Relationship between cannabis use in adolescence and the incidence of psychosis in adulthood – Literature Review
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Faculty of Medicine, Medical University of Silesia in Katowice, Zabrze, Poland
Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
Faculty of Medicine, Medical University of Silesia in Katowice, Katowice, Poland
Corresponding author
Tomasz Furgoł   

Wydział Nauk Medycznych, Śląski Uniwersytet Medyczny w Katowicach, Zabrze, Polska
Introduction and objective:
Cannabis is one of the most widely used illegal stimulants in the world. With a worldwide usage rate of about 4% of the population, it definitely leaves other drugs behind. Currently, the trend of cannabis use is upward which is most visible in the adolescent and young adult age groups. Earlier onset of cannabis use may be associated with psychiatric side effects in adulthood.

Review methods:
PubMed, PubMed Central and Google Scholar online databases were searched using phrases related to the topic. After reviewing the abstracts, articles in English, French and Polish presenting the latest knowledge were selected whenever possible. The types of articles reviewed were original papers, and review papers. Finally, a total of 62 items of literature and websites were selected. A simple summary of the research is presented in Table 2.

Abbreviated description of the state of knowledge:
Cannabis psychoactive compounds, mainly Δ-9-tetrahydrocannabinol, act by binding to cannabinoid receptors. This mainly affects the mental sphere leading to memory lapses, abnormal sense of time or perceptual impact. Long-term use can result in psychosis or schizophrenia. Studies prove that in addition to the dose of cannabis used, the main risk factor for psychosis is the early age of initiation ocurring usually in adolescence. Cannabis use during the most intensive brain development can result in abnormal cognitive functions with resulting exposure to psychosis in adulthood.

Cannabis use in adolescence is unanimously considered unsafe and may lead to mental disorders in adulthood. The illegal status of cannabis in Poland, additional environmental influences and comorbidities can only exacerbate the prognosis. People in adolescence should be exposed to psychoactive substances minimally as possible.

UN International Drug Control Programme. World drug report: United Nations International Drug Control Programme. Oxford: Oxford University Press (NY); 1997.
UN Office on Drugs and Crime. Annual prevalence of the use of cannabis, cocaine, opioids, opiates, amphetamine-type stimulants and “ecstasy” by region and globally 2016. dataUNODC. (access: 2023.12.04).
Europejskie Centrum Monitorowania Narkotyków i Narkomanii.. Europejski raport narkotykowy 2022: tendencje i osiągnięcia. Luksemburg: Urząd Publikacji UE, 2022. (access: 2023.12.04).
Malczewski A, Bevz M, Dalmata M, et al. Raport o stanie narkomanii w Polsce 2020. Krajowe Biuro do Spraw Przeciwdziałania Narkomanii, 2020. (access: 2023.12.04).
Bonnet U, Specka M, Roser P, et al. Cannabis use, abuse and dependence during the COVID-19 pandemic: a scoping review. J Neural Transm (Vienna). 2023;130(1):7–18.
Budney AJ, Borodovsky JT. The potential impact of cannabis legalization on the development of cannabis use disorders. Prev Med. 2017;104:31–36.
Zou S, Kumar U. Cannabinoid Receptors and the Endocannabinoid System: Signaling and Function in the Central Nervous System. Int J Mol Sci. 2018;19(3):833.
National Academies of Sciences, Engineering, and Medicine. The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Washington, DC: The National Academies Press; 2017. p. 2465.
Lowe DJE, Sasiadek JD, Coles AS, et al. Cannabis and mental illness: a review. Eur Arch Psychiatry Clin Neurosci. 2019;269(1):107–120.
Haffajee RL, MacCoun RJ, Mello MM. Behind Schedule – Reconciling Federal and State Marijuana Policy. N Engl J Med. 2018;379(6):501–504.
Legality of cannabis. Wikipedia The Free Encyclopedia, 2023. (access: 2023.12.04).
Ustawa z dnia 24 marca 2022 r. o zmianie ustawy o przeciwdziałaniu narkomanii (DzU 2022 poz. 763). (access: 2023.12.04).
Bołtryk P. Kryminologiczne i prawne aspekty posiadania narkotyków w Polsce (na przykładzie pochodnych konopi innych niż włókniste). Białystok, 2014. (access: 2023.12.04).
Longoria V, Parcel H, Toma B, et al. Neurological Benefits, Clinical Challenges, and Neuropathologic Promise of Medical Marijuana: A Systematic Review of Cannabinoid Effects in Multiple Sclerosis and Experimental Models of Demyelination. Biomedicines. 2022;10(3):539.
Häuser W, Welsch P, Klose P, et al. Efficacy, tolerability and safety of cannabis-based medicines for cancer pain: A systematic review with meta-analysis of randomised controlled trials. Schmerz. 2019;33(5):424–436.
Pratt M, Stevens A, Thuku M, et al. Benefits and harms of medical cannabis: a scoping review of systematic reviews. Syst Rev. 2019; 8:320.
Cyrny W. Medyczna marihuana – Polacy zażyli jej ponad 2 tony. Kiedy legalizacja rekreacyjnego palenia? My Company Polska, 2023. (access: 2023.12.04).
Pawłowski M. Zrealizowano ponad 200 tysięcy recept na medyczną marihuanę., 2023. (access: 2023.12.04).
Urits I, Charipova K, Gress K, et al. Adverse Effects of Recreational and Medical Cannabis. Psychopharmacol Bull. 2021;51(1):94–109.
Health Canada. For health care professionals: Cannabis and cannabinoids. Government of Canada, 2018. (access: 2023.12.04).
Marconi A, Di Forti M, Lewis CM, et al. Meta-analysis of the Association Between the Level of Cannabis Use and Risk of Psychosis. Schizophr Bull. 2016;42(5):1262–1269.
Gałecki P, Szulc A. Psychiatria. Tom 1. Wrocław: Edra Urban & Partner; 2023.
Jarema M. Psychiatria: podręcznik dla studentów medycyny. 2nd ed. Warszawa: Wydawnictwo Lekarskie PZWL; 2016.
Lachance A, Bélanger RE, Riva M, et al. A Systematic Review and Narrative Synthesis of the Evolution of Adolescent and Young Adult Cannabis Consumption Before and After Legalization. J Adolesc Health. 2022;70(6):848–863.
Harrison ME, Kanbur N, Canton K, et al. Adolescents' Cannabis Knowledge and Risk Perception: A Systematic Review. J Adolesc Health. 2023;74(3):402–440.
Keshavan MS, Giedd J, Lau JY, et al. Changes in the adolescent brain and the pathophysiology of psychotic disorders. Lancet Psychiatry. 2014;1(7):549–558.
Kilford EJ, Garrett E, Blakemore SJ. The development of social cognition in adolescence: An integrated perspective. Neurosci Biobehav Rev. 2016;70:106–120.
Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication [published correction appears in Arch Gen Psychiatry. 2005 Jul;62(7):768. Merikangas, Kathleen R [added]]. Arch Gen Psychiatry. 2005;62(6):593–602.
Pitchforth J, Fahy K, Ford T, et al. Mental health and well-being trends among children and young people in the UK, 1995–2014: analysis of repeated cross-sectional national health surveys. Psychol Med. 2019;49(8):1275–1285.
Hughes AR, Grusing S, Lin A, et al. Trends in intentional abuse and misuse ingestions in school-aged children and adolescents reported to US poison centers from 2000–2020. Clin Toxicol (Phila). 2023;61(1):64–71.
Wu LT, Brady KT, Mannelli P, et al. Cannabis use disorders are comparatively prevalent among nonwhite racial/ethnic groups and adolescents: a national study. J Psychiatr Res. 2014;50:26–35.
Bagot KS, Milin R, Kaminer Y. Adolescent Initiation of Cannabis Use and Early-Onset Psychosis. Subst Abus. 2015;36(4):524–533.
Koenis MMG, Durnez J, Rodrigue AL, et al. Associations of cannabis use disorder with cognition, brain structure, and brain function in African Americans. Hum Brain Mapp. 2021;42(6):1727–1741.
Gage SH, Jones HJ, Burgess S, et al. Assessing causality in associations between cannabis use and schizophrenia risk: a two-sample Mendelian randomization study. Psychol Med. 2017;47(5):971–980.
Jones HJ, Gage SH, Heron J, et al. Association of Combined Patterns of Tobacco and Cannabis Use in Adolescence With Psychotic Experiences. JAMA Psychiatry. 2018;75(3):240–246.
Jones JD, Calkins ME, Scott JC, et al. Cannabis Use, Polysubstance Use, and Psychosis Spectrum Symptoms in a Community-Based Sample of U.S. Youth. J Adolesc Health. 2017;60(6):653–659.
Davis GP, Compton MT, Wang S, et al. Association between cannabis use, psychosis, and schizotypal personality disorder: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Schizophr Res. 2013;151(1–3):197–202.
Fairman BJ, Furr-Holden CD, Johnson RM. When Marijuana Is Used before Cigarettes or Alcohol: Demographic Predictors and Associations with Heavy Use, Cannabis Use Disorder, and Other Drug-related Outcomes. Prev Sci. 2019;20(2):225–233.
Stefanis NC, Dragovic M, Power BD, et al. Age at initiation of cannabis use predicts age at onset of psychosis: the 7- to 8-year trend. Schizophr Bull. 2013;39(2):251–254.
Ryan JE, Veliz P, McCabe SE, et al. Association of early onset of cannabis, cigarette, other drug use and schizophrenia or psychosis. Schizophr Res. 2020;215:482–484.
Ringen PA, Nesvåg R, Helle S, et al. Premorbid cannabis use is associated with more symptoms and poorer functioning in schizophrenia spectrum disorder. Psychol Med. 2016;46(15):3127–3136. S0033291716001999.
Karlsgodt KH. Cannabis Use in Adolescence: Vulnerability to Cognitive and Psychological Effects. Biol Psychiatry Glob Open Sci. 2023;3(2):167–168.
Dervaux A, Krebs MO, Laqueille X. Les troubles cognitifs et psychiatriques liés à la consommation de cannabis [Cannabisinduced cognitive and psychiatric disorders]. Bull Acad Natl Med. 2014;198(3):559–577.
Hanna RC, Shalvoy A, Cullum CM, et al. Cognitive Function in Individuals With Psychosis: Moderation by Adolescent Cannabis Use. Schizophr Bull. 2016;42(6):1496–1503. sbw030.
Setién-Suero E, Martínez-García O, de la Foz VO, et al. Age of onset of Cannabis use and cognitive function in first-episode non-affective psychosis patients: Outcome at three-year follow-up. Schizophr Res. 2018;201:159–166.
Di Forti M, Sallis H, Allegri F, et al. Daily use, especially of highpotency cannabis, drives the earlier onset of psychosis in cannabis users. Schizophr Bull. 2014;40(6):1509–1517. schbul/sbt181
Hosseini S, Oremus M. The Effect of Age of Initiation of Cannabis Use on Psychosis, Depression, and Anxiety among Youth under 25 Years. Can J Psychiatry. 2019;64(5):304–312. https://doi. org/10.1177/0706743718809339.
Iseger TA, Bossong MG. A systematic review of the antipsychotic properties of cannabidiol in humans. Schizophr Res. 2015;162(1–3):153–161.
Bhattacharyya S, Wilson R, Appiah-Kusi E, et al. Effect of Cannabidiol on Medial Temporal, Midbrain, and Striatal Dysfunction in People at Clinical High Risk of Psychosis: A Randomized Clinical Trial. JAMA Psychiatry. 2018;75(11):1107–1117.
Gage SH, Hickman M, Heron J, et al. Associations of cannabis and cigarette use with psychotic experiences at age 18: findings from the Avon Longitudinal Study of Parents and Children. Psychol Med. 2014;44(16):3435–3444.
Wilkinson ST, Radhakrishnan R, D'Souza DC. Impact of Cannabis Use on the Development of Psychotic Disorders. Curr Addict Rep. 2014;1(2):115–128.
Ksir C, Hart CL. Cannabis and Psychosis: a Critical Overview of the Relationship. Curr Psychiatry Rep. 2016;18(2):12. https://doi. org/10.1007/s11920-015-0657-y
Power RA, Verweij KJ, Zuhair M, et al. Genetic predisposition to schizophrenia associated with increased use of cannabis. Mol Psychiatry. 2014;19(11):1201–1204.
Hiemstra M, Nelemans SA, Branje S, et al. Genetic vulnerability to schizophrenia is associated with cannabis use patterns during adolescence. Drug Alcohol Depend. 2018;190:143–150. https://doi. org/10.1016/j.drugalcdep.2018.05.024
Kiburi SK, Molebatsi K, Ntlantsana V, Lynskey MT. Cannabis use in adolescence and risk of psychosis: Are there factors that moderate this relationship? A systematic review and meta-analysis. Subst Abus. 2021;42(4):527–542. https:/
Ortiz-Medina MB, Perea M, Torales J, et al. Cannabis consumption and psychosis or schizophrenia development. Int J Soc Psychiatry. 2018;64(7):690–704.
Sarris J, Sinclair J, Karamacoska D, et al. Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review. BMC Psychiatry. 2020;20(1):24.
Klimkiewicz A, Jasińska A. Zdrowotne następstwa rekreacyjnego używania kannabinoidów. Psychiatry. 2018;15(2):88–92.
Wahbeh MH, Avramopoulos D. Gene-Environment Interactions in Schizophrenia: A Literature Review. Genes (Basel). 2021;12(12):1850.
Bechtold J, Hipwell A, Lewis DA, et al. Concurrent and sustained cumulative effects of adolescent marijuana use on subclinical psychotic symptoms. Am Psychiatry. 2016;173(8):781–789. appi.ajp.2016.15070878.
Day NL, Goldschmidt L, Day R, et al. Prenatal marijuana exposure, age of marijuana initiation, and the development of psychotic symptoms in young adults. Psychol Med. 2015;45(8):1779–1787. https://doi. org/10.1017/S0033291714002906.
Wikimedia Commons. Map showing legal status of medical cannabis across the world. 2023. (access: 2023.12.04).
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