Understanding Cannabis Use in Youth with Early Psychosis to Enhance Engagement, Education and Harm Reduction: A Qualitative Study

Background: The emergence of psychosis can have devastating effects for young people, including challenges with family relationships, peer connections, education, and isolation. Cannabis use can contribute to psychosis and increase risk for more severe symptoms, longer hospital admissions, and disengagement from treatment after an episode. In Canadian early psychosis intervention (EPI) programs, significant numbers of youth self-report cannabis consumption despite discouragement from mental health professionals. Many young people with early psychosis do not wish to stop using this drug and abstinence-based approaches may be exacerbating barriers to care. Youth perspectives toward their cannabis use and service needs are not well understood, yet critical to improving treatment provision. This qualitative study investigated the views of youth in EPI programs to inform engagement, education, and harm reduction strategies.

Methods: Interpretative Phenomenological Analysis was utilized to explore perspectives, meanings, and lived experiences related to cannabis use. Fifteen psychiatrically stable young people with a history of heavy cannabis use (>3x daily) were recruited purposively through eight EPI services. Data were collected through in-depth, semi-structured interviews with 30 open ended questions to understand cannabis-related motivations, risk perceptions, social dynamics, and service needs. The researcher established rapport prior to interviews and a member check was conducted to verify the findings. A reflexive process was employed to minimize researcher bias.

Results: The participants resided in rural and suburban locations and the median age was 26 years. They consumed a mean total of 8.08 grams/week, and most were daily users. Participants reported using cannabis to relax, enhance social activity, self-medicate health difficulties, and experience euphoria. They described it as a significant aspect of their social lives and beneficial to their friendships through stimulating fun and conversation while reducing anxiety. Most had parents who disapproved of their use, though over half consumed with family members. Participants acknowledged risks related to cognition, psychosis, respiration, addiction, motivation, isolation, finances, and relationships. To reduce the risks, they viewed peer support as essential and recommended other young people use in moderation, delay use, consume lower-risk products, access legal sources, and avoid high dosages. Participants were primarily educated about cannabis by peers and noted difficulties in communicating with service providers. A variety of educational and harm reduction needs were identified.

Conclusions and Implications: A multipronged engagement and assessment approach is needed to understand the role of cannabis in the social lives, family dynamics, anxiety regulation, and health management of EPI clients. Examining risk perceptions and goals can reveal motivation for change and educational needs. Peer support and group recovery programs can enhance engagement while addressing factors that contribute to problematic use. Youth involvement in the development of harm reduction strategies is critical to information uptake. After study completion, knowledge mobilization included workshops with service providers to discuss youth-informed methods for improving trust, communication, and harm reduction practice. This research initiated a process for developing educational resources designed for cannabis-consuming clients. Future research should focus on evaluating the efficacy of educational approaches in reducing harm and understanding the reasons for service discontinuation among cannabis users.