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Metabolic syndrome in people with a psychotic illness: is cannabis protective?

  • A. Waterreus (a1), P. Di Prinzio (a1), G. F. Watts (a2), D. Castle (a3), C. Galletly (a4) and V. A. Morgan (a1) (a5)...



Rates of the metabolic syndrome in people with psychotic illness are high. Emerging evidence suggests that cannabis use may have a positive impact on cardiometabolic risk factors in the general population, but little is known about its impact for people with psychotic illness. Our aim was to investigate whether the rate of the metabolic syndrome in people with psychotic illness was associated with frequency of cannabis use.


The 2010 Australian psychosis survey used a two-phase design to randomly select a nationally representative sample of 1825 adults with psychotic illness for interview and physical assessment. This study is based on 1813 participants who provided data on cannabis use. Multiple logistic regression was used to model the influence of frequency of cannabis use on the metabolic syndrome, adjusting for potential covariates including antipsychotic medication use, smoking, alcohol use and cognitive function.


One-third (33.0%) of participants had used cannabis in the past year. The proportion of non-users, occasional users and frequent users with the metabolic syndrome was 63.0, 51.7 and 43.5%, respectively (p < 0.001). In unadjusted analyses, both occasional use and frequent cannabis use were associated with significantly lower odds of the metabolic syndrome. In the adjusted analyses, the association between the metabolic syndrome and frequent cannabis use remained significant [odds ratio = 0.56, 95% confidence interval (CI) 0.39–0.80], but not the association with occasional use (odds ratio = 0.75, 95% CI 0.49–1.13).


While cannabis use may be detrimental for mental health, these data suggest that it may also have a cardiometabolic protective effect. Further investigation is required to understand the mechanism underlying this paradoxical finding.


Corresponding author

*Address for correspondence: A. Waterreus, Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, Level 3 MRF Building, rear 50 Murray Street, Perth, WA 6000, Australia. (Email:


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Alberti, KGMM, Eckel, RH, Grundy, SM, Zimmet, PZ, Cleeman, JI, Donato, KA, Fruchart, J-C, James, WPT, Loria, CM, Smith, SC (2009). Harmonizing the Metabolic Syndrome: A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120, 16401645.
Australian Bureau of Statistics (2008). 2039.0 - Information Paper: An Introduction to Socio-Economic Indexes for Areas (SEIFA), 2006 ( Accessed December 2015.
Australian Schizophrenia Research Bank (2011). Customised data provided by the Australian Schizophrenia Research Bank which is supported by the National Health and Medical Research Council of Australia, the Pratt Foundation; Ramsay Health Care and the Schizophrenia Research Institute ( Accessed December 2015.
Barrowclough, C, Gregg, L, Lobban, F, Bucci, S, Emsley, R (2015). The impact of cannabis use on clinical outcomes in recent onset psychosis. Schizophrenia Bulletin 41, 382390.
Bush, K, Kivlahan, DR, McDonell, MB, Fihn, SD, Bradley, KA (1998). The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Archives of Internal Medicine 158, 17891795.
Castle, D, Jablensky, A, McGrath, J, Carr, V, Morgan, V, Waterreus, A, Valuri, G, Stain, H, McGuffin, P, Farmer, A (2006). The Diagnostic Interview for Psychoses (DIP): development, reliability and applications. Psychological Medicine 36, 6980.
Ceccarini, J, Kuepper, R, Kemels, D, van Os, J, Henquet, C, Van Laere, K (2015). [18F]MK-9470 PET measurement of cannabinoid CB1 receptor availability in chronic cannabis users. Addiction Biology 20, 357367.
Chopra, RN, Chopra, GS (1940). Present position of hemp drug addiction in India. British Journal of Inebriety 38, 7174.
Correll, C, Frederickson, A, Kane, J, Manu, P (2006). Metabolic syndrome and the risk of coronary heart disease in 367 patients treated with second-generation antipsychotic drugs. Journal of Clinical Psychiatry 67, 575583.
Cota, D, Sandoval, DA, Olivieri, M, Prodi, E, D'Alessio, DA, Woods, SC, Seeley, RJ, Obici, S (2009). Food intake-independent effects of CB1 antagonism on glucose and lipid metabolism. Obesity 17, 16411645.
Craig, CL, Marshall, AL, Sjostrom, M, Bauman, AE, Booth, ML, Ainsworth, BE, Pratt, M, Kelund, U, Agneta, Y, Sallis, JF, Oja, P (2003). International Physical Activity Questionnaire: 12-country reliability and validity. Medicine and Science in Sports and Exercise 35, 13811395.
D'Souza, DC, Ranganathan, M, Braley, G, Gueorguieva, R, Zimolo, Z, Cooper, T, Perry, E, Krystal, J (2008). Blunted psychotomimetic and amnestic effects of Δ-9-tetrahydrocannabinol in frequent users of cannabis. Neuropsychopharmacology 33, 25052516.
Després, J-P, Golay, A, Sjöström, L (2005). Effects of rimonabant on metabolic risk factors in overweight patients with dyslipidemia. New England Journal of Medicine 353, 21212134.
Di Marzo, V (2008). The endocannabinoid system in obesity and type 2 diabetes. Diabetologia 51, 13561367.
Galleano, M, Calabro, V, Prince, PD, Litterio, MC, Piotrkowski, B, Vazquez-Prieto, MA, Miatello, RM, Oteiza, PI, Fraga, CG (2012). Flavonoids and metabolic syndrome. Annals of the New York Academy of Sciences 1259, 8794.
Galletly, CA, Foley, DL, Waterreus, A, Watts, GF, Castle, DJ, McGrath, JJ, Mackinnon, A, Morgan, VA (2012). Cardiometabolic risk factors in people with psychotic disorders: the second Australian national survey of psychosis. Australian and New Zealand Journal of Psychiatry 46, 753761.
Green, B, Young, R, Kavanagh, D (2005). Cannabis use and misuse prevalence among people with psychosis. British Journal of Psychiatry 187, 306313.
Gunasekaran, N, Long, L, Dawson, B, Hansen, G, Richardson, D, Li, K, Arnold, J, McGregor, I (2009). Reintoxication: the release of fat-stored Δ9-tetrahydrocannabinol (THC) into blood is enhanced by food deprivation or ACTH exposure. British Journal of Pharmacology 158, 13301337.
Hayatbakhsh, MR, O'Callaghan, MJ, Mamun, AA, Williams, GM, Clavarino, A, Najman, JM (2010). Cannabis use and obesity and young adults. American Journal of Drug and Alcohol Abuse 36, 350356.
Hirvonen, J, Goodwin, R, Li, C-T, Terry, G, Zoghbi, S, Morse, C, Pike, V, Volkow, N, Huestis, M, Innis, R (2011). Reversible and regionally selective downregulation of brain cannabinoid CB1 receptors in chronic daily cannabis smokers. Molecular Psychiatry 17, 642649.
Jablensky, A, McGrath, J, Herrman, H, Castle, D, Gureje, O, Evans, M, Carr, V, Morgan, V, Korten, A, Harvey, C (2000). Psychotic disorders in urban areas: an overview of the study on low prevalence disorders. Australian and New Zealand Journal of Psychiatry 34, 221236.
John, AP, Koloth, R, Dragovic, M, Lim, SC (2009). Prevalence of metabolic syndrome among Australians with severe mental illness. Medical Journal of Australia 190, 176179.
Laursen, TM (2011). Life expectancy among persons with schizophrenia or bipolar affective disorder. Schizophrenia Research 131, 101104.
Lawrence, DM, Holman, CDaJ, Jablensky, AV, St Hobbs, M (2003). Death rate from ischaemic heart disease in Western Australian psychiatric patients 1980–1998. British Journal of Psychiatry 182, 3136.
Le Foll, B, Trigo, JM, Sharkey, KA, Strat, YL (2013). Cannabis and Δ9-tetrahydrocannabinol (THC) for weight loss? Medical Hypotheses 80, 564567.
Le Strat, Y, Le Foll, B (2011). Obesity and cannabis use: results from 2 representative national surveys. American Journal of Epidemiology 174, 929933.
Lichtman, A, Martin, B (2005). Cannabinoid tolerance and dependence. Handbook of Experimental Psychology 168, 691717.
McCullough, ML, Peterson, JJ, Patel, R, Jacques, PF, Shah, R, Dwyer, JT (2012). Flavonoid intake and cardiovascular disease mortality in a prospective cohort of US adults. American Journal of Clinical Nutrition 95, 454464.
McEvoy, JP, Meyer, JM, Goff, DC, Nasrallah, HA, Davis, SM, Sullivan, L, Meltzer, HY, Hsiao, J, Scott Stroup, T, Lieberman, JA (2005). Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophrenia Research 80, 1932.
Meier, MH, Caspi, A, Ambler, A, Harrington, H, Houts, R, Keefe, RSE, McDonald, K, Ward, A, Poulton, R, Moffitt, TE (2012). Persistent cannabis users show neuropsychological decline from childhood to midlife. Proceedings of the National Academy of Sciences 109, E2657E2664.
Morgan, VA, McGrath, JJ, Jablensky, A, Badcock, JC, Waterreus, A, Bush, R, Carr, V, Castle, D, Cohen, M, Galletly, C, Harvey, C, Hocking, B, McGorry, P, Neil, AL, Saw, S, Shah, S, Stain, HJ, Mackinnon, A (2014). Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis. Psychological Medicine 44, 21632176.
Morgan, VA, Waterreus, A, Jablensky, A, Mackinnon, A, McGrath, JJ, Carr, V, Bush, R, Castle, D, Cohen, M, Harvey, C (2012). People living with psychotic illness in 2010: the second Australian national survey of psychosis. Australian and New Zealand Journal of Psychiatry 46, 735752.
Muniyappa, R, Sable, S, Ouwerkerk, R, Mari, A, Gharib, AM, Walter, M, Courville, A, Hall, G, Chen, KY, Volkow, ND, Kunos, G, Huestis, MA, Skarulis, MC (2013). Metabolic effects of chronic cannabis smoking. Diabetes Care 36, 24152422.
Pagotto, U, Marsicano, G, Cota, D, Lutz, B, Pasquali, R (2006). The emerging role of the endocannabinoid system in endocrine regulation and energy balance. Endocrine Reviews 27, 73100.
Park, Y-W, Zhu, S, Palaniappan, L, Heshka, S, Carnethon, MR, Heymsfield, SB (2003). The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988–1994. Archives of Internal Medicine 163, 427436.
Penner, EA, Buettner, H, Mittleman, MA (2013). The impact of marijuana use on glucose, insulin, and insulin resistance among US adults. American Journal of Medicine 126, 583589.
Pertwee, RG (2008). The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: Δ9-tetrahydrocannabinol, cannabidiol and Δ9-tetrahydrocannabivarin. British Journal of Pharmacology 153, 199215.
Rajavashisth, TB, Shaheen, M, Norris, KC, Pan, D, Sinha, SK, Ortega, J, Friedman, TC (2012). Decreased prevalence of diabetes in marijuana users: cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) III. BMJ Open 2, e000494.
Randolph, C, Tierney, MC, Mohr, E, Chase, TN (1998). The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): preliminary clinical validity. Journal of Clinical and Experimental Neuropsychology 20, 310319.
Rodondi, N, Pletcher, MJ, Liu, K, Hulley, SB, Sidney, S (2006). Marijuana use, diet, body mass index, and cardiovascular risk factors (from the CARDIA study). American Journal of Cardiology 98, 478484.
Roxburgh, A, Hall, WD, Degenhardt, L, McLaren, J, Black, E, Copeland, J, Mattick, RP (2010). The epidemiology of cannabis use and cannabis-related harm in Australia 1993–2007. Addiction 105, 10711079.
Saari, KM, Lindeman, SM, Viilo, KM, Isohanni, MK, Järvelin, M-R, Lauren, LH, Savolainen, MJ, Koponen, HJ (2005). A 4-fold risk of metabolic syndrome in patients with schizophrenia: the Northern Finland 1966 Birth Cohort study. Journal of Clinical Psychiatry 66, 559563.
Saha, S, Chant, D, McGrath, J (2007). A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Archives of General Psychiatry 64, 11231131.
Saunders, JB, Aasland, OG, Babor, TF, de la Fuente, JR, Grant, M (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction 88, 791804.
Singh, N, Vrat, S, Ali, B, Bhargava, K (1981). An assessment of biological effects of chronic use of cannabis marihuana in human subjects. Pharmaceutical Biology 19, 8191.
Smit, E, Crespo, CJ (2001). Dietary intake and nutritional status of US adult marijuana users: results from the Third National Health and Nutrition Examination Survey. Public Health Nutrition 4, 781786.
Teixeira, D, Pestana, D, Faria, A, Calhau, C, Azevedo, I, Monteiro, R (2010). Modulation of adipocyte biology by Δ9-tetrahydrocannabinol. Obesity 18, 20772085.
Tetrault, JM, Crothers, K, Moore, BA, Mehra, R, Concato, J, Fiellin, DA (2007). Effects of marijuana smoking on pulmonary function and respiratory complications: a systematic review. Archives of Internal Medicine 167, 221228.
Van Gaal, LF, Rissanen, AM, Scheen, AJ, Ziegler, O, Rössner, S (2005). Effects of the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk factors in overweight patients: 1-year experience from the RIO-Europe study. Lancet 365, 13891397.
Wargent, ET, Zaibi, MS, Silvestri, C, Hislop, DC, Stocker, CJ, Stott, CG, Guy, GW, Duncan, M, Di Marzo, V, Cawthorne, MA (2013). The cannabinoid Δ9-tetrahydrocannabivarin (THCV) ameliorates insulin sensitivity in two mouse models of obesity. Nutrition and Diabetes 3, e68.
Weiss, L, Zeira, M, Reich, S, Har-Noy, M, Mechoulam, R, Slavin, S, Gallily, R (2006). Cannabidiol lowers incidence of diabetes in non-obese diabetic mice. Autoimmunity 39, 143151.
Wing, JK, Babor, T, Brugha, T, Burke, J, Cooper, J, Giel, R, Jablenski, A, Regier, D, Sartorius, N (1990). SCAN: Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry 47, 589593.
World Health Organization (2000). Obesity: Preventing and Managing the Global Epidemic. World Health Organization: Geneva.


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Metabolic syndrome in people with a psychotic illness: is cannabis protective?

  • A. Waterreus (a1), P. Di Prinzio (a1), G. F. Watts (a2), D. Castle (a3), C. Galletly (a4) and V. A. Morgan (a1) (a5)...


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