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    Journal of Dual Diagnosis
    Volume 19, Issue 2-3
    Jul 2023
    Review Article

    Recommendations for Reducing the Risk of Cannabis Use-Related Adverse Psychosis Outcomes: A Public Mental Health-Oriented Evidence Review

    B. Fischer et al.
    View Review Article page
    Benedikt Fischer, Wayne Hall, Thiago M. Fidalgo, Eva Hoch, Bernard Le Foll, Maria-Elena Medina-Mora, Jens Reimer, Philip G. Tibbo and Didier Jutras-Aswad
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    © 2023 The Author(s). Published with license by Taylor & Francis Group, LLC
    PublisherTaylor & Francis
    PrintApril-September 2023
    Pages71 - 96
    Abstract

    Objective: Cannabis use is increasingly normalized; psychosis is a major adverse health outcome. We reviewed evidence on cannabis use-related risk factors for psychosis outcomes at different stages toward recommendations for risk reduction by individuals involved in cannabis use. Methods: We searched primary databases for pertinent literature/data 2016 onward, principally relying on reviews and high-quality studies which were narratively summarized and quality-graded; recommendations were developed by international expert consensus. Results: Genetic risks, and mental health/substance use problem histories elevate the risks for cannabis-related psychosis. Early age-of-use-onset, frequency-of-use, product composition (i.e., THC potency), use mode and other substance co-use all influence psychosis risks; the protective effects of CBD are uncertain. Continuous cannabis use may adversely affect psychosis-related treatment and medication effects. Risk factor combinations further amplify the odds of adverse psychosis outcomes. Conclusions: Reductions in the identified cannabis-related risks factors—short of abstinence—may decrease risks of related adverse psychosis outcomes, and thereby protect cannabis users’ health.

  • Outline

    Sections

    1. Abstract
    2. Methods
      1. Scope and approach
      2. Data search and inclusion strategy
      3. Evidence presentation
      4. Evidence grading
      5. Recommendation development
    3. Results
      1. General mechanisms and epidemiology
      2. Genetic risk factors
      3. Age of use
      4. Cannabis product composition
      5. Frequency of use
      6. Modes of use
      7. Other substance use
      8. Psychosis course, treatment and outcomes
      9. Medication interactions and effects
      10. Intermittent/suspended cannabis use
      11. Combinations of risk factors
      12. Other cannabis-related health risks and outcomes
    4. Discussion
    5. Acknowledgements
    6. Authors’ contributions
    7. Disclosure statement
    8. Funding
    9. Data availability statement
    10. References
    11. Appendix A. The recommendations

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