In a survey of nearly 400 Washington state physicians, more than half expressed strong concern about the mental health risks of marijuana use, and nearly 20% reported seeing patients with marijuana-related health problems two to three times a month.
Research reports this and related findings today in the Journal of Substance Use & Addiction. Their 20-question survey received responses from 388 doctors, nurses and other health professionals between December 2024 and March 2025. The questions were about clinical experiences with patients who had health problems from the use of marijuana after Washington legalized the drug for recreational use in 2012.
“Healthcare providers are paying attention, and are concerned about the adverse events of cannabis,” said Beatriz Carlini, lead author of the paper. She is a research associate professor of psychiatry and behavioral science at the University of Washington School of Medicine.
“It is also interesting,” he added, “that we could not find another research paper in which doctors in the United States were asked about treating adverse conditions related to marijuana. Their voices have not been heard on this topic before now.”
Four conditions appear as relatively more common and concerning among the respondents:
- Cannabis hyperemesis syndrome: 70% of clinicians reported treating patients who endured repeated cycles of severe nausea and vomiting, which can lead to dehydration and prolonged emergency department visits.
- Cannabis use disorder: 65% of respondents identify patients who show signs of addiction or dependence on cannabis.
- Anxiety: 63% of respondents identified patients with anxiety related to cannabis use.
- Psychosis or hallucinations: 53% of respondents identified psychosis and hallucinations linked to cannabis use; 34% called this the most serious adverse event they had seen.
Asked how knowledgeable they were on several questions about clinical topics related to cannabis, the most frequent answer given by respondents was “moderate”. (Other options are “very/very” and “somewhat/not at all.”)
The survey, however, showed a gap in the training of doctors to care for this population: 65.9% of respondents reported having little or no knowledge about how cannabis interacts with other medications, and 42.8% reported limited knowledge about psychosis caused by cannabis. Almost 75% expressed a desire for more training on how to screen for cannabis use and how to manage related health risks.
Respondents also identified system-level barriers to treating cannabis-related conditions more effectively. More than 80% said they would be more likely to screen and intervene if they had defined treatment protocols and more referral options for patients.
The lack of providers with expertise in cannabis-related care continues to be a significant challenge, Carlini said. Nationally, traditional substance use treatment providers are overwhelmed with opioid and methamphetamine use disorder patients, and alcohol continues to harm people. This pressure makes it less likely that people seeking help with cannabis – often considered a low-risk substance – will receive adequate support, he said.
“This reflects the lack of systemwide response to drugs that have become more potent and more available. There is no capacity-building to properly respond in the healthcare setting,” said Carlini.
The study did not measure whether the adverse health effects associated with marijuana are on the rise in Washington, but Carlini said literature from other regions suggests that is likely.
Related: Is marijuana addictive?
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