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Rewired realities: novel insights into the neurobiology of cannabis use disorder and psychosis

Neuropsychopharmacology (2025)Cite this article

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Mounting epidemiological evidence indicates that the development of cannabis use disorder (CUD) may potentiate psychosis risk. Recent large-scale studies have shown a four-fold increase over the last two decades in the proportion of schizophrenia that can be attributable to CUD in Denmark (cited in [1, 2]) and a near tripling of CUD-associated psychosis cases in Ontario [2]. The largest-to-date genetic study also indicated that CUD was most associated with schizophrenia compared to other psychiatric disorders [3]. Psychosis most often develops during late teens and early adulthood, while cannabis use is often initiated at a younger age [4]. In Ontario, the prevalence of CUD among adolescents has risen substantially, and CUD-associated psychosis cases are most evident from ages 19–24 [2]. Alongside rising rates of CUD, cannabis potency has increased dramatically, which has raised concerns for impacts on these psychiatric outcomes [5]. A multi-site study indicated that daily users of potent products are 5x more likely to develop a psychotic disorder [4], and use of these products increases the likelihood of developing CUD/problematic use [5]. Neurobiological substrates that develop during adolescence and are vulnerable to cannabis likely contribute to the emergence of CUD, psychosis, or both.

It is challenging for research to inform policy, as it often takes several years to determine outcomes of changes in product availability and use. Rapid implementation of translational assessments of the impact of adolescent cannabis use and changes in the use landscape (potency, patterns of use) as well as genetic/epigenetic factors is necessary to determine mechanisms that promote CUD and psychosis risk. These efforts will provide opportunities to prevent or treat these conditions. Converging evidence from animal and human research calls for public health campaigns that translate a clear and engaging message to mitigate the rising rates of CUD and psychosis during adolescence.

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Fig. 1: Large-scale epidemiological studies are reporting that co-occurring cases of cannabis use disorder (CUD) and psychosis are becoming more prevalent and often emerge during adolescence.

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Authors and Affiliations

  1. Department of Psychiatry, The Addiction Institute at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Jacqueline-Marie N. Ferland

  2. Department of Social, Genetic, and Developmental Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

    Marta Di Forti

  3. South London and Maudsley NHS Foundation Trust, London, UK

    Marta Di Forti

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  1. Jacqueline-Marie N. Ferland
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  2. Marta Di Forti
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JMF and MDF conceived, wrote, revised, and approved the paper.

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Correspondence to Jacqueline-Marie N. Ferland.

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Ferland, JM.N., Di Forti, M. Rewired realities: novel insights into the neurobiology of cannabis use disorder and psychosis. Neuropsychopharmacol. (2025). https://doi.org/10.1038/s41386-025-02189-x

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