Cannabis use precedes the onset of psychotic symptoms in young people

Cannabis is the most commonly used illicit drug in the world, particularly among adolescents, and is consistently linked with an increased risk for mental illness. However, it is not clear whether the link between cannabis and psychosis is causal, or whether it is because people with psychosis use cannabis to self medicate their symptoms.

So a team of researchers, led by Professor Jim van Os from Maastricht University in the Netherlands, set out to investigate the association between cannabis use and the incidence and persistence of psychotic symptoms over 10 years.

The study took place in Germany and involved a random sample of 1,923 adolescents and young adults aged 14 to 24 years.

The researchers excluded anyone who reported cannabis use or pre-existing psychotic symptoms at the start of the study so that they could examine the relation between new (incident) cannabis use and psychotic symptoms.

The remaining participants were then assessed for cannabis use and psychotic symptoms at three time points over the study period (on average four years apart).

Incident cannabis use almost doubled the risk of later incident psychotic symptoms, even after accounting for factors such as age, sex, socioeconomic status, use of other drugs, and other psychiatric diagnoses. Furthermore, in those with cannabis use at the start of the study, continued use of cannabis over the study period increased the risk of persistent psychotic symptoms

There was no evidence for self medication effects as psychotic symptoms did not predict later cannabis use.

These results "help to clarify the temporal association between cannabis use and psychotic experiences," say the authors. "In addition, cannabis use was confirmed as an environmental risk factor impacting on the risk of persistence of psychotic experiences."

The major challenge is to deter enough young people from using cannabis so that the prevalence of psychosis is reduced, say experts from Australia in an accompanying editorial.

Professor Wayne Hall from the University of Queensland and Professor Louisa Degenhardt from the Burnet Institute in Melbourne, question the UK's decision to retain criminal penalties for cannabis use, despite evidence that removing such penalties has little or no detectable effect on rates of use. They believe that an informed cannabis policy "should be based not only on the harms caused by cannabis use, but also on the harms caused by social policies that attempt to discourage its use, such as criminal penalties for possession and use."

Provided by British Medical Journal