Psychopathology and Psychiatric Risks Linked to High-Potency Cannabis, Crack Cocaine and Novel Psychoactive Substances

Abstract

Background: High potency cannabis (HPC), crack cocaine, and novel psychoactive substances (NPS) have significantly reshaped the landscape of substance-related psychopathology. This transformation is driven both by the increased psychoactive potency of known substances and by the emergence of new synthetic compounds. The aim of this paper is to provide a practical clinical reference for settings lacking laboratory support. Methods: This study analyzes 69 articles published between 2015 and 2025, encompassing a total of 126,365 patients reporting symptoms associated with the use of HPC, crack, and NPS. Results: HPC is associated with an increased risk of acute and persistent psychosis, seems proportional link to THC concentration. Synthetic cannabinoids are also frequently associated with acute psychosis, hallucinations, and delusions. Cathinones are associated with psychotic symptomatology, while crack cocaine is primarily linked to mood disorders, depressive symptomatology, and suicidality. Discussion: Increasing THC concentrations in HPC appear to be associated with more severe psychotic manifestations, such as paranoia, aggression, and hallucinations. Synthetic cannabinoids can trigger auditory and visual hallucinations, underlining that stimulation of the endocannabinoid system can elicit pronounced psychotic symptomatology. Cathinones are also associated with psychotic symptomatology, with a more heterogeneous presentation, but can additionally induce alterations of vital parameters and elevated Creatine Phosphokinase (CPK) levels. Depressive symptomatology is predominant in crack cocaine use, while all substances under review demonstrate an association with anxiety symptoms. Conclusions: All three substance groups constitute a major and evolving challenge for mental health services. Distinctive symptom profiles can guide identification and evidence-based management in resource-limited settings.

Keywords

high-potency cannabis / crack cocaine / novel psychoactive substances (NPS) / psychopathology / psychosis / depression

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