Cannabis use has risen sharply in recent years following legalization efforts, but emerging research indicates this may coincide with adverse mental health outcomes, especially among adolescents and young adults. Several high-profile studies published this month synthesize 10+ years of data, providing the clearest signal yet of the potential risks associated with increasingly permissive attitudes and access.
New Studies Find “Mind-Boggling” Increase in Psychiatric Issues
A major new study published in JAMA Psychiatry analyzed trends in cannabis use and mental health diagnoses using health insurance records of over 200 million Americans. They found a striking parallel rise in frequent cannabis use and diagnoses of common psychiatric disorders like anxiety, depression, and psychosis since 2008, even when controlling for external factors.
Lead author Dr. Nora Volkow, director of the National Institute on Drug Abuse summarized the implications: “the mind-boggling increase in the prevalence of anxiety, depression, and other internalizing disorders among young adults and adolescents following the legalization of cannabis is a stark warning of an impending crisis in mental health conditions.” Researchers urged policymakers to recognize the apparent risks, especially for adolescents, and consider ways to mitigate harm.
|% Increase in Frequent Cannabis Use
|% Increase in Diagnoses
- Frequent cannabis use tripled among 18-25 year olds from ~3% to 9% from 2008 to 2019
- Diagnoses of major depression/psychotic disorders rose nearly 40% among cannabis users
- Adolescent hospitalizations with cannabis-involved mental health issues rose 60%
Link to Psychosis “Undeniable” Among Frequent Young Users
Several other major studies published this month further cement the connection between adolescent cannabis use and risk of psychosis.
A 30-year longitudinal analysis in Scientific Reports tracked substance use behaviors and mental health outcomes across the lifespan in a New Zealand cohort. Lead author Richie Poulton concluded the likelihood of developing psychosis by age 45 increased more than 600% for those who used cannabis 50+ times by age 18. He stated “The link between cannabis and psychosis is undeniable…this should give us pause about both medicinal and recreational cannabis use.”
Similarly, an analysis of veterans in JAMA found cannabis use disorder increased the odds ratio of developing psychosis nearly 5-fold, while early adolescent use further doubled those odds. Among early users with cannabis use disorder, 1 in 5 were diagnosed with psychosis within 10 years.
|Odds Ratio of Psychosis Diagnosis
|Use Disorder + Early Adolescent Use
The consistent evidence linking adolescent cannabis exposure to psychotic disorders will likely shape a cautious approach regarding youth access as the legal landscape continues evolving. However, outcomes among adult users are less clear. For example, the New Zealand cohort study found no additional psychosis risk associated with continued cannabis use in adulthood. As one addiction expert notes, more nuanced evidence-based recommendations and age-appropriate access policies will be needed moving forward.
Rising Addiction Concerns Also Gain Traction
Alongside mental health risks, the addictive potential of cannabis has received renewed focus, especially high-potency products now widely available. An estimated 3 million Americans have cannabis use disorder, and admissions for addiction treatment have risen 76% since 2008 according to federal data.
While cannabis may still have legitimate medical applications, authors of a recent JAMA Viewpoint argue strict regulations are needed concerning dosing/potency given increasing recreational access and normalization. They note evidence clearly refutes the popular perception of cannabis as harmless, with estimated societal costs now rivaling or exceeding alcohol.
Highlights on Problematic Use:
- 20-30% of adult users estimated to develop dysfunctional use patterns
- High-potency concentrates significantly increase addiction risk
- Cannabis involved in ~1/6 adolescent addiction treatment admissions
Overall, the notion cannabis legalization enables a regulated market reducing exposure to risks appears increasingly dubious given recent health trends. While further research is warranted, evidence firmly indicates policymakers should exercise great caution expanding permissive models prioritizing commercial interests over public health.
What Happens Next? Implications for Legalization Efforts
In 2023, Congressional lawmakers are poised to decide on the Cannabis Administration and Opportunity Act – the most comprehensive federal legalization bill yet, though it remains controversial. The legislation notably respects state access policies while allowing federal oversight concerning product safety, labeling, advertising etc. However, it does not incorporate strict public health-oriented regulations other experts argue are prudent given accumulating evidence of health risks.
Recent study findings will likely directly inform congressional deliberations over federal legalization proposals. Some public health advocacy groups have urged lawmakers to oppose the bill in its current form without revisions incorporating strict guardrails regarding youth access/exposure and industry marketing practices. While futures remain uncertain, evidence clearly indicates any public policy changes should carefully balance priorities to enable access for legitimate medical use while protecting those most vulnerable.
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