Australia has seen a growing interest in cannabis for anxiety relief. The medicinal community has grown exponentially, giving patients better access to alternative remedies. It’s an exciting time to be a practitioner, but it entails careful consideration.
What role does cannabis have in treating anxiety? Tailored prescriptions with different compounds could offer unique benefits. We’re here to help you find the right combo, whether it’s more THC, CBD, or a balanced ratio of both.
Our comprehensive guide covers all you need to make informed prescription decisions.
Understanding anxiety
Mental health is a topic of importance across the world. Various disorders affect many individuals, with the most prevalent being anxiety and depression.
According to the Australian Institute of Health and Welfare, 3.4 million people live with anxiety disorders.¹ That’s 17% of the population. This data is from 2019–2020, and the number of sufferers has risen since then.
Anxiety is normal to experience. It’s part of the body’s natural fight-or-flight response in certain situations. An exam, social conflict, interview, schoolwork, or job could cause anyone to be anxious.
Below are 12 common physical and mental effects of anxiety:
- Difficulty breathing
- Increased heart rate
- Dry mouth
- Restlessness
- Dizziness
- Upset stomach or disrupted metabolism
- Sweating
- Blurred or tunnel vision
- Weakness
- Poor memory or brain fog
- Muscle tension
- Dissociation or concentration issues
These symptoms may be common among anyone experiencing acute anxiety. Your patient could have a disorder if the feelings are recurring and severe. They feel helpless, uncomfortable, and powerless.
Anxiety disorders are more severe, as they involve prolonged symptoms. Patients may experience increased levels of stress, worry, fear, and similar feelings. These can lead to distress or functional impairment in daily life.
Understanding the different types helps to plan your prescription. Below is an overview of each:
- Social anxiety disorder. Involves heightened fear when facing social situations. Individuals typically get anxious about judgement or performance pressures in public. It could cause them to avoid people and spend most of their time in isolation.
- Agoraphobia. Involves fears of specific situations or places that might cause feelings of entrapment. They could be open or enclosed spaces, elevators, or public transport.
- Generalised anxiety disorder (GAD). Involves consistent and excessive worrying about various situations. The triggers could be from work, finances, social interactions, or health. The worry usually persists for longer than six months.
- Phobias. Some people have intense fears related to a specific situation, entity, or object. They may be scared of heights, certain animals, needles, or shadows. The perceived danger is typically far more intense than the actual threat.
- Panic disorder. These individuals experience sudden, unexpected, and recurring panic attacks. The symptoms could happen even without triggers or apparent danger. They may cause feelings of helplessness and fear of future attacks.
- Separation anxiety disorder. Involves heightened fears of being separated from loved ones. It can include panic attacks and nightmares and disrupt daily activities. Children are more prone to developing it, but it can also affect adults.
Anxiety disorders are highly treatable. Psychotherapy, or talk therapy, is a common solution. Some may benefit from a combination of medication and cognitive behavioural therapy (CBT).
Some commonly prescribed medications are controversial. The Therapeutic Goods Administration (TGA) requires boxed warnings on opioid products.² Some anti-anxiety drugs like Alprazolam and other benzodiazepines might cause physical dependence or withdrawal.
That’s where cannabis for anxiety may be a worthy alternative.
Cannabis and anxiety: Unravelling the connection
Cannabis has gained recognition and approval worldwide for treating various conditions. Anxiety disorders account for the second highest reason for prescriptions in Australia.³ Chronic pain is the most common.
The basics of cannabis treatment involve understanding the endocannabinoid system (ECS). This biological network manages several processes, like hunger, sleep, cognition, and immunity.
The ECS has two primary components, the CB1 and CB2 cannabinoid receptors. It also contains endocannabinoids like 2-AG and anandamide. These molecules modulate anxiety and fear by interacting with CB receptors.⁴
Phytocannabinoids may also aid in modulating the ECS. Patient-reported use of medical cannabis shows 50% of users praising it for anxiety relief.⁵ It contrasts the figure against 34% using it for depression and 64% for pain.
The role of CBD in anxiety management
CBD is one of the primary compounds showing promise in cannabis for anxiety. It doesn’t have psychoactive effects and isn’t intoxicating. The cannabinoid was the first to gain legal medicinal recognition worldwide.
Insights from preclinical research in 2021 looked at cannabidiol as a potential treatment for anxiety and mood disorders. It outlined various evidence and positive outcomes. They labelled CBD as a “promising new agent in the treatment of anxiety and mood disorders.”.⁶
Another study showed CBD increased ethyl cysteinate dimer (ECD) uptake in the right posterior cingulate gyrus. It reduced ECD uptake in the hippocampus, parahippocampal gyrus, and inferior temporal gyrus.⁷
The results from the study suggested reduced anxiety in individuals with generalised social anxiety disorder (SAD). It related this outcome with CBD’s effects on activity in the brain’s limbic and paralimbic areas.
Prescribing CBD usually involves tinctures, edibles, or smokable hemp flowers. Topicals only treat external issues, like skin conditions or inflammation. Ingesting the cannabinoid is more suitable for potentially relieving anxiety.
Many anecdotal reports praise CBD when using cannabis for anxiety. It’s popular for promoting mental and physical relaxation. These effects may combat anxious and stressful feelings.
The ideal CBD dosage varies across patients. Starting them low at around 10–20 mg once daily is best. You may increase it gradually until you find the optimal amount that combats anxiety.
A case report on the treatment of social anxiety disorder examined CBD’s effects in a 20-year-old male. He reported significant symptom reduction when taking 800 mg daily.⁸
Requesting analysis certificates for CBD products is crucial. THC contamination is a common problem, and some patients don’t react well to it. Isolates are the best option.
THC and anxiety: The balancing act
Limited clinical evidence exists surrounding THC’s positive effects on anxiety. The cannabinoid is well-known for inducing psychoactive feelings.
THC can be anxiolytic or anxiogenic, depending on the patient. The former reduces anxiety, while the latter increases it.
Anecdotal evidence speaks positively about THC in cannabis for anxiety. Reports include mood improvements, better sleep, and increased relaxation. Some claim it also helps them combat negative thoughts and traumatic memories.
THC dosing and administration differ from CBD. The starting amount is usually around 2.5 mg once or twice daily. Cannabis products may contain varying CBD:THC ratios, for example, 10:1.
Consider terpenes when suggesting strains. Some of them, like myrcene, pinene, limonene, and linalool, could combat anxiety. Sativas with lower THC levels may also be more effective.
Assessing your patients for eligibility
Conducting thorough patient evaluations is the first step in prescribing cannabis for anxiety. The initial consultation determines whether the treatment is right for them. Gathering their information also helps you optimise patient outcomes.
Below is a checklist to follow when collecting your patient’s history.
- Family and personal mental health. This includes a history of individual or genetic mental illnesses, especially schizophrenia.
- Physical health and medical history. Determine whether they’ve had liver, cardiovascular, or renal disease before.
- Current symptoms. How severe are the feelings of anxiety? Determine if they have a previous diagnosis, or assess them for one of the primary disorders.
- Medications. Check if they’re currently on other treatments. Ask them which past regimens they’ve tried that didn’t work for them.
- Risks and responsibilities. Find out if the patient has “at risk” behaviours related to substance abuse or drug dependence. Consider their family responsibilities, child safety, and work demands.
Your patient may have already tried cannabis for anxiety relief. Encourage them to be open with you, as it helps you curate a better treatment plan. Remind them that legal medicinal products are of higher quality and more consistent.
Crafting individualised treatment plans
Determining an ideal treatment plan involves comprehensive knowledge and experimentation. Aim to get your patients onto the minimum effective dose (MED). You want the lowest amount that provides the desired benefits. Going higher could cause adverse effects.
Gathering patient characteristics helps to establish appropriate dosages. Different ages have unique metabolisms and endocannabinoid systems. Individual tolerance and desired outcomes can also help you find the right prescription.
Patient education and discussing potential side effects
Patient education is equally important as your own. Using cannabis for anxiety offers several benefits, but it may also have downsides.
Below are six considerations to discuss with your patients before committing to treatment.
- Share an extensive list of potential benefits, risks, and alternative options.
- Inform them about the difference between approved and unapproved products. Share information about the TGA and their role in regulation.
- Outline the potential costs of treatment. Include monthly expenses and the possibility of increases if the dose changes.
- Ask if they’re willing to remain open and honest with you. Encourage them that doing so will help both parties find the ideal treatment.
- Discuss their privacy and consent. Ask if you can share their information with other healthcare professionals. Explain that it could also help you find the best solution if necessary.
- Discuss the laws about driving while using cannabis for anxiety. It’s legal to operate a vehicle after using CBD, but not under the influence of THC.
Cannabis products often come with a grapefruit warning. The ingredients in the food may interact negatively with CBD and THC.⁹ Ask your patient to take precautions to avoid consuming them together.
Encourage holistic approaches to mental health. Cannabis and other treatments may help, but a healthy lifestyle is optimal. Mindfulness meditation, deep breathing, and regular exercise could combat anxiety. Sufficient sleep and nutrition may also reduce symptoms.
Collaborating with patients and healthcare providers
Building open communication channels with patients is vital for positive outcomes. Be authentic with them, and they’ll do the same. Your initial consultation should focus on formulating a base goal and schedule.
Below is a checklist for outlining a plan when prescribing cannabis for anxiety.
- Treatment goals. Establish a mutually agreeable outcome the patient would like to achieve. Provide clear dosages and instructions with every prescription.
- Informed consent. Provide your patient with all the information they need before writing a prescription. Ensure they understand everything about the cannabis product and treatment plan. Share other patient experiences with them to encourage peace of mind.
- Monitoring. Encourage your patient to track their progress in a journal. Ask them to bring it to each consultation so you can see how they’re doing. Remind them of the importance of paying attention to benefits and side effects.
- Follow-ups. Set up regular check-ins, particularly during the initial titration stages. Encourage your patient to book their next appointment before leaving each session.
- Risk management. Some patients may need controlled dispensing if you’re concerned about them self-dosing. Encourage them to report back with any side effects they experience or worries they have.
- Exit strategy. Discuss an end goal with your patient. Explain that you may explore alternative treatments if cannabis isn’t working.
Prescribing cannabis for anxiety is a fine art. Collaborating with other healthcare professionals is beneficial, particularly when facing unique cases. You may also need to refer your patient to a specialist if they require psychiatric help.
Empower yourself and others with PlantEd’s courses
Anxiety affects many people in various aspects of life. Recurrent symptoms may indicate a disorder, which is usually remediable. Some patients don’t respond well to conventional treatments, but cannabis might help.
THC, CBD, and various terpenes and cannabinoids each have promising potential. Each compound may affect patients uniquely, so finding the right regime is crucial.
Establish an individualised treatment plan, ensure open communication, and make regular follow-up appointments. Prescribing cannabis for anxiety involves experimentation and personalisation. You may need to consult with other professionals to find the right approach.
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References
- Australian Institute of Health and Welfare. (2024). Prevalence and impact of mental illness - Mental health. Australian Institute of Health and Welfare. https://www.aihw.gov.au/mental-health/overview/prevalence-and-impact-of-mental-illness
- Therapeutic Goods Administration. (2019). Opioids: boxed warning and class statements. Therapeutic Goods Administration (TGA). https://www.tga.gov.au/resources/resource/guidance/opioids-boxed-warning-and-class-statements
- Arnold, J. C., Nation, T., & McGregor, I. S. (2020). Prescribing medicinal cannabis. www.nps.org.au, 43(5). https://doi.org/10.18773/austprescr.2020.052
- Patel, S., Hill, M. N., Cheer, J. F., Wotjak, C. T., & Holmes, A. (2017). The endocannabinoid system as a target for novel anxiolytic drugs. Neuroscience & Biobehavioral Reviews, 76 (Part A), 56–66. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5407316/
- Kosiba, J. D., Maisto, S. A., & Ditre, J. W. (2019). Patient-reported use of medical cannabis for pain, anxiety, and depression symptoms: Systematic review and meta-analysis. Social Science & Medicine, 233, 181–192. https://doi.org/10.1016/j.socscimed.2019.06.005
- Melas, P. A., Scherma, M., Fratta, W., Cifani, C., & Fadda, P. (2021). Cannabidiol as a Potential Treatment for Anxiety and Mood Disorders: Molecular Targets and Epigenetic Insights from Preclinical Research. International Journal of Molecular Sciences, 22(4), 1863. https://doi.org/10.3390/ijms22041863
- Crippa, J. A. S., Derenusson, G. N., Ferrari, T. B., Wichert-Ana, L., Duran, F. L. S., Martin-Santos, R., Simões, M. V., Bhattacharyya, S., Fusar-Poli, P., Atakan, Z., Santos Filho, A., Freitas-Ferrari, M. C., McGuire, P. K., Zuardi, A. W., Busatto, G. F., & Hallak, J. E. C. (2010). Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: A preliminary report. Journal of Psychopharmacology (Oxford, England), 25(1), 121–130. https://doi.org/10.1177/0269881110379283
- Berger, M., Li, E., & Amminger, G. P. (2020). Treatment of social anxiety disorder and attenuated psychotic symptoms with cannabidiol. BMJ Case Reports, 13(10), e235307. https://doi.org/10.1136/bcr-2020-235307
- Thorpe, M. (2017). Grapefruit Warning: It Can Interact With Common Medications. Healthline; Healthline Media. https://www.healthline.com/nutrition/grapefruit-and-medications