A review proposed that CBD could improve outcomes for people with recent-onset psychosis who also use cannabis, based on evidence that CBD has antipsychotic and anxiolytic properties and attenuates THC's psychotogenic, anxiogenic, and cognitive effects.
Read this if you or someone you know has experienced psychosis and continues to use cannabis, or if you are interested in CBD's therapeutic potential for psychotic disorders.
CBD attenuates THC's psychotogenic, anxiogenic, and cognitive effects
What the researchers found
This review examined the potential of CBD as a treatment specifically for cannabis users with recent-onset psychosis, a population with currently poor outcomes and no specialized effective intervention.
Cannabis misuse is a major factor associated with poor outcomes after a first psychotic break and is especially common in individuals with recent-onset psychosis. Behavioral interventions aimed at reducing cannabis use have been unsuccessful in this population.
The review compiled evidence that CBD has a broad pharmacological profile including antipsychotic and anxiolytic effects, does not activate CB1 or CB2 receptors (unlike THC), and has at most subtle subjective effects.
Critically, CBD attenuates THC's harmful effects both acutely and chronically, including psychotogenic, anxiogenic, and cognitive impairments. Modern cannabis strains have low CBD concentrations, which may contribute to their higher psychosis risk.
The authors proposed that CBD treatment could improve the disease trajectory for this specific population by both treating psychotic symptoms and mitigating the ongoing harm from THC if patients continue using cannabis.
Why it matters
People with early psychosis who use cannabis represent a treatment-resistant group: behavioral interventions to stop cannabis use have failed, and continued use worsens outcomes. CBD potentially addresses both the psychosis and the cannabis harm simultaneously, offering a novel therapeutic strategy.
The numbers in context
Cannabis misuse is prevalent in schizophrenia and especially common in recent-onset psychosis. Modern cannabis strains have low CBD concentrations. CBD does not activate CB1 or CB2 receptors. Behavioral interventions for cannabis reduction have been unsuccessful in this population.
How the study worked
Narrative review synthesizing evidence on CBD's pharmacological profile, antipsychotic properties, neuroprotective effects, and capacity to attenuate THC's adverse effects, with focus on clinical implications for recent-onset psychosis with comorbid cannabis use.
What this study cannot tell us
The proposal is based on indirect evidence combining separate findings on CBD as antipsychotic and CBD as THC-attenuator. No clinical trials had directly tested CBD in cannabis-using psychosis patients at the time. CBD's antipsychotic evidence, while growing, was still limited. The optimal dosing and treatment duration were unknown.
How to read the evidence
Narrative review proposing a therapeutic strategy based on converging indirect evidence, providing moderate rationale that awaits direct clinical testing.
When this study was published
Published in 2018. Several clinical trials of CBD for psychosis have reported results since, with mixed but generally encouraging findings.
The bigger picture
This review represents a shift in thinking about treating dual-diagnosis patients: instead of trying to eliminate cannabis use (which has proven difficult), CBD could potentially reduce the harm from ongoing use while simultaneously treating the psychotic disorder.
Questions still open
- Would a clinical trial confirm CBD's benefit specifically for cannabis-using psychosis patients? What CBD dose would be needed to counteract the THC levels from modern high-potency cannabis? Could CBD reduce cannabis use itself, or only mitigate harm?
Common questions
Can CBD treat psychosis?
Why is cannabis use a problem for psychosis?
Read the original research
The Potential of Cannabidiol Treatment for Cannabis Users With Recent-Onset Psychosis.
Schizophrenia bulletin, 44(1), 46-53
Citation
Hahn, Britta. (2018). The Potential of Cannabidiol Treatment for Cannabis Users With Recent-Onset Psychosis.. Schizophrenia bulletin, 44(1), 46-53. https://doi.org/10.1093/schbul/sbx105
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