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  • Chapter 6 - Policy Implications of the Evidence on Cannabis Use and Psychosis
  • from Part II - The Changing Face of Cannabis
  • Edited by Deepak Cyril D'Souza, Staff Psychiatrist, VA Connecticut Healthcare System; Professor of Psychiatry, Yale University School of Medicine, David Castle, University of Tasmania, Australia, Sir Robin Murray, Honorary Consultant Psychiatrist, Psychosis Service at the South London and Maudsley NHS Trust; Professor of Psychiatric Research at the Institute of Psychiatry
  • Book: Marijuana and Madness
  • Published online: 12 May 2023
  • Print publication: 01 June 2023, pp 51-60
  • View extract

    Summary

    There is consistent observational evidence and biological plausibility for the hypothesis that regular cannabis use is a contributory cause of psychosis. The evidence is at least as strong as that for causal relationships between heavy alcohol and amphetamine use and psychosis. On the grounds of prudence, the evidence warrants organized efforts to discourage regular cannabis use among adolescents and young adults. Clinical services should specifically identify young adults with psychoses who use cannabis and encourage them to desist. We need to develop preventive programmes that effectively inform young people about the mental health risks of early and frequent cannabis use. Jurisdictions that have legalized cannabis for medical or recreational use should regulate cannabis products in ways that reduce young people’s access to high potency products at an early age and prevent cannabis retailers from promoting more frequent and longer-term cannabis use among young adults.

  • 10 - The association between cannabis use and depression: a review of the evidence
  • Edited by David Castle, University of Melbourne, Robin M. Murray, Deepak Cyril D'Souza, Yale University, Connecticut
  • Book: Marijuana and Madness
  • Published online: 05 November 2011
  • Print publication: 27 October 2011, pp 114-128
  • View abstract

    Summary

    Cannabinoid receptors can be activated not only by cannabis-derived and synthetic agonists but also by endogenous cannabinoids produced in mammalian tissues and usually referred to as endocannabinoids. There are numerous data in the literature that provide strong support for the notion that the endocannabinoid system (ECS) plays a crucial role in the modulation of several other systems ranging from the central and autonomic nervous systems to the endocrine system, the gastrointestinal tract and the reproductive, immune and cardiovascular systems. The ECS has been reported to become upregulated in a wide range of disorders, such as multiple sclerosis, cancer, schizophrenia, post-traumatic stress disorders, certain types of pain, some intestinal and cardiovascular diseases, excitotoxicity and traumatic head injury. The ECS has prompted a number of important advances in the field of cannabinoid research. It is a key player in several physiological processes and pathological conditions in both central and peripheral tissues.
  • 5 - What are the policy implications of the evidence on cannabis and psychosis?
  • Edited by David Castle, University of Melbourne, Robin M. Murray, Deepak Cyril D'Souza, Yale University, Connecticut
  • Book: Marijuana and Madness
  • Published online: 05 November 2011
  • Print publication: 27 October 2011, pp 55-65
  • View extract

    Summary

    This chapter explores the policy implications of the evidence on cannabis and psychosis for mental health services, health education about the risks of cannabis use, and public policy toward recreational cannabis use. It is useful to compare the strength of the evidence on cannabis and psychosis with that of observational evidence on relationships between adverse health effects and other types of drug use. These comparisons facilitate more consistent, even-handed appraisals of the comparative strengths and weakness of evidence on the adverse effects of different drugs. Providing credible advice to young people on the mental health risks of cannabis use is complicated by the polarized views on the health risks of cannabis expressed in the larger cannabis policy debate. It seems likely that governments in most developed countries will continue to prohibit cannabis use by adults, regardless of whether they do so by imposing criminal or civil penalties for use.
  • Outcomes of occasional cannabis use in adolescence: 10-year follow-up study in Victoria, Australia
  • Louisa Degenhardt, Carolyn Coffey, John B. Carlin, Wendy Swift, Elya Moore, George C. Patton
  • Journal: The British Journal of Psychiatry / Volume 196 / Issue 4 / April 2010
  • Published online by Cambridge University Press: 02 January 2018, pp. 290-295
  • Print publication: April 2010
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  • View abstract
    Background

    Regular adolescent cannabis use predicts a range of later drug use and psychosocial problems. Little is known about whether occasional cannabis use carries similar risks.

    Aims

    To examine associations between occasional cannabis use during adolescence and psychosocial and drug use outcomes in young adulthood; and modification of these associations according to the trajectory of cannabis use between adolescence and age 20 years, and other potential risk factors.

    Method

    A 10-year eight-wave cohort study of a representative sample of 1943 secondary school students followed from 14.9 years to 24 years.

    Results

    Occasional adolescent cannabis users who continued occasional use into early adulthood had higher risks of later alcohol and tobacco dependence and illicit drug use, as well as being less likely to complete a post-secondary qualification than non-users. Those using cannabis at least weekly either during adolescence or at age 20 were at highest risk of drug use problems in young adulthood. Adjustment for smoking in adolescence reduced the association with later educational achievement, but associations with drug use problems remained.

    Conclusions

    Occasional adolescent cannabis use predicts later drug use and educational problems. Partial mediation by tobacco use raises a possibility that differential peer affiliation may play a role.

  • Chapter 9 - Summary and conclusions
  • Shane Darke, University of New South Wales, Sydney, Louisa Degenhardt, University of New South Wales, Sydney, Richard Mattick, University of New South Wales, Sydney
  • Book: Mortality amongst Illicit Drug Users
  • Published online: 30 September 2009
  • Print publication: 21 September 2006, pp 135-144
  • View extract

    Summary

    Introduction

    Over the course of this book, we have examined many aspects of a particularly complex problem. In this chapter, we summarise the major findings from each of the areas covered and, briefly, look to the future.

    Why should society care about drug-related death?

    The question posed early in this book was: Does drug-related death matter? While it is undeniable that drug use and drug-related mortality have increased, should this be seen as a significant concern for society? As we saw, arguments could be made that these deaths are self-inflicted, and may even be of benefit to society due to reductions in crime and disease (Chapter 1). If we exclude simple compassion, which not all in a society would share, can the allocation of attention and resources to this problem be justified?

    As was seen, the argument that death due to illicit drug use is an essentially self-inflicted harm does not stand up to any close intellectual scrutiny. Drug dependence is not an act of free will made in the absence of precipitating causes. There are a number of well-delineated psychosocial factors that engender dependent illicit drug use, most particularly the clinical picture of a “shattered childhood”. Furthermore, and most importantly, we have seen that the majority of drug-related fatalities occur amongst drug-dependent individuals.

  • Chapter 8 - Reducing drug-related mortality
  • Shane Darke, University of New South Wales, Sydney, Louisa Degenhardt, University of New South Wales, Sydney, Richard Mattick, University of New South Wales, Sydney
  • Book: Mortality amongst Illicit Drug Users
  • Published online: 30 September 2009
  • Print publication: 21 September 2006, pp 111-134
  • View extract

    Summary

    Introduction

    The preceding chapters have presented detailed analyses of the major causes of illicit drug-related mortality, as well as the demographic characteristics of drug-related fatalities, possible mechanisms, and risk factors for such deaths. In this chapter we examine various means of reducing such deaths. Some interventions are well established, such as the various treatment modalities for opioid dependence. Others have been proposed, but have yet to be implemented and/or evaluated. The area of drug-related traumatic injury has not been addressed at all by intervention, so any discussion is necessarily speculative.

    Drug treatment

    As noted in Chapter 3, drug-dependence treatment has a substantial role in reducing mortality and morbidity associated with illicit drug use. This is especially true in the context of opioid dependence, the drug class associated with the greatest risk of death (cf. Chapter 3). The strongest, and largest body, of research in this regard comes from studies of methadone-maintenance treatment (and other opioid replacement therapies), and its effect on drug-injecting behaviour and mortality rates. This is not, of course, to suggest that retention in other forms of long-term treatment, such as drug-free residential rehabilitation, do not reduce risk of death. Indeed, long-term retention in both maintenance and residential rehabilitation have been demonstrated to reduce the risk of non-fatal heroin overdose (Darke et al., 2005f; Stewart et al., 2002), and thus the risk of one of the major killers of opioid users.

  • Chapter 7 - Mortality and trauma
  • Shane Darke, University of New South Wales, Sydney, Louisa Degenhardt, University of New South Wales, Sydney, Richard Mattick, University of New South Wales, Sydney
  • Book: Mortality amongst Illicit Drug Users
  • Published online: 30 September 2009
  • Print publication: 21 September 2006, pp 96-110
  • View extract

    Summary

    Introduction

    In this chapter we examine deaths attributable to trauma. Death from trauma among illicit drug users is understudied by comparison with overdose and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), but, nonetheless, there are strong reasons for believing that it plays a role in premature mortality. Firstly, there are lifestyle factors surrounding illicit drug use that suggest that trauma may play a significant role in causing illicit drug user deaths. Illicit drugs are expensive, and highly sought after by dependent drug users. The scope for violence in such circumstances is high. High levels of crime and sex work performed to support drug use are well documented (Flynn et al., 2003; Gossop et al., 1998; Kaye et al., 1998), activities that carry a high trauma risk. At the psychological level, there is a strong association between antisocial personality disorder (ASPD), borderline personality disorder (BPD) and dependent drug use, diagnoses specifically associated with impulsivity, risk-taking and violent behaviours (American Psychiatric Association, 2000). In addition to the more direct results of the illicit drug using lifestyle, there is also a strong association between motor vehicle accident (MVA) trauma, other accidents and illicit drug use (Kelly et al., 2004; Turk & Tsokos, 2004). Finally, there are the specific psychotropic effects of particular drugs to consider.

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