Two cases of "cannabis acute psychosis" following the administration of oral cannabis

Abstract

Background: Cannabis is the most commonly used illegal drug and its therapeutic aspects have a growing interest. Short-term psychotic reactions have been described but not clearly with synthetic oral THC, especially in occasional users.

Case presentations: We report two cases of healthy subjects who were occasional but regular cannabis users without psychiatric history who developed transient psychotic symptoms (depersonalization, paranoid feelings and derealisation) following oral administration of cannabis. In contrast to most other case reports where circumstances and blood concentrations are unknown, the two cases reported here happened under experimental conditions with all subjects negative for cannabis, opiates, amphetamines, cocaine, benzodiazepines and alcohol, and therefore the ingested dose, the time-events of effects on behavior and performance as well as the cannabinoid blood levels were documented.

Conclusion: While the oral route of administration achieves only limited blood concentrations, significant psychotic reactions may occur.

Figure 1

Whole blood concentrations of THC, 11-OH-THC (actives metabolites) and THC-COOH (inactive metabolite) after oral intake of 20 mg dronabinol and of a hemp milk decoction containing traces of cannabinoids (placebo).

Figure 2

Subjective effects (feeling of intoxication or driving capability) after oral intake of 20 mg dronabinol. The subject reported no feeling of intoxication or of driving impairment after ingestion of the placebo.