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CONCERNS HAVE BEEN raised about a possible link between psychosis and vape products containing synthetic cannabis, with some experts calling for HHC to be made illegal.
There are growing concerns that vapes containing HHC (hexahydrocannabinol), a semisynthetic cannabinoid, are triggering psychotic episodes in certain people.
Irish researchers recently published a paper detailing two case studies of apparent HHC-induced psychosis.
In both cases, which occurred in Galway and Cork, the men in question had been using HHC vapes prior to their episodes. Both men experienced hallucinations and had to be hospitalised.
Dr Brian O’Mahony from the Department of Psychiatry at University Hospital Galway co-authored the paper, which was published in the Irish Journal of Psychological Medicine in February.
O’Mahony said these two cases occurred in the first half of 2023, noting that he and his colleagues have treated more apparent HHC-induced psychotic episodes since then.
Speaking to The Journal , he said that while the relationship between cannabis and the development of psychotic illness has been well established, more research is needed on a possible link between synthetic forms of cannabis and psychosis.
O’Mahony believes HHC should be made illegal because of the impact it can have on people’s mental health, but says it exists in a “murky area” as it’s not technically classified as a psychoactive substance – despite inducing psychoactive effects.
HHC vapes are widely available online, and in vape and CBD shops.
Brands which sell HHC vapes advertise that people will get anything from 300 to 600 puffs out of a 1ml vape. These vapes typically contain around 95% HHC and cost €30 to €40.
HHC is also available in liquid and gummy form.
HHC was first reported to the European Monitoring Centre for Drugs and Drug Addiction as a substance of concern in May 2022. Several countries have banned it, including the UK, France and Denmark.
Speaking in the Dáil recently, Health Minister Stephen Donnelly noted that HHC has been reported as “a drug of concern” by the HSE and adolescent service providers.
However, the Department of Health confirmed to The Journal there are no current plans to make HHC illegal in Ireland.
The spokesperson acknowledged there is “growing concern on the potential impact of using this substance on young people’s mental health including the possible link with psychosis”.
They added that some young people have reported adverse effects such as loss of consciousness after use.
The spokesperson said evidence related to harms associated with HHC is being “carefully monitored” by the department, the HSE and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).
“There is limited information on the health impact of this substance,” they added.
Since December, it is illegal in Ireland to sell vapes to people under the age of 18. More regulations in relation to vapes are currently being considered by the Government.
A cannabis plant naturally contains more than 100 cannabinoids, the most prominent being cannabidiol (CBD) and tetrahydrocannabinol (THC).
CBD, which is legal but heavily regulated in Ireland, generally has a relaxing effect and is used by many people for pain relief. THC, which is not legal in Ireland, is the compound that makes people high.
The amount of THC in cannabis can vary widely – the higher the potency, the greater the effect it has on a person’s brain and body. Some people who smoke THC experience hallucinations and delusions. In certain cases, people will experience psychosis.
CBD is often derived from low-THC cannabis (hemp). HHC is derived from CBD, but is similar in chemical structure to THC and has psychoactive properties.
“It’s not like CBD where people take it and it might help anxiety or whatever. People take it because it helps them to get high, it will induce a similar high to THC,” O’Mahony stated.
He said there are two types of people who use HHC.
One cohort are thinking, ‘How is this legal? I’m getting high off this, this is great. I hope people don’t cop on to it’. And there’s a second cohort which think, ‘Well, if it’s legal, it can’t be that bad for you’.
Many people who smoke cannabis or HHC don’t experience overly negative side effects, but it can heavily impact other people – especially those who are predisposed to psychosis. And many people don’t know they are predisposed to it until they experience a psychotic episode.
If a family member, especially a close one like a parent, has previously experienced psychosis, you are more likely to experience it too. However, other factors also play a role.
“Your genetics will give you a probabilistic chance of having psychosis,” O’Mahony explained.
“So a lot of people have a very small chance of having psychosis, some people would have a bigger chance of having psychosis.
Then things that happen to you during your life – whether it’s trauma or injury or other conditions – can increase your risk of psychosis.
If you are predisposed to having psychosis, taking cannabis or semisynthetic forms of it like HHC will increase that risk, he said. Once you’ve had one episode, you’re more likely to experience another.
In one of the case studies in the report, the man in question had a prior episode of cannabis-induced psychosis. The other man reported that his grandmother had a psychotic illness.
Both men had taken other drugs in the past but O’Mahony said HHC was the common denominator in their psychotic episodes.
In the study, O’Mahony and his co-authors note that more research needs to be carried out on the topic. Although a link between synthetic cannabinoids and psychotic illness is established, “no such literature has yet specifically referred to HHC”.
They also note one possible consequence of the continuing illegality, and therefore lack of regulation, of cannabis in certain jurisdictions is that some users consume high-potency or synthetic cannabinoids.
When asked about the issue, Vape Business Ireland, the country’s largest vaping trade association, said it supports the work of the Government, the Department of Health and HSE in “introducing evidence-based regulation around cannaboid products”.
The spokesperson said that vaping products proposed for sale in Ireland must be notified to the HSE for a six-month period before they can be legally sold in shops.
They added that the recently introduced ban on the sale of vapes to under 18s needs to be “strongly enforced”, adding: “This is the best way we can protect consumers and ensure only safe and properly regulated products are available to adult vapers.”
One man in Cork who experienced a psychotic episode believes it was brought on by using HHC vapes for two months prior to the incident.
Cathal*, not one of the two case studies in the above research, experienced an intense psychotic episode last year. He said he had been smoking cannabis and taking cocaine recreationally for a few years prior, but didn’t appear to have any adverse effects.
In the two months leading up to his episode, he started to “heavily” use HHC vapes.
“I was smoking about a cartridge of those weed vapes over about a two-day period, then I’d get another one,” Cathal, who is aged in his early 20s, said.
A lot of his friends were using HHC vapes at the time, and he didn’t think too much of it.
“Everyone else [was using them] and I enjoyed it. I never thought it would affect me the way it did,” he told The Journal.
In the weeks prior to the episode he would sometimes randomly burst into tears and not understand why. He started to feel very low and it escalated to the point where his colleagues intervened to get him help.
“I was inside in work one morning and I was just completely overwhelmed with feelings of such anxiousness, depression. I couldn’t handle my emotions at all, I didn’t know what was going on. I was hallucinating, I was seeing and hearing things that weren’t there.
I was being followed around by demons. Did you ever watch The Conjuring movie? I felt like I was literally in The Conjuring.
Cathal was brought to the emergency department in Cork University Hospital before being admitted to the psychiatric unit.
While there, he kept seeing demons and devils. He is not religious in general but when his parents visited him, he was “begging and pleading with them” to bring him rosary beads and the Bible.
“I was reading out of the Bible and I was relating to it. I was like, ‘Oh my god, this is what’s happening to me, I’m being raptured’.”
Cathal was given antipsychotic medication which started to kick in after a few days. He was kept in hospital for 10 days before being released and referred to RISE, an early intervention in psychosis (EIP) team.
There are five EIP teams in Ireland at present, but they are not all fully staffed and currently only treat adult patients, as previously reported by The Journal. The country’s first CAMHS EIP team is expected to start seeing patients under 18 in the near future.
As well as taking antipsychotic medication and antidepressants, Cathal was linked up with a key worker, therapist and other experts via RISE. He said getting access to an EIP team so quickly was vital in his recovery.
“You need support, you need people to help you through. No matter what age you are, everyone should be able to get those supports,” he said.
Cathal is still taking antidepressants but no longer needs antipsychotic medication. He is doing much better and has returned to work. He no longer uses HHC or any drugs.
*Name changed at interviewee’s request
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Read more articles in this series >>
FALLING THROUGH THE CRACKS
How are inadequate services impacting young people with psychosis?
By Órla Ryan
The Journal and Noteworthy are exploring access to services for people with psychosis and/or schizophrenia as part of a wider series called Falling Through the Cracks.
We would like to hear from teenagers and young adults – or their parents / guardians – who have been impacted by the lack of services available to them. Please email orla@thejournal.ie to share your story.
Supported by the Rosalynn Carter Fellowship for Mental Health Journalism in the Republic of Ireland in partnership with Headline, a Shine programme.
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If you have been affected by any of the issues mentioned in this article, you can reach out for support through the following helplines. These organisations also put people in touch with long-term supports:
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