Continued versus discontinued cannabis use in patients with psychosis: a systematic review and meta-analysis
Abstract
Background Although the link between cannabis use and development of psychosis is well established, less is known about the effect of continued versus discontinued cannabis use after the onset of psychosis. We aimed to summarise available evidence focusing on the relationship between continued and discontinued cannabis use after onset of psychosis and its relapse. Methods In this systematic review and meta-analysis, we searched MEDLINE for articles published in any language from the database inception date up until April 21, 2015 that included a sample of patients with a pre-existing psychotic disorder with a follow-up duration of at least 6 months. We used a combination of search terms for describing cannabis, the outcome of interest (relapse of psychosis), and the study population. We excluded studies if continued cannabis use or discontinued cannabis use could not be established. We compared relapse outcomes between those who continued (CC) or discontinued (DC) cannabis use or were non-users (NC). We used summary data (individual patient data were not sought out) to estimate Cohen's d, which was entered into random effects models (REM) to compare CC with NC, CC with DC, and DC with NC. Meta-regression and sensitivity analyses were used to address the issue of heterogeneity. Findings Of 1903 citations identified, 24 studies (16 565 participants) met the inclusion criteria. Independent of the stage of illness, continued cannabis users had a greater increase in relapse of psychosis than did both non-users (dCC-NC=0·36, 95% CI 0·22-0·50, p<0·0001) and discontinued users (dCC-DC=0·28, 0·12-0·44, p=0·0005), as well as longer hospital admissions than non-users (dCC-NC=0·36, 0·13 to 0·58, p=0·02). By contrast, cannabis discontinuation was not associated with relapse (dDC-NC=0·02, -0·12 to 0·15; p=0·82). Meta-regression suggested greater effects of continued cannabis use than discontinued use on relapse (dCC-NC=0·36 vs dDC-NC=0·02, p=0·04), positive symptoms (dCC-NC=0·15 vs dDC-NC=-0·30, p=0·05) and level of functioning (dCC-NC=0·04 vs dDC-NC=-0·49, p=0·008) but not on negative symptoms (dCC-NC=-0·09 vs dDC-NC=-0·31, p=0·41). Interpretation Continued cannabis use after onset of psychosis predicts adverse outcome, including higher relapse rates, longer hospital admissions, and more severe positive symptoms than for individuals who discontinue cannabis use and those who are non-users. These findings point to reductions in cannabis use as a crucial interventional target to improve outcome in patients with psychosis. Funding UK National Institute of Health Research.
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Continued cannabis use in people with psychosis is associated with longer hospital stays than in non-users.
“A meta-analysis of longitudinal studies [54] found that continued cannabis use in people with psychosis is associated with an increased risk of relapse to psychosis and with longer hospital stays than in non-users [55].”
From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [54]
Continued cannabis use in people with psychosis is associated with an increased risk of relapse to psychosis.
“A meta-analysis of longitudinal studies [54] found that continued cannabis use in people with psychosis is associated with an increased risk of relapse to psychosis and with longer hospital stays than in non-users [55].”
From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [54]
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The pharmacokinetics and the pharmacodynamics of cannabinoids
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Self-citationNon-Genetic Factors in Schizophrenia
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Self-citationColizzi, M., McGuire, P. K., Pertwee, R. G., & Bhattacharyya, S. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.03.010 · Cited by 146 · see citing works
Self-citationColizzi, M., & Bhattacharyya, S. (2017) · Current Addiction Reports · doi:10.1007/s40429-017-0142-2 · Cited by 138 · see citing works
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Self-citationCannabis use, cannabis use disorder, and comorbid psychiatric illness: a narrative review
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Cannabis Use and the Risk for Psychosis and Affective Disorders
Sideli, L., Quigley, H., Cascia, C. L., & Murray, R. M. (2019) · Journal of Dual Diagnosis · doi:10.1080/15504263.2019.1674991 · Cited by 137 · see citing works
Self-citationCannabis, cannabinoids and health: a review of evidence on risks and medical benefits
Hoch, E., Volkow, N. D., Friemel, C. M., Lorenzetti, V., Freeman, T. P., & Hall, W. (2025) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-024-01880-2 · Cited by 139 · see citing works
“A meta-analysis of longitudinal studies [54] found that continued cannabis use in people with psychosis is associated with an increased risk of relapse to psychosis and with longer hospital stays than in non-users [55].”
The adverse health effects and harms related to marijuana use: an overview review.
Memedovich, K. A., Dowsett, L., Spackman, E., Noseworthy, T., & Clement, F. (2018) · CMAJ Open · doi:10.9778/cmajo.20180023 · Cited by 111 · see citing works
Cannabidiol as a potential treatment for psychosis
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Self-citationAssociation Between Continued Cannabis Use and Risk of Relapse in First-Episode Psychosis
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Self-citationThe Effects of Cannabis Use on the Development of Adolescents and Young Adults
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Tao, R., Li, C., Jaffe, A. E., Shin, J. H., Deep‐Soboslay, A., Yamin, R., Weinberger, D. R., Hyde, T. M., & Kleinman, J. E. (2020) · Translational Psychiatry · doi:10.1038/s41398-020-0832-8 · Cited by 88 · see citing works
Residual effects of cannabis use in adolescent and adult brains — A meta-analysis of fMRI studies
Blest‐Hopley, G., Giampietro, V., & Bhattacharyya, S. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.03.008 · Cited by 89 · see citing works
Self-citationIs It Possible to Predict the Future in First-Episode Psychosis?
Suvisaari, J., Mantere, O., Keinänen, J., Mäntylä, T. J. S., Rikandi, E., Lindgren, M., Kieseppä, T., & Raij, T. T. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00580 · Cited by 88 · see citing works
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Consensus paper of the WFSBP task force on cannabis, cannabinoids and psychosis
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Self-citationBlest‐Hopley, G., Colizzi, M., Giampietro, V., & Bhattacharyya, S. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00859 · Cited by 85 · see citing works
Self-citationContinuity of cannabis use and violent offending over the life course
Schoeler, T., Theobald, D., Pingault, J., Farrington, D. P., Jennings, W. G., Piquero, A. R., Coid, J., & Bhattacharyya, S. (2016) · Psychological Medicine · doi:10.1017/s0033291715003001 · Cited by 82 · see citing works
Self-citationColizzi, M., Weltens, N., McGuire, P. K., Lythgoe, D. J., Williams, S., Oudenhove, L. V., & Bhattacharyya, S. (2019) · Molecular Psychiatry · doi:10.1038/s41380-019-0374-8 · Cited by 74 · see citing works
Self-citationCannabis regulatory science: risk–benefit considerations for mental disorders
Borodovsky, J. T., & Budney, A. J. (2018) · International Review of Psychiatry · doi:10.1080/09540261.2018.1454406 · Cited by 73 · see citing works
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Self-citationCannabis use and adherence to antipsychotic medication: a systematic review and meta-analysis
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Self-citationDellazizzo, L., Potvin, S., Athanassiou, M., & Dumais, A. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.567887 · Cited by 68 · see citing works
A scoping review of the use of cannabidiol in psychiatric disorders
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Exposure to cannabinoids can lead to persistent cognitive and psychiatric disorders
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Cannabis and Psychosis: What Degree of Proof Do We Require?
Murray, R. M., & Forti, M. D. (2016) · Biological Psychiatry · doi:10.1016/j.biopsych.2016.02.005 · Cited by 58 · see citing works
Self-citationRates and Predictors of Relapse in First-Episode Psychosis: An Australian Cohort Study
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Cannabis use and violence in patients with severe mental illnesses: A meta-analytical investigation
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Self-citationCannabidiol for the treatment of autism spectrum disorder: hope or hype?
Pedrazzi, J. F. C., Ferreira, F. R., Silva-Amaral, D., Lima, D. D. A., Hallak, J. E. C., Zuardi, A. W., Bel, E. A. D., Guimarães, F. S., Costa, K. C. M., Campos, A. C., et al. (2022) · Psychopharmacology · doi:10.1007/s00213-022-06196-4 · Cited by 52 · see citing works
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Self-citationExogenous Cannabinoid Efficacy: Merely a Pharmacokinetic Interaction?
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Schizophrenia: A developmental disorder with a risk of non-specific but avoidable decline
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Self-citationOuellet‐Plamondon, C., Abdel‐Baki, A., Salvat, É., & Potvin, S. (2017) · Psychological Medicine · doi:10.1017/s0033291717000976 · Cited by 43 · see citing works
Persistency of Cannabis Use Predicts Violence following Acute Psychiatric Discharge
Dugre, J. R., Dellazizzo, L., Giguère, C., Potvin, S., & Dumais, A. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00176 · Cited by 43 · see citing works
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Cannabidiol (CBD) as a novel treatment in the early phases of psychosis
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Self-citationGender differences in the association between environment and psychosis
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The interaction of gender and cannabis in early phase psychosis
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Todd, S. M., Zhou, C., Clarke, D. J., Chohan, T. W., Bahceci, D., & Arnold, J. C. (2017) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2016.12.004 · Cited by 38 · see citing works
Cannabidiol modulation of hippocampal glutamate in early psychosis
O’Neill, A., Annibale, L., Blest‐Hopley, G., Wilson, R. P., Giampietro, V., & Bhattacharyya, S. (2021) · Journal of Psychopharmacology · doi:10.1177/02698811211001107 · Cited by 37 · see citing works
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Self-citationRethinking the course of psychotic disorders: modelling long-term symptom trajectories
Morgan, C., Dazzan, P., Lappin, J., Heslin, M., Donoghue, K., Fearon, P., Jones, P. B., Murray, R. M., Doody, G. A., & Reininghaus, U. (2021) · Psychological Medicine · doi:10.1017/s0033291720004705 · Cited by 37 · see citing works
Self-citationAdverse effects of heavy cannabis use: Even plants can harm the brain
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A Review of Cases of Marijuana and Violence
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The effects of cannabis use on salience attribution: a systematic review
Wijayendran, S. B., O’Neill, A., & Bhattacharyya, S. (2016) · Acta Neuropsychiatrica · doi:10.1017/neu.2016.58 · Cited by 35 · see citing works
Self-citationPossible therapeutic applications of cannabis in the neuropsychopharmacology field
Fernández‐Ruíz, J., Galve‐Roperh, I., Sagredo, O., & Guzmán, M. (2020) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2020.01.013 · Cited by 34 · see citing works
Cannabinoids, reward processing, and psychosis
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Self-citationColizzi, M., McGuire, P. K., Giampietro, V., Williams, S., Brammer, M. J., & Bhattacharyya, S. (2018) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2018.04.003 · Cited by 28 · see citing works
Self-citationAthanassiou, M., Dumais, A., Gnanhoue, G., Abdel-Baki, A., Jutras-Aswad, D., & Potvin, S. (2021) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2021.1942845 · Cited by 29 · see citing works
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Self-citationSchoeler, T., Petros, N., Forti, M. D., Klamerus, E., Foglia, E., Murray, R. M., & Bhattacharyya, S. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.05.009 · Cited by 26 · see citing works
Self-citation"Considerations for the Use of Medical Cannabis: An Overview of Benefits and Harms"
Shakya, D. R. (2021) · Biomedical Journal of Scientific & Technical Research · doi:10.26717/bjstr.2021.36.005886 · Cited by 8 · see citing works
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Self-citationCannabis and Mental Health: A Review.
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Early onset of cannabis use and violent behavior in psychosis
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Current Cannabidiol Safety: A Review
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Self-citationCorrelation still does not imply causation
Ksir, C. J., & Hart, C. L. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(16)30005-0 · Cited by 21 · see citing works
Kansagara, D. L., Hill, K. P., Yost, J., Humphrey, L. L., Shaw, B., Obley, A. J., Haeme, R., Akl, E. A., Qaseem, A., Humphrey, L. L., et al. (2025) · Annals of Internal Medicine · doi:10.7326/annals-24-03319 · Cited by 20 · see citing works
Levi, L. W., Haim, M. B., Rossum, I. W.-V., Davidson, M. L., Leucht, S., Fleischhacker, W. W., Park, J., Davis, J. M., Kahn, R. S., & Weiser, M. (2023) · Schizophrenia Bulletin · doi:10.1093/schbul/sbad033 · Cited by 20 · see citing works
Reid, S. W., & Bhattacharyya, S. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.112523 · Cited by 20 · see citing works
Self-citation
- Authors
- Schoeler, T., Monk, A., Sami, M. B., Klamerus, E., Foglia, E., Brown, R., Camuri, G., Altamura, A. C., Murray, R., & Bhattacharyya, S.
- Affiliations
- King's College London (GB)
- University of Milan (IT)
- Corresponding author
- Bhattacharyya, Sagnik
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2016-03
- Volume
- 3
- Issue
- 3
- Pages
- 215-225
- ISSN
- 2215-0366 (ISSN-L)
- OpenAlex
- W2257957527
- Cited by
- 322
- References
- 90
- Citations by year
- 2026: 17 · 2025: 25 · 2024: 33 · 2023: 34 · 2022: 39 · 2021: 28 · 2020: 39 · 2019: 34 · 2018: 30 · 2017: 24 · 2016: 18
- FWCI
- 4.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0512-10110, NIHR-CS-011-001, RP-PG-0606-1049)
- Medical Research Council (MR/J012149/1, MR/K013807/1)
- Topics
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- cannabis use, psychosis, relapse, hospitalization, positive symptoms, functioning, schizophrenia, bipolar disorder, schizoaffective disorder, delusional disorder, cannabis harm reduction, relapse prevention
- MeSH terms
- Humans, Marijuana Smoking, Psychotic Disorders, Recurrence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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