As of July 2020, 11 states in the US had legalized the recreational use of cannabis and 16 others had decriminalized it, with all but 2 of the remaining 23 states allowing some form of legal use for medical purposes. Although this progressive shift in cannabis legislation has been applauded by many, there has been increasing concern among some in the medical and health care professions that the potential mental health risks of cannabis use are being downplayed or ignored. A recent Viewpoint in JAMA Psychiatry suggests that legalizing cannabis may be associated with increased incidence and prevalence of psychosis.1 Assuming an increase in use, epidemiologic research supports the association of cannabis with psychosis because there is convincing evidence that high-potency (>10% tetrahydrocannabinol) cannabis taken at frequent doses may be associated with nontransient cases of schizophrenia-spectrum disorders.2 While we take seriously the concern that increased use of cannabis or use of higher-potency cannabis may be associated with increased incidence and prevalence of psychosis at the population level as well as its potential association with other factors, such as cognition and educational attainment, there may also be important and unintended consequences to criminalization of cannabis possession and use.
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DeVylder JE, Mittal VA, Schiffman J. Balancing the Public Health Costs of Psychosis vs Mass Incarceration With the Legalization of Cannabis. JAMA Psychiatry. Published online September 02, 2020. doi:10.1001/jamapsychiatry.2020.2591
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