Does cannabis use predict aggressive or violent behavior in psychiatric populations? A systematic review

ABSTRACT

Background: Despite an increase in information evaluating the therapeutic and adverse effects of cannabinoids, many potentially important clinical correlates, including violence or aggression, have not been adequately investigated.

Objectives: In this systematic review, we examine the published evidence for the relationship between cannabis and aggression or violence in individuals with psychiatric disorders.

Methods: Following PRISMA guidelines, articles in English were searched on PubMed, Google Scholar, MEDLINE, and PsycINFO from database inception to January 2022. Data for aggression and violence in people with psychiatric diagnoses were identified during the searches.

Results: Of 391 papers identified within the initial search, 15 studies met inclusion criteria. Cross-sectional associations between cannabis use and aggression or violence in samples with post-traumatic stress disorder (PTSD) were found. Moreover, a longitudinal association between cannabis use and violence and aggression was observed in psychotic-spectrum disorders. However, the presence of uncontrolled confounding factors in the majority of included studies precludes any causal conclusions.

Conclusion: Although cannabis use is associated with aggression or violence in individuals with PTSD or psychotic-spectrum disorders, causal conclusions cannot be drawn due to methodological limitations observed in the current literature. Well-controlled, longitudinal studies are needed to ascertain whether cannabis plays a causal role on subsequent violence or aggression in mental health disorders.

KEYWORDS:

• Cannabis
• aggression
• violence
• mental illness
• schizophrenia
• mood disorders

Disclosure statement

Dr George has received consulting fees from the Canadian Center for Substance Use and Addiction (Chair, Scientific Advisory Committee), the American College of Neuropsychopharmacology (ACNP; Deputy Editor, Neuropsychopharmacology), Frutarom, Aelis, and Sanford Burnham Prebys Neurosciences.

Additional information

Funding

The preparation of this article was supported in part by NIDA grant R21-DA-043949 and the Astrid H. Flaska Funds from the CAMH Foundation (to Dr George), an award from the Soroptimist Society of Canada, a graduate student award from the TC3 Cannabis and Cannabinoid Consortium of the Temerty Faculty of Medicine, University of Toronto, and an Ontario Graduate Scholarship (to Ms. Sorkhou); Centre for Addiction and Mental Health [Astrid H. Flaska Funds]; National Institute on Drug Abuse [R21-DA-043949]