Lynn Silver, MD, MPH, FAAP, warns of psychiatric risks with adolescent cannabis use

In this Contemporary Pediatrics interview, Lynn Silver, MD, MPH, FAAP, senior adviser at Public Health Institute, discussed the clinical and public health implications of a large study examining cannabis use and mental health outcomes in adolescents.

With an adjusted hazard ratio of 2.19 for incident psychotic disorders, Silver emphasized that pediatricians should view this as a significant and concerning risk. The study adds to a growing body of evidence linking adolescent cannabis use to a doubled risk of psychotic and bipolar disorders, along with a roughly one-third increase in depression and a 25% increase in anxiety diagnoses.

These findings underscore the need for routine screening for cannabis use in pediatric practice and for proactive counseling, particularly among youth already experiencing mental health challenges. Silver noted that many adolescents mistakenly perceive cannabis as a safe, “natural” remedy for stress or anxiety, when evidence suggests it may worsen these conditions.

She explained that biologic vulnerability during adolescence likely contributes to the stronger associations observed with psychotic and bipolar disorders. The brain continues to develop into the mid-20s, and the endocannabinoid system is especially sensitive to exogenous cannabinoids, such as tetrahydrocannabinol (THC). Interference with this system during critical periods of neurodevelopment may produce lasting physiologic and neuropsychiatric effects.

Notably, while associations with anxiety and depression attenuated with age, the increased risk for psychotic and bipolar disorders did not, suggesting persistent vulnerability. The study’s large sample size—over 463,000 adolescents aged 13 to 17 years—and its demonstration that cannabis exposure preceded diagnosis strengthen the argument for a potential causal role.

Silver urged clinicians to prioritize screening, particularly in high school populations where use rises sharply, and to integrate cannabis assessment into broader behavioral health screening. She also raised concerns about increasingly potent THC products and youth-targeted marketing in states with legalized sales, warning of parallels to the tobacco and opioid industries.

Finally, she advocated for universal education, early intervention using Screening, Brief Intervention, and Referral to Treatment models, and active pediatric engagement in policy advocacy to implement safeguards that better protect children and adolescents from cannabis-related harms.

No relevant disclosures.

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1. Study: adolescent cannabis use linked to doubling risk of psychotic and bipolar disorders. News release. Public Health Institute. February 20, 2026. Accessed February 24, 2026. https://www.eurekalert.org/news-releases/1117004?
2. Young-Wolff KC, Cortez CA, Alexeeff SE, et al. Adolescent cannabis use and risk of psychotic, bipolar, depressive, and anxiety disorders. JAMA Health Forum. 2026;7(2):e256839. doi:10.1001/jamahealthforum.2025.6839