Sue D. Muggar, Jaime A. Perez, Farrah Laviolette and Molly McVoy
Abstract
Objectives: To utilize a retrospective observational design to characterize adolescents aged 13 – 17 presenting to emergency rooms (ER) in the United States (US) from 2016 to 2024 with psychosis and/or delta-9-tetrahydrocannabinol (THC) exposure via urine drug screens (UDS) and to evaluate trends in THC exposure, psychiatric comorbidities, and demographics.
Material and methods: De-identified, Institutional Review Board–exempt data from the TriNetX database were analyzed. Adolescents were identified with psychosis or THC exposure via International Classification of Diseases (ICD)-10 codes. Exclusions included neurocognitive and neurodevelopmental disorders, non-cannabis substance use, repeat ER visits, or prior antipsychotic use. Logistic regressions assessed trends and demographics.
Results: The odds of psychosis among adolescents with THC exposure decreased by 5% annually (adjusted odds ratio (OR) 0.95 per year, p < 0.001) while THC exposure among those with psychosis remained stable (OR = 1.00, 95% confidence intervals (Cl): 0.98 – 1.02, p = 0.80). Among 22,705 adolescents with THC exposure, 1,799 (7.9%) had a psychosis diagnosis. Among 11,219 adolescents with psychosis, 1,993 (17.8%) were THC-positive. Males had higher odds of THC when presenting with psychosis (adjusted OR 1.73, p < 0.001). Black youth had lower odds of a psychosis diagnosis vs White youth (adjusted OR 0.55, p < 0.001). Among THC-positive adolescents, psychiatric comorbidities were associated with psychosis. In THC-negative patients, anxiety and depression were common.
Conclusion: This large national analysis highlights distinct demographic and psychiatric comorbidity patterns among adolescents presenting with psychosis and THC exposure, which may inform targeted ER assessment, risk stratification, and follow-up care.
Published on: August 14, 2026
doi: 10.17756/jap.2026-054
Citation: Muggar SD, Perez JA, Laviolette F, McVoy M. 2026. Trends in Cannabis Exposure and Psychosis Among U.S. Adolescents in Emergency Rooms from 2016 to 2024. J Addict Psychiatry 10(1): 13-24.
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