Does marijuana cause psychosis? Experts explain what to know

(WJW) – A California woman recently avoided prison time in a fatal stabbing in what prosecutors called an “episode of cannabis-induced psychosis.”

The case made national headlines.

Cannabis-induced psychosis sounds scary, so what is the real risk?

FOX 8 talked to medical professionals and law enforcement about cannabis-induced psychosis to understand what it is, how it happens and who it affects.

What is cannabis-induced psychosis?

Psychosis is when someone loses touch with reality.

According to the National Institutes of Mental Health, psychosis can result from multiple causes, including psychiatric illnesses like schizophrenia, genetic risk, a variety of drugs, or exposure to stressors or trauma.

They may have paranoia, delusions or hear voices, among many symptoms, shares forensic psychiatrist Susan Hatters-Friedman. Hatters-Friedman is the Phillip Resnick Professor of Forensic Psychiatry at the Case Western Reserve University Medical School and teaches Psychiatry and Law at the School of Law.

Cannabis-induced psychosis is when hallucinations or delusions begin shortly after consuming the drug, in some cases, Hatters-Friedman said, where people have prominent visions.

Dr. Ryan Marino is a University Hospitals ER Physician, Medical Toxicologist and Addiction Specialist.

“Any substance that affects the body in different ways has potential for harm,” he said about marijuana.

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“Millions of people use cannabis products and THC in our country, it’s not clear why it happens to some people and not others,” Marino said.

The New England Journal of Medicine estimates 52.4 million people 12 and older used cannabis in 2021, which is the most recent data available.

By the numbers

Nationwide, studies show that since 2019, there has been an increase in cannabis-related ER visits.

Marino said he’s seen an increase at University Hospitals during that same time frame.

“It’s not that they’re seeing tons of problems,” Marino added.

Marino noted that a high number of ER visits are drug-related but not necessarily cannabis-related.

According to data from the Cleveland Department of Public Health, there were 632 cannabis-related ER visits in 2023.

However, since 2017, there have been only 33 incidents involving cannabis-related psychosis events at Cleveland emergency rooms.

“The dose makes the poison”

“This does seem to be a dose-related phenomenon,” Marino said. “The dose makes the poison,” he added.

Marino said the most frequent adverse reactions happen with high potency, usually edible products.

“This ain’t your mother’s marijuana,” Surgeon General Jerome Adams said in 2019 health warning about marijuana use.

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“The cannabis of the 60s and 70s is gone, and as a society, we need to start contending with the new breed of high-potency cannabis,” Psychology Today author Amanda L. Giordano Ph.D., LPC said.

So how much is too much marijuana?

The National Institute on Drug Abuse established 5 mg as a standard unit of THC for research purposes, however, there are no guidelines for dosage.

Because cannabis can be consumed in many ways, the body metabolizes the compounds in the plant differently, which can cause a wide range of experiences from person to person.

“Marijuana isn’t risk-free”

”We know that THC has neuropsychological effects,” Marino told FOX 8.

That means it affects how your brain works for things like reading, attention and behavior.

“Marijuana is a mind-altering psychoactive drug,” Brian McNeal of the Drug Enforcement Administration (DEA) told FOX 8.

“The effect of marijuana on perception and coordination are responsible for serious impairments,” McNeal said.

Alcohol responsible for 5x more ER visits than pot

Like alcohol, many people can use it responsibly while others do not.

“People don’t even think of alcohol as a drug,” Marino added.

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Yet alcohol was the most common drug used in ER visits in Cleveland; 3,331 incidents in 2023, CDPH data shows.

A reminder that just because it’s legal, doesn’t mean it’s harmless.

“Anything in excess is dangerous to the wrong person,” said legal expert Robert Siddall.

“A lot of people feel it (marijuana) is totally safe,” Hatters-Friedman said, talking about the increased need for public education on the risks associated with marijuana use. “There aren’t warnings like you see with tobacco smoke.”

Twenty-four states have legalized recreational use of cannabis, with Ohio being one of the most recent.

However, Marino said legalization can also make products safer.

“When we legalize drugs, the benefit is that you can regulate them,” Marino said.

The Federal Drug Administration (FDA) has been regulating all medications in the U.S. since 1906.

While marijuana is not federally legal, states are able to regulate it in places where it has been legalized.

More research needed

We do not yet know all the potential effects of long-term, high-potency cannabis use because the marijuana industry is expanding at a much quicker pace than the research, Hatters-Friedman shared.

In-depth studies take years to complete, and marijuana’s impact on our communities is constantly changing as more states expand access and more products are introduced.

The same also goes for local data. FOX 8 reached out to University Hospitals, Cleveland Clinic, and the Cuyahoga County Board of Health for information on marijuana-related ER visits. All reported they did not have any local data on adverse incidents related to marijuana.

If you or a loved one is experiencing a problem with substance use, help is available via the Substance Abuse and Mental Health Services Administration Helpline at 1-800-662-HELP.

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