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Study breakdown

Cannabis-induced psychosis rates more than doubled in Denmark from 2006 to 2016

Longitudinal CohortStrong evidence
The takeaway

The incidence of cannabis-induced psychosis in Denmark rose steadily from 2.8 to 6.1 per 100,000 person-years between 2006 and 2016, paralleling increases in THC potency and cannabis use.

Psychiatrists, public health officials, and policymakers evaluating cannabis regulation.

Cannabis-induced psychosis: 2.8 to 6.1 per 100,000 over 10 years

What the researchers found

Cannabis-induced psychosis incidence more than doubled from 2.8 per 100,000 in 2006 to 6.1 per 100,000 in 2016. A corresponding increase occurred in dual diagnoses of schizophrenia with cannabis use disorder. In contrast, alcohol-induced psychosis decreased over the same period, and other substance-induced psychoses showed no trend.

Why it matters

The selective increase in cannabis-induced psychosis (while alcohol-induced psychosis declined and others remained stable) suggests this trend is specific to cannabis rather than reflecting general changes in diagnostic practices or healthcare access.

The numbers in context

Cannabis-induced psychosis: 2.8 per 100,000 (2006) to 6.1 per 100,000 (2016). Alcohol-induced psychosis decreased. Other substance-induced psychoses showed no trend. Dual diagnosis (schizophrenia + CUD) also increased.

How the study worked

National registry study using the Danish Psychiatric Central Research Register. Analyzed absolute incidence and incidence rates per 100,000 person-years for cannabis-induced psychosis, other substance-induced psychoses, and dual diagnosis (schizophrenia + CUD) from 1994 to 2016.

What this study cannot tell us

Registry data depends on clinical diagnostic accuracy. Cannot directly link individual THC exposure levels to psychosis. Changes in help-seeking behavior or cannabis availability could partially explain trends.

How to read the evidence

National registry covering entire Danish population with consistent methodology over 22 years. Strong for trend detection.

When this study was published

2021 study analyzing Danish registry data from 1994-2016.

The bigger picture

Denmark has seen both rising cannabis use and increasing THC potency during this period. The parallel rise in both cannabis-induced psychosis and schizophrenia with CUD dual diagnoses suggests a real clinical impact that tracking systems are capturing consistently.

Questions still open

  • How much of the increase is attributable to higher THC potency vs. more widespread use? Are countries with different cannabis policies seeing similar trends? Would availability of lower-potency products slow the increase?

Common questions

Could changes in diagnosis explain the increase?
The authors examined this and concluded diagnostic practice changes do not appear to explain the increase, partly because other substance-induced psychoses did not show similar trends.
Did schizophrenia with cannabis use also increase?
Yes. Dual diagnoses of schizophrenia with cannabis use disorder showed a corresponding increase over the same period, suggesting the cannabis-psychosis relationship extended beyond acute episodes.

Read the original research

Annual incidence of cannabis-induced psychosis, other substance-induced psychoses and dually diagnosed schizophrenia and cannabis use disorder in Denmark from 1994 to 2016.

Psychological medicine, 51(4), 617-622

Citation

Hjorthøj, Carsten; Larsen, Maria Oku; Starzer, Marie Stefanie Kejser; Nordentoft, Merete. (2021). Annual incidence of cannabis-induced psychosis, other substance-induced psychoses and dually diagnosed schizophrenia and cannabis use disorder in Denmark from 1994 to 2016.. Psychological medicine, 51(4), 617-622. https://doi.org/10.1017/S0033291719003532

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