Two years ago, Sharon Levy, MD, MPH, co-authored a report published in JAMA Pediatrics about a survey conducted with adolescents ages 14 to 18 during a routine physical exam.
Levy, Boston Children’s Hospital director of adolescent substance abuse and addiction program and her co-author, Elissa Weitzman, ScD, MSc, asked specific questions like: Have you used marijuana in the past year? Have you had any hallucinations, paranoia, or anxiety using it?
The responses were disturbing.
“Hallucinations, paranoia, and anxiety are considered symptoms of psychosis. We were surprised at the high number of kids using marijuana who were having these kinds of symptoms,” she said. “This doesn’t mean they have a psychotic disorder, but more data is needed.”
Levy went on to say that they put this report together hoping other researchers would pick up on it and take the next step. For years, there has been a documented connection between marijuana use and psychotic symptoms.
One 2019 study published in JAMA Psychiatry showed that the genetic link between cannabis and psychosis is anywhere from 69 percent to 84 percent. But as Levy put it, it’s more of a “which came first, the chicken or the egg” situation. Does the pot cause the psychosis or does it just reveal a condition that was already there?
No Clear Answer
The answer is unclear.
But what is clear is that the younger the person, the higher the concentration of marijuana, and the longer the exposure, the more likely psychotic symptoms will appear.
“Clinically, we’re seeing more psychosis and we think it’s the THC that’s causing the problem,” said Levy.
THC, or tetrahydrocannabinol, is the psychoactive component of marijuana and the concentration of it is far higher in what’s being produced today.
According to the November/December 2018 issue of Missouri Medicine, the THC content was less than two percent prior to the 1990s. But during the 90s, it jumped to four percent. Between 1995 and 2015, there was a 212 percent increase in the THC content.
With concentrated products like oils, dab, vapes, and edibles, the THC levels can rise to as much as 95 percent. The concentration is meant solely for a high and no research backs up any claims that the potency is actually beneficial.
Marijuana, like hemp, is a part of the cannabis plant. Marijuana carries levels of THC while CBD, or cannabidiol, is typically extracted from hemp.
CBD has often been associated with decreasing the effects of depression, anxiety, schizophrenia, and even epilepsy. Because of the recent focus on the benefits of CBD, marijuana is often considered more of a “soft drug” and no longer has the same kind of stigma as harsher drugs like cocaine or heroin, for example.
Add to that the full legalization of it in 11 states plus the District of Columbia, more people are using marijuana than ever—many of whom are 18 and under.
Adolescent Use of Pot on the Rise
“Adolescents are more susceptible to the effects of smoking marijuana as opposed to adults because of their developing brains,” Levy said. “In other words, a kid smoking pot at 14 would be more likely to develop psychotic symptoms than someone at age 30.”
According to a 2018 report in the American Journal of Psychiatry, 41 percent of those who experience cannabis-induced psychosis later convert to schizophrenia. Studies have shown where mental illness like schizophrenia already exists, heavy and prolonged pot use may make symptoms worse.
Many teens and young adults who experience psychosis also frequently misuse substances making it a challenge to determine substance-induced psychosis from a primary psychotic disorder.
Those statistics have alarmed those in the medical and psychiatric fields. In May 2019, 40 pediatricians, mental health and addiction clinicians, and scientists in Massachusetts submitted a “Statement of Concern” about marijuana regulation.
They pointed out risk factors included addiction, impairment of cognitive function, possibility of causing lung cancer if inhaling, as well as mental illnesses like psychosis, paranoia, schizophrenia, depression, anxiety, and suicide.
The increased rate in cannabis-induced psychosis hasn’t made getting the mental help necessary any easier. Many parents have complained that pot is far more available than the mental illness treatment needed for the symptoms linked to it.
A 2018 Substance Abuse and Mental Health Services Administration (SAMHSA) survey showed there were less than 4,000 substance abuse treatment programs for adolescents in the country. That’s a quarter of what’s available for adults.
Elinore McCance-Katz, Ph.D, MD, assistant secretary for mental health and substance abuse at SAMHSA, noted in a NAMI blog post that year that there is a distinction between a substance causing psychosis and one revealing a predisposition. But as far as she’s concerned, it’s a dangerous mindset for users and producers to continue pretending that marijuana is a harmless substance.
“It is time for medical professionals to courageously share what the data say, even if the conclusion is a socially unpopular one,” she stated. “Our people—particularly our young people—are depending on us.”