Cases of cannabis-induced psychosis increase during COVID-19 pandemic

Since the COVID-19 pandemic began, Silver Oaks Behavioral Hospital in New Lenox has noticed an increase in cannabis-induced psychosis.

Such patients tend to be highly agitated and aggressive and need a lot of support and “calming down," according to Dr. Jyoti K. Randhawa, chief medical officer of Silver Oaks Behavioral Hospital.

Before the COVID-19 pandemic, Randhawa saw a patient with cannabis-induced psychosis maybe once every few months, she said.. Now she’s seen an average of four a month, she added.

Patients also need more restraint from staff, she said.

“When you have a high concentration of marijuana in your system, that can lead to psychosis,” Randhawa said.

Symptoms family members notice that lead to the patient's hospitalization include abrupt changes in mood and behavior, paranoia symptoms, insomnia and agitation, Randhawa said.

“Loved ones see that something isn’t right, and they call an ambulance or take the patient to the hospital,” Randhawa said.

Randhawa said patients with this type of behavior and aggression are evaluated very carefully.

A medical history may show new onset of symptoms. Lab work is done. A drug screen may reveal cannabis in the person's system .

These are some of the ways health care professionals learn they are dealing with a substance-abuse psychosis, she said.

Care is supportive, Randhawa said. This includes a non-stimulating environment to help the patient rest, second generation anti-psychotic medication to stabilize moods, food and plenty of fluids, she said..

If this sounds simple, keep in mind that typical medication dosages often aren’t enough for people with cannabis-induced psychosis.

“It takes quite a lot to stabilize these patients,” Randhawa said.

And patients should expect a one to two-week hospital stay – and maybe some mental health issues in the future.

“More than 30 percent of people who have cannabis-induced psychosis will develop some type of psychosis later in life,” Randhawa said.

Randhawa said that may be due to people staying home more, lack of outside socialization, attempts to self-medicate themselves by vaping cannabis and not fully realizing how concentrated this form of cannabis is, and by having a mindset that vaping is a healthy way to obtain it.

In fact, vamping itself has doubled from 2017 to 2019, Randhawa said.

“Plus, this year medical marijuana and recreational marijuana is more accessible,” Randhawa said.

Patients across every economic and population spectrum (except age 50 and up who may still feel a stigma associated with marijuana use) have been affected. In fact, young people are especially vulnerable because vaping cannabis has a “hip coolness factor to it,” she said

The only population not affected is the elderly, Randhawa said. The most common reasons for self-medicating are anxiety and depression because the THC in marijuana either helps them get high or makes them feel calm, she said.

The fact that high potency cannabis can cause acute psychosis is nothing new, Randhawa said.

In 2015, The Lancet published a study that showed ingesting high potency cannabis resulted in a greater proportion of patients with first-episode psychosis that was attributed in cannabis.

The Centers for Disease Control has reported similar findings in teens.

And on March 17, Lancet Psychiatry published a study that showed the amount of THC, about one marijuana joint, could induce psychotic symptoms in healthy adults.

“However, we’re seeing it more acutely now,” Randhawa said. “Vaping [cannabis] on a regular basis – more than twice a week - increases your chance of psychosis.”

Randhawa said the Centers for Disease Control used to think nicotine was the gateway drug for other substances.

[ Now Randhawa has heard some discussion that the gateway drug may be cannabis. ]

In fact, both nicotine and opioid use has gone down in teens, according to a study by the National Institute of Health, Randhawa said.

But now, 3.5% of 12th graders are vaping on daily basis, Randhawa said.

And that can come with serious repercussions for teens, according to a study published by JAMA Psychiatry.

Older adults who smoked marijuana at college parties might be wondering what the big deal is, But the cannabis from 10 to 20 and more years ago was not that potent and dangerous as the cannabis of today, Randhawa said.

“No one died from smoking marijuana,” Randhawa said.

The fact that it’s often odorless makes it that more difficult for parents to discover their teens using it, she said.

So be aware, Randhawa said.

Because so many times, even the patients Randhawa has seen didn’t realize how dangerous this form of cannabis could be.

“Each and everyone has said, “I didn’t realize that. I didn’t know that,’” Randhawa said.

About Dr. Jyoti K. Randhawa, chief medical officer at Silver Oaks Behavioral Center

Randhawa completed her general adult Psychiatry training at Michigan State University and a child and adolescent psychiatry fellowship at the University of Chicago.

She has actively practiced in the outpatient and inpatient clinical setting within urban, suburban and veteran and military communities.

She has held positions as an Associate Professor of Psychiatry at Rosalind Franklin University and as a supervisor for nurse practitioners.

For more information, call 24/7 at 844-580-5000 or visit silveroaksbehavioralhospital.com.