How Cannabis Triggers Psychotic-Like Experiences in Otherwise Healthy People | Research

The takeaway

High-potency cannabis, genetic predisposition, and environmental stressors combine to increase psychotic-like experiences in non-clinical populations, with evidence suggesting the relationship runs both ways.

People curious about the psychosis-cannabis link, especially those using high-potency products; parents of young cannabis users; mental health researchers

38 studies analyzed across four risk factor categories

What the researchers found

Across 38 studies, four major risk factor categories emerged for psychotic-like experiences (PLEs) in non-clinical populations: biological vulnerabilities (metabolic profiles, genetics, neurobiology), substance use patterns (especially high-potency cannabis), socio-demographic factors (digital media, ethnic density, gender), and downstream consequences (suicidal behavior, cognitive impairment). The cannabis-PLE relationship appeared bidirectional.

Why it matters

Psychotic-like experiences are more common in the general population than most people realize, and cannabis -- particularly high-potency products -- is one of the strongest modifiable risk factors. Understanding that the relationship may be bidirectional (people experiencing PLEs may also seek out cannabis) complicates simple cause-and-effect narratives.

The numbers in context

38 studies analyzed; four risk factor categories identified; bidirectional relationship found between cannabis use and PLEs; high-potency cannabis showed strongest substance-related associations

How the study worked

Systematic review following PRISMA guidelines, searching PubMed/Medline and Scopus for peer-reviewed studies through January 2024 examining risk factors for PLEs in non-clinical samples. Registered with PROSPERO. 38 articles analyzed after screening.

What this study cannot tell us

Focused on non-clinical populations, so findings may not generalize to people with diagnosed psychotic disorders. Cross-sectional designs in many included studies limit causal inference. Search limited to two databases.

How to read the evidence

Systematic review with PROSPERO registration and PRISMA methodology, but many included studies were cross-sectional, limiting causal conclusions.

When this study was published

Published in 2025 with literature through January 2024.

The bigger picture

This review supports a multifactorial model where genetics, cannabis use patterns, and social-environmental factors all feed into whether someone develops psychotic-like experiences. It moves beyond the simplistic "cannabis causes psychosis" framing while still highlighting potency as a key variable.

Questions still open

Could regular screening for PLEs in young cannabis users prevent progression to clinical psychosis? How do different cannabis potency thresholds map onto PLE risk? What role does digital media use play as an independent or interactive risk factor?

Common questions

What are psychotic-like experiences?

PLEs include things like hearing voices, paranoid thoughts, or unusual perceptual experiences that occur in otherwise healthy people without a diagnosed psychotic disorder. They are more common than clinical psychosis.

Does high-potency cannabis definitely cause psychosis?

The review found strong associations but also evidence that the relationship is bidirectional -- people experiencing PLEs may be more likely to use cannabis. Multiple factors interact, making simple cause-and-effect statements insufficient.

Who is most at risk?

People with specific genetic predispositions, those using high-potency cannabis, younger users, and those exposed to certain environmental stressors like discrimination or high digital media use showed elevated risk.

Read the original research

Cannabis use and psychotic-like experiences: A systematic review of biological vulnerability, potency effects, and clinical trajectories.

Psychiatry research, 348, 116496

View on PubMed ↗Publisher’s paper ↗

Citation

Ricci, Valerio; Chiappini, Stefania; Martinotti, Giovanni; Maina, Giuseppe. (2025). Cannabis use and psychotic-like experiences: A systematic review of biological vulnerability, potency effects, and clinical trajectories.. Psychiatry research, 348, 116496. https://doi.org/10.1016/j.psychres.2025.116496