Can Marijuana Use Lead to Suicidal Ideation in Some Adolescents?

By Laura Stack

The evidence-based negative effects of cannabis on adolescents are many and varied, especially for young people, and we’ve covered them numerous times in previous blogs. But today, I want to discuss openly a very sensitive topic: THC as it relates to adolescent suicidal ideation and suicide. TRIGGER WARNING: METHODS OF SUICIDE MENTIONED.

On August 30, 2018, I received a very chilling text from Johnny, who was two weeks into his freshman year at Colorado State University (CSU). I was reassuring him that it was normal to feel worried about making new friends, and he replied, “Is it normal to think about killing yourself every day?” That text started the worst 14 months of my life that ended with the worst day of my life on November 20, 2019, when Johnny completed suicide. Our grief and questions continue today.

We disenrolled him from CSU, where he had received the highest scholarship for academic performance in high school (4.0), and admitted him to a mental hospital, where they held him for 72 hours. He told me he had “been dabbing for two weeks non-stop” with his roommate, who had moved to Colorado from Minnesota just to use marijuana. We knew he had experimented with marijuana since it was legalized in Colorado when he was 14, but now we really started to learn about “dabs” and how potent it is compared to the grass we had as teenagers.

During visiting hours at the hospital, Johnny told me he would just kill himself anyway when they let him out. We begged the hospital not to release Johnny, but he lied to them and told them he wasn’t suicidal, so they released him anyway. Several days later, when we had to go to CSU to retrieve his items from the dorm, he tried to hang himself in his bedroom closet at our house. He called me on the phone and told me he had just tried to kill himself. I kept him on the phone while calling the police on John’s phone. Thankfully, the police blocked him on our street while he was attempting to drive off and took him to the hospital, and then he was re-admitted to the mental hospital.

Two weeks later, the marijuana had worn off in his body, and he no longer felt suicidal. The discharge paperwork said he was suffering from “THC Abuse Severe.” Here is an image of the doctor’s writing:

So, yes, if you doubt it, it’s true that people can feel suicidal after using marijuana, especially at a young age, using high-THC products like dabs in high frequency. I know because it happened to my son.

An independent study came up with a nearly 7-fold elevation in risk in suicidal tendencies in adolescents who use marijuana. At the least, part of the risk for suicide may be exerted through the mental disorders that marijuana triggers, particularly psychotic disorders and depression. But another corrected for a prior history of mood disorders, including depression and risk of suicide attempt, and concluded that marijuana elevated risk of suicide 7.5-fold. There is also evidence that marijuana’s effect can be more immediate from a recent study illustrating the likelihood of suicidal thoughts increased on the days when an adolescent uses marijuana.

After four months at home, the marijuana had worn off in his mind, and he recovered. We were all so hopeful when he said he said he wanted to try again to go to college. We enrolled him at a different university this time, the University of Northern Colorado (UNC) in Greeley. He started off well, but sadly he gravitated toward the marijuana culture and started using again. This time, it caused a psychotic break, and Johnny claimed UNC was secretly an FBI base, and he was wanted for being a terrorist. Since he was 18, the University wouldn’t keep us in the loop. Shockingly, even after he told his Resident Advisor (RA) he felt suicidal (she told me so in a Facebook message after he died), they didn’t call the police. They simply moved him to a different dorm because he thought his room was bugged. It took significant maneuvering, but we finally got him admitted to a different mental hospital.

(Side note here parents—make sure to get a medical or durable power of attorney and a HIPAA authorization for your children before they leave for college, so you can help them in these instances. UNC wasn’t prepared to handle Cannabis-Induced Psychosis (CIP) and did the wrong things, the most egregious of which was not calling the police and/or having him admitted to a mental hospital.)

Fast forward, Johnny didn’t stop using. Eventually, after repeated CIP incidents, the psychosis didn’t go away when he stopped using, and it triggered schizophrenia. After countless doctors, medicines, treatments, programs—someday I’ll detail everything we tried in a book—he stopped taking the antipsychotics he now needed to get his brain under control (a common part of the illness).

Five weeks before he died, to his credit, he made a valiant effort to stop using marijuana. We know he had stopped using marijuana, because his toxicology report showed NO THC in his system. We know from his texts that he used October 13, and he died on November 20. Sadly, it was too late for him. Four days before his death, he wrote in his journal the mob was after him and everybody knew everything about him, so his delusions were still very apparent.

Three days before his death, he held me tightly and told me, “You were right all along. You told me marijuana would hurt my brain, and it’s ruined my mind and my life. I’m sorry, and I love you.” We just couldn’t watch him 24/7. In a final impulsive act of delusion and paranoia, he jumped from a 6-story building.

Johnny is now in the presence of our Lord and free from his pain, which is the only thing that gives me comfort from my sense of failure from my inability to prevent it. John and I will always struggle with the hundreds of decision points that led up to this and wonder if we could have changed the outcome.

I share this (long) story with you, because Johnny became just ONE of the EIGHTY youths in Colorado ages 15-19 who died by suicide in 2019. According to the Colorado Department of Public Health and Environment, in 2019, SUICIDE WAS THE #1 CAUSE OF DEATH for adolescents 10-19. In Colorado, the THC positive toxicology screens in youth aged 15-19 have consistently increased over the past several years (while such data was being collected by the Colorado Department of Health), such that it became the leading drug found in suicide victims of that age range (32% were positive by 2017, about 1.5-fold higher than the average monthly use rate for that age group in Colorado). Marijuana is the most prevalent substance found in completed teen suicide in Colorado (it USED to be alcohol followed by marijuana, but that trend reversed in 2012, coinciding with legalization in CO), and percentage of youth suicides with marijuana on board has steadily increased since then.

This is no coincidence. We want the world to know Johnny isn’t just a statistic—there is a reason Johnny died—and it is marijuana. Johnny didn’t have any delusion before marijuana. Johnny’s marijuana use led to changes in his brain development, which led to mental illness, which led to suicide. So, while it’s rare to die from an acute overdose of THC, we know for a fact that long-term cannabis use can result in thoughts of suicide and suicide itself, evidenced by our beautiful boy.

The Harsh Proof

Upon my request, Christine L. Miller, Ph.D., kindly wrote a white paper just for Johnny’s Ambassadors in September 2020 on “Applying the Bradford Hill Criteria for Causation to the Relationship Between Marijuana Use and Suicidal Behavior.” Dr. Miller has researched the causes of psychosis for 30+ years in the academic setting, publishing 33 papers in peer-reviewed journals. Her specialty is molecular neuroscience, i.e. the study of molecular influences on brain function. She has acted as a reviewer for several journals, including the Journal of Neuroscience, Biological Psychiatry, Schizophrenia Bulletin, and Bipolar Disorders. Dr. Miller holds a B.S. degree in Biology from M.I.T. and a Ph.D. in Pharmacology from the University of Colorado Health Sciences Center. 

Her research has considered the abovementioned studies and more, using the rigorous Bradford Hill Criteria to link cannabis use and suicidal behavior. As Miller explains,

“In 1965, Sir Bradford Hill developed a set of tests designed to elucidate causal relationships in epidemiology. These criteria have subsequently become accepted as important standards for epidemiological and clinical science.”

There are nine Bradford Hill Criteria:

1. Demonstration of a strong association between the causative agent and the outcome.
2. Consistency of the findings across research sites and methodologies.
3. Demonstration of specificity of the causative agent in terms of the outcomes it produces (not applicable in this illustration)
4. Demonstration of the appropriate temporal sequence so that the causative agent occurs prior to the outcome.
5. Demonstration of a biological gradient, in which more of the causative agent leads to a poorer outcome.
6. Demonstration of a biologic rationale, such that it makes sense that the suspected agent causes the outcome.
7. Coherence of the findings, such that the causation argument is in agreement with what we already know.
8. Experimental evidence.
9. Evidence from analogous conditions (not applicable in this illustration)

Miller concludes that all but #4 in the above list of relevant criteria are satisfied by the research results on marijuana use and suicidal behavior. (For that single criterion, not enough evidence has been presented to prove an appropriate temporal sequence, though Miller points out that the data is “strongly suggestive.”) Ultimately, she makes it clear that the weight of the current evidence:

“Should be regarded as strong enough to elicit widespread public health warnings about the suspected role of marijuana use in precipitating suicidal behaviors, since the mandate of the relevant authorities is to err on the side of protecting public health rather than to establish scientific certainty beyond a shadow of a doubt.”

That’s as close to a ringing declaration that marijuana use can lead to suicidal ideation and suicide as we have thus far, and I have little doubt that, within the next few years, that link will be proven beyond a scientific doubt. By then, we will have lost of generation of young people. How long did it take for them to make the connection between tobacco use and death?

An Ounce of Prevention

The time is now. Pandora’s box has been opened. The bottom line is that young, developing brains CAN’T COPE WITH THE DEMANDS OF TODAY’S HIGH-THC MARIJUANA. A teen’s judgment is already impaired by puberty, as much as they might like to think otherwise. Their decision-making abilities aren’t the best, and they may assume that just because something is legal, it isn’t dangerous to their health. The media and pot industry makes everything sound so safe. But anything can be abused, and substances like cannabis and alcohol have hidden dangers that adolescents may not know or fully understand.

As a society, we do make some efforts in schools and in the media to discourage teen substance abuse. I’m not sure, however, that we do enough to make it clear that teens should not touch some substances that are legal for adults—not just for legal reasons, but because of biological effects that are much worse for young people, whose brains and bodies are still developing. Why don’t kids play with rattlesnakes? We teach them they are dangerous from an early age, and kids develop a healthy fear of rattlesnakes. The SAME THING must be done with marijuana, so children have a healthy fear of what it can do to them. They need to know that suicidal ideation is just one of the horrible side effects of marijuana use, and some young users are especially susceptible, and it could be them.

Johnny’s Ambassadors seeks to educate parents and teens about the dangerous impact of today’s high-THC marijuana on adolescent brain development and suicide. We don’t want this to happen to another young person and need to sound the alarm! We are doing all we can do develop a new online curriculum we hope to take half a million teens and parents through our program in the next three years, while simultaneously trying to raise enough money to stay just ahead of our development. We could really use your financial support raising funds during Suicide Prevention Week, Sept. 6-12 and beyond.

It’s up to US, as parents, grandparents, caretakers, teachers, doctors, older siblings, and YOUTH THEMSELVES to make a sincere, strong effort to discourage adolescent cannabis use. Even then, sometimes it’s not enough, and our Johnny is lost to this poison forever. Several people have written to me since the inception of Johnny’s Ambassadors and sadly reported “Your story is now my story.” It could be your child, your grandchild, your niece or nephew. If they are using, please tell them to stop using marijuana NOW. If they aren’t using, talk to them about never starting. The brain continues to form until the late 20s we know now. We must spread the word about what pot really can do to kids (and indeed to some adults, but youth are our mission). I don’t want to see any other families damaged by the suicidal effects of marijuana use.