Across 25 systematic reviews, evidence generally showed a positive association between recreational cannabis use and suicidal ideation and attempts, with younger initiation, longer use, and heavier consumption linked to worse outcomes, while therapeutic CBD was considered safe.
Psychiatrists, suicide prevention researchers, public health communicators, cannabis policy makers.
22 of 25 systematic reviews found positive association between cannabis and suicidality
What the researchers found
25 systematic reviews were included (24 on recreational use, 1 on therapeutic). Only 3 recreational use reviews found no effect or inconsistent results. Evidence showed positive associations between cannabis and suicidal ideation and attempts across general population, military veterans, and patients with bipolar or major depression. Younger initiation, long-term use, and heavy consumption were associated with worse outcomes. A bidirectional causal association was mentioned. Therapeutic CBD was considered safe.
Why it matters
This is the highest level of evidence synthesis available on cannabis and suicide risk. The consistency across 25 reviews, with only 3 finding null or inconsistent results, represents a strong signal that should inform both clinical practice and public health messaging.
The numbers in context
25 systematic reviews included. 24 on recreational use. 3 found no effect or inconsistent results. Associations found in general population, veterans, and bipolar/depression patients. Dose-response pattern with initiation age, duration, and amount.
How the study worked
Umbrella review searching 7 databases and 2 registries without restrictions. AMSTAR-2 for quality assessment. Corrected covered area and citation matrix for overlap assessment.
What this study cannot tell us
Umbrella review is limited by the quality of included reviews. AMSTAR-2 scores varied. Cannot determine causation from observational evidence alone. Overlap between included reviews may inflate apparent consistency. Publication bias possible.
How to read the evidence
Umbrella review (highest level of evidence synthesis) of 25 systematic reviews. Consistent findings across most reviews.
When this study was published
Published in 2023.
The bigger picture
Cannabis is the most common illicit substance found in suicide victims' toxicology tests. This umbrella review consolidates the evidence suggesting this is not coincidental. The distinction between recreational and therapeutic use (CBD appears safe) is clinically important.
Questions still open
- Does cannabis directly increase suicide risk or is the association mediated by depression and other mental health factors?
- Should suicide risk screening be standard for patients reporting heavy cannabis use?
Common questions
Is cannabis linked to suicide risk?
Is CBD safe regarding suicide risk?
Read the original research
Suicidality risk after using cannabis and cannabinoids: An umbrella review.
Dialogues in clinical neuroscience, 25(1), 50-63
Citation
Shamabadi, Ahmad; Ahmadzade, Ali; Pirahesh, Kasra; Hasanzadeh, Alireza; Asadigandomani, Hassan. (2023). Suicidality risk after using cannabis and cannabinoids: An umbrella review.. Dialogues in clinical neuroscience, 25(1), 50-63. https://doi.org/10.1080/19585969.2023.2231466
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