Antipsychotics may ease psychotic episodes from marijuana overuse

Overuse of marijuana is increasingly being linked to dangerous bouts of psychosis, and a new study finds that antipsychotics may be needed to keep such patients out of the hospital.

Psychotic episodes involve a dangerous psychiatric state in which people lose their connection with reality. These episodes can get so out of control that people may need hospitalization.

However, new research finds that people who overuse marijuana and then experience their first psychotic episode may be helped by the quick use of injected antipsychotics.

"These findings encourage the early use of second-generation, long-acting injectables as an important secondary pre­vention strategy to reduce rates of hospitalization" in such patients, reports a team led by Dr. Alexander Denissoff, of the University of Turku in Finland.

His team tracked outcomes for 1,820 people who had a first psychotic episode and also had cannabis use disorder between 2006 and 2021.

Just over 1,100 of these patients ended up being hospitalized due to "psychotic relapse," according to the American Psychiatric Association news release. However, folks who had received any antipsychotic med were a third less likely to require hospitalization due to relapse, compared to those who hadn't gotten these drugs.

Comparing the effectiveness of various antipsychotics, risperidone came out on top, cutting the odds for relapse-linked hospitalization by 60%, the researchers found, followed by aripiprazole (58% reduction), oral clozapine (57%), and paliperidone (54%).

Denissoff's team stressed the odds that a person with cannabis use disorder experiences multiple psychotic episodes rises if they use marijuana after experiencing a first episode and/or do not take antipsychotic medicines as prescribed.

For those who were hospitalized due to any substance use disorder, clozapine seemed to work best, with an 86% lower risk of re-hospitalization due to any substance use, followed by risperidone (67%) and paliperidone (63%), the researchers said.

The findings were published recently in the journal Schizophrenia Bulletin.

More information

Find out more about the marijuana-psychosis connection at the Child Mind Institute.

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