From the Guidelines
Illicit drugs such as cocaine, amphetamines, and hallucinogens can cause psychosis.
- Cocaine, particularly at high doses and with prolonged use, has been linked to psychotic episodes 1.
- Amphetamines, such as methamphetamine, can also induce psychosis at high doses and with prolonged use 1.
- Hallucinogenic substances like lysergic acid diethylamide (LSD) and psilocybin have been associated with psychotic episodes, often at low doses and with even a single use 1. Additionally, other substances like phencyclidine, heroin, MDMA, and marijuana may also contribute to the development of psychosis 1. It is essential to consider the possibility of substance-induced psychosis when evaluating patients with psychotic symptoms, as treatment approaches may differ from those for primary psychotic disorders 1.
From the FDA Drug Label
Anxiety, psychosis, hostility, aggression, and suicidal or homicidal ideation have also been observed with CNS stimulants abuse and/or misuse. Misuse and abuse of CNS stimulants, including methamphetamine hydrochloride tablets, can result in overdose and death New Psychotic or Manic Symptoms CNS stimulants, at recommended doses, may cause psychotic or manic symptoms (e.g., hallucinations, delusional thinking, or mania) in patients without a prior history of psychotic illness or mania.
Illicit drugs that can cause psychosis include:
- Methamphetamine: as it can cause psychotic symptoms, such as hallucinations and delusional thinking, especially with abuse and/or misuse 2 2.
From the Research
Illicit Drugs Associated with Psychosis
The following illicit drugs have been linked to psychosis:
- Cocaine: Cocaine use can induce transient psychotic symptoms, including suspiciousness, paranoia, hallucinations, and other cocaine-related behaviors 3
- Amphetamine: Amphetamine use has been associated with psychotic symptoms, substance-induced psychosis, and primary psychosis, with risk factors including patterns of drug use and nondrug-related vulnerability 4
- Cannabis: Cannabis use has been linked to psychosis, particularly in cases where high amounts are consumed or in individuals with a history of cannabis dependence 5
- LSD: LSD use has been associated with mystical experiences and psychosis, with the frequency and intensity of these experiences increasing in a dose-dependent manner 6
- Psilocybin: Psilocybin use has also been linked to mystical experiences and psychosis, with a similar dose-dependent relationship 6
- Phencyclidine (PCP): PCP use has been associated with psychosis, including delusions of physical power, altered sensations, and unusual experiences 7
- Synthetic cannabinoid receptor agonists: These substances have been linked to psychosis, with a frequency of 15.4% in one study 5
- Tryptamines: Tryptamines have been associated with psychosis, with a frequency of 57.1% in one study 5
- Methylphenidate: Methylphenidate use has been linked to psychosis, with a frequency of 23.1% in one study 5
- Methylenedioxypyrovalerone (MDPV): MDPV use has been associated with psychosis, with a frequency of 27.3% in one study 5
Risk Factors and Mechanisms
Risk factors for psychosis associated with illicit drug use include:
- Patterns of drug use, such as high doses or frequent use 3, 4
- Nondrug-related vulnerability, such as genetic predisposition or underlying mental health conditions 4
- Comorbidity with other substance use disorders or mental health conditions 3, 5
- Neurobiological mechanisms, such as GABAergic dysfunction 4