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In discussions about cannabis and especially cannabis legalization, one question is asked again and again: Does cannabis lead to psychosis disorders? The answers are often unclear, different or even contradictory. We are trying to provide some clarity. However, there are no absolute truths to be read here either, as these hardly exist as things stand today.
The known connections
A link between psychosis and cannabis has been demonstrated in several studies. [1] In studied groups of patients with schizophrenic psychosis, cannabis use was more common than in society as a whole, and conversely, cannabis users developed psychotic disorders more often and earlier. To deny this connection per se would be absurd in view of the available data. To what extent the cannabis plant should be demonized because of this, however, is another question – more about that later…
Special risk of psychosis disease for young people
The process of brain maturation in humans lasts until the early 20s. Thus, young adults continue to live with an unfinished brain for a long time. If substances such as alcohol or cannabis are consumed during this time, it also seems to have an impact on brain development. For example, there is a correlation between regular cannabis use by adolescents and the thickness of the cerebral cortex. (Those areas of the brain that have high numbers of CB1 receptors are particularly affected).
With regard to psychosis, it can be stated that consumption at a young age, in particular, is a determining factor in the frequency and timing of psychosis. [2] While cannabis use is hardly the sole culprit, it is definitely one factor among others.
Influence of THC content on the risk of psychosis
Meanwhile, the studies also identified some factors that make consumption particularly risky. Besides the frequency or the amount consumed, the potency, i.e. the THC content, of the cannabis plant plays an important role. Higher THC levels appear to increase the likelihood of psychosis. From this perspective, the massive increase in THC content in recent decades must be viewed at least critically. In 1993, cannabis seized in the U.S. had an average of 3.4% THC. In 2008, this figure was 8.8% and at 17.7% in 2017, the figure has doubled again in just 10 years. [3] At the same time, such high potency cannabis flowers often have very low CBD content. We will show why this is relevant in the next section.
CBD for deeper psychosis risk
CBD is also an important agent in the context of psychosis. The fascinating thing is that cannabis seems to work the other way around. For example, one study showed that significantly fewer psychoses occurred when subjects took CBD beforehand. Currently, CBD is even being tested as a potential drug to treat psychotic episodes in people with schizophrenia – and some studies suggest that the prospects for success are real.
What remains unclear?
So are all these studies now saying that cannabis causes psychosis? It’s not that simple. While there is undeniably a connection, and certain patterns of consumption exacerbate the problem. At the same time, however, it has not really been proven that THC by itself causes a psychotic disorder in a perfectly healthy person. Often, those affected already have a genetically predisposed risk – and cannabis use then acts in part as a specific trigger. [4] Further, the question arises whether it does not also run the other way around to a certain degree: People with a psychotic predisposition might show an increased tendency to use cannabis, e.g. in the sense of self-medication.
Furthermore, there are many risk factors that favor the onset of psychosis: Depression, sleep disorders, living with a male body, migration history or living in urban areas – to name a few. What is striking about this list is that many of these factors also increase the likelihood that a person will come into contact with cannabis. Of course, scientists try to calculate these factors out of their studies – but it is hardly ever possible to do so perfectly.
What does this mean for legalization
All in all, then, it seems entirely plausible that cannabis use carries significant risk under certain circumstances. So are the opponents of legalization right and we should definitely continue to ban this dangerous substance? You guessed it: of course not. First, we live in a society that tolerates diverse risks in quite a few areas. Second, even without legalization, much cannabis is consumed, often under riskier circumstances.
Risk is part of our society
Even if cannabis triggers psychosis and thus greatly complicates the lives of some affected people, the current discussion is quite absurd. Of course, it is important to know about the risks of a substance. However, the side effects of cannabis use are quite harmless compared to those of many other substances, such as alcohol, tobacco, or sugar. With all of these substances, we know that they cause significant harm to human health when consumed in excess – and yet they are legal and widely available. There are many people who suffer significant psychological damage from problematic alcohol consumption, and again, there are studies that say that the brains of adolescents in particular suffer greatly from excessive alcohol consumption. Nevertheless, we can buy beer in any supermarket. Our society tolerates many risks and often leaves the decision to what extent people want to expose themselves to these risks to the individual. Therefore, while it is important that we know as much as possible about the risks of substances like cannabis – at the same time, these risks alone are far from a reason for an extremely elaborate and hardly successful prohibition policy.
Transparency & prevention is important
In the current situation, many people buy cannabis regularly. Since this is illegal, it happens in hiding (stress is harmful!) and without any quality standards. With black market flowers, you have no way of knowing what the THC content of that cannabis plant actually is now. And the dealer is usually hardly interested in whether the clientele is still young and therefore more at risk.
In contrast, clear transparency and quality requirements could be enforced in a legal, regulated market. This would allow consumers to decide what level of THC and CBD they want to consume. In addition, the tax revenue could be used for effective prevention work for young people – instead of the money flowing into the pockets of criminal organizations. With such options, the risk of developing psychosis would not have disappeared. However, it would be a risk that could be assessed and controlled – and one that needs to be explored further.