Cannabis Induced Psychosis

Our Experience

Our experience with cannabis-induced psychosis is that cannabis-induced psychosis was a much less frequently occurring condition in the early 90s and 2000s but in the last 20 years has become much more prevalent in patients between the ages of 20 and 30. Dr. Sanchez estimates there has been a 200-300% uptick in cannabis psychotic induced cases. There are multiple factors for this increase, including the availability of cannabis, the concentration of the cannabis itself, and specifically in the last 4 years it could be argued that the stress from the COVID-19 pandemic might also be playing a role.

WHAT IS CANNABIS INDUCED PSYCHOSIS?

Recent or regular use of cannabis may lead to clinically significant problematic behavioral or psychological changes. These changes may include:

Impaired motor coordination
Euphoria
Depression
Anxiety
Sensation of slowed time
Impaired judgment
Social withdrawal

Such changes may develop during or shortly after cannabis use. Additionally, at least two of the following short-term effects may be observed within two hours of cannabis use:

Conjunctival injection
Increased appetite
Dry mouth
Tachycardia

It is important to note that these symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. Longer-term effects of cannabis use may include:

Presence of perceptual disturbances
Hallucinations with intact reality testing
Auditory, visual, or tactile illusions occurring in the absence of delirium

A SUMMARY
OF THC AND ADDICTION

This is very real and not easy to treat. IT ALSO MATTERS.
Can often require long stays in treatment and antipsychotic medications
Traditional rates were around 10%, but today rates are reaching 30% as a result of increased potency (Janni Leungn et al 10/20)
Many of these addicted patients require physical detox and medical intervention

Marijuana has become significantly more potent since the 1960's

CANNABIS WITHDRAWAL SYNDROME (CWS)

DSM-5 Diagnostic Criteria for Cannabis Withdrawal Syndrome (e6)

A. Cessation of cannabis use that has been heavy and prolonged (i.e. usually daily or almost daily use over a period of at least a few months)

B. 3 or more of the following signs and symptoms develop within approximately 1 week of Criterion A:

Irritability, anger, or aggression
Nervousness or anxiety
Sleep difficulty (insomnia, disturbing dreams)
Decreased appetite or weight loss
Restlessness
Depressed mood
At least one of the following physical symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache

C. The signs or symptoms from Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to another medical condition and are not better explained by another mental disorder.

CANNABIS WITHDRAWAL SYNDROME CONCLUSIONS

Appears to affect 47% of users and up to 93% of very frequent users
Patients are leaving care over CWS
Symptoms will peak Day 3-4
Expect a strong resurgence of symptoms around Day 14
Will greater impact females than males
Still waiting for meds

Conclusions and Relevance: These findings suggest that Cannabis Withdrawal Syndrome (CWS) appears to be prevalent among regular users of cannabis. Clinicians should be aware of the prevalence of CWS in order to counsel patients and support individuals who are reducing their use of cannabis.

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CANNABIS INDUCED PSYCHOSIS