Marijuana is often framed as “natural” and “safer than other drugs”, especially in states where it is legal. A recent study published in Jama Psychiatry highlights serious concerns about recreational marijuana markets and the increased risk that it presents for individuals with mental health conditions such as psychosis.

The study followed adults in a large national survey from 2014 to 2022 and focused on people who had reported being diagnosed with schizophrenia or other psychotic disorders. They compared how marijuana use changed over time in states that later legalized recreational use.

The study found that after a state moved to legalized recreational use, adults with a history of psychosis showed about a 9.5 percentage point increase in past-30-day marijuana use compared with individuals living in states that did not legalize and had similar condition, suggesting legal markets are associated with increased use among a vulnerable population.

Recreational commercialization doesn’t just increase access to marijuana, it also increases the amount of advertising people are exposed to, including ads that make false claims about mental health. Exposure to this messaging is risky for people living with psychosis, because it normalizes consumption downplaying potential harm. Yet only two states require clear warnings about the metal health risks associated with marijuana use.

Why is this so concerning?

Psychotic disorders affect mood, thinking, and perception and decades of research on marijuana has consistently shown that marijuana use can worsen these problems for many people. Studies have found that:

  • Continued marijuana use after a psychotic episode is associated with relapses and hospitalizations.
  • Daily use or use of high-potency products is also linked to more severe symptoms and higher risk of psychosis in the first place.

This study adds an important piece of knowledge: when access and marketing expand, people with psychosis use more marijuana, not less.

Researchers Recommendations

Clinicians should ask about marijuana use on every mental health visit, especially for individuals with psychosis. Additionally, states should require health warnings and create policies limiting potency as well as advertising.

References:

Hyatt, A.S., Flores, M.W., Johnson, J., Bien-Aime, D., Evins, E., Öngür, D., Lê Cook, B. (2026). Cannabis Use Among Individuals With Psychosis After State-Level Commercial Cannabis Legalization. JAMA Psychiatry. 83(1):74–77. doi:10.1001/jamapsychiatry.2025.2539

McDonald AJ, Kurdyak P, Rehm J, Roerecke M, Bondy SJ. Age-dependent association of cannabis use with risk of psychotic disorder. (2024). Psychological Medicine. Published online 2024:1-11. doi:10.1017/S0033291724000990