Marijuana, SMI, and Violence: Practical Guidance for Practitioners-View Presentation

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Video Summary

The webinar examined how cannabis use may affect people with serious mental illness (SMI), with particular attention to psychosis and violence. Presenters noted that cannabis use is more common among people with mental illness and that newer products can contain much higher THC concentrations than traditional marijuana. High-potency concentrates, vaping products, edibles, and synthetic cannabinoids may carry distinct risks; synthetic products can cause severe psychiatric and medical effects and may not appear on standard urine drug screens.<br /><br />Research discussed in the presentation links cannabis use—especially early, frequent, or heavy use—to increased risk of psychosis. Cannabis-related psychosis may be followed by schizophrenia or bipolar disorder, particularly among younger people and those who exhibit self-harm. In people with SMI, cannabis use is associated with greater violence risk, with stronger associations for misuse and heavier use. The presenters emphasized that these findings do not establish a single cause-and-effect pathway.<br /><br />Clinicians were encouraged to ask about age at first use, frequency, product type and potency, adverse effects, and other substance use. The “SATIVA” acronym summarizes factors to consider when assessing violence risk: serious mental illness, younger age, type and intensity of cannabis use, victim or intimate-partner context, and additional substances.<br /><br />There are currently no well-established medications specifically for cannabis cravings, but behavioral approaches—including motivational interviewing, cognitive behavioral therapy, and contingency management—may help. Urine testing can support monitoring, though results depend on use patterns and do not detect synthetic cannabinoids. The speakers stressed nonjudgmental, collaborative care that considers patients’ goals and co-occurring conditions.

Keywords

cannabis use

serious mental illness

psychosis

violence risk

high-potency THC

synthetic cannabinoids

substance use assessment

motivational interviewing

cognitive behavioral therapy

contingency management