Long-acting injectable antipsychotics reduced rehospitalization in cannabis-using psychosis patients | Research

The takeaway

Early psychosis patients who used cannabis were more dissatisfied with medication and more likely to be rehospitalized, but those on long-acting injectable antipsychotics had fewer rehospitalizations than those on oral formulations.

Psychiatrists treating early psychosis, patients with psychosis who use cannabis, and mental health policy researchers.

Long-acting injectables reduced rehospitalization in cannabis users

What the researchers found

Cannabis users were significantly more dissatisfied with antipsychotic medication (Chi-square 9.67, p < .002) and more likely to be rehospitalized (Chi-square 4.40, p = .036). Patients on long-acting injectable antipsychotics were rehospitalized less frequently than those on oral formulations (Chi-square 4.61, p = .032).

Why it matters

Cannabis-using psychosis patients face a double challenge: they are less satisfied with medication and more likely to relapse. Long-acting injectables may help by removing the daily adherence decision.

The numbers in context

24 cannabis users, 27 non-users. Cannabis users more dissatisfied (p < .002) and more rehospitalized (p = .036). Long-acting injectables associated with fewer rehospitalizations (p = .032).

How the study worked

Retrospective study in an early psychosis program in mid-Michigan. Compared cannabis users (n=24) and non-users (n=27) on medication satisfaction and rehospitalization. Patient perceptions assessed using a single question from the NAVIGATE Patient Self-Rating Form.

What this study cannot tell us

Small retrospective study. Single site. Medication satisfaction assessed with a single question. Cannot determine if cannabis caused dissatisfaction or if more dissatisfied patients were more likely to use cannabis.

How to read the evidence

Preliminary: small retrospective study from a single site with limited sample sizes.

When this study was published

Published in 2019.

The bigger picture

Non-adherence is a major driver of relapse in psychosis, and cannabis use appears to worsen this. Long-acting injectables bypass the adherence problem, which may be especially important for patients who use cannabis.

Questions still open

Why are cannabis-using patients more dissatisfied with antipsychotics? Would earlier initiation of long-acting injectables prevent first rehospitalization? Could addressing cannabis use improve medication satisfaction?

Common questions

What are long-acting injectable antipsychotics?

These are antipsychotic medications given as injections every few weeks instead of daily pills. They ensure consistent medication levels regardless of whether the patient remembers or chooses to take a daily dose.

Why might cannabis make people dissatisfied with antipsychotics?

Possible reasons include cannabis counteracting the sedating effects patients may dislike about antipsychotics, cannabis users having different expectations about medication, or underlying factors that drive both cannabis use and treatment dissatisfaction.

Read the original research

A retrospective study of the role of long-acting injectable antipsychotics in preventing rehospitalization in early psychosis with cannabis use.

Addictive behaviors reports, 10, 100221

View on PubMed ↗Publisher’s paper ↗

Citation

Rozin, Emily; Vanaharam, Vivek; D'Mello, Dale; Palazzolo, Scott; Adams, Cathy. (2019). A retrospective study of the role of long-acting injectable antipsychotics in preventing rehospitalization in early psychosis with cannabis use.. Addictive behaviors reports, 10, 100221. https://doi.org/10.1016/j.abrep.2019.100221