Cannabis for PTSD and Anxiety: Risks and Uncertain Benefits

Introduction to Risks and Benefits

• A 2023 systematic review concluded that no recommendation was possible regarding cannabis use for anxiety or depression in any population due to lack of primary outcome data 1

The Well-Documented Harms

Worsening Mental Health Conditions

• Cannabis use is associated with increased risk for developing depressive disorders and may exacerbate existing psychiatric disorders in vulnerable individuals 2
• High doses of THC are associated with psychotic symptoms 2

Substance Use Disorder Risk

• Approximately 10% of adults with chronic cannabis use develop cannabis use disorder, characterized by clinically significant impairment 2
• A randomized trial found participants receiving a medical cannabis card had almost twice the incidence of developing cannabis use disorder within 12 weeks compared to controls 2
• Early onset cannabis use strongly predicts future dependence 2

Cardiovascular and Other Risks

• Cannabis is associated with adverse cardiovascular events including arrhythmias, orthostatic hypotension, myocardial infarction, and stroke 2, 3
• Cannabis users are more than twice as likely to be involved in motor vehicle crashes 3
• Older adults face higher risk of confusion, falls, and behavioral health issues including anxiety and depression 2

Clinical Implications

• The 2024 ASCO guideline states that evidence remains insufficient to recommend for or against cannabis for managing symptoms outside specific cancer-related contexts 4
• Benefits have not been proven - the data quality and quantity are inadequate to establish efficacy 4
• Risks are well-documented - psychiatric harms, substance use disorder, cardiovascular events, and impaired functioning are established 2