A study published in JAMA Network Open has uncovered disturbing trends in mental health treatment following cannabis legalisation, raising serious concerns about the broader psychological impact of liberalised cannabis policies. While advocates have celebrated decreased benzodiazepine prescriptions, a careful analysis of the data reveals a more complex and potentially alarming picture of deteriorating mental health outcomes in states with legalised cannabis.
Cannabis is one of the most widely used psychoactive substances globally, but its effects on mental health remain a topic of significant concern and misunderstanding. With changing cannabis compositions and increasing availability, many individuals wrongly believe it has therapeutic benefits for psychiatric conditions. However, mounting evidence reveals that cannabis use, particularly at high potency and early in life, is more likely to exacerbate mental health issues rather than alleviate them. This post highlights the risks and misconceptions surrounding cannabis and its relationship with psychiatric disorders.
nd ethnic disparities in cannabis-related ED visits reveal a troubling pattern:
Brandon Danielson’s story haunts the medical community. Just 27 years old, newly married and house-hunting with his high school sweetheart, Brandon died in September 2019 after a severe bout of vomiting triggered catastrophic organ failure. The culprit? Daily use of high-THC cannabis concentrates. His death certificate lists a condition many doctors are still learning to recognise: cannabinoid hyperemesis syndrome (CHS).
Standing room only at his funeral, the crowd packed with faces from around the world – a testament to a life cut devastatingly short. “He was very outgoing. He had tons of friends,” his father Don Danielson recalls, the kind of person who’d rather point to evidence than state opinions. Now he points to his son’s death certificate, letting the stark medical reality speak for itself.
The THC Arms Race: An Industry Unleashed
The transformation of cannabis potency tells a story of unbridled escalation. In 1995, illegal cannabis averaged 4% THC. Today’s numbers paint a startling picture: average vape oils clock in at 71.6% THC, while modern concentrates push toward an almost pure 99%. This isn’t your parents’ pot – it’s a different drug entirely.
The industry has fought tooth and nail against any attempt at regulation. Washington State Representative Lauren Davis spent five frustrating years trying to pass basic THC safeguards. Her initial discovery was telling: while the state capped THC in edibles at 10% and flower at 30%, concentrates faced no limits whatsoever. When she proposed reasonable restrictions, the industry deployed tactics straight from Big Tobacco’s playbook: economic threats, scientific distraction, and attempts to discredit researchers.
The Science of Suffering: CHS
The cruel irony of CHS lies in its mechanism. Cannabis, long used to treat nausea, turns on chronic users through complex interactions with the endocannabinoid system. Dr. Ethan Russo, a neurologist with nearly 30 years studying cannabis medicine, puts it bluntly: “The difference between a medicine and a poison is the dose.”
CHS develops in three distinct phases:
- Prodrome: Early morning nausea, fear of vomiting, and abdominal discomfort lasting days
- Hyperemesis: Intense nausea, frequent vomiting, and diffuse pain lasting up to 24 hours
- Recovery: Gradual resolution of symptoms
The science behind CHS reveals a complex interplay between the body’s endocannabinoid system and stress response. Chronic cannabis use can lead to downregulation or desensitisation of CB1 receptors, disrupting the hypothalamic-pituitary-adrenal axis. The highly lipophilic nature of cannabinoids means they accumulate in fatty tissue over time, potentially releasing during stress or fasting to trigger episodes.
The Neurological Mechanisms of Cannabis Harm
The endocannabinoid system’s disruption by chronic cannabis use reveals a complex cascade of neurological events. CB1 receptors, found throughout the central nervous system and gastrointestinal tract, normally modulate gastric secretion, motility, inflammation, and sensation. The system acts as a critical regulator of stress response and allostasis. However, chronic exposure to high-THC cannabis can overwhelm this delicate balance.
When functioning normally, the endocannabinoid system inhibits the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system response to stressful stimuli. Chronic cannabis use disrupts this regulation through several mechanisms:
- Downregulation and desensitisation of CB1 receptors
- Accumulation of cannabinoids in fatty tissue
- Altered neurotransmitter signaling affecting dopamine, serotonin, and GABA systems
- Disrupted thermoregulation through hypothalamic effects
The Mental Health Cascade
Recent research has uncovered disturbing links between high-potency cannabis and severe psychiatric conditions. A 2024 study found teens who use cannabis face an eleven-fold increased risk of developing psychotic disorders. Even more alarming, the Danish healthcare system discovered that 20% of schizophrenia cases in young men might be preventable by avoiding cannabis use disorder.
The progression from cannabis-induced psychosis to schizophrenia shows particularly troubling patterns. Finnish researchers tracking over 18,000 people found nearly half of those experiencing cannabis-induced psychosis received schizophrenia diagnoses within eight years. This isn’t correlation – it’s a clear pathway to severe mental illness.
The Healthcare System Strain: A Crisis in Numbers
The medical cost of delayed CHS diagnosis reveals a staggering waste of resources. A study of just 17 patients found:
Average cost per patient: $76,920.92
- 17.9 emergency department visits before correct diagnosis
- 58 total hospital admissions
- Unnecessary procedures including:
- 3 surgeries
- 8 colonoscopies
- 17 endoscopies
The radiation exposure from repeated CT scans alone (49.4–98.8 mSv) exceeds the 35 mSv threshold where increased cancer risk becomes statistically significant. We’re creating secondary health crises in our attempts to diagnose the primary one.
Treatment Protocols: A Clinical Challenge
The medical community has developed increasingly sophisticated approaches to treating cannabis-related disorders, though success rates vary widely. For CHS specifically, treatment focuses on three primary areas:
Acute Phase Management: Standard antiemetics like ondansetron often fail, leading to a cascade of alternative treatments:
- Benzodiazepines (especially lorazepam) show promise through GABA modulation
- Haloperidol emerges as surprisingly effective, possibly due to its unique dopamine antagonism
- Topical capsaicin cream targets TRPV1 receptors, mimicking the relief patients find in hot showers
Hydration and Electrolyte Management: Severe CHS cases require aggressive fluid replacement and careful monitoring of electrolyte levels, particularly potassium. Brandon Danielson’s case highlights the potentially fatal consequences of severe dehydration leading to organ failure.
Long-term Recovery: The only proven cure remains complete cannabis cessation. Recovery timelines vary significantly:
- 50% of schizophrenia conversions occur within 3.1 years
- 50% of bipolar disorder conversions occur within 4.4 years
- Male patients with cannabis-induced psychosis convert to schizophrenia faster (2.0 years) than females (4.4 years)
Emerging Research Trends
Recent studies have uncovered previously unknown aspects of cannabis-related disorders:
Genetic Factors: New research suggests genetic variations in the cytochrome P450 system may explain why some chronic users develop CHS while others don’t. This may also influence individual susceptibility to psychotic disorders.
Brain Structure Changes: CT scans of severe cases show alarming changes:
- Flattening of brain folds
- Widespread swelling
- Loss of clear boundaries between brain layers
Demographic Shifts: The profile of affected individuals is changing:
- Younger average age of onset
- Higher rates among daily concentrate users
- Increased prevalence in legal states
- Generation Z shows particular vulnerability
The Prevention Gap
Despite mounting evidence of harm, prevention efforts remain underfunded and fragmented. The industry’s resistance to regulation has created a dangerous vacuum:
- No standardised potency limits for concentrates
- Insufficient warning labels
- Limited public education about risks
- Inadequate treatment resources, especially for youth
Dr. Denise Walker of the University of Washington emphasises: “We need more prevention research that acknowledges the harms of cannabis, particularly with [young people]. We need to, as a state, be rethinking our policies around what we sell and what we allow people to consume.”
The latest research points to an urgent need for comprehensive policy changes. However, as long as the industry continues to prioritise profits over public health, implementing these changes will remain an uphill battle.
The Young Adult Crisis
Generation Z has become the unwitting test subjects in this massive public health experiment. Emergency departments across the country report dramatic increases in cannabis-related visits, jumping 80% over five years. Kelly Kerby, a mental health counselor at Seattle Children’s Hospital, estimates that 85% of the young people she sees weekly have cannabis use disorder.
“Youth treatment is an abomination in the state,” Kerby notes, highlighting the bitter irony that despite Washington collecting over $454 million in cannabis taxes in 2024, treatment resources remain scarce.
The Policy Battle: Industry vs. Public Health
The cannabis industry’s response to mounting health concerns follows a familiar playbook. When confronted with evidence of harm, they:
- Threaten economic consequences of regulation
- Distract from core issues by introducing tangential topics
- Attempt to discredit researchers and advocates
Only in 2024 did Washington state finally pass a watered-down version of Rep. Davis’s bill, requiring dispensaries to display basic warnings about high-potency products. The industry fought even this modest measure through multiple legislative sessions.
A Glimmer of Hope?
Recent efforts by Kristen Haley, the public health education liaison at Washington’s Liquor and Cannabis Board, show promise in bridging the divide between industry and public health officials. Her “Hybrid High-THC Work Group” has begun facilitating actual dialogue between these traditionally opposed camps.
“Before these conversations happened, our only exposure to one another was during testimony during [legislative] session,” Haley explains. “We would just get up to the mic and shout at each other and just have this battle, and then we’d go away, and we’d never talk behind the scenes.” As cannabis legalisation continues spreading and potency levels keep climbing, we’re conducting a massive public health experiment in real-time. Don Danielson’s perspective cuts through the noise: “We’re not against the use of weed, but we just want people to know that there are consequences now. The weed of today is not the weed of yesterday, not by any stretch of the imagination.”
The mounting evidence suggests we’re headed for a public health reckoning that no amount of tax revenue can justify. The question isn’t whether there will be consequences – it’s how many more Brandon Danielsons there will be before we act.
In a move that should concern parents and public health advocates alike, DoorDash has decided to join the troubling trend of normalising drug use by launching home delivery of cannabis products. The same app that brings you tacos and groceries will now deliver THC-laden gummies and beverages right to your doorstep. How convenient – and how utterly irresponsible.
