Tag: Cannabis use disorder

Substance-Induced Psychosis vs. Primary Psychosis: Treatment, Prognosis, and the Cannabis Connection

Psychosis can emerge from a range of causes, but distinguishing between substance-induced psychosis (SIP) and primary psychotic disorders like schizophrenia is critical for effective treatment and prognosis. While the clinical presentation often overlaps—hallucinations, delusions, disorganized thinking—the underlying etiology, treatment approach, and long-term outcomes can diverge significantly.

Defining the Two

Substance-Induced Psychosis (SIP) occurs when symptoms of psychosis are directly caused by intoxication with or withdrawal from substances such as cannabis, amphetamines, alcohol, hallucinogens, or synthetic cannabinoids (e.g., spice or K2). The psychosis typically emerges during or shortly after substance use and resolves with abstinence.

Primary Psychosis, on the other hand, refers to psychotic disorders that are not directly attributable to substances or medical conditions. This includes schizophrenia, schizoaffective disorder, and brief psychotic disorder, among others.

Treatment: Overlapping Tools, Different Emphasis

1. Acute Management
Both SIP and primary psychosis are often treated with antipsychotic medications during acute episodes. The initial goals are the same: reduce agitation, manage delusions or hallucinations, and ensure safety.

  • Commonly used antipsychotics include risperidone, olanzapine, haloperidol, and quetiapine. In SIP, short-term use is typically sufficient.
  • In cases involving severe agitation or aggression, benzodiazepines (like lorazepam) may be used adjunctively, especially if stimulant intoxication is suspected.

2. Long-Term Strategy

  • SIP: After stabilization, the primary strategy is abstinence from the offending substance and psychosocial support (e.g., CBT, motivational interviewing, relapse prevention).
  • Primary psychosis: Typically requires ongoing antipsychotic treatment, often for life. Psychosocial interventions, supported employment, and cognitive remediation are also central to recovery.

Conversion to Schizophrenia: What’s the Risk?

One of the key concerns with SIP is whether the episode is a harbinger of an underlying primary psychotic disorder.

  • Approximately 20–50% of individuals with substance-induced psychosis later develop a primary psychotic disorder, such as schizophrenia.
  • Amphetamine- and cannabis-induced psychosis carry the highest risk of conversion, particularly when psychosis occurs in adolescence or early adulthood.
  • A meta-analysis by Niemi-Pynttäri et al. (2013) found that 46% of people with SIP later developed schizophrenia-spectrum disorders over a follow-up of 8 years.

Predictors of conversion include:

  • Younger age at first psychotic episode
  • Family history of psychotic illness
  • Persistent psychotic symptoms after substance clearance
  • Poor premorbid functioning

Do Antipsychotics Work in SIP?

Antipsychotics reduce acute psychotic symptoms in SIP, but their long-term utility is less clear.

  • Studies show rapid resolution of psychosis within days to weeks in most SIP cases when abstinence is achieved.
  • Long-term antipsychotic treatment does not reduce the conversion rate to schizophrenia in confirmed SIP, suggesting their role should be time-limited unless ongoing symptoms or risk factors emerge.
  • A 2020 review in Psychological Medicine emphasized that monitoring over the 6–12 months post-episode is essential for risk stratification and avoiding premature chronic medication exposure.

Cannabis: A Powerful Catalyst

Cannabis has become the most studied and most controversial substance linked to psychosis. Here’s what the evidence says:

  • Daily cannabis users are 3–5 times more likely to develop a psychotic disorder compared to non-users, especially with high-THC strains (≥10% THC).
  • A 2019 Lancet Psychiatry study by Di Forti et al. showed that strong cannabis use accounts for 12% of new psychosis cases in Amsterdam, and 30% in London.
  • Adolescents who use cannabis, particularly those with a family history of psychosis, are at dramatically increased risk.

Mechanistically, THC may dysregulate the dopamine system in vulnerable brains, tipping the balance toward psychosis. Cannabidiol (CBD), in contrast, may be protective, but commercial cannabis typically contains very little CBD.

Final Thought: Clinicians must balance vigilance and restraint—treating psychosis aggressively when needed but also avoiding unnecessary chronic antipsychotic exposure in what may be a reversible, substance-driven episode.

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🧪 Exciting Breakthrough in Cannabis Use Disorder Treatment!

A recent Phase 2b clinical trial has shown that PP-01, an investigational therapy by PleoPharma, significantly reduces cannabis withdrawal symptoms in individuals with Cannabis Use Disorder (CUD). The study demonstrated a clear dose-response relationship, with the highest dose yielding clinically meaningful results (p=0.02). Importantly, PP-01 was well-tolerated with no safety concerns.

Recognizing the urgent need for effective treatments, the FDA has granted Fast Track designation to PP-01, expediting its development and review process. This brings hope to the approximately 19.2 million Americans affected by CUD, as there are currently no FDA-approved medications for cannabis withdrawal.

PP-01 works by targeting suppressed CB1 receptors and neurotransmitter dysregulation in the brain’s reward pathway, offering a novel approach to mitigating withdrawal symptoms. As it enters Phase 3 trials, PP-01 holds promise as a first-in-class treatment for those seeking to overcome cannabis dependence.

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🚨 New JAMA Study: Cannabis Legalization & Schizophrenia

A groundbreaking study just dropped in JAMA Psychiatry, shedding light on the link between cannabis use disorder (CUD) and schizophrenia following cannabis legalization.

📊 Key Findings:

  • Higher rates of schizophrenia diagnoses were observed in young men with CUD after legalization.
  • The association was strongest in males aged 18–24, a group already at high risk for schizophrenia onset.
  • No significant changes were found in individuals without CUD, reinforcing concerns about cannabis as a potential trigger in vulnerable populations.

🧠 What This Means:
Cannabis legalization doesn’t just increase access—it may be shifting the trajectory of severe mental illness in at-risk groups. While correlation ≠ causation, this study adds weight to the argument that heavy cannabis use isn’t harmless, especially for young people with genetic or neurodevelopmental vulnerabilities.

⚖️ Clinical & Policy Implications:

  • Should we rethink cannabis policy in light of these findings?
  • Do we need stronger public health messaging about the psychiatric risks of heavy cannabis use?
  • How can we better screen and intervene early for CUD in young men?

As psychiatrists, we see these cases firsthand—the young man with new-onset psychosis, the family blindsided, the struggle to regain lost cognitive and social function.

This study is a wake-up call. Legal ≠ safe for everyone.

What are your thoughts? Should legalization come with more psychiatric safeguards? Drop your insights below. ⬇️

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🚨 New Study: Cannabis Use Disorder Linked to 3X Higher Mortality in Hospital & ER Patients

A major new study has uncovered a staggering risk: Patients diagnosed with Cannabis Use Disorder (CUD) in hospitals or ERs had nearly THREE TIMES the mortality rate over the next five years compared to those without the disorder.

🔎 Key Findings:

🛑 Patients with CUD had a significantly higher risk of death within five years.

🛑 Cannabis use was associated with worse health outcomes, even after adjusting for other factors.

🛑 Findings challenge the assumption that cannabis is a “harmless” substance.

💡 Why This Matters:

As cannabis use becomes more common and legalized, we can’t ignore the potential long-term health consequences—especially in vulnerable populations. This study raises urgent questions about how cannabis impacts physical and mental health in the long run.

📢 What do you think? Should we be taking Cannabis Use Disorder more seriously in medical settings? Drop your thoughts below! 👇

🔗 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829914

#Cannabis #PublicHealth #Addiction #ER #Medicine #addictionmedicine #addiction #cannabisusedisorder #addictionpsychiatry #medical #doctor #medication #marijuana

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🚨 Cannabis & Brain Function: Short- & Long-Term Effects You NEED to Know 🚨

Cannabis use is everywhere, but do we truly understand its impact on the brain? 🤔 A growing body of research reveals short- and long-term effects that can’t be ignored. Let’s break it down:

🧠 Short-Term Effects
🔹 Impaired memory & attention
🔹 Slower reaction time
🔹 Altered judgment & coordination
🔹 Increased anxiety or paranoia (in some users)

But here’s where it gets even more concerning…

🧠 Long-Term Effects (Especially with frequent or early use)
🔻 Structural brain changes in memory & executive function areas
🔻 Persistent cognitive impairment in heavy users
🔻 Increased risk of psychiatric disorders (psychosis, depression, anxiety)
🔻 Lower IQ in adolescent-onset users

💡 The Takeaway? While cannabis has potential therapeutic uses, chronic or early use can have lasting effects on brain function—especially in young people. Understanding these risks is crucial as legalization expands.

🔬 Have you seen changes in cognition or mental health in cannabis users? Let’s discuss below! 👇 #Cannabis #BrainHealth #Neuroscience #MentalHealth

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Clearing the Smoke: What We Know About Cannabis for Mental Health Treatment

Research into the therapeutic potential of cannabis for mental health disorders has grown in recent years, with mixed findings from randomized controlled trials (RCTs).

Anxiety Disorders

  • CBD (Cannabidiol) has shown promise in reducing anxiety symptoms in RCTs, particularly for social anxiety disorder (SAD). For instance, a small RCT found that a single dose of 300 mg of CBD reduced anxiety levels in participants undergoing a simulated public speaking test.
  • Some RCTs suggest that CBD may be anxiolytic without causing impairment or euphoria, making it preferable for anxiety compared to THC-dominant cannabis products, which may exacerbate anxiety in some users.

Post-Traumatic Stress Disorder (PTSD)

  • RCTs exploring THC and CBD combinations in PTSD have had mixed outcomes. Some studies indicate that THC may reduce nightmares and improve sleep in PTSD patients, though these findings are generally based on small sample sizes and short-term trials.
  • A recent RCT with a synthetic cannabinoid (nabilone) reported some symptom improvement in PTSD-related insomnia and nightmares. However, larger trials with longer follow-ups are necessary to clarify the efficacy and safety for PTSD.

Depression

  • Few RCTs show consistent evidence supporting cannabis (CBD or THC) as an effective treatment for major depressive disorder. Some trials indicate that CBD may have antidepressant-like effects, possibly due to serotonin receptor activity, but more robust and long-term studies are needed.
  • Concerns persist over THC’s potential to exacerbate depressive symptoms, particularly with regular or heavy use.

Schizophrenia and Psychotic Disorders

  • THC-dominant products have been associated with increased risk of psychosis and exacerbation of symptoms in people predisposed to psychotic disorders. This has led to caution against THC use in people with schizophrenia.
  • CBD has shown promise as an adjunctive treatment in some RCTs, with findings suggesting that it may have antipsychotic effects without the psychoactive effects of THC. For example, an RCT found that CBD reduced psychotic symptoms and improved cognitive function when added to standard antipsychotic treatment, though the effects were modest.

Bipolar Disorder

  • Evidence from RCTs on the use of cannabis in bipolar disorder is sparse and generally negative. Some trials indicate that THC may worsen manic and depressive symptoms in bipolar patients, and there is little to no support for cannabis as a treatment for bipolar depression.

Sleep Disorders

  • Some RCTs have evaluated cannabinoids for sleep disturbances, with CBD showing potential for improving sleep quality. However, THC may reduce REM sleep, which could impact sleep architecture negatively over time.
  • For PTSD-related insomnia, cannabinoids like nabilone have shown some benefit, but the effects on sleep in general populations remain uncertain.

Limitations

  • Sample Sizes and Duration: Many RCTs are small and short-term, limiting the generalizability and understanding of long-term effects.
  • Dosing and Formulations: Variability in cannabinoid content (THC vs. CBD), formulations (edibles, oils, vapes), and dosages across studies makes comparison challenging.
  • Side Effects: Both CBD and THC can have side effects, though THC’s psychoactive properties can lead to cognitive impairment, addiction potential, and negative impact on mood in some patients.

While CBD shows some promise in anxiety, PTSD, and psychotic disorders, RCT evidence for other mental health conditions remains inconclusive or even negative, especially with THC. Further large-scale, long-term RCTs are needed to establish the efficacy and safety profile of cannabis-based treatments in mental health.

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ADHD and Cannabis Use Disorder: Key Facts You Shouldn’t Ignore

1. Prevalence and Patterns of Use

People with ADHD have been shown to use cannabis at higher rates than those without ADHD. Studies indicate that adolescents and adults with ADHD are more likely to use cannabis, and they may start using it at a younger age. This may be due to self-medication attempts, as people with ADHD often report using cannabis to help with symptoms like impulsivity, anxiety, and sleep difficulties which seems like a bad idea to me but lets look at the reasons.

2. Cannabis as a Self-Medication Attempt

Some people with ADHD use cannabis in an attempt to self-manage their symptoms. Anecdotally, users report feeling more focused, relaxed, and less anxious, though the scientific evidence on cannabis’s effectiveness for ADHD symptom management is not robust. Studies show that while some ADHD symptoms like restlessness might feel alleviated short-term, long-term outcomes often do not show sustained benefit, and impairment can increase over time.

3. Impact on ADHD Symptoms

Research on cannabis’s effect on ADHD symptoms is mixed:

  • Impulsivity and Attention: Cannabis can impair attention, memory, and executive functioning, which are already areas of struggle for individuals with ADHD. Heavy cannabis use is associated with poorer performance on tasks measuring these cognitive domains.
  • Cognitive Function: Longitudinal studies have shown that chronic cannabis use can worsen cognitive functions over time, especially if use begins in adolescence. These cognitive impacts may compound ADHD-related deficits.
  • Motivation and Goal-Directed Behavior: Cannabis can affect motivation and goal-directed behavior, which can exacerbate some ADHD symptoms, particularly in individuals who already struggle with organization and task completion.

4. ADHD as a Risk Factor for Cannabis Use Disorder

Studies suggest that people with ADHD may be more prone to developing cannabis use disorder (CUD) compared to the general population. Traits like impulsivity and sensation-seeking, common in ADHD, may increase vulnerability to addiction. Additionally, the reinforcing effects of cannabis (e.g., reduction in perceived anxiety) may lead to increased use and dependency in those with ADHD.

5. Genetic and Neurobiological Factors

There is some evidence suggesting that the overlap between cannabis use and ADHD may have a genetic or neurobiological basis:

  • Genetic Overlap: Studies have found that genes linked to ADHD, particularly those affecting dopamine function, are also implicated in substance use disorders, including cannabis use disorder.
  • Endocannabinoid System: ADHD and cannabis use affect dopamine and endocannabinoid systems. Some research posits that dysregulation in these systems might underlie both the propensity for ADHD and substance use, but this remains an area for further research.

6. Cannabis and Medication Interactions

For those with ADHD taking stimulant medications, cannabis use can interfere with treatment. THC, the psychoactive component of cannabis, can interact with medications like methylphenidate or amphetamine-based treatments, potentially reducing their effectiveness or exacerbating side effects like anxiety and heart palpitations.

7. Longitudinal and Population Studies

Long-term studies generally show that early and heavy cannabis use is associated with worse outcomes for individuals with ADHD. These include lower academic achievement, increased rates of unemployment, and higher incidences of mental health issues, especially when cannabis use starts in adolescence.

Summary

While some people with ADHD report short-term symptom relief with cannabis, research shows that heavy, frequent use tends to worsen cognitive deficits associated with ADHD over time. Additionally, ADHD may predispose individuals to higher rates of cannabis use and a greater risk of developing cannabis use disorder. While cannabis might seem beneficial for symptom relief in the short term, its long-term use is generally not supported as an effective management strategy for ADHD.

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Recent Data Shows Marijuana Use Surpasses Alcohol in the U.S.

For the first time in U.S. history, recent data shows that marijuana use has overtaken alcohol consumption. According to surveys and studies, more Americans now regularly consume cannabis than alcohol, marking a significant cultural and behavioral shift. This trend is driven by several factors:

  • Legalization: Recreational marijuana is now legal in 23 states and Washington, D.C., making it more accessible to adults across the country.
  • Changing Social Attitudes: Perceptions about marijuana have shifted, with more people viewing it as a safer, less harmful alternative to alcohol.
  • Health and Wellness Trends: Some individuals are opting for cannabis to manage stress, anxiety, and pain without the perceived risks of alcohol, such as liver damage and hangovers.

As a frontline healthcare worker, I can say with certainty that chronic, high-potency marijuana use can have serious implications for both physical and mental health. While some claim potential benefits, we currently lack comprehensive data on its medical efficacy, and more importantly, we do not yet fully understand the long-term consequences of regular, heavy consumption. As marijuana use increases, it’s critical to approach it with caution and prioritize further research into its effects on overall health.

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Should Marijuana be Reclassified? 

The potential reclassification of marijuana to Schedule III under the Controlled Substances Act would represent a significant shift in how the United States views and regulates the drug. Currently listed as a Schedule I substance, alongside drugs like heroin and LSD, marijuana is classified as having no accepted medical use and a high potential for abuse according to federal law. However, the mounting evidence of its medicinal benefits and changing attitudes toward its use have sparked discussions about revisiting its scheduling.

Moving marijuana to Schedule III would acknowledge its recognized medical applications while still imposing regulatory controls. Drugs in this category, such as certain opioids like codeine, have a moderate to low potential for physical and psychological dependence and are accepted for medical use with restrictions. This reclassification could facilitate further research into its therapeutic properties and enable easier access for patients who could benefit from its use.

However, the reclassification process is complex and involves various legal, political, and scientific considerations. Advocates argue that placing marijuana in Schedule III or lower would align its scheduling with scientific evidence and public opinion, potentially reducing stigma and barriers to research. Critics express concerns about the potential for increased recreational use and addiction, as well as the regulatory challenges of managing a substance with psychoactive properties.

Any decision to reschedule marijuana would require careful deliberation, weighing the potential benefits against the risks and ensuring that public health and safety remain paramount. 

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The Dangers of Marijuana Use While Driving

I recently had an opportunity to review an article for The Carlat Addiction Psychiatry Report on the topic of cannabis use and driving. I wanted to further evaluate the risk of cannabis use while operating a motor vehicle.

Driving under the influence of any substance, including marijuana, poses significant risks to the driver, passengers, and others on the road. Despite its increasing legalization and acceptance for both medicinal and recreational use, marijuana remains a potent drug with effects that can impair driving abilities.

Marijuana use and driving don’t mix:

Impairment of Motor Skills and Reaction Time

Slowed Reaction Time: Marijuana affects the central nervous system, leading to slower reflexes and reaction times. This delay can be crucial in driving situations that require quick decision-making, such as avoiding sudden obstacles or responding to traffic signals.

Impaired Motor Coordination: THC, the active ingredient in marijuana, can impair fine motor skills and coordination. This makes tasks such as steering, braking, and maintaining lane position more challenging.

Cognitive Impairments

Altered Perception of Time and Distance: Marijuana use can distort a driver’s perception of time and distance, making it difficult to judge speed and the proximity of other vehicles or pedestrians.

Difficulty Concentrating: Staying focused on the road becomes harder under the influence of marijuana. Distractions can increase, and the ability to track multiple moving objects is diminished.

Increased Risk of Accidents

  • Higher Accident Rates: Studies have shown that drivers who use marijuana are more likely to be involved in motor vehicle accidents compared to sober drivers. The risk is particularly high within the first few hours after consumption.
  • Combining Substances: The dangers are amplified when marijuana is used in combination with other substances, such as alcohol. The combined effects can drastically increase the likelihood of a crash.

Legal and Social Consequences

DUI Charges: Driving under the influence of marijuana is illegal and can result in DUI charges, fines, license suspension, and even imprisonment.

Insurance Implications: Being involved in an accident while under the influence can lead to increased insurance premiums or denial of coverage.

Personal and Public Safety

  • Endangering Lives: Driving under the influence of marijuana not only endangers the driver’s life but also the lives of passengers, pedestrians, and other road users.
  • Public Health Impact: The broader societal impact includes the strain on emergency services, healthcare systems, and the economic costs associated with accidents and injuries.

Conclusion

The bottom line is clear: marijuana use and driving do not mix. The impairments caused by marijuana significantly increase the risk of accidents and the potential for harm. Responsible use of marijuana means understanding its effects and making informed decisions to ensure personal and public safety. If you’ve used marijuana, it’s crucial to wait until its effects have fully worn off before getting behind the wheel.

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