When Should Cannabis be Considered for the Management of Anxiety?
Cannabis is not a first-line treatment
In comparison to most other pharmacological treatment options, there is generally less evidence supporting the role of medical cannabis for a variety of conditions. Medical cannabis is rarely considered a first-line treatment option for the management of any medical condition.
Consider medical cannabis in patients not reaching treatment goals
There are many patients with anxiety and anxiety-related disorders who are not reaching treatment goals with the recommended treatment options of psychological and/or pharmacotherapy.1 Some patients with these conditions also have contraindications or cannot tolerate many of the treatment options due to adverse effects or potential risks (e.g. dependence with benzodiazepines).
Cannabis can be considered as a treatment option in patients who have adequately tried first-line treatment options and have not experienced significant results.
Cannabis for anxiety in the experienced user
Cannabis is one of the only pharmacotherapy options where a patient may have tried it for their condition/symptoms prior to seeing their clinician. This can provide insight on the relative effectiveness of cannabis for conditions and symptoms such as chronic pain, anxiety and insomnia. In a patient who self-reports cannabis use, it is important for clinicians to assess:
When cannabis was last used
Frequency of use
Amount of use
Method of administration
Response to cannabis
Adverse effects of cannabis use
Strain or chemovar used (if known)
This information can provide clinicians with important information on whether cannabis may be effective for this patient.
Consider cannabis in patients with anxiety and other chronic condition(s)
Health Canada’s Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the cannabinoids found a small number of studies demonstrating a role of medical cannabis in patients experiencing symptoms of anxiety and/or depression secondary to chronic diseases (e.g. patients with HIV/AIDS, MS, and chronic neuropathic pain).2
Consider cannabis in patients who are experiencing anxiety and have multiple conditions/symptoms which may respond to medical cannabis. Clinicians may consider cannabis earlier in the course of treatment due to the potential benefits across multiple symptomology.
Cannabis can be considered as an adjunct
Medical cannabis can be considered as an adjunct to traditional treatments for mental health disorders such as anxiety. This may allow the patient to use lower doses of traditional agents or have a more robust response than with his/her current treatment options.