Cannabis use and the development of psychosis or schizophrenia, analysis of current legislation and regional mapping: A systematic review



Palabras clave:

Psicosis, Cannabis, Legalización, Despenalización


Introduction: The relationship between cannabis use and the onset of psychotic symptoms is sufficiently substantiated. The legalization and/or decriminalization of cannabis could increase the frequency and quantity of cannabis use among its users. Objective: This systematic review aims to summarize the findings of studies that investigated the risk, precocity and intensity of psychosis in cannabis users, taking into account the status of legalization and/or decriminalization of cannabis use in different countries. Methodology: Articles published up to May 2018 were included, in English, Portuguese and Spanish, all extracted from the PubMed and SciELO databases, respecting the inclusion and exclusion criteria. Results: 19 studies from 18 countries were included. The relationship of cannabis use and the onset of psychotic symptoms was sufficiently substantiated. However, there was no data that supported an increase in the risk, precocity or intensity of psychosis in cannabis users from countries with higher levels of legalization/decriminalization of cannabis use to the date of the present study. Conclusion: The use of cannabis is associated with the development of psychosis. So far, there is no data pointing to an increase in the precocity, risk or intensity of psychosis in cannabis users, due to the legalization or decriminalization of the use of cannabis. However, the absence of data to date does not exclude these possibilities, since none of the studies analyzed in this review specifically assessed the effects of legalization/decriminalization policies on those outcomes. Therefore, prospective studies focused on the effects of legalization or decriminalization policies should be conducted in countries such as Canada, Spain, the United States of America (some states), the Netherlands, and Uruguay.


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Kaur K. Drug abuse! Problem is intense in Punjab, India. Hum Biol Rev. 2017; 6: 20-29. URL.

Malone DT, Hill MN, Rubino T. Adolescent cannabis use and psychosis: epidemiology and neurodevelopmental models. Br J Pharmacol. 2010;160(3):511-522.

Wilkinson ST, van Schalkwyk GI, Davidson L, D'Souza DC. The Formation of Marijuana Risk Perception in a Population of Substance Abusing Patients. Psychiatr Q. 2016;87(1):177-187.

Smart R, Caulkins JP, Kilmer B, Davenport S, Midgette G. Variation in cannabis potency and prices in a newly legal market: evidence from 30 million cannabis sales in Washington state. Addiction. 2017;112(12):2167-2177.

Blevins CE, Marsh E, Banes KE, Stephens RS, Walker DD, Roffman RA. The Implications of Cannabis Policy Changes in Washington on Adolescent Perception of Risk, Norms, Attitudes, and Substance Use. Subst Abuse. 2018;12:1178221818815491.

Lubman DI, Cheetham A, Yücel M. Cannabis and adolescent brain development. Pharmacol Ther. 2015;148:1-16.

Wilson J, Freeman TP, Mackie CJ. Effects of increasing cannabis potency on adolescent health. Lancet Child Adolesc Health. 2019;3(2):121-128.

Hall W, West R, Marsden J, Humphreys K, Neale JO, Petry N. The need for more consistent evidential standards in cannabis policy evaluations. Addiction. 2018;113(8):1553-1554.

Rogeberg O. Prohibition, regulation or laissez faire: The policy trade-offs of cannabis policy. Int J Drug Policy. 2018;56:153-161.

Buckner JD, Walukevich KA, Lemke AW, Jeffries ER. The Impact of University Sanctions on Cannabis Use: Individual Difference Factors that Predict Change in Cannabis Use. Transl Issues Psychol Sci. 2018;4(1):76-84.

Ortiz-Medina MB, Perea M, Torales J, Ventriglio A, Vitrani G, Aguilar L, et al. Cannabis consumption and psychosis or schizophrenia development. Int J Soc Psychiatry. 2018;64(7):690-704.

Torales J, Ventriglio A, Vitrani G, Barrios I, Medina A, Ruiz Díaz C, et al. Uso de cannabis y desarrollo de esquizofrenia: ¿cuáles son los vínculos?. An. Fac. Cienc. Méd. (Asunción). 2017;50(2):95-102.

Paruk S, Jhazbhay K, Singh K, Sartorius B, Burns JK. A comparative study of socio-demographic and substance use correlates in early-onset psychosis. Early Interv Psychiatry. 2018;12(3):339-347.

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.

Karcher NR, Barch DM, Demers CH, Baranger DAA, Heath AC, Lynskey MT, et al. Genetic Predisposition vs Individual-Specific Processes in the Association Between Psychotic-like Experiences and Cannabis Use. JAMA Psychiatry. 2019;76(1):87-94.

Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

Barnett JH, Werners U, Secher SM, Hill KE, Brazil R, Masson K, et al. Substance use in a population-based clinic sample of people with first-episode psychosis. Br J Psychiatry. 2007;190:515-20.

Donoghue K, Medley I, Brewin J, Glazebrook C, Mason P, Cantwell R, et al. The association between substance misuse and first-episode psychosis in a defined UK geographical area during the 1990s. Soc Psychiatry Psychiatr Epidemiol. 2011;46(2):137-142.

Barnes TR, Mutsatsa SH, Hutton SB, Watt HC, Joyce EM. Comorbid substance use and age at onset of schizophrenia. Br J Psychiatry. 2006;188:237-242.

Bhavsar V. Environmental factors, including cannabis, are strongly related to the age of onset and morbidity of schizophrenia. Evid Based Ment Health. 2015;18(3):84.

Ferdinand RF, van der Ende J, Bongers I, Selten JP, Huizink A, Verhulst FC. Cannabis--psychosis pathway independent of other types of psychopathology. Schizophr Res. 2005;79(2-3):289-295.

Foti DJ, Kotov R, Guey LT, Bromet EJ. Cannabis use and the course of schizophrenia: 10-year follow-up after first hospitalization. Am J Psychiatry. 2010;167(8):987-993.

González-Pinto A, Alberich S, Barbeito S, Gutierrez M, Vega P, Ibáñez B, et al. Cannabis and first-episode psychosis: different long-term outcomes depending on continued or discontinued use. Schizophr Bull. 2011;37(3):631-639.

Pencer A, Addington J, Addington D. Outcome of a first episode of psychosis in adolescence: a 2-year follow-up. Psychiatry Res. 2005;133(1):35-43.

Wobrock T, Falkai P, Schneider-Axmann T, Hasan A, Galderisi S, Davidson M, et al. Comorbid substance abuse in first-episode schizophrenia: effects on cognition and psychopathology in the EUFEST study. Schizophr Res. 2013;147(1):132-139.

Helle S, Ringen PA, Melle I, Larsen TK, Gjestad R, Johnsen E, et al. Cannabis use is associated with 3years earlier onset of schizophrenia spectrum disorder in a naturalistic, multi-site sample (N=1119). Schizophr Res. 2016;170(1):217-221.

Mané A, Fernández-Expósito M, Bergé D, Gómez-Pérez L, Sabaté A, Toll A, et al. Relationship between cannabis and psychosis: Reasons for use and associated clinical variables. Psychiatry Res. 2015 Sep 30;229(1-2):70-74.

Kelley ME, Wan CR, Broussard B, Crisafio A, Cristofaro S, Johnson S, et al. Marijuana use in the immediate 5-year premorbid period is associated with increased risk of onset of schizophrenia and related psychotic disorders. Schizophr Res. 2016 Mar;171(1-3):62-67.

Tosato S, Lasalvia A, Bonetto C, Mazzoncini R, Cristofalo D, De Santi K, et al. The impact of cannabis use on age of onset and clinical characteristics in first-episode psychotic patients. Data from the Psychosis Incident Cohort Outcome Study (PICOS). J Psychiatr Res. 2013;47(4):438-444.

Schoeler T, Petros N, Di Forti M, Pingault JB, Klamerus E, Foglia E, et al. Association Between Continued Cannabis Use and Risk of Relapse in First-Episode Psychosis: A Quasi-Experimental Investigation Within an Observational Study. JAMA Psychiatry. 2016;73(11):1173-1179.

Fergusson DM, Horwood LJ, Swain-Campbell NR. Cannabis dependence and psychotic symptoms in young people. Psychol Med. 2003;33(1):15-21.

Schoeler T, Petros N, Di Forti M, Klamerus E, Foglia E, Ajnakina O, et al. Effects of continuation, frequency, and type of cannabis use on relapse in the first 2 years after onset of psychosis: an observational study. Lancet Psychiatry. 2016;3(10):947-953.

Saddichha S, Sur S, Sinha BN, Khess CR. How is substance use linked to psychosis? A study of the course and patterns of substance dependence in psychosis. Subst Abus. 2010;31(1):58-67.

Basu D, Malhotra A, Bhagat A, Varma VK. Cannabis psychosis and acute schizophrenia. a case-control study from India. Eur Addict Res. 1999 Jun;5(2):71-73.

Sevy S, Robinson DG, Napolitano B, Patel RC, Gunduz-Bruce H, Miller R, et al. Are cannabis use disorders associated with an earlier age at onset of psychosis? A study in first episode schizophrenia. Schizophr Res. 2010;120(1-3):101-107.

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Country Drug Reports 2018 [Internet]. Lisbon: EMCDDA; 2019 [cited 9th February, 2019]. Available from:

Governing. State Marijuana Laws 2018 Map [Internet]. California: Governing; 2018 [cited 9th February, 2019]. Available from:

Hill KP, George TP. Cannabis legalisation in Canada: a crucial trial balloon. Lancet Psychiatry. 2019;6(1):5-6.

Rychert M, Wilkins C. What products are considered psychoactive under New Zealand's legal market for new psychoactive substances (NPS, 'legal highs')? Implications for law enforcement and penalties. Drug Test Anal. 2016;8(8):768-778.

Room R. Legalizing a market for cannabis for pleasure: Colorado, Washington, Uruguay and beyond. Addiction. 2014;109(3):345-351.






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