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Early Cannabis Use Is Associated With Severity of Cocaine-Induced Psychosis Among Cocaine Smokers in Martinique, French West Indies

Trape, Sandrine MD; Charles-Nicolas, Aimé MD, PhD; Jehel, Louis MD, PhD; Lacoste, Jérôme MD

doi: 10.1097/ADM.0000000000000003
Original Research

Objectives: Cocaine intoxication can induce transient psychotic symptoms. The principal aim of this study was to determine sociodemographic and clinical characteristics associated with cocaine-induced psychosis (CIP) and to identify clinical factors predicting CIP in crack cocaine smokers in Martinique. The second aim was to identify clinical factors associated with severity of CIP, assessed with the Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis (SAPS-CIP).

Methods: Fifty-three cocaine-dependent smokers (45 men and 8 women) seeking treatment for cocaine dependence were included. Patients were assessed using the Cocaine Experience Questionnaire (CEQ), an instrument for the identification of cocaine-induced paranoia, and a French version of the SAPS-CIP, for the severity of CIP.

Results: Thirty-five (66%) patients reported cocaine-induced paranoia on the CEQ (CIP(+) patients). The mean SAPS-CIP total score was 6.1 ± 3.7, with a significant difference between CIP(+) and CIP(−) patients (P < 0.0001). Age at first cannabis use was associated with occurrence of CIP on the CEQ, and adolescent-onset cannabis use was associated with severity of hallucinations score on the SAPS-CIP.

Conclusions: Cocaine-induced psychosis is frequent in crack cocaine smokers in Martinique, and early cannabis use is associated with the occurrence and the severity of psychotic symptoms during cocaine intoxication in this population. Patients developing psychotic symptoms during cocaine use began smoking cannabis earlier during adolescence than patients without CIP. These results confirm those of previous studies, highlighting the need to better assess early cannabis use in cocaine users, because early cannabis use is associated with severity of CIP.

From the Service de Psychiatrie et Addictologie (ST, ACN, LJ, JL), CHU de Martinique, Fort de France, Martinique, French West Indies; and Inserm U669 (LJ), Université Paris Sud, Paris, France.

Send correspondence and reprint requests to Jérôme Lacoste, Service de Psychiatrie et Addictologie, CHU de Martinique, CS 90632, 97261 Fort de France cedex, Martinique. E-mail:

The authors declare no conflicts of interest.

Received January 17, 2013

Accepted September 23, 2013

© 2014 American Society of Addiction Medicine