Impact of non-medical cannabis legalization with market restrictions on health service use and incident cases of psychotic disorder in Ontario, Canada

Int J Drug Policy. 2024 Jan:123:104285. doi: 10.1016/j.drugpo.2023.104285. Epub 2023 Dec 10.


Background: Cannabis is a risk factor in the onset and persistence of psychotic disorders. There is concern that non-medical cannabis legalization in Canada may have population-level impacts on psychotic disorders. We sought to examine changes in health service use and incident cases of psychotic disorder following cannabis legalization, during a period of tight restrictions on retail stores and product types.

Methods: We conducted a cross-sectional interrupted time-series analysis using linked population-based health administrative data from Ontario (Canada) from January 2014 to March 2020. We identified psychosis-related outpatient visits, emergency department visits, hospitalizations, and inpatient length of stay, as well as incident cases of psychotic disorders, among people aged 14 to 60 years.

Results: We did not find evidence of increases in health service use or incident cases of psychotic disorders over the short-term (17 month) period following cannabis legalization. However, we found clear increasing trends in health service use and incident cases of substance-induced psychotic disorders over the entire observation window (2014-2020).

Conclusion: Our findings suggest that the initial period of tight market restriction following legalization of non-medical cannabis was not associated with an increase in health service use or frequency of psychotic disorders. A longer post-legalization observation period, which includes expansion of the commercial cannabis market, is needed to fully understand the population-level impacts of non-medical cannabis legalization; thus, it would be premature to conclude that the legalization of non-medical cannabis did not lead to increases in health service use and incident cases of psychotic disorder.

Keywords: Cannabis; Epidemiology; Mental health services; Psychotic disorders; Public mental health.

MeSH terms

  • Canada
  • Cannabinoid Receptor Agonists
  • Cannabis*
  • Cross-Sectional Studies
  • Hallucinogens*
  • Humans
  • Legislation, Drug
  • Ontario / epidemiology
  • Patient Acceptance of Health Care
  • Psychotic Disorders* / epidemiology


  • Cannabinoid Receptor Agonists
  • Hallucinogens