High Potency Cannabis Linked to Anxiety Disorder, More Serious Cannabis Use

passing joint
Policy changes have occurred alongside the proliferation of high potency cannabis, which may lead to more memory issues or psychotic effects.

Adults who use high potency cannabis are more likely to report problems resulting from cannabis use and anxiety disorder compared with those who use lower potency strains, according to an article published in JAMA Psychiatry. Policy changes, including decriminalization and legalization, have occurred alongside the proliferation of high potency cannabis, which may lead to more memory issues or psychotic effects.

Lindsey A. Hines, PhD, from Population Health Sciences, Bristol Medical School, United Kingdom, and colleagues examined data from the Avon Longitudinal Study of Parents and Children. They focused on participants (n=1087; mean age at onset of use, 16±3.0 years; 580 women) who reported past-year cannabis use. Of the participants, 141 (13.0%) reported high potency cannabis use. After adjusting for frequency of cannabis use and early adolescent mental health, the research team investigated the correlation between cannabis potency and substance use and mental health outcomes.

High potency cannabis use was associated with a significant increase in the frequency of cannabis use (adjusted odds ratio [aOR], 4.38; 95% CI, 2.89-6.63), likelihood of cannabis problems (aOR, 4.08; 95% CI, 1.41-11.81), and risk of anxiety disorder (aOR, 1.92; 95% CI, 1.11-3.32). Psychotic experiences were slightly increased among individuals using high-potency cannabis (aOR 1.29; 95% CI, 0.67-2.50); however, attenuation in this risk was noted after adjustment for frequency of cannabis use. Similarly, cannabis use frequency attenuated tobacco dependence and other illicit drug use.

The study is limited by the fact that the potency of cannabis in illegal markets varies, and participants may not have been accurately informed about the potency of the cannabis they used. The study sample was more likely to be white, female, and affluent compared to the population from which the participants were originally drawn, and results may differ for patients from other backgrounds.

“Providing public health messaging regarding the importance of reducing both the frequency of cannabis use and the potency of the drug, as well as limiting the availability of high-potency cannabis, may be effective for reducing the harms associated with cannabis use,” the researchers concluded.


Hines LA, Freeman TP, Gage SH, et al. Association of high-potency cannabis use with mental health and substance use in adolescence [published online May 27, 2020]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2020.1035