背景:大麻是欧洲消费最多的非法物质。尽管它的销售和使用仍然被普遍禁止,近年来,欧洲公共政策通过将大麻合法化用于医疗用途并考虑将其合法化用于娱乐用途而演变。然而,在文献中,有观点支持大麻消费与精神病症状发展之间的特殊关系。因此,由于大麻消费量随着合法化而增加,本综述的目的是调查娱乐性大麻合法化对世界上已经相关地区精神病风险的影响.
方法:根据PRISMA标准,于2024年4月在PubMed-Medline数据库中对文献进行了系统综述。使用的关键字顺序如下:(\“大麻\”[网状]或大麻)和(\“精神病性疾病\”[网状]或精神病)或(\“精神分裂症谱系和其他精神病性疾病\”[网状])或(\“精神分裂症\”[网状]或精神分裂症)和合法使用。本系统评价中用于选择文章的纳入标准是:(1)任何文章调查大麻娱乐用途合法化对精神病风险的潜在影响(根据ICD-9,ICD-10,DSM-4或DSM-5诊断的任何类型的精神病)通过流行病学(发病率或患病率)和/或临床(门诊咨询,紧急就诊或住院)标准,(2)任何类型的研究(横截面,纵向,prospective,回顾性,介入性和实验性)的方法包括对与娱乐性大麻合法化相关的精神病风险进行时间和/或地理比较,但文献综述和临床病例描述除外,(3)对所研究人群的年龄和发表日期没有限制,(4)用英语或法语写的文章。经过两位作者对确定的160篇文章的评估,本系统文献综述包括7项研究,这些研究调查了娱乐性大麻合法化对精神病风险的影响.
结果:四项研究表明,娱乐性大麻合法化后,精神病医疗服务的使用没有增加,而另外三项研究强调了娱乐性大麻合法化对精神病风险的负面影响。所有这些研究都是在北美进行的,其特点是科学证据水平较低。
结论:鉴于评估娱乐性大麻合法化对精神病风险的影响的复杂性,通过更好的科学质量的研究进行额外的调查是必不可少的。然而,基于现有的数据,有一些证据表明,由于娱乐性大麻合法化,对心理健康有潜在的负面影响。在这种情况下,如果将大麻合法化用于娱乐用途,则建议使用较低风险的大麻(限制使用频率,推迟首次消费的年龄,控制产品的THC含量并促进预防/教育)。最后,为了实现公共卫生战略的动态演变,随着大麻合法化的发展,建立持续监测至关重要。
BACKGROUND: Cannabis is the most consumed illicit substance in Europe. Although its sale and use remain generally prohibited, European public policies have evolved in recent years by legalizing cannabis for medical use and considering its
legalization for recreational use. However, in the literature there are arguments in favor of a particular relationship between cannabis consumption and the development of psychotic symptoms. Thus, since cannabis consumption tends to increase with
legalization, the aim of this review was to investigate the impact of the
legalization of cannabis for recreational use on the risk of psychosis in regions of the world already concerned.
METHODS: A systematic review of the literature was carried out in April 2024 in the PubMed-Medline database according to PRISMA criteria. The sequence of keywords used was as follows: (\"Cannabis\" [Mesh] or cannabis) AND ((\"Psychotic Disorders\" [Mesh] or Psychotic Disorders) or (\"Schizophrenia Spectrum and Other Psychotic Disorders\" [Mesh]) or (\"Schizophrenia\" [Mesh] or Schizophrenia)) AND legal use. The inclusion criteria applied for the selection of articles in this systematic review were: (1) any article investigating the potential impact of the legalization of cannabis for recreational use on the risk of psychosis (any type of psychosis diagnosed according to ICD-9, ICD-10, DSM-4 or DSM-5) by the intermediary of epidemiological (incidence or prevalence) and/or clinical (ambulatory consultations, emergency visits or hospitalizations) criteria, (2) any type of study (cross-sectional, longitudinal, prospective, retrospective, interventional and experimental) with a methodology including a temporal and/or geographic comparison of the risk of psychosis associated with the legalization of cannabis for recreational use with the exception of literature reviews and clinical cases descriptions, (3) absence of limitation for the age of the populations studied and for the date of publication, and (4) articles written in English or French. After evaluation by the two authors of the 160 articles identified, seven studies investigating the impact of the legalization of cannabis for recreational use on the risk of psychosis were included in this systematic literature review.
RESULTS: Four of the studies showed no increase in the use of health services for psychosis following the legalization of cannabis for recreational use whereas three other studies highlighted a negative impact of the legalization of cannabis for recreational use on the risk of psychosis. All of these studies were carried out in North America and were characterized by a low level of scientific evidence.
CONCLUSIONS: Given the complexity of assessing the impact of the
legalization of cannabis for recreational use on the risk of psychosis, additional investigations through studies of better scientific quality are essential. However, based on the data already available, there is some evidence that there is a potential negative impact on mental health due to the legalization of cannabis for recreational use. In this context, in the event of
legalization of cannabis for recreational use it seems essential to recommend lower risk use of cannabis (limit the frequency of use, delay the age of first consumption, control the THC content of products and promote prevention/education). Finally, in order to enable dynamic evolution of public health strategies the establishment of continued monitoring is essential as cannabis legalization evolves.