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Cannabis-Induced Psychosis

Last Updated on August 3, 2021 by Chris Weatherall

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

cannabis use disorderMany illicit drugs cause intense psychoactive effects, similar to cannabis-induced psychosis. Although the American public generally assumes marijuana to be one of the “safest” options in terms of recreational drug use, the reality is that extensive cannabis consumption can lead to dangerous mental health events, including the appearance of the symptoms of psychosis. This risk is intensified in individuals who already struggle with psychological conditions such as depression, anxiety, or personality disorders.

Cannabis-induced psychosis and other forms of substance-induced psychosis can leave devastating effects. It is essential to understand the links between cannabis and psychosis to reduce the risks associated with use. It is never safe to assume that an incident of cannabis-induced psychosis symptoms is an isolated event; these situations can escalate and prove dangerous for everyone involved.

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What Is Cannabis-Induced Psychosis?

To the question “what is psychosis,” think of it as a set of symptoms rather than one single onset. Psychosis is not exactly a condition but rather the description of symptoms that may arise out of several mental health disorders, including addiction. The symptoms of psychosis can include a sense of detachment from reality, hallucinations, overwhelming anxiety, unrealistic paranoia, and uncharacteristic behaviors that may pose a threat of physical harm to the individual experiencing the psychotic break or those around him or her.

Many illicit drugs are capable of producing symptoms of psychosis, though the effects are short-lived and immediately follow consumption of the drug. The symptoms of intoxication from some types of drugs, including cocaine and methamphetamine, can easily mirror acute psychotic episodes. Cannabis-induced psychosis is different as it builds over time with consistent cannabis abuse, eventually leading to climactic and often dangerous episodes.

Cannabis-induced psychosis is a type of drug-induced psychosis that manifests with prolonged marijuana consumption. Any type of substance abuse disorder can eventually lead to psychological problems, personality changes, and episodes of acute distress — including marijuana. Psychosis not only poses these dangers, but also the threat of bodily injury to the individual struggling with psychotic symptoms and those around him or her. People experiencing psychotic episodes may lash out violently and harm themselves or others. Oftentimes, they are completely unaware of their actions.

Types of Substance-Induced Psychosis

Cannabis is only one type of drug-induced psychosis. Several other illicit substances can cause psychotic symptoms, including:

  • LSD or “acid,” a powerful hallucinogen. This drug causes intense hallucinations and psychotic symptoms such as detachment from reality, sensations described as “out of body” experiences, and inability to interpret time and space accurately.
  • Amphetamines, including methamphetamine. These drugs produce intense effects very quickly. Extreme potency variations of these stimulants can cause severe psychotic reactions immediately after consumption.
  • Opioids, such as heroin, morphine, and methadone. These drugs are powerful painkillers and depress the central nervous system. The profound euphoric effects can cause feelings of detachment from reality.
  • Sedatives, including sleep disorder medications and anti-anxiety medications. These drugs interfere with the body’s circadian rhythms. Sleep problems can manifest as psychotic symptoms if left unchecked for too long.
  • Cocaine, a powerful stimulant. Similar to other stimulants like methamphetamine, high doses of cocaine can produce psychosis-like symptoms in some users immediately after dosing.
  • Alcohol, likely the most commonly abused drug. Alcohol intoxication can make it difficult to process reality in real-time, slow reaction times, and cause dissociative feelings.

Despite the fact that these substances are generally more harmful than cannabis, the appearance rate of cannabis-induced psychosis is much greater than any other type of drug-induced psychosis. States that have recently enacted legislation permitting recreational marijuana sale and consumption have reported sharp increases in the number of cannabis-induced psychotic episodes1 reported by emergency room personnel.

Symptoms and Diagnosis

cannabis-induced psychosisWhile cannabis consumption itself does not directly cause psychotic episodes in all cannabis users, excessive cannabis use can act as a trigger for psychotic symptoms in individuals susceptible to mental health disorders or with preexisting psychological conditions. For example, an individual struggling with depression, general anxiety disorder, or schizophrenia may experience a marked increase in symptom intensity after prolonged marijuana consumption. Eventually, this pattern of abuse could lead to a psychotic episode.

The potency of marijuana currently available both legally and on the street in the United States is also much greater2 than in previous years. Higher-potency cannabis produces more intense effects, and also causes tolerance to build more quickly. This can easily escalate an individual’s risk of experiencing a psychotic episode. The more high-potency cannabis consumed, the greater the risk of experiencing cannabis-induced psychosis in the future.

Cannabis-induced psychosis can cause many troubling symptoms, and some of these symptoms may appear earlier than others. Some may manifest mildly while others manifest more intensely. If you witness any of these symptoms in a loved one or friend who uses cannabis on a regular basis, it is vital to understand that the situation could quickly worsen.

Signs of Cannabis-induced psychosis:

  • Atypical behavior, such as a formerly outgoing person becoming withdrawn and reclusive.
  • Severe anxiety. Escalating feelings of paranoia or unrealistic interpretations of one’s environment can become overwhelming very quickly without intervention.
  • Hallucinations. These experiences may be auditory, such as hearing voices, or visual, such as seeing people, places, or things that are not really there. In some cases, people even cultivate false memories.
  • Detachment from reality. Some people experiencing psychotic episodes may seem unresponsive or distracted. They may temporarily have difficulty recognizing familiar people or remembering the names of friends and loved ones.
  • Sleep problems. People struggling with the onset of drug-induced psychosis may have trouble falling asleep, staying asleep, or sleeping at acceptable times.
  • Depression. Feeling detached from reality can be a distressing experience, causing some people to develop symptoms of depression. This is dangerous because it can increase the chances of the individual attempting to self-medicate for relief.*

*The Journal of Affective Disorders has published a study that states that while cannabis can lighten symptoms such as anxiety or depression or stress in the short term, the use of cannabis exacerbates depression over time.

There is no single pattern of symptoms that every person will experience during the onset of cannabis-induced psychosis. If you notice any of these symptoms in another person who uses cannabis, encourage them to seek treatment before the issue escalates out of control.

Diagnosing Cannabis-Induced Psychosis

The first step in cannabis-induced psychosis treatment is identifying the signs of psychotic symptoms and cannabis use disorder. Medical professionals will typically diagnose a patient with cannabis-induced psychosis if he or she displays psychotic symptoms that are apparently unlinked to a preexisting psychological condition. For example, if an individual has no history of anxiety problems and begins experiencing intense anxiety attacks after prolonged use of cannabis, this would likely confirm a diagnosis of cannabis-induced psychosis.

A diagnosing physician will also look at the timeframe of the appearance of the patient’s psychotic symptoms. If symptoms appeared shortly after consuming cannabis or within a month of ceasing cannabis consumption, this timing would likely confirm a cannabis-induced psychosis diagnosis. The severity of the patient’s symptoms also confirms the diagnosis; an individual experiencing intense visual and auditory hallucinations is not the same thing as an individual experiencing the typical delirium and euphoria associated with cannabis intoxication.

Cannabis-induced psychosis generally does not cause acute transitory episodes of psychotic symptoms; these symptoms can persist for days, weeks, or even longer. They will continue to escalate in intensity, disrupt everyday life, and pose a more severe danger the longer they remain unchecked.

Signs of Cannabis Use Disorder

When diagnosing cannabis-induced psychosis or any other type of substance-induced psychosis, the diagnosing physician will ask several questions related to the patient’s substance abuse:

  1. Does the patient overuse cannabis despite his or her intentions to abstain?
  2. Has the patient tried to cease cannabis use in the past but failed?
  3. Has the patient experienced negative personal consequences for using cannabis such as legal action, jail time, fines, or strained personal relationships but continues using cannabis anyway?
  4. Does the patient report cannabis use interfering in his or her everyday routine and responsibilities?
  5. Has the patient continued to use cannabis despite experiencing negative physical, mental, financial, or interpersonal effects of his or her cannabis use?
  6. Does the patient experience cannabis cravings frequently?
  7. Has the patient increased his or her cannabis consumption due to tolerance?
  8. Does the patient experience withdrawal symptoms within a few hours of using cannabis?

Typically, a diagnosing physician will consider two or more affirmative answers to these questions as sufficient grounds to diagnose a patient with cannabis use disorder. Although public perception of cannabis is very different than it is of drugs like heroin, cocaine, and methamphetamine, any type of substance abuse can be incredibly destructive. All cannabis users — and their friends and loved ones — should consider the dangerous link between cannabis and psychosis symptoms.

Ultimately, the brain is one of the most vulnerable parts of the human body when it comes to toxic exposure, and consistent cannabis use has an undeniable effect on brain chemistry and one’s ability to handle preexisting mental health conditions. Those facing the highest level of risk are individuals with untreated mental health disorders and unchecked cannabis consumption.

Co-Occurring Disorders & Cannabis Abuse

Another troubling aspect of addressing cannabis-induced psychosis is the appearance rate of co-occurring disorders, or “dual diagnosis” cases. A dual diagnosis is a case in which an individual suffers from a substance use disorder and a mental health condition such as anxiety, depression, or schizophrenia. In substance abuse treatment, a “co-occurring disorder” refers to a patient’s mental health disorder that runs in tandem with his or her addiction.

Treatment for co-occurring disorders fails unless those providing treatment address both the patient’s mental health disorder and his or her addiction simultaneously; it is not possible to cure one problem without treating the other. Research also confirms that untreated cannabis use disorder significantly increases the likelihood of not only experiencing cannabis-induced psychosis later but also developing other psychotic disorders later, such as bipolar disorder or schizophrenia.

  • About 41% of people who experience cannabis-induced psychosis later go on to develop schizophrenia and about 6% develop bipolar disorder.
  • An individual with an established risk of experiencing a psychotic disorder is far more likely to experience a temporary onset of psychotic symptoms after consuming marijuana.
  • About 25% of people suffering from schizophrenia also struggle with cannabis use disorder.
  • People with schizophrenia who consume marijuana before age 18 develop schizophrenia symptoms about ten years earlier than those who develop the condition with no marijuana use.

Ultimately, the appearance of cannabis-induced psychotic episodes is a clear precursor to an individual’s future risk of developing a serious psychological condition.3,4,5 Cannabis-induced psychosis is not only dangerous in the short-term when it comes to the risk of physical injury and detachment from reality. It’s also harmful in the long term due to the cultivation of serious personality disorders and psychological conditions like bipolar disorder and schizophrenia.

Cannabis-Induced Psychosis Prognosis

The appearance of cannabis-induced psychosis signifies a deeper underlying issue that requires immediate treatment. As with any type of substance abuse, the sooner treatment begins, the sooner the individual can experience relief and start managing the psychological disorder in a healthier, more constructive, and safer way.

The first step in any type of addiction treatment or chemical dependency is detox, which flushes the last of the drugs from a patient’s body so he or she can begin the recovery process. There is no one-size-fits-all solution to cannabis-induced psychosis recovery. Each person is different and with an initial health assessment, the treating practitioner may recommend a gentle titration off cannabis.

After the diagnosis, the patient should receive an individualized treatment plan that addresses his or her substance abuse disorder and the mental health prognosis at the same time. The most successful treatment plans generally include a blend of individual counseling, group therapy, learned coping skills, and holistic therapies that ease the withdrawal process and help prevent relapse of use.

Overcoming Cannabis Use Disorder

Alternative to Meds Center does not believe in trading one drug dependency for another. Our team of treatment specialists employs evidence-based holistic therapies to help people overcome drug use and effectively manage mental health conditions without reliance on medications. We also know the value of the detox process and how an integrated and personalized approach increases the chances of a positive recovery experience. The Holistic Detox Program at Alternative to Meds Center helps clean the body to enable a better recovery experience. Various holistic therapies and treatments help remove environmental toxins and identify nutritional deficiencies from prolonged substance abuse and the physical toll addiction takes on the human body.

Contact us today to learn more about our Holistic Detox program. Cannabis-induced psychosis is a dangerous condition that requires immediate attention before the problem spirals out of control. With comprehensive treatment, anyone struggling with cannabis use disorder and a co-occurring condition can learn how to manage triggers, stressors, and drug cravings to live a healthier and balanced life. Call us for more information about Alternative to Meds Center’s treatment programs for cannabis-induced psychosis and other related issues.

1. Garey J, “Marijuana and Psychosis.” Child Mind Institute [Internet] N.D. [cited 2020 Dec 17]

2. Chatterjee R “Daily Marijuana Use And Highly Potent Weed Linked To Psychosis”, 2019 Mar 19 [INTERNET] [cited 2020 Dec 17]

3. Mathers DC, Ghodse AH. “Cannabis and psychotic illness.” Br J Psychiatry. 1992 Nov;161:648-53. doi: 10.1192/bjp.161.5.648. PMID: 1358394. [cited 2020 Dec 17]

4. Degenhardt L. “The link between cannabis use and psychosis: furthering the debate.” Psychol Med. 2003 Jan;33(1):3-6. doi: 10.1017/s0033291702007080. PMID: 12537030. [cited 2020 Dec 17]

5. Verdoux H, Gindre C, Sorbara F, Tournier M, Swendsen JD.” Effects of cannabis and psychosis vulnerability in daily life: an experience sampling test study.” Psychol Med. 2003 Jan;33(1):23-32. doi: 10.1017/s0033291702006384. PMID: 12537033.[cited 2020 Dec 17]

Originally Published Jun 28, 2019 by Diane Ridaeus

This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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Cannabis-Induced Psychosis
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