Although medical cannabis has been used to treat anxiety, a history of misrepresentations, misunderstandings and misinterpretations clouds public perception of cannabis.
This has resulted in cannabis being perceived as an addictive “hippie” drug that leads to the use and abuse of more severe substances. Cannabis is also perceived to induce loss of memory, psychosis, and even lung disease. Nevertheless, an increasing number of people are beginning to use medical cannabis to help manage their anxiety and depression but what does the science say?
Decades old restrictions on medical cannabis research has resulted in a lack of conclusive evidence on the role that medical cannabis plays in reducing anxiety. A further complication is that medicinal cannabis consists of many different chemical compounds such as cannabinoids, terpenes, and flavonoids. Different strains of medical cannabis contain different combinations of these compounds with each one potentially having a different effect on each person’s unique endocannabinoid system. As a result, published research results are mixed and often seem contradictory as these strain variations might not always be taken into consideration.
Medical cannabis, also referred to as medical marijuana, consists of cannabinoids, naturally occurring compounds found in the sativa plant. These cannabinoids act on the cannabinoid receptors found in the brain that constitute our endocannabinoid system. This system plays a vital role in several bodily functions such as appetite, memory, mood and pain perception.
The two best known and studied cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the psychoactive compound of cannabis, while CBD is non-intoxicating.
As a plant, cannabis can be bred to highlight specific characteristics. The two dominant strains are known as Sativa and Indica. Sativa strains usually have higher levels of the psychoactive THC. Indica strains are often mellower, with higher levels of CBD, thereby lowering psychoactive reactions. The two strains are often combined into hybrid strains that produce various effects from total relaxation to uplifting and energizing. When people usually think of cannabis they think of high THC strains used recreationally. Most people don’t realize there are plenty of low THC high CBD strains which are being utilized to help reduce anxiety.
CBD has no psychoactive component and using this medical cannabis to treat anxiety is regarded as an alternative method of medication for many users. However, there is work involved in finding the ideal product and dosing for each individual and ideally this should be managed with the help of a mental health professional such as a GP or specialist. Doctors at Australian Cannabis Clinics specialize in using cannabis as medicine and can also play a vital role in this process.
Several ongoing research studies are currently being undertaken to identify the role that medical cannabis can play to treat people suffering from anxiety. While the demand for medical cannabis in treating anxiety is booming, doctors and researchers are still working to understand if many people’s positive experience can be replicated in a clinical trial setting.
According to Dr Jordan Tishler from Boston, USA, who operates a cannabis-based practice, the few current research findings that do exist lack critical information such as exact amount taken (dosing) and at what times during the day people take it. The other critical piece of information, or rather lack thereof, is the THC and CBD levels in the dosing used on people taking part in clinical trials. All these data points are critical in being able to effectively determine the efficacy of medical cannabis for treating people with anxiety.
The Difference Between Anxiety and Stress
An added complication, according to Tishler, is that cannabis users are often confused when it comes to differentiating between anxiety and stress.
Stress is an emotion triggered by difficult situations, such as the breakdown of a relationship. Anxiety arises when sufferers are overcome with feelings of distress for no apparent reason. Tishler says that many people self-medicate for anxiety when they are suffering from stress. Self-medicating with cannabis could provide users with a buffer to avoid taking action to improve their lives.
Tishler says medical cannabis can be an effective anxiety treatment especially useful when taken in small dosages before going to bed. This can “create an [anti-anxiety] effect that outlasts any intoxication”. People who use cannabis with THC throughout the day need to make sure they are using it responsibly and ensuring they don’t become dependent and unproductive. In practice in Australia, most patients who use medical cannabis to reduce anxiety are prescribed CBD dominant medication with little or no THC in the product, so this risk is greatly reduced.
The Different Types of Anxiety
In recent years, anxiety has become one of the most prevalent mental health problems for Australians with Beyond Blue estimating that in any one year over 2 million Australians experience anxiety. Listed below are most common types according to Beyond Blue:
- • Generalized Anxiety Disorder (GAD) – Feeling anxious all the time without specific triggers
- • Social Anxiety – intense fear of being criticized, embarrassed or humiliated, even in everyday situations.
- • Specific Phobias – fearful about a particular object or situation, e.g. an injection or travelling on a plane.
- • Panic Disorder – panic attacks, which are intense, overwhelming and often uncontrollable feelings of anxiety
- • Obsessive Compulsive Disorder – trying to relieve anxiety through certain behaviours or rituals. E.g. constant washing of hands in fear of germs.
- • Post Traumatic Stress Disorder – Usually occurs after experiencing a traumatic event (e.g. war, car accident, or natural disaster).
Anxiety and Covid-19
Anxiety is part-and-parcel of everyday life but according to Beyond Blue, a mental health not for profit organization, the coronavirus pandemic has triggered a spike of anxiety levels among the general population. Anxiety and fear about the disease can trigger strong emotions and people subject to anxiety attacks can become overwhelmed.
This situation has put scientific research into the efficacy of medical cannabis to treat anxiety under the spotlight. However, there is still much work to be done with the scientific community concluding that the benefits of medical cannabis are usually short-term. According to an article published in Science Direct, medical cannabis users reported a 58% reduction in anxiety levels after just two puffs. Women were found to experience larger levels of relief from anxiety than men.
The increased popularity of medical cannabis, particularly in the United States, could be based on its portrayal as a user-friendly substance that can mellow reactions to everyday stress levels. However, medical cannabis remains clouded in a history of controversy with discussions based on inconclusive and inconsistent research findings.
Ongoing Cannabis Research
A two-month placebo-controlled pilot study on a type of medical cannabis, Cannabidiol (CBD), for the treatment of anxiety disorders is currently being undertaken by McMaster University, a public research university based in Ontario, Canada. The study will evaluate the efficacy of daily use of CBD to treat:
- • Generalized Anxiety Disorder
- • Social Anxiety Disorder
- • Panic Disorder
- • Agoraphobia
Adult participants between the ages of 21 and 65 years will be administered CBD oil capsules or a placebo of sunflower lecithin oil capsules. Researchers will evaluate any relationship between anxiety, inflammation and CBD, while also investigating the neurocognitive effects of a CBD treatment regime.
Other trials currently under investigation are:
- • Cannabidiol for adolescent anxiety (CAPS) at the Lambert Initiative for Cannabinoid Therapeutics
- • Anxiety, Inflammation, and Stress at the University of Colorado, Boulder
- • Sublingual Cannabidiol for Anxiety at McLean Hospital, a psychiatric hospital in Belmont, Massachusetts
Positive Effects of Reducing Depression, Anxiety, and Stress may be Short-term
Washington State University scientists have published a research study in the Journal of Affective Disorders that says using cannabis can significantly reduce levels of anxiety, depression and stress in the short term. But they found that repeated cannabis use does not produce a long-term reduction of symptoms. Instead, cannabis use can increase levels of depression some time.
Nevertheless, cannabis for medicinal use is on the rise. This is highlighted in several recent articles in which industry sources have said that more people are using cannabis to manage General Anxiety Disorder (GAD). While scientific research remains limited, there are many anecdotal reports of cannabis creating a calming experience and offering users temporary relief from anxiety.
Differentiating Between Types of Medical Cannabis (CBD and THC)
Clinical tests and other scientific research have found that the THC content in cannabis induces anxiety while medical cannabis, with a higher CBD content, actually reduces symptoms.
Chronic recreational users run significant health risks and suffer from increased levels of anxiety, particularly during periods of non-use.
People suffering from Post-Traumatic Stress Disorder (PTSD) or chronic pain experience reduced levels of anxiety and related problems when using medical cannabis.
Research has found no direct link of psychosis or death being caused by cannabis. However, research does suggest that the use of cannabis in high doses can trigger addiction or psychotic health disorders in certain individuals. It can also lead to impaired cognition and affect the overall quality of life in long-term recreational users. Withdrawal symptoms, anxiety and irritability are other negative side-effects.
However, a meta-analysis, a statistical procedure that combines data from multiple studies, disputes any adverse effects when using medical cannabis. Twenty Three control trials were analysed and the result was that there is no evidence to support higher adverse outcomes with the use of medical cannabis. Supporting this claim is a study of 244 medical cannabis patients suffering from chronic pain. The study found that 64% of the patients experienced a decrease in opiate use, decreased amount and intensity of side effects of adjunct medications, and improved quality of life.
Cannabis displays both the ability to reduce or to increase anxiety levels. THC in cannabis displays anxiety-induction, while CBD has properties that reduce anxiety.
Clinical Research on Medical Cannabis Effects (CBD)
Twenty four people suffering from social anxiety disorders were subjected to randomized double-blind study. They were given a 600 mg dose of CBD that resulted in reduced anxiety levels.
In 2019 a study of 72 patients suffering from anxiety and sleep disorders decreased the symptoms with the use of CBD over one month.
Also in 2019, a Canadian study of 888 medical cannabis users found that their anxiety disorders had improved.
A systematic review of medical cannabis to treat people suffering from PTSD found evidence of reduced anxiety, sleeping difficulties, restlessness and irritability.
Medical Cannabis versus Pharmaceuticals
According to Marijuana Doctors, medical cannabis can replace pharmaceutical anti-anxiety medication. One of the most often prescribed anti-anxiety medication is benzodiazepines. They manage neurotransmitter levels known as GABA. These balance anxiety levels. One of the side-effects of benzodiazepines is that patients build a quick tolerance, leading to thousands of overdose deaths annually.
Early studies found that the components in cannabidiol (CBD), also manage the amount of GABA in the brain. Medical cannabis has also shown the potential to lower the levels of cortisol. This is a stress-related hormone and, the lower the level of cortisol the greater the effect of lower stress levels.
According to Marijuana Doctors, medical cannabis is a holistic alternative to anxiety prescribed medication without the bad side effects and is being used as an effective treatment for anxiety disorders in a countless number of patients. As mentioned earlier, consultation with a cannabis-trained doctor will ensure the use of the right strains of cannabis. Cannabis rich in CBD has been used successfully in patients suffering from anxiety as well as other medical conditions such as pain and epileptic-type spasms. CBD does not induce feelings of euphoria (being high) and offers many therapeutic properties.
Nabilone (brand name Cesamet) is an FDA-approved synthetic cannabis drug for use by cancer patients suffering from nausea and vomiting. However, it has not received FDA approval for any other medical use. This synthetic cannabinoid mimics THC (tetrahydrocannabinol), the psychoactive compound found in cannabis.
In a recently completed trial, the New York State Psychiatric Institute examined the efficacy of Nabilone to treat adults suffering from Obsessive-Compulsive Disorder (OCD). OCD is a disorder that morphs from anxiety into a psychiatric disorder. Sufferers experience invasive feelings, thoughts and ideas that manifest in repetitive behaviour patterns.
Sixteen participants between the ages of 18 and 60 years received 1 mg of Nabilone daily over four weeks. They were also subjected to therapist-guided Exposure and Response Prevention Therapy in which they had to confront the situations that trigger obsessive distress while refraining from OCD behaviour. The research was headed by Helen B Simpson (M.D., PhD) from the New York State Psychiatric Institute. Conclusive findings have not yet been published.
Most of the patients tested with Nabilone during controlled clinical trials reported adverse reactions. These included ataxia, dry mouth, dizziness, drowsiness, euphoria, headache, vertigo and lack of concentration and co-ordination. Other reported side-effects of this drug are insomnia, memory loss, depression, weakness and confusion.
Nabilone has also been found to trigger anxiety.
Is Medical Cannabis Used to Treat Anxiety in Australia?
Australia’s Therapeutic Goods Administration has approved many applications of medical cannabis to treat anxiety and depression. However it is important to note that currently medical cannabis is not a first line treatment so patients need to have trialled at least one other prescribed medication before being considered. The TGA also acknowledges that there is limited data from which to draw specific recommendations for treatment. If you would like to learn more about treating anxiety with medical cannabis you can call Australian Cannabis Clinics at (02) 9098 9128 or email email@example.com. You can also send us a message through our contact form on our homepage.
Despite the flood of information dealing with medical cannabis as a treatment for anxiety, there is still much research needed to be done on this topic. But one clear fact is that medical cannabis, taken under medical supervision in the right doses and strains, does help to relieve the symptoms of this debilitating condition. Click here to take our free eligibility test and book in an appointment with one of our doctors.