Why Cannabis Is Not a Good Treatment Option for Anxiety

The USFood and Drug Administration (FDA) has not approved the use of cannabis as a treatment for any medical condition. However, after a long legalization campaign, most states now allow "medical" use of marijuana to treat pain, nausea, and other conditions. Twenty-three states, theDistrict of Columbia, and Guam have fully legalized the drug for recreational use as public support for legalization rose rapidly—despite marijuana being illegal at the federal level.

Cannabis sativa (the marijuana plant) contains many active compounds. The best known aredelta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the primary ingredient in marijuana that makes people "high."

Today, many Americans believe in the unproven health benefits of cannabis, but few people know about the danger of addiction and other health impacts of marijuana use. The FDA continues to classify cannabis as a Schedule I controlled substance "with no currently accepted medical use and a high potential for abuse." Recent research estimates that approximately three in ten people who use marijuana have cannabis use disorder (CUD). For people who begin using cannabis products before the age of 18, the risk of developing a marijuana addiction is even greater.

Among the many risks and possible side effects of "medical" marijuana, the Mayo Clinic lists  

increased risk of heart attack and stroke, potential for addiction, hallucinations or mental illness, and withdrawal symptoms.

FoundryTreatment Center Steamboat CEO Ben Cort has raised awareness of these health risks for years. In a recent webinar forHarmony Foundation, Cort pointed out that the THC levels in cannabis products have dramatically increased in the last few decades from less than one percentTHC in the seventies to well beyond 40 percent in recent years. And that's just the plants—concentrates and other products can reach 99 percent THC. 

Cort doesn't really want to talk about the plant anymore because the people who are treated at Foundry Treatment Center Steamboat for CUD have not been smoking the pot passed around in the 1970s. "Concentrates are everywhere and are not just being used by the fringe; they are mainstream, and they are what many people picture when they talk about marijuana," Cort wrote in his 2017book Weed, Inc. "You are going to think some of this must be talking about hardcore users on the edge, but it's not; concentrates are everywhere and have become synonymous with weed for this generation of users." Cort will publish a new book in 2024 that focuses, in part, on the wide-ranging effects of expanded cannabis commercialization since the release of his first publication.

One group of individuals regularly self-medicating with cannabis is people with anxiety. "Lots of people with anxiety are counting on cannabis's ability to treat their symptoms," wrote Andrea Petersen and Julie Wernau in the Wall Street Journal in October. But "there's a problem: The science shows that it probably doesn't help, and it may make those symptoms worse."

The cannabis industry is promoting its products as helpful for anxiety because it's a very lucrative market. "Anxious consumers have turned to weed and edibles for relief as treatments for their ailments have become harder to find," wrote Petersen and Wernau. "The number of available and affordable therapists badly lags demand, and traditional medications don't work for everyone."

Petersen has personal experience with anxiety issues and cannabis use. In her 2017book On Edge – A Journey Through Anxiety, she used that experience and her expertise as a health reporter to explore the nature of anxiety and its treatment options. 

WhenPetersen smoked marijuana in college, she experienced a psychotic episode and had a panic attack. She didn't try to self-medicate with cannabis again. Sheavoided alcohol, too, realizing that her abstention was not typical. "Many people with anxiety disorder drink to relax, a way of self-medicating."

In OnEdge, Petersen also recalled the example of her friend Mike, who turned toalcohol and drugs to try to ease his anxiety and depression. "For Mike,marijuana and narcotics like Vicodin were a revelation," she wrote."They took away the worrying. They calmed his twitchy body." Itdidn't last, of course. "After a while, the marijuana turned on Mike. Itstarted making him more anxious. His drinking and use of narcotics slid intoaddiction. He went to rehab. He relapsed. He kicked the drugs and alcoholagain." 

Manyusers want to believe that cannabis can make them less anxious, and themarijuana industry is more than happy to accommodate that belief. "Yetlittle independent scientific evidence shows that cannabis is an effectivetreatment for anxiety problems, and some studies have found it can worsensymptoms," wrote Petersen and Wernau. "Researchers say this isparticularly true for products high in THC, the substance responsible formarijuana's intoxicating effects."

"Ihave patients who use it every day. They say it really helps," BethSalcedo, a psychiatrist and medical director of the Ross Center in Washington,DC, who specializes in treating anxiety disorders, told the Wall StreetJournal. "My message is that if it were really working for you, youwouldn't be here with me."

WhenDr. Salcedo talks with patients about what their anxiety was like before cannabis, she said they usually report that their anxiety is unchanged. Any transient relief they feel may be due in part to marijuana's high, she said.

Cannabis is big business. Anxiety is one of the most common symptoms that customers of cannabis dispensaries are looking to address. Several states have made anxiety a qualifying condition to receive a "medical" marijuana card despite there being any supporting evidence to support this. 

"Two recent studies show the potential problems with treating anxiety with cannabis," explained Petersen and Wernau. "Cannabis use was significantly associated with increased odds of developing anxiety conditions, according to a review of research published in 2020 in the Canadian Journal ofPsychiatry. Recent cannabis use was associated with more severe symptoms in people with anxiety and mood disorders, according to another review published in 2018 in the Journal of Clinical Psychiatry."

Unsurprisingly, the marijuana industry has funded its own studies. In some surveys, cannabis users have reported that they have felt relief from anxiety symptoms after consuming cannabis. "There is some evidence that cannabidiol, or CBD, which is a nonintoxicating substance derived from cannabis, may relieve anxiety symptoms," reported Petersen and Wernau. However, the science is limited and does not support the use of THC to relieve symptoms. 

While the benefits are questionable, the risks are clear. "Using cannabis regularly comes with a significant risk of addiction," wrote the WallStreet Journal reporters. "Marijuana use can become a disorder when people need to use an increasing amount to get the same effect and when the use interferes with work and relationships, among other symptoms."

Marijuana users also run a higher risk of psychosis. "Research has shown that cannabis use is associated with an increased risk for an earlier onset of psychotic disorders (such as schizophrenia) in people with other risk factors, such as family history," according to the National Institute on Drug Abuse(NIDA). "Cannabis intoxication can also induce a temporary psychotic episode in some individuals, especially at high doses. Experiencing such an episode may be linked with a risk of later developing a psychotic disorder."

Cannabis use disorder is a potentially serious condition frequently requiring treatment. "At Foundry Treatment Center Steamboat, we treat patients whose CUD was dismissed as 'only weed' because much of our society does not recognize cannabis as an addictive substance," says Cort. "One of the most pernicious effects of the cannabis industry's strategy of positioning the drug as medicine is that people generally believe that it is safe or poses no significant health risks. This extends to perpetuating the long-held belief that cannabis can provide a form of mental and physical relaxation. While this may be the case for some users, others have the opposite experience, and it can lead to very real and serious medical and mental health problems. The problem with allowing those profiting from the sale to define its uses is that they will always only tell one side of the story unless compelled to tell the entire story. Without considering negative, potentially negative, and unknown effects, it's like telling the story of Jack and The Beanstalk without the giant,"says Cort.

FoundryTreatment Center Steamboat developed a specific treatment track for people affected by cannabis use disorder (CUD) because the condition poses specific challenges. In 2000, Ben co-authored the first published best practices on treating CUD alongside Dr. LaTisha Bader in a medical text and reference book entitled Cannabis In Medicine and Evidence-Based Approach. He has spent the years since working to educate clinicians and medical professionals in our field on these practices. Many people experiencing cannabis use disorder suffer from extended periods of cannabis-induced psychosis and must be safely housed and medically supervised until their symptoms subside enough for them to start treatment programming.