Cannabis Pen-Induced Psychosis in a First-Time Adolescent User

An adolescent female presented to the emergency department with acute psychosis after using a cannabis vape pen. Her symptoms were self-limited and resolved without significant intervention, leading to a diagnosis of cannabis-induced psychosis (CIP). Cannabis vaping is growing in popularity among adolescents due to ease of concealment and lack of odor, and vape products often contain higher THC concentrations than traditional cannabis leaf, potentially increasing the risk for adverse effects including dysphoria and psychosis. The case is used to discuss CIP symptomatology and treatment, and the broader implications of cannabis vaping for adolescent neurodevelopment, substance use, and psychiatric comorbidities.

Study at a glance

Abstract

Cannabis is a widely used illicit substance that is historically consumed via smoking, but alternative methods of cannabis consumption have been growing in popularity over the past several decades. One such modality is vaporization, which can appeal specifically to adolescent consumers given these pen devices’ ease of concealment, lack of characteristic odor, and marketability. Cannabis products designed for vaping often have higher concentrations of the psychoactive component of cannabis, tetrahydrocannabinol (THC), when compared with traditional cannabis leaf smoking. This can increase the intensity of cannabis-related effects such as analgesia, relaxation, appetite stimulation, and reduced nausea and emesis, but also potentially increases the risk for adverse effects such as dysphoria, and more severely, cannabis-induced psychosis (CIP). Here, we present the case of an adolescent female who was brought after school to our emergency department presenting with symptoms of acute psychosis. Her subsequent workup was effectively normal apart from a urine drug screen positive for THC, which the patient confirmed was due to use of a cannabis pen prior to leaving school that day. This prompted the diagnosis of CIP, which was self-limited and resolved without significant intervention. We use this case to provide the symptomatology and treatment of CIP secondary to cannabis pen use, as well as more broadly discuss the potential implications of cannabis vaping on adolescent neurodevelopment, substance use, and psychiatric comorbidities.