By Andrew Monti
On June 21, 2022, a teenage boy experienced an unexpected horror that permanently and drastically changed his life.
Late at night, he and his brother were casually hanging out and smoking cannabis—a seemingly trivial aspect of their daily routine. Shortly after, the boy immediately knew something was wrong. At first, he brushed off audible hallucinations as a strange manifestation of his internal monologue, but the voices he was experiencing became painfully intolerable as minutes passed. He went upstairs to bed for his early shift at 6 a.m., hoping he could sleep the “sounds” away; however, the opposite happened. The audial hallucinations intensified by the second, crescendoing into the sound of a blaring speaker screaming directly in his ears.
Next, visual hallucinations began accompanying the auditory ones. In the ceiling corners of his room, he saw nonhuman creatures menacingly leering at him as if he were prey. His feelings of paranoia and helplessness dramatically altered his sense of reality and self-stabilization. Like a frightened child hiding from the monsters in his room, he fell asleep under the sheets.
A few weeks later, a medical consultation concluded that the boy had experienced a drug-induced psychotic episode from cannabis, something he never imagined.
That boy was me.
Psychosis: What is it?
Psychosis is the onset of specific symptoms that impact an individual’s mind by disconnecting them from reality. During an episode, individuals experience disrupted perceptions and hallucinations, which can interfere with their ability to distinguish between reality and not (National Institute of Mental Health, 2023). Currently, psychosis is understood as a combination of multiple susceptibility factors for its development: family history and genetics, exposure to trauma and stressors, and differences in brain development (National Institute of Mental Health, 2023).
Another less commonly recognized way for one to develop psychosis, however, is through substance abuse. Excessive use or withdrawal from a drug can cause a phenomenon called substance-induced psychosis (what I experienced), a potential implication that most adolescents remain entirely unaware of.
The Changing Drug Preference
Throughout the past few decades, alcohol has consistently been the top illicit drug choice in the United States. However, in recent years, cannabis has outweighed alcohol in terms of daily users. Researcher Jonathan Caulkins analyzed national survey data from the National Survey on Drug Use and Health (NSDUH) regarding the self-reporting of cannabis and alcohol use throughout the past four decades (1979-2022) among the population ages twelve and higher, finding 17.7 million DND (daily or near-daily users) cannabis consumers, while just 14.7 million DND alcohol consumers in 2022 (Caulkins, 2024).
There is no direct cause for this uptick in cannabis rates. Although there is a positive correlation between state legalization and cannabis usage rates, this does not necessarily mean public policy is the leading or only cause of this phenomenon; changes in social norms and general views may also factor in, particularly for adolescents, who tend to be more influenced by perceptions of their peers (Caulkins, 2024).
The Harms of Cannabis in Adolescents
While many adolescents view marijuana as substantially safer for them than alcohol, this view is both dangerous and fundamentally incorrect, placing vulnerable groups like teenagers under the false impression that cannabis is risk-free.
In an 18-month study, researchers (Camchong et al., 2016) reported two patterns in adolescent individuals with cannabis use disorder (CUD): (1) a consistent and significant decrease in functional connectivity between the caudal anterior cingulate cortex (ACC), the left dorsolateral prefrontal cortex (DLPFC), and the orbitofrontal cortex (OFC); (2) Stagnant development of resting functional connectivity with the superior frontal gyrus (SFG). These areas in the brain are responsible for everyday functions like decision-making, visceral reactions, and mood regulation, meaning these brain areas fail to function at their maximum potential in adulthood. Crucially, cannabis use in young adults permanently alters the foundational biological aspects of their brains, impairing their judgment and regulation for life. Along with the physiological impacts of cannabis use, psychosis and other psychotic disorders are also of concern. Recently, researchers (McDonald et al., 2024) at the University of Cambridge found that adolescent cannabis users were eleven times more likely to develop psychotic disorders than those who did not consume the drug. In contrast, those aged 20-33 found no association between cannabis use and the development of psychotic disorders (McDonald et al., 2024). That is to say, while societal understandings of marijuana as less harmful than other substances are not false, attempting to extend this understanding to sensitive and vulnerable developing minds is incredibly misguided.
Reported psychotic-like symptoms among teenagers from cannabis use have been growing at alarming rates in the past few decades, potentially due to increases in THC concentration (McDonald et al., 2024).
Cannabis research as a whole is a grey area since it is a relatively new field. Because our knowledge of the drug is narrow, it is challenging to investigate and answer specific questions surrounding its nature and implications. While there is evidence supporting the idea of cannabis consumption and psychosis development among the adolescent population, more research is necessary because current findings and links are limited in their understanding and scope.
What Now…?
It is essential to continue educating individuals—particularly adolescents— about marijuana as research continues since the young population is far more susceptible to the severe effects of the drug than the general public is. Considering that social norms surrounding adolescent use of the substance remain prevalent, information surrounding the potential implications for young people must be accessible and taught in schools to prevent more people from having the same type of experience I once did.
References
Camchong, J., Lim, K. O., & Kumra, S. (2017). Adverse Effects of Cannabis on Adolescent Brain Development: A Longitudinal Study. Cerebral Cortex (New York, N.Y. 1991), 27(3), 1922–1930. https://doi.org/10.1093/cercor/bhw015
Caulkins, J. P. (2024). Addiction. Changes in Self-Reported Cannabis Use in the United States from 1979 to 2022, 1–5. https://doi.org/10.1111/add.16519
McDonald, A. J., Kurdyak, P., Rehm, J., Roerecke, M., & Bondy, S. J. (2024). Age-Dependent Association of cannabis use with risk of psychotic disorder. Psychological Medicine, 1–11. https://doi.org/10.1017/s0033291724000990
U.S. Department of Health and Human Services. (n.d.-b). Understanding psychosis. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/understanding-psychosis#part_6514
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