Suicidality risk after using cannabis and cannabinoids: An umbrella review

Abstract

The increasing prevalence and burden of suicide have led to numerous studies to identify its risk factors. Cannabis is the most common illicit substance detected in suicide victims’ toxicology tests. This study aims to identify and appraise systematic reviews investigating suicidality after using cannabis and cannabinoids. Seven databases and two registries were searched without restrictions for systematic reviews investigating cannabis effects on suicidality. AMSTAR-2 was used for quality assessment and corrected covered area and citation matrix were used to determine overlap. Twenty-five studies were included, of which 24 were on recreational use and one was on therapeutic use. Only three of the studies on recreational use reported no effect or inconsistent results. Evidence generally showed a positive association between cannabis use and suicidal ideation and attempt among the general population, military veterans, and bipolar or major depression patients. A bidirectional causal association between cannabis and suicidal ideation was also mentioned. Moreover, a younger age of initiation, long-term use, and heavy consumption were reported to be associated with even worse suicidal outcomes. On the contrary, current evidence indicates that the therapeutic cannabis is safe. In conclusion, the literature supports the cannabis-suicidality association in recreational use but considers cannabidiol safe for treatment. Further studies with quantitative and interventional approaches are recommended.

Keywords:

• Marijuana
• medicinal cannabis
• self injury
• substance use disorder
• suicidal ideation
• systematic review

Acknowledgments

This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

AS: conceptualisation, project administration, supervision, methodology, protocol registration, software, data curation, writing – original draft, writing – review and editing. AA: supervision, software, data curation, writing – original draft, writing – review and editing. KP: data curation, investigation, writing – original draft, writing – review and editing. AH: data curation, investigation, writing – original draft. HA: writing – original draft, writing – review and editing. All authors approved the final version of the manuscript and had accountability for all work aspects.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

No data were created or analysed except as fully presented in the full text and appendices.