The Cannabis-Psychosis Spectrum: Clinical Manifestations, Conversion Risk, and Therapeutic Strategies

Cannabis-induced psychosis (CIP) is a growing public health concern as global cannabis use and potency increase. Recent studies estimate CIP incidence at 2.7 to 6.1 per 100,000 person-years. The condition involves complex neurobiological interactions between THC and the endocannabinoid system, affecting dopamine, GABA, and glutamate signaling. Clinical features typically include acute paranoid delusions and hallucinations, often distinguishable from primary psychotic disorders by their temporal link to cannabis use and relatively preserved insight. Treatment is challenging with limited evidence-based guidelines, though second-generation antipsychotics and benzodiazepines show efficacy. Conversion to schizophrenia-spectrum disorders occurs in 33–50% of cases, underscoring the need for early identification and intervention.

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Abstract

Cannabis-induced psychosis (CIP) represents a significant public health concern in the context of increasing global cannabis use and potency. This review synthesizes current evidence on the epidemiology, neurobiological mechanisms, clinical features, and treatment approaches for cannabis-induced psychotic disorders. Recent epidemiological data indicate rising incidence rates of CIP, with estimates ranging from 2.7 to 6.1 per 100,000 person-years in recent studies. The neurobiological mechanisms involve complex interactions between Δ9-tetrahydrocannabinol (THC) and the endocannabinoid system, affecting dopaminergic, GABAergic, and glutamatergic neurotransmission. Clinical manifestations typically include acute onset of paranoid delusions and hallucinations, often distinguishable from primary psychotic disorders by their temporal relationship to cannabis use and relatively preserved insight. Treatment remains challenging, with limited evidence-based guidelines, though second-generation antipsychotics and benzodiazepines show efficacy. The conversion rate to schizophrenia-spectrum disorders ranges from 33–50%, highlighting the importance of early identification and intervention. This review emphasizes the need for improved diagnostic criteria, treatment protocols, and prevention strategies as cannabis legalization continues worldwide.