Abstract
The recent scientific literature has reported increasing trends in the use of high concentrated cannabis products among adolescents. These includes vaping, combining traditional smoking with other high potency products, edible cannabis, and beverages. These new products are much more potent containing on an average of 55% tetrahydrocannabinol (THC) as compared with 17% about 10 years ago.
Case
A 16-year-old adolescent patient presented to the emergency department with rapid speech, disorganized thought processes, and delusions ideations. The patient was observed talking with strangers, mumbling bizarre statements, making unusual gestures, and also loudly responding to internal stimuli. The laboratory investigations were complete blood and metabolic profile, urinalysis, and all results were in normal range except positive for cannabinoids. Computed tomography scan reported normal cortical sulci and ventricular size, no bleeding or midline shift, and normal posterior fossa. The patient was referred for inpatient mental health treatment. On the initial assessment, patient family reported symptoms of psychosis started 2 days ago. Patient had history of affective illness and treated with selective serotonin reuptake inhibitor. There was no medical history. There was a family history of anxiety disorders. There were no developmental delays but had in utero exposure to nicotine. On mental status examination, the patient was significantly disheveled and psychomotor agitated. The mood was irritable with incongruent labile affect. The thought process was disorganized with bizarre delusions and was responding to internal stimuli. Patient initially was not cooperative for cognitive examination but on day 5 was oriented in time, place, and person and working, short- and long-term memory was within normal range and intelligence was average. The patient was started on olanzapine 5 mg, which was titrated to 15 mg over a period of 1 week. After 1 week, patient demonstrated clinical improved and reported history of eating large amounts of edible cannabis cookies at a party a week before the admission. Patient was discharged back in the community with full remission of psychosis.
Discussion
A recent survey reported emerging trends in the modes of cannabis use in adolescents. While the smoking (99%) was most frequent and consistent route of administration, it was followed by edible cannabis (61%) and vaping (44%) (Knapp et al. 2019). Legalization of cannabis is attributed for decrease in risk perception (Borodovsky et al. 2017). The use is more where there is a longer duration of legal cannabis law and presence of more dispensaries. The edible cannabis has delayed peak, longer duration of action, and often leads of overconsumption. In the past decade, overall concentration of cannabis (also referred to THC potency which is THC:Cannabidiol ratio) has increased two times and price is halved. The higher potency of cannabis is linked with worse mental health outcomes (Chan et al. 2016). There is also significant increase in accidental overdose due to edible cannabis products in pediatric population. The risk of psychosis is higher with use at younger age, more potent products and longer duration of use (Di Forti et al. 2019). The neuroimaging studies has linked the early and mid-adolescence use of cannabis with alteration of the cortical maturation. These findings point toward processes underlying cortical maturation as a possible link between cannabis and psychosis. The knowledge of emerging trends of adolescent cannabis use, reduced risk perceptions, changes in potency, reduction in price, and pharmacodynamics are critical in addressing serious mental health outcomes.
Footnotes
Disclosures
I would also like to state that there are no conflicts of interest.