Marijuana psychosis is a mental condition triggered by the consumption of marijuana, leading to symptoms such as hallucinations, delusions, and a loss of personal identity. It is a severe side effect that can occur in some individuals, particularly those with a predisposition to mental health disorders. This condition can be temporary or lead to long-term psychiatric disorders. It's crucial to seek immediate medical attention if symptoms of marijuana psychosis are experienced.
What is Marijuana?
Marijuana, also known as weed, is a green, brown, or grey mix of dried, crumbled parts from the marijuana plant [1]. It is a product derived from the Cannabis sativa plant and, in scientific literature, is referred to as cannabis [2]. Marijuana is also one of the most common drugs in the world, similar to opioids [3].
Marijuana is composed of two main active compounds: delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) [4]. THC is the active psychoactive compound in cannabis that is responsible for the high, whereas CBD is the non-psychoactive component [5]. CBD, in particular, is now being licensed in countries worldwide due to its health benefits. Other than CBD, marijuana or weed includes a spectrum of herbal compounds.
Uses of Marijuana
Marijuana is usually inhaled as smoke but can also be used as a vapour, taken by mouth as a spray, ingested in tea or as butter in baked goods, or in capsule form and used as an oil [6]. It can produce feelings of euphoria, distorted perceptions, and trouble-solving problems [3].
Medically, it is used in a spectrum of medical conditions. These include:
- ADHD
- antiemetic agent in nausea, including in chemotherapy for cancer [7]
- anxiety
- epilepsy
- neuropathic pain
The combination of THC and CBD will depend on the medical indication.
What is Marijuana Psychosis?
Marijuana psychosis, also known as cannabis-induced psychosis disorder, is a mental health condition lasting at least 48 hours that can occur in some individuals during or after the use of cannabis. It is a formal diagnosis according to the diagnostic and statistical manual of mental health [8].
According to the UK schizophrenia consortium, marijuana consumption is the single most preventable risk factor for developing schizophrenia [9].
Marijuana psychosis, or weed psychosis, is characterized by a disconnection from reality, often manifesting as severe hallucinations or delusions that first appear during cannabis use or shortly after [10]. The appearance of these symptoms after taking weed is a critical distinction between weed psychosis and schizophrenia, although many patients go on to develop schizophrenia or bipolar disorder.
Symptoms of Marijuana Psychosis
Persisting hallucinations are the primary symptom of marijuana psychosis. Hallucinations are sensory experiences one perceives that are unreal, such as touch, sounds or visions. Delusions are another core feature of marijuana psychosis. These differ from hallucinations as they refer to beliefs that an individual may hold. A common example of a delusion is a belief that you are being followed or that you are a famous historical figure. Although delusions and hallucinations are distinct, both can be present in weed psychosis [10].
Other symptoms of weed psychosis include disorganized speech, confusion, memory loss, grandiosity, difficulty feeling or expressing emotions, hyperexcitability, and uncooperativeness. Critically, these symptoms persist longer than 48 hours [10].
Being high is not psychosis
While mild delusions or brief hallucinations can occur while using cannabis, these usually disappear along with the high.
Neurobiology of Marijuana Psychosis
The neurobiology of marijuana is fascinating but very complex. Here, we will touch on the basic neurobiology of how marijuana works and how this can lead to marijuana psychosis.
Cannabis is the primary substance in marijuana, which contains the psychoactive substance THC. THC interacts with the brain's endocannabinoid system, which is responsible for endorphin highs, relieves pain, and regulates mood [11]. The interaction of THC with the endocannabinoid receptors leads to various psychological effects, including an increased risk of psychosis in some individuals [12, 13]. The endocannabinoid system also regulates the levels of monoamines in the brain: dopamine, serotonin and noradrenaline. These monoamines have been linked to the neurobiology of schizophrenia and may explain why cannabis can trigger psychosis.
Genetics are another plausible connection, the strongest evidence being that cannabis can trigger one’s predisposition to develop schizophrenia. This was demonstrated in a twin study, where identical twins exposed to cannabis were more likely to develop psychosis compared to their twins who had not been exposed to cannabis.
Summary: Symptoms and Neurobiology of Marijuana Psychosis
To summarise, marijuana or week psychosis is a psychotic episode lasting longer than 48h that can be formally diagnosed through the DSM. It is characterised by hallucinations, delusion, thought disturbance and difficulty regulating mood. It can be caused by genetic factors and may be linked to monoamine neurotransmission in the brain.