Cleaning the Misunderstanding – a review of ABCs article, Doctors warn of a significant increase in people hospitalised with psychosis after being prescribed medicinal cannabis.
Article Written by Adam Isaac Miller
I must admit, upon reading this article, my initial response was a feeling of frustration due to the inaccurate title and fear tactics that the ABC used to portray the issues of cannabis being linked to Psychosis. Nonetheless, some valid points were highlighted, but unfortunately, only half the story was told. So here is my attempt to tell the other half.
For context, there has been a recent uproar across the cannabis industry (including patient criticism) over an article published by ABC journalists Janelle Miles and Elise Worthington titled Doctors warn of a significant increase in people hospitalised with psychosis after being prescribed medicinal cannabis.
The reporters highlight growing concerns among Australian medical professionals about the increased hospitalisation of patients with psychosis after being prescribed medicinal cannabis.
Understanding Definitions - Psychosis VS Psychotic Episode
First, let’s start by defining the different the difference between psychosis and a psychotic episode – which is what patients are likely presenting initially.
The reason it’s important to underscore the difference between psychosis and a psychotic episode is that it describes what is happening to a patient when they are experiencing this type of adverse reaction to cannabis, which is a psychotic episode.
Now, an increase in psychotic episodes can lead to chronic psychosis, therefore, as a standard procedure, doctors who are treating ANY PATIENT with medical cannabis should inform patients that if psychotic episodes occur, they must stop using the specific product that caused the reaction immediately and report this to their treating doctor.
We should not throw the baby out with the bathwater, so this does not mean a patient needs to stop using medical cannabis altogether but rather adjust their treatment protocol – likely to a CBD-dominant product.
Assessing the Research – what does that data say?
One of the most comprehensive meta-analyses by Schoeler et al. (2024) published in June 2024, assessed the rates and predictors of cannabis-associated psychotic symptoms (CAPS) across observational, experimental, and medical research of 162 studies with 210,283 individual cases demonstrated that:
Rates of cannabis-associated psychotic symptoms (CAPS) vary significantly across different study designs. Medicinal cannabis studies reported much lower rates of 1-2%, while observational and experimental studies reported rates of around 19% and 21%, respectively.
Meta-analysis of the included studies revealed that about 1 in 200 (0.5%) cannabis users may experience a severe CAP episode.
Risk factors for CAPS include younger age, female gender, pre-existing mental health conditions (especially depression, bipolar disorder and psychosis liability), and higher doses of THC.
Interestingly, contrary to long-term psychosis risk, the study found no association between CAPS and factors like frequency of cannabis use, age of onset of use, or preferred cannabis strain.
It’s important to note the paper suggests that cannabis use, particularly early-onset and heavy use, may be a contributory cause of psychosis, citing previous research. However, it does not provide a specific quantification of this contribution.
Outlandish Claims - "There's no evidence that medicinal cannabis is helpful or treats those conditions."
Second, let's examine some evidence relating to the claim made by Professor Brett Emmerson, Queensland chair of the Royal Australian and New Zealand College of Psychiatrists, and published by the ABC, which states that "there's no evidence that medicinal cannabis is effective in treating anxiety or insomnia."
Anxiety
Numerous studies indicate that CBD has potential as as a treatment for a range of neuropsychiatric disorders, including anxiety disorders (Blessing et al., 2015). Furthermore, studies have shown that CBD exhibits anxiolytic properties, suggesting its potential in reducing anxiety (Schier et al., 2012). In addition to the evidence demonstrating CBD's utility to support patients with mood-related conditions, cannabis products containing equivalent concentrations of THC and CBD have been found to induce less state anxiety compared to THC-dominant cannabis, highlighting the potential of CBD in mitigating anxiety (Hutten et al., 2022).
Furthermore, the use of medical cannabis has been associated with improvements in mood, reduction in anxiety, and better stress management among adults with chronic pain, supporting the notion that cannabis may have positive effects on anxiety symptoms (McMahon et al., 2023). Additionally, individuals with medical cannabis prescriptions commonly reported using cannabis for anxiety, depression, sleep problems, and chronic pain, indicating a perceived benefit in alleviating these conditions (Kendzor et al., 2022).
This is a solid evidence base, with many more studies available that demonstrate the validity of the exploration of cannabis use to treat anxiety. However, it's important to note that the Schoeler et al. study found that individuals with pre-existing mental health conditions, including anxiety and depression, showed a higher risk of experiencing cannabis-associated psychotic symptoms. This underscores the need for careful monitoring and personalized treatment approaches when considering cannabis for anxiety or mood disorders.
The study also highlights that the pharmacological properties of cannabis, particularly THC content, play a significant role in the risk of psychotic symptoms. This supports the idea that CBD-dominant products may be a safer option for some patients, especially those with a history of or predisposition to psychotic symptoms.
Sleep
Cannabis has garnered attention in the field of sleep research due to its potential impact on sleep patterns and disorders.
Research has shown that acute exposure to cannabis can influence various aspects of sleep, such as reducing sleep latency and altering rapid eye movement (REM) phases (Furer et al., 2018).
Additionally, specific cannabinoids can potentially enhance sleep quality and reduce sleep disturbances (Kuhathasan et al., 2019). Studies have also demonstrated significant improvements in perceived insomnia with the consumption of cannabis flower under naturalistic conditions (Vigil et al., 2018).
The relationship between cannabis use and sleep problems like insomnia is complex, with some studies indicating that cannabis products are commonly used to address sleep issues (Davis et al., 2023).
Preliminary research suggests that cannabidiol (CBD) may hold therapeutic potential for treating insomnia (Babson et al., 2017). Furthermore, cannabinoids may impact sleep-related mechanisms and physiology, indicating a possible role in managing sleep disorders (Kuhathasan et al., 2021).
Moreover, there is a growing trend in the reported use of cannabis for alleviating symptoms of sleep disorders, with effects varying based on the type and concentration of cannabinoids (Earl & Proano, 2022).
Some individuals receiving medical cannabis for pain have reported improved sleep, particularly those with mood disorders. The findings suggest that cannabinoids like CBD and THC may enhance sleep quality and address sleep-related concerns.
It's clear that while cannabis may have potential benefits for conditions like anxiety and insomnia, its use should be carefully considered and monitored, especially in vulnerable populations. The study emphasises the need for more comprehensive research on the long-term effects of medicinal cannabis use and the importance of developing evidence-based guidelines for its prescription and use.
With all this in mind, I’m surprised that as the Queensland chair of the Royal Australian and New Zealand's College of Psychiatrists, Brett Emmerson made such an outlandish remark that "There's no evidence that medicinal cannabis is helpful or treats those conditions." Furthermore, I’m surprised that ABC did not do its homework on the topic and provide a voice to another speaker who could add much-needed perspective on such a comment.
In Closing
The reality is cannabis, like any drug, has side effects and can cause harm if not correctly managed. However, producing media content like this article by the ABC also contributes to misinformation and, in turn, can lead to harm by way of legitimate patients not having the ability to access cannabis due to lack of prescriber support from fear of ‘psychosis’ – as an example.
Millions of Australians consume cannabis – that is a fact. As a means towards better harm reduction, I think there should be a more nuanced approach to cannabis regulation via medical and adult use channels with correct supervision from regulators regarding access – just like tobacco and alcohol, which are available to people who choose to consume whilst understanding the risk of consumption.
Adam has spent over eight years working with unregistered medicines. With a specialization in Cannabinoid Therapeutics, Adam has supported the development, implementation, and market entry of multiple cannabinoid product portfolios in markets such as Australia, New Zealand, Germany, and Brazil. Before working in the medical cannabis field, Adam spent almost a decade building various B2B businesses within education, investment, and medicinal cannabis, with progressive roles including business development, strategy, product development, and project management. He has consulted private and listed cannabis producers and ancillary businesses since 2015 as one of the early entrants and experts in the burgeoning Australian cannabis industry. Adam founded and sat on the board of The Medical Cannabis Council, Australia’s first not-for-profit industry body. He is a frequent public speaker and publishes a widely read industry newsletter. Adam earned a Bachelor of Entrepreneurship from the Royal Melbourne Institute of Technology. Adam has appeared in several major news outlets, including the Sydney Morning Herald, The Australian Financial Review, Nine News, Startup Smart, SBS, SkyNews, MJBizDaily, and other major publications.
Disclaimer: This information is shared with a global readership for educational purposes only and does not constitute medical or business advice. All patient-related information has been de-identified OR fictional to protect privacy. Nothing in this article is intended to promote the use or supply of medical cannabis to members of the public.