Abstract
IMPORTANCE: Cannabis use is common in people with severe mental illness and its adverse effects on outcomes are well established. However, adverse outcomes may also result from cannabis withdrawal syndrome (CWS). CWS includes symptoms such as agitation, irritability, and aggression, and typically peaks after 3 to 5 days of abstinence. OBJECTIVE: To assess whether cannabis use prior to admission is associated with an increase in the risk of transfer to a psychiatric intensive care unit (PICU) during the cannabis withdrawal risk period. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used clinical data from a secondary mental health care database and took place at 4 psychiatric hospitals in London, United Kingdom, between January 2008 and December 2023. Patients included adults admitted to general psychiatric wards and PICUs. Data were analyzed from June 2023 to February 2025. EXPOSURE: Cannabis use was determined from clinical records, using natural language processing and manual review. MAIN OUTCOMES AND MEASURES: The primary outcome was transfer from a general ward to PICU during the cannabis withdrawal risk period (3 to 5 days after presentation to the hospital). Secondary outcomes included admission to PICU at any time point. Outcomes were analyzed according to cannabis use status with multivariable models, which adjusted for age, gender, ethnicity, diagnosis, tobacco use, stimulant use, comorbid alcohol or substance use disorder, and admission year. RESULTS: There were 52 088 hospital admissions identified, of which 4691 involved admission to a PICU (9.0%). Cannabis users were more likely to be admitted to a PICU than nonusers (adjusted odds ratio [aOR], 1.44; 95% CI, 1.33-1.55; P < .001). There were 1236 admissions where the patient was transferred to PICU after initial admission to a general ward (mean [SD] age, 33.4 [10.4] years; 810 male [66%] and 426 female [34%]). At 3 to 5 days postpresentation (the risk period for cannabis withdrawal), transfer from a general ward to a PICU was more common in cannabis users (31.0%) than nonusers (24.2%) (aOR, 1.36; 95% CI, 1.01-1.81; P = .04). The association was particularly evident in women (aOR, 2.03; 95% CI, 1.22-3.39; P = .007) and in those older than 35 years (aOR, 2.53; 95%CI: 1.52-4.21; P < .001). CONCLUSIONS AND RELEVANCE: People with severe mental illness who are cannabis users may develop cannabis withdrawal syndrome shortly after hospital admission, and this can exacerbate their mental state.