A recreational drug’s relaxing reputation might be more complicated. Recent research has found a link between cannabis use and increased violent behavior.

Scientists in the UK examined the literature on cannabis and violence. People who regularly used cannabis were significantly more likely to commit a violent act than non-users, they found; they were also more likely to be a victim of a violent act. Though the research doesn’t prove a cause-and-effect link, it suggests that cannabis use might be an important and potentially modifiable risk factor for interpersonal violence, the authors say.

“The findings of our study underscore the importance of addressing this issue at both a societal and clinical level,” they wrote in their paper, published late last month in the journal Psychological Medicine.

Enjoyable as cannabis is for many people, it isn’t without its potential harms, especially in larger doses over a long period of time. Some studies have pointed to an increased risk of violence linked to cannabis among certain groups, such as younger children and people with existing severe mental illness. According to the authors, however, it’s been unclear whether this risk can be seen in the average cannabis user, too.

The researchers conducted a large review of 63 cannabis-related studies that collectively involved a quarter-million people. These studies looked at people in the general population as well as patients receiving psychiatric care.

Overall, the researchers found, cannabis use was associated with a twofold higher risk of perpetrating violence among the general population. 5 times higher among psychiatric patients who used cannabis.

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