Cannabis use predicts future psychotic symptoms, and vice versa

Aims To assess if cannabis use is a risk factor for future psychotic symptoms, and vice versa, in adolescents and young adults from the general population. Design Cohort study. Setting/participants 'Zuid Holland' study, a 14-year follow-up study of 1580 initially 4-16-year-olds who were drawn randomly from the Dutch general population. Because cannabis use is generally condoned in the Netherlands, false-negative reports of cannabis use may occur less frequently than in countries with stricter drug policies, which supports the value of the present study. Measurements Life-time cannabis use and psychotic symptoms, assessed with the Composite International Diagnostic Interview (CIDI). Findings Cannabis use, in individuals who did not have psychotic symptoms before they began using cannabis, predicted future psychotic symptoms (hazard ratio = 2.81; 95% confidence interval = 1.79-4.43). However, psychotic symptoms in those who had never used cannabis before the onset of psychotic symptoms also predicted future cannabis use (hazard ratio = 1.70; 95% confidence interval = 1.13-2.57). Conclusions The results imply either a common vulnerability with varying order of onset or a bi-directional causal relationship between cannabis use and psychosis. More research on patterns and timings of these relationships is needed to narrow down the possibilities.