Abstract Paranoia is common and has negative implications at clinical and societal levels. Cannabis may cause paranoia, although conflicting evidence exists. We reviewed studies on the association between cannabinoid use and paranoid symptoms. PubMed was searched from inception to July 2023, seeking experimental and observational studies that measured paranoid symptoms with specific assessments. Data of 13 studies (n = 13.559 participants) were pooled using Bayesian Model-Averaged Meta-Analysis, hierarchical Bayesian meta-analyses and Robust Bayesian Meta-Analysis. Effect size measures were Standardized Mean Difference (SMD) or Odds Ratio (OR). Five experimental studies showed that participants receiving cannabinoids developed more severe paranoid symptoms than those receiving placebo (SMD = 0.47; 95 % CI, 0.13 – 0.48, Posterior Probability of Inclusion, PPI:...