Is cannabis an effective treatment for anxiety disorders?

Navigating the complexities of medical cannabis for anxiety

With the rise in popularity of medical cannabis in the United States, many people are considering whether to embrace the trend. Often hailed as a user-friendly substance capable of alleviating stress and anxiety, medical cannabis has piqued the interest of those seeking alternative treatment options.

However, due to its checkered history, inconsistent research, and the current federal regulations surrounding cannabis in this country, finding a definitive answer to the question “Can medical cannabis effectively treat anxiety?” proves to be a complex endeavour. Let us delve into the scientific realm of cannabis, its use, and its legal implications to gain a deeper understanding and perhaps shed light on the question of whether one should begin using cannabis.

What is cannabis ?

Cannabis, also known as “marijuana”, consists of naturally occurring compounds called cannabinoids, which are derived from the Cannabis sativa plant. These cannabinoids interact with cannabinoid receptors in the brain, forming the endocannabinoid system, which plays an important role in various bodily processes, including memory, pain perception, mood and appetite. Of the many cannabinoids, tetrahydrocannabinol (THC) and cannabidiol (CBD) are the best known and most extensively studied. THC serves as the primary psychoactive component, while CBD has non-intoxicating properties.

Cannabis manifests itself in different strains, each with different characteristics. The two polarised strains, Sativa and Indica, have different compositions of THC and CBD. Sativa strains typically contain higher levels of psychoactive THC and lower levels of non-intoxicating CBD, while indica strains are perceived as more calming, with lower levels of THC and higher levels of CBD. However, mixing strains allows for a wider range of cannabis effects. In addition, methods of ingestion and dosage add to the complexity of cannabis use.

Cannabis – Fact vs. Fiction

Cannabis, a substance shrouded in a turbulent past and misrepresented by popular culture, has given rise to a plethora of misconceptions and misunderstandings about its effects. These misconceptions often stem from historical context, including the controversial “War on Drugs” initiated by former President Richard Nixon in the 1970s. Let us examine some of the common myths about cannabis:

• Cannabis is a harmful drug that causes memory loss, lung disease, psychosis or even death.
• Cannabis acts as a gateway drug, paving the way for more serious substance abuse.
• Cannabis is highly addictive and widely abused.

However, it is important to acknowledge that advocates of cannabis use can also contribute to misinformation by exaggerating its benefits, particularly in the treatment of mood disorders and anxiety. Surveys of the general population show that anxiety management is the second most common reason for medical cannabis use. This suggests that individuals struggling with anxiety may turn to cannabis as a potential treatment option, highlighting the need to examine objective evidence on this topic. Some misconceptions perpetuated by cannabis advocates include

• There is conclusive evidence to support the use of cannabis for the treatment of anxiety.
• The negative side effects of cannabis are minimal.
• Cannabis is safe for long-term use.

What does the research say?

Exploring the scientific landscape surrounding the use of cannabis for anxiety reveals a complex set of findings. Here are some key findings from the research:

• THC vs. CBD: THC, the psychoactive component of cannabis, tends to cause anxiety, while CBD, a non-intoxicating compound, has mild anxiolytic properties.
• Health risks and withdrawal: Chronic recreational cannabis use can pose significant health risks and increase anxiety, particularly during withdrawal. However, the link between cannabis use and psychosis or death remains inconclusive.
• PTSD and chronic pain: Individuals with PTSD or chronic pain have reported a reduction in anxiety-related symptoms when using cannabis for medical purposes.
• Limited conclusions: Research on the use of cannabis for anxiety has been hampered by small sample sizes and significant limitations, making it difficult to draw definitive conclusions about its benefits.

Contrary to common misconceptions, research does not establish a direct causal link between cannabis use and psychosis or death. In addition, although cannabis is the most commonly used illicit drug and is often used in combination with other substances, the evidence is mixed regarding its role as a ‘gateway’ drug to more harmful substances. However, high-dose cannabis use has been associated with addiction, psychosis-related health problems in susceptible individuals, cognitive impairment, and adverse health outcomes and quality of life in long-term recreational users.

Do you have Cannabis Use Disorder?

While positive outcomes have been observed in individuals using cannabis for medical purposes, determining its therapeutic utility for anxiety symptoms remains challenging. THC has shown potential to increase anxiety, while CBD shows promising anxiolytic properties. The efficacy of different cannabis strains in the treatment of anxiety remains unclear.

On the one hand, research suggests that CBD may reduce anxiety in conditions such as social anxiety disorder, generalised anxiety disorder, obsessive-compulsive disorder, panic disorder and post-traumatic stress disorder. Some studies report reductions in anxiety scores and perceived symptom improvement with CBD use. However, people with social anxiety may be more prone to marijuana abuse and related problems.

In the context of post-traumatic stress disorder (PTSD), studies suggest that the synthetic form of cannabis, nabilone, may reduce treatment-resistant nightmares and have an anxiolytic effect. A systematic review of cannabis use in people with PTSD shows potential benefits such as improved emotion regulation, reduced anxiety and improved overall functioning.

Understanding the complexities of cannabis use for anxiety requires careful consideration of the available research. While some studies suggest the potential benefits of CBD and cannabis in certain contexts, more extensive research with larger sample sizes is needed to provide conclusive evidence.

Other related articles about cannabis that may be of interest to you:

• Does Using Cannabis Help Manage Anxiety?
• Marijuana May Not Be The Best Solution For Anxiety Relief
• What your kids need to know about the drug
• How marijuana affects ours mental health
• Using Cannabis to Cope with Social Anxiety
• Cannabis use greatly affects still developing brains

Navigating the legal landscape of medicinal cannabis

The legal framework surrounding medical cannabis has changed significantly over the years. Once a widely accepted treatment option, the federal government imposed sanctions on the sale and cultivation of cannabis in 1937, leading to its classification as a Schedule I controlled substance in 1970. While cannabis containing THC remains prohibited under federal law, individual states have enacted their own regulations, creating a patchwork of laws governing its medical and recreational use.

Currently, only four states – Idaho, Kansas, Nebraska and South Dakota – have chosen not to legalise cannabis in any way. In contrast, thirty-two states, as well as Washington D.C., Guam, Puerto Rico, and the U.S. Virgin Islands, have enacted their own laws allowing for various forms of medical cannabis use. However, the specific conditions for which medical treatment is approved may vary from state to state.

Medical cannabis is most commonly recommended for chronic conditions such as cancer, HIV/AIDS, chronic pain, anorexia and wasting syndrome, seizure disorders, multiple sclerosis and post-traumatic stress disorder. While anxiety is explicitly listed as a qualifying condition for medical cannabis in only a few states, such as New Jersey and West Virginia, physicians in other states may have the flexibility to designate anxiety as a qualifying condition under the “other” category.

Conflicting federal and state regulations on the sale and use of medical cannabis, particularly THC cannabis, create legal technicalities. For example, federal law prohibits physicians from “prescribing” medical cannabis, and they can only certify or recommend its use for patients with state-approved medical conditions. In addition, neither federal nor private health insurance companies allow reimbursement for alternative treatments such as medical cannabis, leaving patients responsible for the full cost of their treatment.

Clinical trials and future research

Ongoing clinical trials are investigating the effects of cannabis use on anxiety. Detailed information on these trials can be found at the link provided. Continued research in this area will contribute to a better understanding of the potential benefits and risks of cannabis use for the treatment of anxiety.

• Title: Cannabidiol for the Treatment of Anxiety Disorders: An 8-Week Pilot Study
  Sponsor: McMaster University
  Link: https://clinicaltrials.gov/ct2/show/NCT03549819

• Title: Anxiety, Inflammation, and Stress
  Sponsor: University of Colorado, Boulder
  Link: https://clinicaltrials.gov/ct2/show/NCT03491384

• Title: Sublingual Cannabidiol for Anxiety
  Sponsor: Mclean Hospital
  Link: https://clinicaltrials.gov/ct2/show/NCT02548559

• Title: Cannabinoid Medication for Adults with OCD (recently completed)
  Sponsor: New York State Psychiatric Institute
  Link: https://clinicaltrials.gov/ct2/show/NCT02911324

Conclusion & Recommendations

The current landscape of medical cannabis regulation and research in the United States presents challenges in determining the safety and efficacy of cannabis as a treatment for anxiety. The complexity of anxiety symptoms and the effects of cannabis use require a cautious approach. Rigorous research is still needed to provide definitive answers.

If you are struggling with anxiety that is significantly affecting your daily life, it is strongly recommended that you seek help from a mental health professional who specialises in anxiety-related disorders. They can accurately diagnose your condition and discuss evidence-based treatments tailored to your specific needs. Cognitive behavioural therapy is considered the most effective first-line treatment for most anxiety disorders and does not carry the potential risks associated with substance use.

Using cannabis or any other substance to treat anxiety without the guidance of a healthcare professional can interfere with therapeutic interventions and potentially worsen your symptoms over time. If you are considering medical cannabis as a potential treatment, it is important to have a full understanding of your anxiety history, including its chronicity and severity, as well as your history of substance use and psychiatric conditions.

Keep the following recommendations in mind when exploring medical cannabis treatment

• Do not rely on cannabis alone as a long-term treatment option.
• Seek counselling from a mental health professional to support your treatment journey.
• Discuss your past and present psychological and physiological symptoms with your healthcare provider to thoroughly assess whether medical cannabis is appropriate for you.
• Understand that medical cannabis is not a one-size-fits-all treatment and may not be appropriate for everyone.

Recommended Resources

1. https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx
2. https://medicalmarijuanapa.net/resources-medical-marijuana-pennsylvania/
3. https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine
4. https://www.drugs.com/illicit/marijuana.html
5. https://norml.org/marijuana/medical

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