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No Notable Rise in Psychosis Diagnoses, Prescriptions in States That Legalized Cannabis
State policies legalizing cannabis are not associated with a statistically significant increase in rates of psychosis-related health outcomes, according to a study published online in JAMA Network Open.
“Importantly, our outcome measures were composed of psychosis-related diagnosis codes associated with health care delivery, and therefore do not capture episodes of psychosis among individuals who do not receive treatment,” wrote corresponding author Holly Elser, MD, PhD, of the Hospital of the University of Pennsylvania in Philadelphia, and coauthors.
Because psychosis is believed to be a potential consequence of cannabis use, researchers were interested in investigating whether states that legalized cannabis showed subsequent increases in psychosis-related health care use compared with states that did not legalize the substance. The cohort study was based on commercial and Medicare Advantage claims data for 63.7 million beneficiaries aged 16 and older between 2003 and 2017.
States with legalization policies for medical and recreational cannabis experienced no statistically significant increases in rates of either psychosis-related diagnoses or antipsychotic prescriptions compared with states with no legalization polices, according to the study.
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Exploratory secondary analyses did show, in states with recreational policies, significant increases in psychosis-related diagnoses for several subgroups: men, people aged 55 to 64 years, and Asian beneficiaries.
The study’s main findings differ from previous studies that reported increases in psychosis-related health outcomes with state and local cannabis legalization, researchers noted.
“Because we cannot reliably distinguish new from existing psychotic disorders using administrative data, it is possible that state cannabis legalization has differential effects on incident vs prevalent psychosis that our results do not reflect,” they wrote. “As states continue to introduce cannabis policies, the implications of state cannabis legalization for psychotic disorders warrants continued study, particularly in data settings where direct measures of disease onset and severity are available.”
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