Hacker News Reader

Comment by jmpman | Hacker News Reader

I’ve wondered how much of our homelessness crisis is due to psychotic breaks from marijuana. It’s a small fraction of users which have psychotic breaks, but our homelessness population is similarly small.

View on HN

I'm a psychiatrist who works with lots of people who are homeless and mentally ill. My experience faces a strong selection bias in that I don't see the homeless people who don't have marked symptoms of mental illness. The ones who come to my attention usually have delusions and hallucinations. Beyond anecdotes, there's some reasonable and ongoing research on the topic.

Methamphetamine remains far more strongly associated with psychosis than cannabis, but both anecdotes and research support that THC extracts are considerably more likely to cause psychosis than whole flowers. There also seems to be something protective about CBD, so THC extract (dabs/oil) products appear to carry more risk due to both their high THC content and the absence of CBD. People who use cannabis heavily in adolescence also have an increased risk of developing a psychotic disorder.

Interesting response. Subjectively, do you THC-linked psychosis regularly?

Again, strong selection bias, but yes. THC stays in your system for a long time. It can take a while to figure out if the issue is a primary psychotic disorder, like Schizophrenia, that has been exacerbated by THC or if it's only drug-induced. I occasionally see cases that appear to be completely accounted for by THC, but at a far lower rate than meth-induced psychosis.

I'm also curious, since you work in psychiatry....

Have you seen any cases of scromiting, or "Cannabinoid hyperemesis syndrome"?

These articles showed up in a big online hit in mid-2022, and never seemingly referenced again. My pessimism indicated that it was likely a hit piece against cannabis, but I'd rather ask for sure than just assume some conspiracy.

Yes, I have seen it, but just a handful of times (single digits).

I had it multiple times as a daily smoker.

Having a psychotic break doesn't suddenly make you homeless. You would need a psychotic break + lack of healthcare + lack of family/friends/support network + lack of money + lack of social programs + lack of affordable housing. The idea that people just one day lose their minds and wander out into the street is not supported by my experiences working with and interacting with unhoused people.

Happens a lot more with stimulants, meth being the worst. Amphetamine psychosis can be permanent & irreversible with heavy enough use.

I'd look to alcohol first. It's been legal for much more of the modern age, and certainly also carries with it the risk of psychosis.

And as the other commenter points out, "Whither Meth?"

Probably all of these things are contributing factors, in some form.

Very little of it. The causes of homelessness are pretty well understood and it's basically poverty, high housing costs, low wages, lack of access to affordable medical care.

Being homeless also does a number on your mental health and my intuition says a lot of those "psychotic breaks" were experiences of homelessness, not causes.

I had a friend who experienced a psychotic break following marijuana use. He was a moderate user, weekends only, for a dozen years prior. If he didn’t have such excellent support structure around him, I’d expect him to be homeless now.

Is there any study or relevant data point that would lead you to believe this is happening? Or is it just a completely wild thought?

https://nida.nih.gov/publications/research-reports/marijuana...

I meant on whether or not it has a significant representation in the homeless community - not that it exists.

Would be interesting to see the homelessness rates in countries with very restricted marijuana access, like Japan, versus countries where it’s widely used. Or some other way to determine if marijuana usage increases homelessness.

You think homeless people have only themselves and their own actions to blame?

Reply on news.ycombinator.com