By Dr. Anthony Policastro

I have always been cautious about being the first one to jump on a new therapy. That has often paid off.

There are many drugs that have been tested in relatively few patients. That resulted in rare side effects only showing up after the drug was in wider use.

We have seen the same thing with vaccines. A vaccine to prevent an intestinal virus in infants wound up causing intestinal obstruction. The Lyme vaccine was discontinued after a year because of side effects.

With increased legalization of marijuana, we are now seeing evidence of a disorder related to its use. The formal name for it is Cannabis Induced Psychosis (CIP). Between 2001 and 2013, the number of cases of CIP increased by 250 percent.

We know that illegal use of cannabis occurs in children. In 2019, 37 percent of high school students reported ever using marijuana with 22 percent reporting having used it in the previous 30 days.

Vaping marijuana is also relatively common. About eight percent of 8th graders do so. The number goes up to 19 percent in 10th graders and is at 22 percent of 12th graders.

CIP symptoms include delusions, hallucinations, anxiety, disorganized thoughts, and paranoia, as well as some other changes in mood and behavior.

The higher the dose, the worse the symptoms will be. Since it is being purchased illegally by minors, they have no concept of how strong the preparation is.

The good news is that in most cases the symptoms resolve in a few hours as the drug wears off. The bad news is that the individual is prone to having it happen again with repeated use.

In addition, those who have a family history of mental illness are more likely to have longer lasting symptoms with repeated use.

While this can occur in older individuals as well, it is more a reaction of younger, not fully developed brains. The incidence is lower if the individual is over age 26 with a mature brain.

The real problem with CIP comes with diagnosis. A patient who shows up with psychotic symptoms in an ER might have CIP. The patient also might be actually psychotic. If no one knows that the patient has recently used cannabis, that makes the diagnosis much more difficult.

The issue is that CIP is treated with a few hours of watchful waiting for it to wear off. Otherwise a psychotic break would require more intense treatment. That would likely include a brief hospitalization until symptoms can be controlled with medication.

It is really not a surprise to see this kind of rare reaction with a drug that is seeing wider use.