High Risk: Understanding Marijuana Psychosis

Marijuana is a commonly used substance that has grown increasingly accepted in recent years. A total of 21 states have legalized cannabis, and another ten have decriminalized its use. While still illegal at the federal level, it does not appear that the U.S. federal government intends to take enforcement action against those who use marijuana.

From Half Baked to Pineapple Express, there are entire movies dedicated to glamorizing the use of cannabis. While funny, they gloss over the dangers cannabis use can pose to a certain portion of the population. All of these developments have resulted in an increasing cultural acceptance of cannabis use and an increase in the prevalence of side effects.

An Obama-era White House report found that marijuana was the most commonly cited drug for hospital admission in the state of South Carolina. Lantana Recovery offers one of the premier rehabilitation models for drug misuse, addiction, and psychosis in the South.

The Danger of Marijuana

Cannabis is not inherently dangerous. Some individuals are able to use it without incident. However, there is no question that cannabis can pose a danger to some individuals.

The Centers for Disease Control and Prevention (CDC) has determined that individuals who use marijuana are more likely to develop temporary psychosis as experimental studies in healthy humans show that cannabis and its active ingredient, delta-9-tetrahydrocannabinol (THC), can produce transient, dose-dependent, psychotic symptoms, as well as an array of psychosis-relevant behavioral, cognitive and psychophysiological effects; the psychotogenic effects can be ameliorated by cannabidiol (CBD). Moreover, the association between marijuana use and schizophrenia is stronger in those who both use the drug at a younger age and use it more frequently. There is also research that links cannabis with conditions such as depression and even suicidal ideation.

The Science of Marijuana Psychosis

Cannabis induces relaxation in most users. The mechanism of relaxation involves the endocannabinoid system (ECS). The ECS is a vast network of neurons. A part of this system encompasses cannabinoid receptors, known as CB1 receptors, which are among the most commonly found receptors in the brain, particularly in the amygdala.

The article “The Endocannabinoid System: Essential and Mysterious” by Harvard Health Publishing describes CB1 receptors as “traffic cops.” They affect the modulation of nearly everything, from temperature to hunger. The CB1 receptors are stimulated by endocannabinoids, which are found in the marijuana plant.

Chronic use of marijuana can result in the overstimulation of the CB1 receptors resulting in adverse effects. The high density of CB1 receptors in the amygdala, which is responsible for detecting threats and regulating unconscious fear, may explain why the use of cannabis can produce paranoia when CB1 receptors are overactivated.

A Dark Turn

Nonmedical (“recreational”) cannabis use and cannabis laws have changed over the past two decades in the United States and the rest of the world. A study out of the University of Chicago found that increased THC content in cannabis was associated with elevated stress in healthy study participants. The study determined that 7.5mg of THC content produced a relaxing effect, while 12.5mg resulted in the opposite result. Another study in Schizophrenia Bulletin determined that intravenous THC increases paranoia in individuals vulnerable to paranoid ideation.

Part of the risk that exists for individuals in the current cannabis market is the increased THC content in almost all forms sold. According to a study in Frontiers in Psychology, over half of sampled products across nine states had no information on their THC content. The same study found that among all of the states studied, 72 to 100% of the samples examined had amounts of THC that would be considered “most intoxicating.”

This is significant in light of a 2019 finding in The Lancet, which determined that daily cannabis use was associated with an increased risk of psychotic disorder. The risk is likely elevated in the context of such high average THC content in cannabis currently on the market.

Signs of Marijuana Psychosis

“Cannabis use is associated with structural GM changes in brain regions consistently associated with psychosis, including the hippocampus, amygdala, as well as striatal, prefrontal cortical, and cerebellar regions” (Association between age of cannabis initiation and gray matter covariance networks in recent onset psychosis, Penzel et al., 2021.) There are a variety of signs of marijuana psychosis, including the following:

• Delusions: Delusions are beliefs that are not real and exist with little or no evidence. A person stuck in a delusion will likely not respond to evidence that contradicts their narrative. The delusions generally take the form of paranoia or grandiosity.
• Paranoia: Paranoia emerges as a mistrust of others. It often involves a web of beliefs related to an overarching threat paradigm. People who are clinically paranoid may interpret neutral conduct as indicative of evidence supporting this threat.
• Grandiosity: Grandiose delusions revolve around an individual believing that they have a superior status (i.e., they believe they are a president’s son, a monarch, or they have a special relationship with a deity). They may also believe that they have certain superpowers.
• Hallucinations: Hallucinations are deceptions of the senses and include hearing voices, seeing things that aren’t real, or imagining scenes that don’t exist. It can also include tactile sensations or smells.
• Dissociation: Dissociation occurs when an individual doesn’t believe that their surroundings are real. They may feel as if they are outside their body as events in life unfold.

Treating Marijuana Psychosis

Acute treatment of marijuana psychosis usually entails a variety of therapeutic approaches. First, an individual will likely require some form of medically supervised detox. This will generally involve a full medical work-up, including a complete blood test (CBC), a test of liver function, chest x-ray, EKG, and vital sign monitoring.

Depending on the facility, an individual may have to voluntarily commit themselves as a patient in a psychiatric facility. This means they will not be able to leave without the approval of a physician. There are also usually strict visiting rules during the detox phase. It is anecdotally described as an uncomfortable and vulnerable place to be in from an emotional perspective.

Medications for Marijuana Psychosis

There are a few medications that are commonly prescribed for acute psychosis:

• Benzodiazepines: These are medications such as Xanax (alprazolam), Ativan (lorazepam), and Klonopin (clonezapam).
• Antipsychotics: The most commonly used antipsychotic for an acute episode of psychosis is Haldol (haloperidol). Other front-line antipsychotics include Zyprexa (olanzapine), Risperdal (risperidone), and Geodon (ziprasidone).

Bottom Line

If you or a loved one are struggling with marijuana psychosis, Lantana Recovery can offer its expertise as a rehabilitation facility. Some struggling with acute psychosis may choose to transfer to Lantana after they have fully detoxed in a more supervised setting. Marijuana psychosis is a documented phenomenon that occurs when CB1 receptors, particularly dense in the amygdala, are overstimulated. The amygdala is responsible for triggering a sense of fear and paranoia that individuals may experience during a marijuana-induced psychosis. Psychosis can be scary, both for the individual experiencing it and for those around them.