA, Krystal JH, Self DW (2001) A neurobiological basis for substance abuse comorbidity in schizophrenia. Biol Psychiatry 50:71–83

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Charilaou P, Agnihotri K, Garcia P, Badheka A, Frenia D, Yegneswaran B (2017) Trends of cannabis use disorder in the inpatient: 2002 to 2011. Am J Med 130:678.e677–687.e677

    Article  Google Scholar 

  23. 23.

    Compton WM, Han B, Jones CM, Blanco C, Hughes A (2016) Marijuana use and use disorders in adults in the USA, 2002–14: analysis of annual cross-sectional surveys. Lancet Psychiatry 3:954–964

    Article  PubMed  Google Scholar 

  24. 24.

    Conway KP, Swendsen J, Husky MM, He J-P, Merikangas KR (2016) Association of lifetime mental disorders and subsequent alcohol and illicit drug use: results from the national comorbidity survey–adolescent supplement. J Am Acad Child Adolesc Psychiatry 55:280–288

    Article  PubMed  Google Scholar 

  25. 25.

    Copeland J, Rooke S, Swift W (2013) Changes in cannabis use among young people: impact on mental health. Curr Opin Psychiatry 26:325–329

    Article  PubMed  Google Scholar 

  26. 26.

    Cougle JR, Bonn-Miller MO, Vujanovic AA, Zvolensky MJ, Hawkins KA (2011) Posttraumatic stress disorder and cannabis use in a nationally representative sample. Psychol Addict Behav 25:554

    Article  PubMed  Google Scholar 

  27. 27.

    Cougle JR, Hakes JK, Macatee RJ, Chavarria J, Zvolensky MJ (2015) Quality of life and risk of psychiatric disorders among regular users of alcohol, nicotine, and cannabis: an analysis of the national epidemiological survey on alcohol and related conditions (nesarc). J Psychiatr Res 66:135–141

    Article  PubMed  Google Scholar 

  28. 28.

    Crean RD, Crane NA, Mason BJ (2011) An evidence based review of acute and long-term effects of cannabis use on executive cognitive functions. J Addict Med 5:1

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Crippa JA, Guimarães FS, Campos AC, Zuardi AW (2018) Translational investigation of the therapeutic potential of cannabidiol (cbd): toward a new age. Front Immunol. https://doi.org/10.3389/fimmu.2018.02009

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Curran H, Morgan C (2014) Desired and undesired effects of cannabis on the human mind and psychological well-being. Handbook of cannabis. Oxford University Press, Oxford, pp 647–660

    Google Scholar 

  31. 31.

    Curran HV, Freeman TP, Mokrysz C, Lewis DA, Morgan CJ, Parsons LH (2016) Keep off the grass? Cannabis, cognition and addiction. Nat Rev Neurosci 17:293

    Article  CAS  Google Scholar 

  32. 32.

    D’Souza DC, Perry E, MacDougall L, Ammerman Y, Cooper T, Braley G, Gueorguieva R, Krystal JH (2004) The psychotomimetic effects of intravenous delta-9-tetrahydrocannabinol in healthy individuals: Implications for psychosis. Neuropsychopharmacology 29:1558

    Article  CAS  PubMed  Google Scholar 

  33. 33.

    D’Souza DC, Abi-Saab WM, Madonick S, Forselius-Bielen K, Doersch A, Braley G, Gueorguieva R, Cooper TB, Krystal JH (2005) Delta-9-tetrahydrocannabinol effects in schizophrenia: implications for cognition, psychosis, and addiction. Biol Psychiatry 57:594–608

    Article  CAS  Google Scholar 

  34. 34.

    Danielsson A-K, Lundin A, Agardh E, Allebeck P, Forsell Y (2016) Cannabis use, depression and anxiety: a 3-year prospective population-based study. J Affect Disord 193:103–108

    Article  CAS  PubMed  Google Scholar 

  35. 35.

    Davis GP, Compton MT, Wang S, Levin FR, Blanco C (2013) Association between cannabis use, psychosis, and schizotypal personality disorder: findings from the national epidemiologic survey on alcohol and related conditions. Schizophr Res 151:197–202

    Article  Google Scholar 

  36. 36.

    Degenhardt L, Coffey C, Romaniuk H, Swift W, Carlin JB, Hall WD, Patton GC (2013) The persistence of the association between adolescent cannabis use and common mental disorders into young adulthood. Addiction 108:124–133

    Article  PubMed  Google Scholar 

  37. 37.

    Degenhardt L, Hall W, Lynskey M (2001) The relationship between cannabis use, depression and anxiety among australian adults: findings from the national survey of mental health and well-being. Soc Psychiatry Psychiatr Epidemiol 36:219–227

    Article  CAS  PubMed  Google Scholar 

  38. 38.

    Di Forti M, Marconi A, Carra E, Fraietta S, Trotta A, Bonomo M, Bianconi F, Gardner-Sood P, O’Connor J, Russo M (2015) Proportion of patients in south london with first-episode psychosis attributable to use of high potency cannabis: a case-control study. Lancet Psychiatry 2:233–238

    Article  Google Scholar 

  39. 39.

    Di Forti M, Morgan C, Dazzan P, Pariante C, Mondelli V, Marques TR, Handley R, Luzi S, Russo M, Paparelli A (2009) High-potency cannabis and the risk of psychosis. Br J Psychiatry 195:488–491

    Article  PubMed  PubMed Central  Google Scholar 

  40. 40.

    Di Forti M, Sallis H, Allegri F, Trotta A, Ferraro L, Stilo SA, Marconi A, La Cascia C, Reis Marques T, Pariante C (2013) Daily use, especially of high-potency cannabis, drives the earlier onset of psychosis in cannabis users. Schizophr Bull 40:1509–1517

    Article  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Dorard G, Berthoz S, Phan O, Corcos M, Bungener C (2008) Affect dysregulation in cannabis abusers. Eur Child Adolesc Psychiatry 17:274–282

    Article  PubMed  Google Scholar 

  42. 42.

    Duperrouzel J, Hawes SW, Lopez-Quintero C, Pacheco-Colón I, Comer J, Gonzalez R (2018) The association between adolescent cannabis use and anxiety: a parallel process analysis. Addict Behav 78:107–113

    Article  PubMed  Google Scholar 

  43. 43.

    Dworkin ER, Kaysen D, Bedard-Gilligan M, Rhew IC, Lee CM (2017) Daily-level associations between ptsd and cannabis use among young sexual minority women. Addict Behav 74:118–121

    Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Earleywine M, Barnwell SS (2007) Decreased respiratory symptoms in cannabis users who vaporize. Harm Reduct J 4:11

    Article  PubMed  PubMed Central  Google Scholar 

  45. 45.

    Earleywine M, Bolles JR (2014) Marijuana, expectancies, and post-traumatic stress symptoms: a preliminary investigation. J Psychoact Drugs 46:171–177

    Article  Google Scholar 

  46. 46.

    Earleywine M, Van Dam NT (2010) Case studies in cannabis vaporization. Addict Res Theory 18:243–249

    Article  Google Scholar 

  47. 47.

    ElSohly MA (2014) Potency monitoring program quarterly report no. 123—reporting period: 09/16/2013–12/15/2013. In: University of Missippi, National Center for Natural Products Research, Oxford, MS

  48. 48.

    ElSohly MA, Mehmedic Z, Foster S, Gon C, Chandra S, Church JC (2016) Changes in cannabis potency over the last 2 decades (1995–2014): Analysis of current data in the united states. Biol Psychiatry 79:613–619

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. 49.

    Ersche KD, Williams GB, Robbins TW, Bullmore ET (2013) Meta-analysis of structural brain abnormalities associated with stimulant drug dependence and neuroimaging of addiction vulnerability and resilience. Curr Opin Neurobiol 23:615–624

    Article  CAS  PubMed  Google Scholar 

  50. 50.

    Feingold D, Weiser M, Rehm J, Lev-Ran S (2016) The association between cannabis use and anxiety disorders: results from a population-based representative sample. Eur Neuropsychopharmacol 26:493–505

    Article  CAS  PubMed  Google Scholar 

  51. 51.

    Feingold D, Weiser M, Rehm J, Lev-Ran S (2015) The association between cannabis use and mood disorders: a longitudinal study. J Affect Disord 172:211–218

    Article  Google Scholar 

  52. 52.

    Fergusson DM, Boden JM, Horwood LJ (2006) Cannabis use and other illicit drug use: testing the cannabis gateway hypothesis. Addiction 101:556–569

    Article  PubMed  Google Scholar 

  53. 53.

    Flórez-Salamanca L, Secades-Villa R, Budney AJ, García-Rodríguez O, Wang S, Blanco C (2013) Probability and predictors of cannabis use disorders relapse: results of the national epidemiologic survey on alcohol and related conditions (nesarc). Drug Alcohol Depend 132:127–133

    Article  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Foti DJ, Kotov R, Guey LT, Bromet EJ (2010) Cannabis use and the course of schizophrenia: 10-year follow-up after first hospitalization. Am J Psychiatry 167:987–993

    Article  PubMed  PubMed Central  Google Scholar 

  55. 55.

    Frank B, Serpell M, Hughes J, Matthews J, Kapur D (2008) Comparison of analgesic effects and patient tolerability of nabilone and dihydrocodeine for chronic neuropathic pain: randomised, crossover, double blind study. BMJ 336:199–201

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. 56.

    Fraser GA (2009) The use of a synthetic cannabinoid in the management of treatment-resistant nightmares in posttraumatic stress disorder (ptsd). CNS Neurosci Ther 15:84–88

    Article  PubMed  PubMed Central  Google Scholar 

  57. 57.

    Gage SH, Hickman M, Heron J, Munafò MR, Lewis G, Macleod J, Zammit S (2015) Associations of cannabis and cigarette use with depression and anxiety at age 18: findings from the avon longitudinal study of parents and children. PLoS One 10:e0122896

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. 58.

    Galvez-Buccollini JA, Proal AC, Tomaselli V, Trachtenberg M, Coconcea C, Chun J, Manschreck T, Fleming J, Delisi LE (2012) Association between age at onset of psychosis and age at onset of cannabis use in non-affective psychosis. Schizophr Res 139:157–160

    Article  PubMed  PubMed Central  Google Scholar 

  59. 59.

    George TP, Hill KP, Vaccarino FJ (2018) Cannabis legalization and psychiatric disorders: Caveat “hemp-tor”. Can J Psychiatry 63:447–450

    Article  PubMed  PubMed Central  Google Scholar 

  60. 60.

    Gieringer D, St. Laurent J, Goodrich S (2004) Cannabis vaporizer combines efficient delivery of thc with effective suppression of pyrolytic compounds. J Cannabis Ther 4:7–27

    Article  CAS  Google Scholar 

  61. 61.

    Giordano GN, Ohlsson H, Sundquist K, Sundquist J, Kendler K (2015) The association between cannabis abuse and subsequent schizophrenia: a swedish national co-relative control study. Psychol Med 45:407–414

    Article  CAS  PubMed  Google Scholar 

  62. 62.

    Grant S, Pedersen ER, Neighbors C (2016) Associations of posttraumatic stress disorder symptoms with marijuana and synthetic cannabis use among young adult us veterans: a pilot investigation. J Stud Alcohol Drugs 77:509–514

    Article  PubMed  PubMed Central  Google Scholar 

  63. 63.

    Green B, Kavanagh D, Young R (2003) Being stoned: a review of self-reported cannabis effects. Drug Alcohol Rev 22:453–460

    Article  PubMed  Google Scholar 

  64. 64.

    Greer GR, Grob CS, Halberstadt AL (2014) Ptsd symptom reports of patients evaluated for the new mexico medical cannabis program. J Psychoact Drugs 46:73–77

    Article  Google Scholar 

  65. 65.

    Guttmannova K, Kosterman R, White HR, Bailey JA, Lee JO, Epstein M, Jones TM, Hawkins JD (2017) The association between regular marijuana use and adult mental health outcomes. Drug Alcohol Depend 179:109–116

    Article  PubMed  PubMed Central  Google Scholar 

  66. 66.

    Hall W, Weier M (2015) Assessing the public health impacts of legalizing recreational cannabis use in the USA. Clin Pharmacol Ther 97:607–615

    Article  CAS  PubMed  Google Scholar 

  67. 67.

    Hasin DS, Kerridge BT, Saha TD, Huang B, Pickering R, Smith SM, Jung J, Zhang H, Grant BF (2016) Prevalence and correlates of dsm-5 cannabis use disorder, 2012–2013: findings from the national epidemiologic survey on alcohol and related conditions–iii. Am J Psychiatry 173:588–599

    Article  PubMed  PubMed Central  Google Scholar 

  68. 68.

    Hayatbakhsh MR, Najman JM, Jamrozik K, Mamun AA, Alati R, Bor W (2007) Cannabis and anxiety and depression in young adults: a large prospective study. J Am Acad Child Adolesc Psychiatry 46:408–417

    Article  PubMed  Google Scholar 

  69. 69.

    Helle S, Ringen PA, Melle I, Larsen T-K, Gjestad R, Johnsen E, Lagerberg TV, Andreassen OA, Kroken RA, Joa I (2016) Cannabis use is associated with 3 years earlier onset of schizophrenia spectrum disorder in a naturalistic, multi-site sample (n = 1119). Schizophr Res 170:217–221

    Article  PubMed  Google Scholar 

  70. 70.

    Hill KP (2015) Marijuana: the unbiased truth about the world’s most popular weed. Simon and Schuster, New York

    Google Scholar 

  71. 71.

    Hill KP (2015) Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review. JAMA 313:2474–2483

    Article  CAS  PubMed  Google Scholar 

  72. 72.

    Hjorthøj C, Østergaard MLD, Benros ME, Toftdahl NG, Erlangsen A, Andersen JT, Nordentoft M (2015) Association between alcohol and substance use disorders and all-cause and cause-specific mortality in schizophrenia, bipolar disorder, and unipolar depression: a nationwide, prospective, register-based study. Lancet Psychiatry 2:801–808

    Article  PubMed  Google Scholar 

  73. 73.

    Hodgson K, Almasy L, Knowles EE, Kent JW, Curran JE, Dyer TD, Göring HH, Olvera RL, Woolsey MD, Duggirala R (2017) The genetic basis of the comorbidity between cannabis use and major depression. Addiction 112:113–123

    Article  PubMed  Google Scholar 

  74. 74.

    Horwood LJ, Fergusson DM, Coffey C, Patton GC, Tait R, Smart D, Letcher P, Silins E, Hutchinson DM (2012) Cannabis and depression: an integrative data analysis of four australasian cohorts. Drug Alcohol Depend 126:369–378

    Article  Google Scholar 

  75. 75.

    Iseger TA, Bossong MG (2015) A systematic review of the antipsychotic properties of cannabidiol in humans. Schizophr Res 162:153–161

    Article  PubMed  Google Scholar 

  76. 76.

    Jetly R, Heber A, Fraser G, Boisvert D (2015) The efficacy of nabilone, a synthetic cannabinoid, in the treatment of ptsd-associated nightmares: a preliminary randomized, double-blind, placebo-controlled cross-over design study. Psychoneuroendocrinology 51:585–588

    Article  CAS  PubMed  Google Scholar 

  77. 77.

    Johns A (2001) Psychiatric effects of cannabis. Br J Psychiatry 178:116–122

    Article  CAS  PubMed  Google Scholar 

  78. 78.

    Johnson MJ, Pierce JD, Mavandadi S, Klaus J, Defelice D, Ingram E, Oslin DW (2016) Mental health symptom severity in cannabis using and non-using veterans with probable ptsd. J Affect Disord 190:439–442

    Article  PubMed  Google Scholar 

  79. 79.

    Kelley ME, Wan CR, Broussard B, Crisafio A, Cristofaro S, Johnson S, Reed TA, Amar P, Kaslow NJ, Walker EF (2016) Marijuana use in the immediate 5-year premorbid period is associated with increased risk of onset of schizophrenia and related psychotic disorders. Schizophr Res 171:62–67

    Article  PubMed  PubMed Central  Google Scholar 

  80. 80.

    Kessler RC (2004) The epidemiology of dual diagnosis. Biol Psychiatry 56:730–737

    Article  PubMed  Google Scholar 

  81. 81.

    Kevorkian S, Bonn-Miller MO, Belendiuk K, Carney DM, Roberson-Nay R, Berenz EC (2015) Associations among trauma, posttraumatic stress disorder, cannabis use, and cannabis use disorder in a nationally representative epidemiologic sample. Psychol Addict Behav 29:633

    Article  PubMed  PubMed Central  Google Scholar 

  82. 82.

    Khantzian EJ (2012) Reflections on treating addictive disorders: a psychodynamic perspective. Am J Addict 21:274–279

    Article  PubMed  Google Scholar 

  83. 83.

    Khantzian EJ (1997) The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harv Rev Psychiatry 4:231–244

    Article  CAS  Google Scholar 

  84. 84.

    Kim S-W, Dodd S, Berk L, Kulkarni J, de Castella A, Fitzgerald PB, Kim J-M, Yoon J-S, Berk M (2015) Impact of cannabis use on long-term remission in bipolar i and schizoaffective disorder. Psychiatry Investig 12:349–355

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  85. 85.

    Koob GF, Le Moal M (2001) Drug addiction, dysregulation of reward, and allostasis. Neuropsychopharmacology 24:97

    Article  CAS  Google Scholar 

  86. 86.

    Koob GF, Volkow ND (2016) Neurobiology of addiction: a neurocircuitry analysis. Lancet Psychiatry 3:760–773

    Article  PubMed  PubMed Central  Google Scholar 

  87. 87.

    Koskinen J, Löhönen J, Koponen H, Isohanni M, Miettunen J (2009) Rate of cannabis use disorders in clinical samples of patients with schizophrenia: a meta-analysis. Schizophr Bull 36:1115–1130

    Article  PubMed  PubMed Central  Google Scholar 

  88. 88.

    Large M, Sharma S, Compton MT, Slade T, Nielssen O (2011) Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Arch Gen Psychiatry 68:555–561

    Article  PubMed  Google Scholar 

  89. 89.

    Lee JY, Brook JS, Finch SJ, Brook DW (2018) Trajectories of cannabis use beginning in adolescence associated with symptoms of posttraumatic stress disorder in the mid-thirties. Subst Abuse 39:39–45

    Article  Google Scholar 

  90. 90.

    Lev-Ran S, Le Foll B, McKenzie K, George TP, Rehm J (2013) Cannabis use and cannabis use disorders among individuals with mental illness. Compr Psychiatry 54:589–598

    Article  PubMed  Google Scholar 

  91. 91.

    Leweke F, Piomelli D, Pahlisch F, Muhl D, Gerth C, Hoyer C, Klosterkötter J, Hellmich M, Koethe D (2012) Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Transl Psychiatry 2:e94

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. 92.

    Loflin M, Earleywine M (2014) A new method of cannabis ingestion: the dangers of dabs? Addict Behav 39:1430–1433

    Article  PubMed  Google Scholar 

  93. 93.

    Lopez-Quintero C, de los Cobos JP, Hasin DS, Okuda M, Wang S, Grant BF, Blanco C (2011) Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the national epidemiologic survey on alcohol and related conditions (nesarc). Drug Alcohol Depend 115:120–130

    Article  Google Scholar 

  94. 94.

    Lynskey M, Hall W (2000) The effects of adolescent cannabis use on educational attainment: a review. Addiction 95:1621–1630

    Article  CAS  PubMed  Google Scholar 

  95. 95.

    Ma M, Coles AS, George TP (2018) Understanding and treating co-occurring bipolar disorder and substance use disorders. Psychiatric Times 35:8–9

    Google Scholar 

  96. 96.

    Manhapra A, Stefanovics E, Rosenheck R (2015) Treatment outcomes for veterans with ptsd and substance use: impact of specific substances and achievement of abstinence. Drug Alcohol Depend 156:70–77

    Article  PubMed  PubMed Central  Google Scholar 

  97. 97.

    Manrique-Garcia E, Zammit S, Dalman C, Hemmingsson T, Andreasson S, Allebeck P (2014) Prognosis of schizophrenia in persons with and without a history of cannabis use. Psychol Med 44:2513–2521

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. 98.

    Marconi A, Di Forti M, Lewis CM, Murray RM, Vassos E (2016) Meta-analysis of the association between the level of cannabis use and risk of psychosis. Schizophr Bull 42:1262–1269

    Article  PubMed  PubMed Central  Google Scholar 

  99. 99.

    McGuire P, Robson P, Cubala WJ, Vasile D, Morrison PD, Barron R, Taylor A, Wright S (2017) Cannabidiol (cbd) as an adjunctive therapy in schizophrenia: a multicenter randomized controlled trial. Am J Psychiatry 175:225–231

    Article  PubMed  Google Scholar 

  100. 100.

    McGuire P, Robson P, Cubala WJ, Vasile D, Morrison PD et al (2018) Cannabidiol (cbd) as an adjunctive therapy in schizophrenia: a multicenter randomized controlled trial. Am J Psychiatry 175:225–231

    Article  PubMed  Google Scholar 

  101. 101.

    Meier MH, Caspi A, Ambler A, Harrington H, Houts R, Keefe RS, McDonald K, Ward A, Poulton R, Moffitt TE (2012) Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl Acad Sci. https://doi.org/10.1073/nas.1206820109

    Article  PubMed  Google Scholar 

  102. 102.

    Metrik J, Bassett SS, Aston ER, Jackson KM, Borsari B (2018) Medicinal versus recreational cannabis use among returning veterans. Transl Issues Psychol Sci 4:6

    Article  PubMed  PubMed Central  Google Scholar 

  103. 103.

    Metrik J, Jackson K, Bassett SS, Zvolensky MJ, Seal K, Borsari B (2016) The mediating roles of coping, sleep, and anxiety motives in cannabis use and problems among returning veterans with ptsd and mdd. Psychol Addict Behav 30:743

    Article  PubMed  PubMed Central  Google Scholar 

  104. 104.

    Moitra E, Anderson BJ, Stein MD (2016) Reductions in cannabis use are associated with mood improvement in female emerging adults. Depression Anxiety 33:332–338

    Article  PubMed  Google Scholar 

  105. 105.

    Morrison P, Zois V, McKeown D, Lee T, Holt D, Powell J, Kapur S, Murray R (2009) The acute effects of synthetic intravenous δ9-tetrahydrocannabinol on psychosis, mood and cognitive functioning. Psychol Med 39:1607–1616

    Article  CAS  PubMed  Google Scholar 

  106. 106.

    Narang S, Gibson D, Wasan AD, Ross EL, Michna E, Nedeljkovic SS, Jamison RN (2008) Efficacy of dronabinol as an adjuvant treatment for chronic pain patients on opioid therapy. J Pain 9:254–264

    Article  CAS  Google Scholar 

  107. 107.

    National Academies of Sciences E, Medicine (2017) The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. National Academies Press, Washington, DC

    Google Scholar 

  108. 108.

    Nunberg H, Kilmer B, Pacula RL, Burgdorf JR (2011) An analysis of applicants presenting to a medical marijuana specialty practice in california. J Drug Policy Anal. https://doi.org/10.2202/1941-2851.1017

    Article  PubMed  PubMed Central  Google Scholar 

  109. 109.

    Østergaard ML, Nordentoft M, Hjorthøj C (2017) Associations between substance use disorders and suicide or suicide attempts in people with mental illness: a danish nation-wide, prospective, register-based study of patients diagnosed with schizophrenia, bipolar disorder, unipolar depression or personality disorder. Addiction 112:1250–1259

    Article  PubMed  Google Scholar 

  110. 110.

    Parsons LH, Hurd YL (2015) Endocannabinoid signalling in reward and addiction. Nat Rev Neurosci 16:579

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  111. 111.

    Patel R, Wilson R, Jackson R, Ball M, Shetty H, Broadbent M, Stewart R, McGuire P, Bhattacharyya S (2015) Cannabis use and treatment resistance in first episode psychosis: a natural language processing study. Lancet 385:S79

    Article  PubMed  Google Scholar 

  112. 112.

    Piontek D, Kraus L, Bjarnason T, Demetrovics Z, Ramstedt M (2013) Individual and country-level effects of cannabis-related perceptions on cannabis use. A multilevel study among adolescents in 32 european countries. J Adolesc Health 52:473–479

    Article  PubMed  Google Scholar 

  113. 113.

    Quello SB, Brady KT, Sonne SC (2005) Mood disorders and substance use disorder: a complex comorbidity. Sci Pract Perspect 3:13

    Article  PubMed  PubMed Central  Google Scholar 

  114. 114.

    Rabin RA, Barr MS, Goodman MS, Herman Y, Zakzanis KK, Kish SJ, Kiang M, Remington G, George TP (2017) Effects of extended cannabis abstinence on cognitive outcomes in cannabis dependent patients with schizophrenia vs non-psychiatric controls. Neuropsychopharmacology 42:2259–2271

    Article  PubMed  PubMed Central  Google Scholar 

  115. 115.

    Rabin RA, Kozak K, Zakzanis KK, Remington G, George TP (2018) Effects of extended cannabis abstinence on clinical symptoms in cannabis dependent schizophrenia patients versus non-psychiatric controls. Schizophr Res 194:55–61

    Article  PubMed  Google Scholar 

  116. 116.

    Rabin RA, Zakzanis KK, Daskalakis ZJ, George TP (2013) Effects of cannabis use status on cognitive function, in males with schizophrenia. Psychiatry Res 206:158–165

    Article  CAS  PubMed  Google Scholar 

  117. 117.

    RachBeisel J, Scott J, Dixon L (1999) Co-occurring severe mental illness and substance use disorders: a review of recent research. Psychiatr Serv 50:1427–1434

    Article  CAS  PubMed  Google Scholar 

  118. 118.

    Rasic D, Weerasinghe S, Asbridge M, Langille DB (2013) Longitudinal associations of cannabis and illicit drug use with depression, suicidal ideation and suicidal attempts among nova scotia high school students. Drug Alcohol Depend 129:49–53

    Article  PubMed  Google Scholar 

  119. 119.

    Ratheesh A, Cotton SM, Betts JK, Chanen A, Nelson B, Davey CG, McGorry PD, Berk M, Bechdolf A (2015) Prospective progression from high-prevalence disorders to bipolar disorder: exploring characteristics of pre-illness stages. J Affect Disord 183:45–48

    Article  PubMed  Google Scholar 

  120. 120.

    Reinarman C, Nunberg H, Lanthier F, Heddleston T (2011) Who are medical marijuana patients? Population characteristics from nine california assessment clinics. J Psychoact Drugs 43:128–135

    Article  Google Scholar 

  121. 121.

    Richter KP, Levy S (2014) Big marijuana—lessons from big tobacco. N Engl J Med 371:399–401

    Article  CAS  PubMed  Google Scholar 

  122. 122.

    Roitman P, Mechoulam R, Cooper-Kazaz R, Shalev A (2014) Preliminary, open-label, pilot study of add-on oral δ 9-tetrahydrocannabinol in chronic post-traumatic stress disorder. Clin Drug Investig 34:587–591

    Article  CAS  PubMed  Google Scholar 

  123. 123.

    Rotermann M, Langlois K (2015) Prevalence and correlates of marijuana use in canada, 2012. Statistics Canada Ottawa, Ontario

    Google Scholar 

  124. 124.

    Sagar KA, Dahlgren MK, Racine MT, Dreman MW, Olson DP, Gruber SA (2016) Joint effects: a pilot investigation of the impact of bipolar disorder and marijuana use on cognitive function and mood. PLoS One 11:e0157060

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  125. 125.

    Sami MB, Rabiner EA, Bhattacharyya S (2015) Does cannabis affect dopaminergic signaling in the human brain? A systematic review of evidence to date. Eur Neuropsychopharmacol 25:1201–1224

    Article  CAS  PubMed  Google Scholar 

  126. 126.

    Schoeler T, Monk A, Sami MB, Klamerus E, Foglia E, Brown R, Camuri G, Altamura AC, Murray R, Bhattacharyya S (2016) Continued versus discontinued cannabis use in patients with psychosis: a systematic review and meta-analysis. Lancet Psychiatry 3:215–225

    Article  PubMed  Google Scholar 

  127. 127.

    Schoeler T, Theobald D, Pingault J-B, Farrington DP, Coid JW, Bhattacharyya S (2018) Developmental sensitivity to cannabis use patterns and risk for major depressive disorder in mid-life: findings from 40 years of follow-up. Psychological Med 48(13):2169–2176

    Article  Google Scholar 

  128. 128.

    Scholes-Balog KE, Hemphill SA, Evans-Whipp TJ, Toumbourou JW, Patton GC (2016) Developmental trajectories of adolescent cannabis use and their relationship to young adult social and behavioural adjustment: a longitudinal study of australian youth. Addict Behav 53:11–18

    Article  PubMed  Google Scholar 

  129. 129.

    Schuckit MA (2006) Comorbidity between substance use disorders and psychiatric conditions. Addiction 101:76–88

    Article  PubMed  Google Scholar 

  130. 130.

    Schuermeyer J, Salomonsen-Sautel S, Price RK, Balan S, Thurstone C, Min S-J, Sakai JT (2014) Temporal trends in marijuana attitudes, availability and use in colorado compared to non-medical marijuana states: 2003–11. Drug Alcohol Depend 140:145–155

    Article  PubMed  PubMed Central  Google Scholar 

  131. 131.

    Sexton M, Cuttler C, Finnell JS, Mischley LK (2016) A cross-sectional survey of medical cannabis users: patterns of use and perceived efficacy. Cannabis Cannabinoid Res 1:131–138

    Article  PubMed  PubMed Central  Google Scholar 

  132. 132.

    Sherva R, Wang Q, Kranzler H, Zhao H, Koesterer R, Herman A, Farrer LA, Gelernter J (2016) Genome-wide association study of cannabis dependence severity, novel risk variants, and shared genetic risks. JAMA Psychiatry 73:472–480

    Article  PubMed  PubMed Central  Google Scholar 

  133. 133.

    Skrabek RQ, Galimova L, Ethans K, Perry D (2008) Nabilone for the treatment of pain in fibromyalgia. J Pain 9:164–173

    Article  CAS  Google Scholar 

  134. 134.

    Solowij N, Stephens RS, Roffman RA, Babor T, Kadden R, Miller M, Christiansen K, McRee B, Vendetti J (2002) Cognitive functioning of long-term heavy cannabis users seeking treatment. JAMA 287:1123–1131

    Article  PubMed  Google Scholar 

  135. 135.

    Strakowski SM, DelBello MP, Fleck DE, Adler CM, Anthenelli RM, Keck PE, Arnold LM, Amicone J (2007) Effects of co-occurring cannabis use disorders on the course of bipolar disorder after a first hospitalization for mania. Arch Gen Psychiatry 64:57–64

    Article  Google Scholar 

  136. 136.

    Swendsen J, Conway KP, Degenhardt L, Glantz M, Jin R, Merikangas KR, Sampson N, Kessler RC (2010) Mental disorders as risk factors for substance use, abuse and dependence: results from the 10-year follow-up of the national comorbidity survey. Addiction 105:1117–1128

    Article  PubMed  PubMed Central  Google Scholar 

  137. 137.

    Swendsen JD, Merikangas KR (2000) The comorbidity of depression and substance use disorders. Clin Psychol Rev 20:173–189

    Article  CAS  PubMed  Google Scholar 

  138. 138.

    Tournier M, Sorbara F, Gindre C, Swendsen JD, Verdoux H (2003) Cannabis use and anxiety in daily life: a naturalistic investigation in a non-clinical population. Psychiatry Res 118:1–8

    Article  PubMed  Google Scholar 

  139. 139.

    Tull MT, McDermott MJ, Gratz KL (2016) Marijuana dependence moderates the effect of posttraumatic stress disorder on trauma cue reactivity in substance dependent patients. Drug Alcohol Depend 159:219–226

    Article  PubMed  Google Scholar 

  140. 140.

    Van Dam NT, Bedi G, Earleywine M (2012) Characteristics of clinically anxious versus non-anxious regular, heavy marijuana users. Addict Behav 37:1217–1223

    Article  PubMed  Google Scholar 

  141. 141.

    van der Pol P, Liebregts N, de Graaf R, ten Have M, Korf DJ, van den Brink W, van Laar M (2013) Mental health differences between frequent cannabis users with and without dependence and the general population. Addiction 108:1459–1469

    Article  PubMed  Google Scholar 

  142. 142.

    Van Laar M, Van Dorsselaer S, Monshouwer K, De Graaf R (2007) Does cannabis use predict the first incidence of mood and anxiety disorders in the adult population? Addiction 102:1251–1260

    Article  PubMed  Google Scholar 

  143. 143.

    Van Os J, Bak M, Hanssen M, Bijl R, De Graaf R, Verdoux H (2002) Cannabis use and psychosis: a longitudinal population-based study. Am J Epidemiol 156:319–327

    Article  PubMed  Google Scholar 

  144. 144.

    Vandermeeren R, Hebbrecht M (2012) The dual process model of addiction. towards an integrated model? Tijdschrift voor psychiatrie 54:731–740

    CAS  PubMed  Google Scholar 

  145. 145.

    Vandrey R, Raber JC, Raber ME, Douglass B, Miller C, Bonn-Miller MO (2015) Cannabinoid dose and label accuracy in edible medical cannabis products. JAMA 313:2491–2493

    Article  CAS  Google Scholar 

  146. 146.

    Villagonzalo K-A, Dodd S, Ng F, Mihaly S, Langbein A, Berk M (2011) The relationship between substance use and posttraumatic stress disorder in a methadone maintenance treatment program. Compr Psychiatry 52:562–566

    Article  PubMed  Google Scholar 

  147. 147.

    Volkow ND, Baler RD, Compton WM, Weiss SR (2014) Adverse health effects of marijuana use. N Engl J Med 370:2219–2227

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  148. 148.

    Volkow ND, Li T-K (2004) Drug addiction: the neurobiology of behaviour gone awry. Nat Rev Neurosci 5:963

    Article  CAS  PubMed  Google Scholar 

  149. 149.

    Walsh Z, Callaway R, Belle-Isle L, Capler R, Kay R, Lucas P, Holtzman S (2013) Cannabis for therapeutic purposes: patient characteristics, access, and reasons for use. Int J Drug Policy 24:511–516

    Article  PubMed  Google Scholar 

  150. 150.

    Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, Keurentjes JC, Lang S, Misso K, Ryder S (2015) Cannabinoids for medical use: a systematic review and meta-analysis. JAMA 313:2456–2473

    Article  CAS  Google Scholar 

  151. 151.

    Wilkinson ST, Stefanovics E, Rosenheck RA (2015) Marijuana use is associated with worse outcomes in symptom severity and violent behavior in patients with posttraumatic stress disorder. J Clin Psychiatry 76:1174–1180

    Article  PubMed  PubMed Central  Google Scholar 

  152. 152.

    Wise RA, Koob GF (2014) The development and maintenance of drug addiction. Neuropsychopharmacology 39:254

    Article  PubMed  Google Scholar 

  153. 153.

    Zorrilla I, Aguado J, Haro J, Barbeito S, Lopez Zurbano S, Ortiz A, Lopez P, Gonzalez-Pinto A (2015) Cannabis and bipolar disorder: does quitting cannabis use during manic/mixed episode improve clinical/functional outcomes? Acta Psychiatr Scand 131:100–110

    Article  CAS  PubMed  Google Scholar 

  154. 154.

    Zvolensky MJ, Lewinsohn P, Bernstein A, Schmidt NB, Buckner JD, Seeley J, Bonn-Miller MO (2008) Prospective associations between cannabis use, abuse, and dependence and panic attacks and disorder. J Psychiatr Res 42:1017–1023

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Tony P. George.

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Ms. Lowe, Ms. Coles, and Ms. Sasiadek have no conflicts of interest in relation to this manuscript. Dr. George has been a consultant to NIH and the Canadian Centre for Substance Abuse, and has grant support from the Canadian Institute of Health Research (MOP-115145) and the National Institute on Drug Abuse (R21-DA-043949).

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Lowe, D.J.E., Sasiadek, J.D., Coles, A.S. et al. Cannabis and mental illness: a review. Eur Arch Psychiatry Clin Neurosci 269, 107–120 (2019). https://doi.org/10.1007/s00406-018-0970-7

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Keywords

  • Cannabis
  • Addiction
  • Therapeutics
  • Harms
  • Schizophrenia
  • Mood disorders
  • Anxiety disorders
  • Post-traumatic stress disorder
  • Legalization