Cannabis, Psychosis, and the Legal Implications : Chicken or Egg ?

which does not produce euphoria or intoxication—is readily available. Early research into the therapeutic effects of CBD compounds is promising with regards to treatment of anxiety, SUDs, posttraumatic stress disorders, and other psychiatric illnesses, and some cannabinoid compounds have been found helpful in treatment of epilepsy. With that said, many CBD products may contain amounts of THC, which can vary in concentration and effect.Legal ImplicationsState laws and public perceptions surrounding cannabis have been changing rapidly. In Texas, marijuana possession is at least a misdemeanor charge with jail time, and/or fines, progressing to felony possession if an individual is found with more than 4 oz. By contrast, 23 other states, Guam, and Washington, DC, have legalized the recreational use of cannabis. At least 38 states have approved cannabinoid products for medicinal use.13The Marijuana Opportunity Reinvestment and Expungement Act passed by the US House of Representatives in April 2022 sought to decriminalize marijuana.14 This bill meant that cannabis would be removed from the list of drugs regulated by the Controlled Substances Act, federal criminal penalties for cannabis use would be eliminated, and past federal cannabis convictions would be expunged. However, no bill to decriminalize cannabis has successfully passed the Senate. To address the issue, in October 2022, President Joseph R. Biden announced that he would grant pardons for federal marijuana possession convictions, urging state governors to do the same for state offenses.15These events are steps in a positive direction for thousands of individuals, particularly minority groups who are disproportionately arrested and incarcerated. An American Civil Liberties Union report from 2020 states that a Black individual is 3.64 times more likely to be arrested for marijuana possession, even though rates of cannabis use by Black and white individuals are the same.16 In some states, Black individuals are up to 10 times more likely to be arrested.16 This trend applies to every state and is prevalent in both rural and urban settings. Beyond actual incarceration, felony convictions prevent individuals from employment, housing options, and the right to vote, making this an issue of racial equity.Individual Risk ProfileGary faced an increased risk of arrest for cannabis possession due to his race/ethnicity. Before his arrest, Gary’s TBI history increased his impulsivity risk and could have complicated his chances at educational attainment and occupational success. Additionally, his history of military trauma may have made continued use of cannabis more likely. Gary likely used cannabis to stifle trauma intrusion and hyperarousal symptoms, as cannabinoids reduce responses to conditioned fear cues, impair retrieval of aversive memories, and trigger the extinction of unwanted memories.17In light of his psychotic symptoms and unsafe behavior while intoxicated, Gary would have benefited from a psychiatric evaluation instead of incarceration, which could hurt his future employment prospects. Gary’s refusal of psychiatric medications and limited insight about the dangers of cannabis use and his legal predicament place him in a real quandary. Yet the severity of his psychotic symptoms is not sufficient to justify involuntary inpatient psychiatric hospitalization. Clinicians need to be ready for this type of complicated presentation as cannabis becomes increasingly legalized.Additionally, although risk of cannabis use in triggering psychosis is recognized, the risk…

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