More than a decade after recreational marijuana was legalized in Washington, a new survey of health care providers suggests that many clinicians are concerned about the impact on patients’ mental health.
In a survey of nearly 400 Washington state clinicians, more than half said they were very concerned about the mental health risks associated with cannabis use. Nearly 1 in 5 people reported seeing patients with cannabis-related adverse health events two to three times a month.
“This is the first time we’ve actually asked clinicians in Washington state what they’re feeling,” said lead author Beatrice Carlini, research associate professor of psychiatry and behavioral sciences at the University of Wisconsin School of Medicine.
The researchers reported their findings this week in the Journal of Substance Use and Addiction. The 20-question survey collected responses from 388 doctors, nurses, and other health professionals between December 2024 and March 2025. Participants were asked about their clinical experience treating patients with health problems believed to be caused by cannabis use.
Cannabis research reveals four conditions and training gaps
Four symptoms appeared most frequently. Cannabis hyperemesis syndrome (severe recurrent vomiting) was reported by 70% of clinicians. cannabis use disorder, 65%; Anxiety, 63%. 53% had psychosis or hallucinations. More than a third called psychosis the most serious adverse event they encountered.
Research reveals significant gaps in training. Almost 66% of respondents reported having little or no knowledge about how cannabis interacts with other drugs. More than 42% said they had limited understanding of cannabis-induced psychosis. Nearly 75% also said they would like more training on how to screen for cannabis use and manage related health risks.
“They’re reporting that they’re concerned. They’re reporting that they’re not educated enough to deal with the situation well,” Carlini said. “Clinicians in our state need more specific training.”
More than 80% said they would be more likely to intervene if they had an established treatment protocol and better referral options.
“For so long, cannabis has been treated as a secondary, relatively harmless substance,” Carlini said. “There are no cannabis-specific facilities, treatments, or resources.”
Cannabis today is much more potent than the one voters legalized in 2012
Carlini pointed out that today’s cannabis products bear little resemblance to those on the market when voters legalized cannabis in 2012. Washington state has no limits on THC levels in flower or concentrates. Flower averaged 21% THC levels in 2022, while concentrates averaged 69%, according to the Washington State Liquor and Cannabis Commission.
“Before it was legalized, it was a much milder substance,” Carlini said. “Manufacturing is now so concentrated that it creates more problems.”
The Washington Cannabusiness Association, an industry group representing licensed businesses, said the study did not distinguish between harm caused by regulated products and harm caused by illegal markets.
“The THC content of regulated products must be listed on the label, and each product is subject to rigorous testing standards that do not exist on the illicit market,” the association said in a statement.
The group noted a 95% compliance rate by licensed retailers with restrictions on sales to customers over 21 and said it supported a crackdown on unlicensed sellers rather than a ban-based approach.
Carlini said he was not calling for an end to legalization, but rather regulation of its potency. She co-authored a 2022 report for the state Legislature containing policy recommendations on THC limits, but none were adopted.
“The reality is we need to make cannabis more similar to cannabis in the past, when we first legalized it,” Carlini said.
Read more of Aaron Granillo’s story here.
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