Cannabis use in adolescence and risk of psychosis: Are there factors that moderate this relationship? A systematic review and meta-analysis
Abstract
Background Previous research has reported increased risk for psychosis among individuals who use cannabis during adolescence. We conducted a systematic review and meta-analysis to investigate the interaction between adolescent cannabis use and other factors in moderating risk for psychosis later in life. Method We searched four electronic databases in June 2020 for articles that assessed adolescent cannabis use, had psychosis as an outcome and analyzed for the association between adolescent cannabis use and psychosis. Analysis was done using random-effects meta-analysis and narrative synthesis. Results A total of 63 studies were included in the narrative review and 18 studies were included in the meta-analysis. Adolescent cannabis use was found to increase risk for psychosis (RR = 1.71 (95%CI, 1.47–2.00, p < 0.00001) and predict earlier onset of psychosis. The following factors moderate the relationship between cannabis use and the risk of psychosis: age of onset of cannabis use, frequent cannabis use, exposure to childhood trauma, concurrent use of other substances and genetic factors. Conclusion Adolescent cannabis use is associated with an increased risk for psychosis later in life. In addition, there are factors that moderate this relationship; therefore there is a need for research to assess the interaction between these factors, adolescent cannabis use and psychosis risk.
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Factors that moderate the relationship between adolescent cannabis exposure and psychosis include age of onset, frequency of cannabis use, exposure to childhood trauma, concurrent use of other substances, and genetic factors.
“Importantly factors that moderate the relationship between ACE and psychosis are being identified, and include age of onset, frequency of cannabis use, exposure to childhood trauma, concurrent use of other substances, and genetic factors [121].”
From Consequences of adolescent drug use (2023) · cites this paper as [121]
A meta-analysis focusing on adolescents showed a 2.5-fold increase in the odds of psychosis onset in frequent v. infrequent cannabis users (OR 2.7, 95% CI 1.65-3.71).
“A meta-analysis focusing on adolescents (Kiburi et al., 2021) showed a 2.5-fold increase in the odds of psychosis onset in frequent v. infrequent cannabis users [odds ratio (OR) 2.7, 95% confidence interval (CI) 1.65–3.71].”
From Risk-thresholds for the association between frequency of cannabis use and the development of psychosis: a systematic review and meta-analysis (2023) · cites this paper as Kiburi et al., 2021
Other reviews have been limited in their level of detail about the relationship between cannabis use frequency and psychosis risk, commonly comparing frequent use to only infrequent or non-use.
“Other reviews, however, have been limited in their level of detail about the relationship between cannabis use frequency and psychosis risk where, for example, frequent use is commonly compared to only infrequent or non-use (Campeny et al., 2020; Hasan et al., 2020; Kiburi et al., 2021; Marconi et al., 2016; Polkosnik et al., 2021; van der Steur et al., 2020).”
From Risk-thresholds for the association between frequency of cannabis use and the development of psychosis: a systematic review and meta-analysis (2023) · cites this paper as Kiburi et al., 2021
Early age-of-use in adolescence combined with frequent use increases the risk significantly compared to either risk factor alone.
“For example, an early age-of-use in adolescence combined with frequent use was found to increase the risk significantly as compared to either risk-factor alone, with genetic pre-dispositions as likely additional contributors (Kiburi et al., 2021).”
From Risk-thresholds for the association between frequency of cannabis use and the development of psychosis: a systematic review and meta-analysis (2023) · cites this paper as Kiburi et al., 2021
The risk of psychosis associated with more frequent cannabis use is likely further influenced by other risk factors (e.g., genetics, family history, cannabis potency) beyond frequency of use.
“While more frequent cannabis use to be appears associated with an elevated risk of psychosis, this risk is likely further influenced by other risk-factors (e.g. genetics, family history, cannabis potency) that require additional consideration for and incorporation into prevention messaging beyond mere frequency-of-use factors”
From Risk-thresholds for the association between frequency of cannabis use and the development of psychosis: a systematic review and meta-analysis (2023) · cites this paper as Kiburi et al., 2021
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Consequences of adolescent drug use
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“Importantly factors that moderate the relationship between ACE and psychosis are being identi fi ed, and include age of onset, frequency of cannabis use, exposure to childhood trauma, concurrent use of other substances, and genetic factors [121].”
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Adolescent Substance Use Disorders
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- Authors
- Kiburi, S. K., Molebatsi, K., Ntlantsana, V., & Lynskey, M. T.
- Affiliations
- Virginia Commonwealth University (US)
- University of Botswana (BW)
- University of KwaZulu-Natal (ZA)
- King's College London (GB)
- Corresponding author
- Kiburi, Sarah Kanana
- Venue
- Substance Abuse
- Publisher
- SAGE Publications
- Published
- 2021-10
- Volume
- 42
- Issue
- 4
- Pages
- 527-542
- ISSN
- 0889-7077 (ISSN-L)
- 1547-0164
- OpenAlex
- W3133405773
- Cited by
- 115
- References
- 104
- Citations by year
- 2026: 13 · 2025: 19 · 2024: 28 · 2023: 22 · 2022: 26 · 2021: 7
- FWCI
- 2.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Substance Abuse (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- 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
- adolescent cannabis use, psychosis risk, transition to psychosis, moderators, childhood trauma, polydrug use, genetic susceptibility
- MeSH terms
- Adolescent, Cannabis, Marijuana Abuse, Humans, Psychotic Disorders, Risk Factors
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.
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