‘Marijuana causes paranoia and psychosis. That fact is now beyond dispute.’
This dire (if entirely inaccurate!) warning comes from Alex Berenson, author of Tell Your Children: The Truth About Marijuana, Mental Illness and Violence. Released in 2019, the book contains passages reminiscent of the 1930’s Bureau of Narcotics film Reefer Madness, which implicated a few puffs of marijuana as a trigger for psychotic and violent acts. (The parallels are not by accident, as Berenson took his title from the film’s original name.)
The modern-day Tell Your Children has drawn widespread backlash from both popular culture and the research community, with accusations that Berenson’s conclusions are based on flawed and cherry-picked data. Critics have pointed out that past studies have also implicated cigarette smoking, alcohol, and even drinking coffee as potential causes of paranoia and psychosis.
But while some aspects of the book seem far over the top, at least one fact remains true: some people do get paranoid when they smoke marijuana…
What Is Paranoia?
The Cleveland Clinic offers this succinct definition of paranoia:
Being overly suspicious and thinking others are out to harm you.
Adding:
Feeling some paranoia every once in a while is normal. But severe paranoia can be a sign of psychosis and certain mental health conditions.
A survey of more than 10,000 adults in the United Kingdom found that 25% of participants reported being mistrustful of others. The authors suggested that these mistrusts may stem from social anxieties such as the fear of rejection, a sense of inferiority, a negative self-image or perceptions, or a lack of control over events.
Research published in Natural Human Behavior asserts that the general feelings of mistrust associated with paranoia came about as early humans formed the first social groups. The authors suggest that some degree of this mistrust of strangers and new acquaintances was a helpful and protective adaptation that is now an ingrained instinct:
Paranoia should not solely be viewed as a pathological symptom of a mental disorder but also as a part of a normally functioning human psychology.
A study published in the September 2024 edition of Schizophrenia Research explores the boundaries between the routine and non-debilitating sensations of paranoia and more pronounced symptoms indicative of mental disorders. The authors suggest that there are four basic levels of awareness associated with the condition. Ranked from mildest to most severe these are:
Interpersonal Sensitivity: The ability to understand the emotional state of others. Though generally considered a positive personality trait, persons who are overly sensitive have an increased risk of developing more advanced symptoms of paranoia.
Mistrust: The inability to trust others or tendency to doubt their intentions despite any lack of evidence. An individual’s background, life experiences and personality play a role in the nature and severity of mistrust.
Ideas of Reference: Interpreting the comments, gestures, and demeanor of others as a negative reflection on one’s self in cases where there is no evidence to support these feelings.
Persecutory Ideas: A delusional disorder that causes individuals to falsely believe they are being mistreated, spied on or at risk of harm.
Paranoia afflicts people across all demographic and age ranges, but not equally. The journal Psychological Medicine reports that paranoia was more often associated with youth, poverty, poor health, lack of social support, unhappiness, loneliness, stress, problem drinking, and…. marijuana use.
There are numerous variables involved in the mechanisms of paranoia. As a result, the sensations of paranoia attributed to marijuana may be triggered or amplified when combined with one or more of the additional associated risk factors. Conversely, individuals experiencing few or none of these risk factors may be less likely to have paranoid sensations when consuming marijuana.
How Does Marijuana Cause Paranoia?
Research has identified THC as the primary source of the temporary symptoms of anxiety, paranoia, and psychotic thoughts that are sometimes experienced by otherwise mentally stable marijuana consumers. The most comprehensive study to date on this subject of was conducted at the University of Oxford and published in the journal Schizophrenia Bulletin. In introductory remarks, the authors postulate that there are two distinct ways that THC may induce symptoms of paranoia.
The first is by evoking the brain’s natural fear responses. This phenomenon has been confirmed by research from Vanderbilt University. As reported in the journal Neuron, THC binds with CB1 receptors in the temporal lobe to over-stimulate the amygdala. This is the portion of the brain responsible for the “fight or flight” response, and when stimulated, it evokes sensations of fear and anxiety.
The authors of the Oxford study suggested that paranoia may also be the result of cognitive changes that create an “anomalous internal state,” writing:
These anomalies may include changes in sensory intensity, distorted sensory experience, sensory flooding, unusual sensory experience, thought echo, and hallucinations. They may also include feelings of unusual salience.
[…] The anomalies may be triggered by life events, poor sleep, or drugs such as cannabis. In essence, the person feels different and this requires an explanation. Odd experiences encourage unusual thoughts [and can trigger] negative, implausible ideas [and paranoia].
The cognitive-altering and potential paranoia-triggering effects of marijuana include short-term memory impairment, time distortion, sedation, changes in visual perception, and mood alteration. These effects are well-known to cannabis consumers, and are sometimes even considered a desirable part of the “high” that comes with use.
Familiarity and adaptations to the cognitive alterations induced by marijuana may be the reason why some individuals who are new to cannabis therapy may feel fearful, while regular users experience reduced or no symptoms of paranoia. Research confirms that some marijuana users never experience paranoia, and that others report these feelings subside or disappear with continued use.
How Common Is Marijuana-Related Paranoia?
To put a number on the frequency of paranoid incidents associated with marijuana use, the Oxford University study recruited 121 adults aged 21 to 50 with no history of mental illness and at least one previous experience with cannabis. Volunteers were given either a placebo or a dose of THC equivalent to a standard marijuana joint. Participants then underwent a series of standard assessments for paranoia.
Study results show that roughly 50% of volunteers who received THC reported some level of paranoid thoughts, that this effect lasted for about 90 minutes, and that these thoughts faded as THC left the bloodstream. For comparison, about 30% of those receiving a placebo also reported paranoid thoughts.
While this outcome suggests a link between marijuana and paranoia, results from the placebo group highlight that some aspect of the condition may be psychological in nature and not related to the physical effects of THC. In simple terms, people with higher levels of fear, negative emotions, worry, and stress are more likely to experience paranoia when using marijuana.
The authors allude to this possibility in their concluding remarks:
The clear clinical implication is that reducing negative emotion in patients with delusions, eg, by reducing the tendency to worry, testing out anxious fears, and increasing self-confidence, will lead to improvements in paranoia.
A similar but simpler explanation was provided in a story in Medical News Today in which the lead author of the Oxford study, Danier Freeman, is quoted as saying:
Paranoia is likely to occur when we are worried, think negatively about ourselves, and experience unsettling changes in our perceptions.
[…] The implication is that reducing time spent ruminating, being more confident in ourselves, and not catastrophizing when unusual perceptual disturbances occur will in all likelihood lessen paranoia.
How to Prevent and/or Reduce Marijuana Paranoia
Patients who are more susceptible to symptoms of paranoia may still be able to enjoy the potential benefits of cannabis therapies by choosing products that pose least risk of evoking mental unease.
As the Oxford study and other sources have shown, THC is the primary component implicated in paranoid responses. Reporting in the Journal of Translational Medicine shows that while THC can lead to feelings of anxiety, panic, and paranoia, CBD has the opposite effect. A possible takeaway from this is that a balanced THC/CBD or higher CBD strain of cannabis may not produce paranoid responses.
New research published in Drug & Alcohol Dependence reports that the terpene d-limonene can reduce the anxiety-provoking effects of THC. CannaMD has previously written about the properties of this terpene and offered suggestions for selecting limonene-rich cannabis strains.
Consumers can also gain product advice and options by browsing popular cannabis websites and forums, and by consulting with licensed doctors within the CannaMD network.
In addition to selecting cannabis products that are less likely to encourage paranoid thoughts, marijuana patients may be able to lower their risk of mental discomfort through changes in their physical environment and mental attitudes. A study published in the Journal Mindfulness found that practices such as self-guided visualization and mindful relaxation could significantly reduce symptoms of paranoia.
Physical environments and social settings may also play a role in marijuana-induced anxiety and paranoia. The Oxford study described how unfamiliar or unsettling environments can trigger paranoid responses. The study also noted that individuals with higher levels of interpersonal sensitivity were more vulnerable to negative thoughts created by concerns of how others perceived them. Research in Psychological Medicine shows that feelings of personal vulnerability and fears of judgment by others are key drivers of paranoid thoughts. A simple remedy for this phenomenon is to enjoy cannabis therapies in a comfortable environment and in the company of friends who are seen as non-judgmental.
Additional elements that may have an impact on the prevalence of cannabis-induced mental discomfort are the changes in legal status of cannabis and evolving social perceptions of marijuana use. The Journal of Cannabis Research reported on unexpected results of research from the University of New Mexico. In this study, 670 cannabis users were monitored for symptoms of agitation/irritability, anxiety, and common stress during 2,300 cannabis sessions. Rather than a predicted increase in mental distress, 95% of participants showed decreased symptoms! In addition, their symptom relief was greater when consuming products with a significant THC content.
Both medical and recreational marijuana are now legal in New Mexico. The study authors felt that this change in the status of marijuana consumption played a role in their findings:
Despite the conventional wisdom that smoking cannabis makes one paranoid, we found consumption much more likely to be associated with relaxation and sense of calm, with users most likely to report feelings of peacefulness, optimism, and happiness.
They go on to say:
One potential explanation for the disparity between our findings and popular perceptions of cannabis is that the “paranoia” users may have historically reported could have arisen in part from cannabis’ illicit status (e.g., anxiety over committing an illegal act), rather than the plant’s typical endemic pharmacodynamic effects when consumed in contexts typical of legal medicinal use.
And that:
Individual factors such as the user’s experience level likely also contribute to cannabis’s effects.
Have More Medical Marijuana Questions?
If you are considering cannabis-based therapies, CannaMD can help. Our Florida network of state-licensed physicians is available to answer questions and determine if cannabis therapy is an appropriate option.
You can learn more by calling us at (855) 420-9170. You can also see if you qualify for medical marijuana using our quick online application!
