The link between cannabis use and psychosis: furthering the debate
The issue of whether an association exists between cannabis and psychosis exists, and why, has received considerable attention in recent years (Hall, 1998; Mueser et al. 1998; Blanchard et al. 2000; Degenhardt & Hall, 2002). There are probably a number of reasons for the sustained interest. First, psychotic disorders such as schizophrenia are often chronic or recurring (Mason et al. 1996), are associated with significant disability (Keith et al. 1991) and they place a considerable burden upon the community at large (Hall et al. 1985; Knapp, 1997). Secondly, over the past few decades, high rates of cannabis use and use disorders have been observed among persons with schizophrenia and other psychoses (Barbee et al. 1989; Fowler et al. 1998), suggesting the possibility that cannabis use may be causally related to psychotic disorders. Thirdly, given what is known about the psychotomimetic effects of cannabis (Hall et al. 2001), it is plausible that high doses of cannabis may produce psychotic symptoms. Finally, clinical research with persons with psychotic disorders has found that problematical substance use is correlated with a range of negative outcomes including relapse, rehospitalization, poor medication compliance, poorer social functioning and increased treatment costs (Salyers & Mueser, 2001), suggesting drug use may be related to worsened clinical outcomes.
c1 Address for correspondence: Dr Louisa Degenhardt, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.