Genetic overlap between cannabis use and psychotic disorders suggests shared biological roots

A Lancet Psychiatry study found shared genetic architecture between cannabis use and schizophrenia/bipolar disorder, with causal evidence running in both directions.

Cheng, Weiqiu et al.·The lancet. Psychiatry·2023·Strong EvidenceObservational
RTHC-04459ObservationalStrong Evidence2023RETHINKTHC RESEARCH DATABASErethinkthc.com/research

Quick Facts

Study Type
Observational
Evidence
Strong Evidence
Sample
N=2,181

What This Study Found

Genome-wide genetic correlations between psychotic disorders and cannabis phenotypes ranged from 0.22-0.35. Causal analysis showed psychotic disorders had a causal effect on cannabis phenotypes, and lifetime cannabis use had a causal effect on bipolar disorder. Polygenic scores for cannabis predicted psychotic disorders independently. Shared loci implicated neuronal cells and drug-gene targets for nicotine, alcohol, and duloxetine.

Key Numbers

Genetic correlations 0.22-0.35; 3-27 shared loci per phenotype pair; 2,181 participants in polygenic score analyses (400 bipolar, 697 schizophrenia, 1,044 controls); 48.6% female; mean age 33.1 years

How They Did This

Genome-wide association summary statistics from European ancestry (Psychiatric Genomics Consortium, UK Biobank, International Cannabis Consortium). Included heritability estimation, genetic correlations, shared loci identification, causal analyses, and polygenic risk score analyses using the Norwegian Thematically Organized Psychosis cohort (n=2,181).

Why This Research Matters

Published in Lancet Psychiatry, this study provides the most comprehensive genetic evidence to date that the cannabis-psychosis relationship involves shared biological vulnerability, not just one causing the other.

The Bigger Picture

The bidirectional causal findings suggest that some individuals are genetically predisposed to both cannabis use and psychotic disorders, supporting targeted prevention in those with high genetic risk rather than population-wide approaches.

What This Study Doesn't Tell Us

Limited to European ancestry populations. Mendelian randomization assumptions may not fully hold. Cannot identify specific causal mechanisms. Shared GWAS loci do not necessarily mean shared functional pathways.

Questions This Raises

  • ?Could genetic risk scores be used clinically to identify individuals who should avoid cannabis?
  • ?Do the shared loci suggest novel treatment targets for both conditions?

Trust & Context

Key Stat:
Genetic correlations of 0.22-0.35 between cannabis phenotypes and psychotic disorders
Evidence Grade:
Large-scale genetic analysis published in a top-tier journal using multiple complementary methods, though limited to European ancestry.
Study Age:
Published 2023
Original Title:
The relationship between cannabis use, schizophrenia, and bipolar disorder: a genetically informed study.
Published In:
The lancet. Psychiatry, 10(6), 441-451 (2023)
Database ID:
RTHC-04459

Evidence Hierarchy

Meta-Analysis / Systematic Review
Randomized Controlled Trial
Cohort / Case-Control
Cross-Sectional / ObservationalSnapshot without intervening
This study
Case Report / Animal Study

Watches what happens naturally without intervening.

What do these levels mean? →

Frequently Asked Questions

Is the link between cannabis and psychosis genetic?

Partly. This study found significant genetic overlap between cannabis use and schizophrenia/bipolar disorder, with shared loci and bidirectional causal effects, suggesting shared biological vulnerability.

Does cannabis cause psychosis or do people with psychosis use more cannabis?

Both appear to be true. Causal analysis showed psychotic disorders increased cannabis use, and lifetime cannabis use had a causal effect on bipolar disorder specifically. The relationship runs in both directions.

Read More on RethinkTHC

Cite This Study

RTHC-04459·https://rethinkthc.com/research/RTHC-04459

APA

Cheng, Weiqiu; Parker, Nadine; Karadag, Naz; Koch, Elise; Hindley, Guy; Icick, Romain; Shadrin, Alexey; O'Connell, Kevin S; Bjella, Thomas; Bahrami, Shahram; Rahman, Zillur; Tesfaye, Markos; Jaholkowski, Piotr; Rødevand, Linn; Holen, Børge; Lagerberg, Trine Vik; Steen, Nils Eiel; Djurovic, Srdjan; Dale, Anders M; Frei, Oleksandr; Smeland, Olav B; Andreassen, Ole A. (2023). The relationship between cannabis use, schizophrenia, and bipolar disorder: a genetically informed study.. The lancet. Psychiatry, 10(6), 441-451. https://doi.org/10.1016/S2215-0366(23)00143-8

MLA

Cheng, Weiqiu, et al. "The relationship between cannabis use, schizophrenia, and bipolar disorder: a genetically informed study.." The lancet. Psychiatry, 2023. https://doi.org/10.1016/S2215-0366(23)00143-8

RethinkTHC

RethinkTHC Research Database. "The relationship between cannabis use, schizophrenia, and bi..." RTHC-04459. Retrieved from https://rethinkthc.com/research/cheng-2023-the-relationship-between-cannabis

Access the Original Study

Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.

This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.