Suicide attempt and paranoia persisting for 28 days following heavy delta‐9‐tetrahydrocannabinolic acid and tetrahydrocannabinol use: A case report

Background: Cannabis contains various cannabinoids, with Δ9-tetrahydrocannabinol (Δ9-THC) being the primary psychoactive compound. A non-psychoactive precursor called Δ9-tetrahydrocannabinolic acid (THC-A) is converted to Δ9-THC slowly over time or rapidly when heated. Cannabis use is linked to psychotic outcomes, with increased risk associated with heavier or earlier use. Additionally, Δ9-THC's lipophilic nature leads to prolonged detection following heavy use. These factors highlight the need for a better understanding of cannabis formulations, dosing, and their psychiatric and pharmacokinetic implications. Case Presentation: This case report describes a patient who attempted suicide after developing paranoia induced by cannabis use. The patient experienced paranoid thoughts following daily consumption of 15-30 mg Δ9-THC gummies and THC-A in dried plant form. He reported being unfamiliar with the dosing and effects of THC-A, which contributed to his excessive and prolonged use. Conclusion: This case highlights the potential risks of consumers being unaware of the differences in cannabinoids and dosing, which can result in adverse outcomes. THC-A, often labeled as non-psychoactive, becomes psychoactive when heated, which can confuse users. Improved product labeling is essential to help prevent poor patient outcomes.