Synthetic Cannabinoid Users Had Worse Psychosis Outcomes at 9 Months Than THC Users or Non-Users

What the researchers found

THC users and especially SPICE users displayed more severe positive symptoms than non-users. Negative symptoms were higher among non-users. After 9 months, non-users had recovered significantly better than SPICE users in global functioning. Dissociative symptoms were significantly greater in substance users. Suicidal ideation was highest in SPICE users.

Why it matters

The 9-month follow-up extends earlier findings at 6 months, confirming that psychosis associated with synthetic cannabinoids follows a more severe and persistent course. The elevated suicidal ideation in SPICE users is a critical clinical concern.

The numbers in context

N=61 (20 non-users, 21 THC users, 20 SPICE users). Assessed at 3 timepoints over 9 months. SPICE users had worst positive symptoms and suicidal ideation. Non-users had best functional recovery.

How the study worked

Comparative study of 61 first-episode psychosis patients divided into non-users (N=20), THC users (N=21), and SPICE users (N=20), assessed at onset, 3 months, and 9 months using validated psychopathological scales.

What this study cannot tell us

Small sample size (~20 per group). Non-randomized group assignment. Self-reported substance use. Single-center study. Cannot control for all confounders between groups.

How to read the evidence

Small comparative study with 9-month follow-up using validated scales, limited by sample size and non-randomized design.

When this study was published

Published in 2023.

The bigger picture

Synthetic cannabinoids bind CB1 receptors with much greater potency than THC, producing more intense psychoactive effects. This clinical data confirms what pharmacology would predict: more potent receptor activation correlates with worse psychotic outcomes.

Questions still open

• Does the outcome gap between SPICE and THC users widen or narrow beyond 9 months?
• Would specific antipsychotic strategies improve outcomes for synthetic cannabinoid psychosis?

Common questions

Read the original research

First episode psychosis with and without the use of cannabis and synthetic cannabinoids: Psychopathology, global functioning and suicidal ideation and antipsychotic effectiveness.

Psychiatry research, 320, 115053

Citation

Ricci, Valerio; Ceci, Franca; Di Carlo, Francesco; Di Muzio, Ilenia; Ciavoni, Laura; Santangelo, Monica; Di Salvo, Gabriele; Pettorruso, Mauro; Martinotti, Giovanni; Maina, Giuseppe. (2023). First episode psychosis with and without the use of cannabis and synthetic cannabinoids: Psychopathology, global functioning and suicidal ideation and antipsychotic effectiveness.. Psychiatry research, 320, 115053. https://doi.org/10.1016/j.psychres.2023.115053

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