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Cannabis use is associated with both violence perpetration and victimization in published studies, but that association does not prove cannabis alone causes violence. A 2026 systematic review found a smaller pooled association for perpetration in longitudinal studies than in cross-sectional studies, and highlighted confounding, inconsistent measures and substantial variation across studies as reasons to interpret the results cautiously.
What the latest review found
Trotta and colleagues’ systematic review and meta-analysis, published online in Psychological Medicine on September 24, 2026, combined 63 peer-reviewed studies involving 265,079 people. Its database searches covered MEDLINE, EMBASE and PsycINFO through November 2024, so the publication date does not mean the evidence search extended through 2026. The review reported associations for both perpetration and victimization, which are distinct outcomes.
The estimates below are pooled odds ratios (ORs), not absolute probabilities. An OR compares the odds of an outcome between groups as defined by the included studies; it does not mean that an individual cannabis user has the stated percentage or multiple of risk. Populations, comparison groups and outcome measures varied across studies.
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1Fix the driver behind crashes, sound loss and screen glitches2Repair Windows errors before they cause bigger problems3Scan for outdated or missing drivers - takes under a minute| Outcome and population or design | Pooled odds ratio (95% CI) |
|---|---|
| Violence perpetration, general population — Trotta et al., 2026 | 2.05 (1.74–2.41) |
| Violence perpetration, psychiatric patients — Trotta et al., 2026 | 2.49 (1.72–3.61) |
| Violence perpetration, longitudinal studies — Trotta et al., 2026 | 1.17 (1.07–1.28) |
| Violence perpetration, cross-sectional studies — Trotta et al., 2026 | 2.37 (1.66–3.40) |
| Violence victimization, general population — Trotta et al., 2026 | 1.49 (1.38–1.60) |
These pooled results should not be read as a single estimate for every person or setting. In particular, the psychiatric-patient estimate describes that studied population, not cannabis users generally. The difference between the cross-sectional and longitudinal estimates also matters: studies that measure exposure and outcome at one point in time cannot establish which came first, while longitudinal studies can examine whether exposure precedes a later outcome but still cannot by themselves rule out other explanations.
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The review rated 13 included studies good quality, 45 fair and 5 poor. These ratings are a further reason to read the pooled estimates alongside the review’s limitations rather than as precise individual predictions. See Trotta et al.’s 2026 review in Psychological Medicine.
Why an association does not establish cause and effect
Timing helps, but does not settle causality
A longitudinal association gives researchers a way to assess whether cannabis use was recorded before a later violence outcome. That temporal ordering is more informative than a cross-sectional snapshot, but it is not proof that cannabis exposure caused the outcome. Unmeasured or incompletely adjusted factors may contribute to both, and the included longitudinal studies differ in their methods and measures.
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Reverse causation is another concern: violence-related circumstances or other factors may precede or influence cannabis use, rather than cannabis use being the initiating cause. A 2020 meta-analysis focused on youths cautioned that even longitudinal associations can be affected by reverse causation. A 2022 scoping review likewise characterized the relationship as correlational and variable by population. These earlier reviews provide context for, rather than replace, the larger 2026 synthesis: the 2020 youth meta-analysis and the 2022 scoping review.
Other influences are difficult to separate
Alcohol and other drug use, impulsivity or antisocial traits, socioeconomic circumstances, and exposure to violent settings may be related to both cannabis use and violence. Excluding studies that combined cannabis with other substances did not eliminate all potential confounding by alcohol or other drugs in the 2026 review. Statistical adjustment can account only for factors that were measured well enough and included in the analysis.
What researchers mean by possible pathways
The 2026 review discusses several possible, potentially interacting explanations: impairment in attention, executive functioning, inhibition or problem-solving; changes in mood and emotional regulation; possible irritability during withdrawal; paranoia; and social or environmental conditions, including violent settings. These are proposed pathways, not proof that any one mechanism directly causes violence. The authors argue that pharmacological effects alone are unlikely to explain the observed association. A 2020 focused review also called for longitudinal work that addresses confounding, rather than treating a proposed pathway as established causation: “Violence and Cannabis Use: A Focused Review of a Forgotten Aspect in the Era of Liberalizing Cannabis”.
Why estimates vary across studies
The review combined research that did not always measure the same exposure or the same outcome. A study of any lifetime use is not equivalent to one that measures frequent use, and a measure of physical violence is not interchangeable with a record of criminal conviction or a report of psychological, sexual or intimate-partner violence. Reporting methods also vary, including self-report and administrative records.
- Study design: cross-sectional studies measure exposure and outcome at one time; longitudinal studies follow participants over time, but may still have confounding or reverse-causation concerns.
- Population: general-population studies and psychiatric or clinical samples are not interchangeable.
- Outcome: perpetration and victimization are different; violence definitions and reporting methods also differ.
- Cannabis exposure: studies often recorded lifetime or recent use without enough detail on frequency, dose, duration, cumulative exposure, or THC/CBD composition for robust intensity or potency analyses.
- Adjustment: the ability to account for alcohol, other drugs and relevant social or individual factors depends on what each study measured.
The meta-analysis also found substantial heterogeneity, meaning study results varied beyond what a single common estimate can neatly represent. Some eligible studies could not be included in the quantitative synthesis because their published data did not allow the reviewers to calculate an effect size. The authors note possible reporting, publication and language bias as additional limitations. The 2022 scoping review also described variation by population and noted a possible stronger association with intensive-use patterns, but the available exposure measures do not establish a dose- or potency-specific causal effect.
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Current evidence does not establish the size of any causal effect, whether any effect differs by cannabis dose or potency, which mechanisms account for the observed associations, or whether reducing cannabis use reduces violent behavior. The 2026 review calls for prospective longitudinal studies that measure frequency, cumulative exposure and THC/CBD composition more precisely, as well as studies testing whether cannabis-reduction interventions change violence outcomes.
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