Cannabis has long been misunderstood and often mislabeled in psychiatric discourse. Mark Viner, MD, addressed the misconception in psychiatry about cannabis in a video interview with Psychiatric Times. Initially categorized as a psychomimetic in the 1970s, it was later separated from hallucinogens in the DSM-5 in 2013. This distinction is significant, as cannabis presents withdrawal symptoms, a characteristic not typically associated with classic hallucinogens.
Despite this classification, cannabis continues to be confused with synthetic cannabinoids and other dangerous substances. As psychedelics gained recognition, terms such as atypical psychedelic or psychedelic-like agent emerged, reflecting cannabis’s complex effects. The younger generation has even introduced new terminology like psychoplasticine to describe its psychoactive properties. While high doses of potent THC can induce a psychedelic-like experience, cannabis is generally not classified as a traditional psychedelic.
Addressing the Stigma and Misconceptions
Cannabis is often misunderstood due to its association with psychosis. However, it is crucial to differentiate between cannabis intoxication and true psychotic disorders. Cannabis intoxication can lead to perceptual disturbances such as illusions and hallucinations, but these typically involve intact reality testing. This contrasts with the delusions and hallucinations seen in conditions like schizophrenia, where reality testing is impaired.
The term “cannabis psychosis” is frequently misapplied. Many reports conflate cannabis-induced symptoms with catatonia, dissociation, severe anxiety, malingering hallucinations, perceptual distortions, and even enhanced creativity or imagination. Studies often fail to account for preexisting psychiatric conditions in patients who exhibit psychotic symptoms after cannabis use. For instance, a patient with schizophrenia who ceases medication while using cannabis may experience psychotic symptoms, but attributing this solely to cannabis is misleading.
The Neurological Impact of Cannabis
Cannabis affects the brain in unique ways, particularly through the cannabinoid receptors densely located in the basal ganglia. This region plays a crucial role in movement and psychomotor functions, yet the impact of cannabis on motor disorders remains underexplored.
Catatonia, a poorly understood condition, can present in various forms—13 different types are recognized. Cannabis can induce mild forms of catatonia, such as catalepsy, mannerisms, grimacing, echolalia, and stupor. Evolutionary studies suggest that cannabis-induced catalepsy has parallels with hibernation behaviors in animals exposed to THC.
This is part 2 of a multipart series. You can view part 1 here.
Dr Viner is a practicing physician who has been working with psychiatric patients in the state of Nevada for over ten years. He serves as a Clinical Professor of Psychiatry and Behavioral Sciences at the University of Nevada School of Medicine.
Mark Viner, MD, shares his thoughts on the place cannabis holds in psychiatry and addressing the stigma cannabis faces. Read More
