In a sibling pair analysis, however, this study also suggested

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There was no evidence of an effect of self medication as pre existing psychotic symptoms did not significantly predict later cannabis use.6 Ferdinand and co workers investigated the role of pre existing self reported psychotic symptoms and showed a bi directional association between cannabis and psychotic symptoms over a 14 year follow up study in the general population.11 They showed that cannabis use predicted later psychotic symptoms in individuals with no evidence of psychotic symptoms before starting to use cannabis and that the reverse was also true, in that psychotic symptoms predicted cannabis use in those who had not used cannabis before the onset of those symptoms.11 A prospective population based cohort study also found evidence for a self medication effect.14 Individuals with self reported hallucinations at the age of 14 had a higher risk of using cannabis on a daily basis at the age of 21. In a sibling pair analysis, however, this study also suggested an independent effect of cannabis use on self reported delusional ideation later in life.14 Thus, although the cannabis psychosis link has been investigated in many studies, results on the temporal association between cannabis use and psychotic symptoms remain conflicting. Longitudinal cohort studies with multiple repeated interview based measures of cannabis use and psychotic symptoms are needed to clarify this issue.

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