Cannabis Use and Anxiety in Adults

Risks of Anxiety Exacerbation

High doses of THC are associated with psychotic symptoms and can precipitate severe anxiety, especially in vulnerable individuals 1, 2, 3.
Cannabis can potentiate the unwanted side effects of some anxiety medications, so they should be avoided when taken simultaneously 1, 4.
Adults who use cannabis have a higher risk of behavioral health problems, including anxiety and depression 3, 5.

Daily, long-term cannabis users may experience withdrawal symptoms after cessation, including anxiety, irritability, restlessness, sleep disturbances, changes in appetite, and abdominal pain 6, 7.

A systematic review in 2023 concluded that no recommendation could be made on the use of cannabis for anxiety or depression in any population due to the lack of primary outcome data 5.
The ASCO guideline from 2024 states that evidence remains insufficient to recommend for or against cannabis for managing symptoms outside of specific cancer-related contexts 5.

Approximately 10% of adults with chronic cannabis use can develop cannabis use disorder, characterized by clinically significant impairment or distress 6, 3, 7.
Early onset of cannabis use, especially weekly or daily use, strongly predicts future dependence 6, 3, 7.
Cannabis is associated with adverse cardiovascular events, including arrhythmias, orthostatic hypotension, myocardial infarction, and stroke 3, 5, 7.
Cannabis users are more than twice as likely to be involved in motor vehicle accidents 6, 3, 5.

The American Society of Clinical Oncology recommends that cannabis should not be prescribed as a treatment for anxiety disorders due to the lack of proven benefits and well-documented risks 5.
Physicians should engage in open and unbiased conversations about cannabis use with patients 6, 7.
If a patient decides to use medical cannabis, they should inform their medical team to evaluate objectives, THC and CBD content, frequency of use, administration route, and perceived effects 1, 2, 4.
Physicians should carefully consider the potential risks and benefits when prescribing medical cannabis for anxiety disorders and should "start low and go slow" 1, 2, 4.
Cannabis should be avoided if there is a history of psychotic episodes or breaks with reality 1, 2, 4.