Schizophrenia is best understood as a syndrome rather than a single disease, with high heritability and multiple genetic and environmental factors pushing individuals over a threshold into clinical expression. Evidence that certain drugs can induce schizophrenia-like psychosis has been neglected as an environmental factor. Over the past 60 years, understanding the link between drug abuse and psychosis has shaped the modern view that liability to psychosis, including schizophrenia, is distributed continuously through the general population, similar to hypertension and diabetes. This review examines hypotheses arising from the association between common psychotomimetic drugs (LSD, amphetamines, cannabis, phencyclidine) and schizophrenia.
Daily use of high-potency cannabis is associated with more positive symptoms and fewer negative symptoms in first-episode psychosis patients. Among 901 patients and 1,235 controls across six European countries, those who used high-potency cannabis daily had the highest scores on positive symptoms, while negative symptoms were more common in patients who never used cannabis. Psychotic experiences in controls were linked to current cannabis use but not to lifetime use. Depressive symptoms showed no differences related to cannabis use in either group.