Trends in Cannabis Exposure and Psychosis Among U.S. Adolescents in Emergency Rooms from 2016 to 2024
Sue D. Muggar, Jaime A. Perez, F. Laviolette, M. McVoy
Journal of addiction psychiatry August 14, 2026 DOI: 10.17756/jap.2026-054 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective observational study Peer reviewed |
|---|---|
| Population | Adolescents aged 13–17 presenting to U.S. emergency rooms with psychosis and/or THC exposure |
| Duration | 2016 to 2024 |
| Topics | Cannabis |
| Key findings | Among adolescents with THC exposure, 7.9% had a psychosis diagnosis, and among those with psychosis, 17.8% were THC-positive. The odds of psychosis among THC-exposed adolescents decreased by about 5% annually, while THC exposure among those with psychosis remained stable. Males with psychosis had higher odds of THC positivity, and Black youth had lower odds of a psychosis diagnosis than White youth. |
Abstract
Objectives: To utilize a retrospective observational design to characterize adolescents aged 13 - 17 presenting to emergency rooms (ER) in the United States (US) from 2016 to 2024 with psychosis and/or delta-9-tetrahydrocannabinol (THC) exposure via urine drug screens (UDS) and to evaluate trends in THC exposure, psychiatric comorbidities, and demographics. Material and
Methods: De-identified, Institutional Review Board–exempt data from the TriNetX database were analyzed. Adolescents were identified with psychosis or THC exposure via International Classification of Diseases (ICD)-10 codes. Exclusions included neurocognitive and neurodevelopmental disorders, non-cannabis substance use, repeat ER visits, or prior antipsychotic use. Logistic regressions assessed trends and demographics.
Results: The odds of psychosis among adolescents with THC exposure decreased by 5% annually (adjusted odds ratio (OR) 0.95 per year, p < 0.001) while THC exposure among those with psychosis remained stable (OR = 1.00, 95% confidence intervals (Cl): 0.98 - 1.02, p = 0.80). Among 22,705 adolescents with THC exposure, 1,799 (7.9%) had a psychosis diagnosis. Among 11,219 adolescents with psychosis, 1,993 (17.8%) were THC-positive. Males had higher odds of THC when presenting with psychosis (adjusted OR 1.73, p < 0.001). Black youth had lower odds of a psychosis diagnosis vs White youth (adjusted OR 0.55, p < 0.001). Among THC-positive adolescents, psychiatric comorbidities were associated with psychosis. In THC-negative patients, anxiety and depression were common.
Conclusion: This large national analysis highlights distinct demographic and psychiatric comorbidity patterns among adolescents presenting with psychosis and THC exposure, which may inform targeted ER assessment, risk stratification, and follow-up care.
Comparable studies
Other observational and cohort studies on cannabis, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| High-potency cannabis and the risk of psychosis People with first episode of psychosis and healthy controls from the local population | 2009 | Case-control study | n = 454 |
| Ayahuasca-Assisted Therapy for Addiction: Results from a Preliminary Observational Study in Canada Rural aboriginal population | 2013 | Observational study | |
| Impaired cognitive performance in drug free users of recreational ecstasy (MDMA) Otherwise healthy young people | 2000 | Observational | |
| Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study Individuals from the general population in Germany aged 14-24 at baseline | 2011 | Observational cohort | n = 1,923 |
| Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: follow-up study of 535 incident cases Patients treated for cannabis-induced psychotic symptoms in Denmark between 1994 and... | 2005 | Observational cohort | n = 535 |