Cannabis Used For Stress Relief

Stress Reduction is a nearly universal benefit of cannabis use.  Psychiatrist Tod Mikuriya, M.D. noted.

“Continued use [of marijuana] exhibits a much more controlled pattern of mood management through a mild stimulation with low repeated inhaled doses.”  

Scientific research supports the medical use of cannabinoids in anxiolytic (stress-reduction) therapies.
In practice, many patients report more than one indication.  One of the most important uses of cannabis is as a substitute for other, more dangerous or costly pharmaceutical drugs.  Many patients report substantial reductions in use of narcotics, non-steroidal anti-inflammatories, anti-depressants, tranquilizers, sleeping pills and other drugs. 

Cannabis and Stress Anxiety

In recent IDMU surveys, relaxation and stress relief were overwhelmingly the most commonly perceived benefits of cannabis use. However, the Department of Health identifies panic attacks and anxiety as effects of acute cannabis intoxication, particularly among naive users, in justifying the refusal of the UK Government to permit the prescribing of cannabis.

Recent advances in fundamental cannabinoid research have been interpreted as indicating a common modality of action of cannabis and opiate drugs, in that naloxone (an opiate antagonist) blocks cannabinoid-induced dopamine release in the limbic system (a primitive brain structure associated with control of emotion and mood) and the a cannabinoid antagonist administered to rats, pretreated with a powerful synthetic cannabinoid agonist, can precipitate corticotrophin releasing factor (CRF) which is held to be the mechanism responsible for mediating the psychological aspects of drug withdrawal symptoms, and leading to anxiety-type behaviours. This was interpreted as demonstrating a cannabis withdrawal syndrome, however the potency of the synthetic cannabinoid used was many times that of THC, and the administration of an antagonist (blocker) would not effectively mimic the gradual decrease in plasma THC which occurs with cessation of normal use.  The fact that a potent cannabis blocker caused anxiety symptoms in rats would be consistent with a general diminution of anxiety levels arising from cannabis use.

Laurie  reported that in a few cases 'anxiety, which may approach panic, often associated with a fear of death or an oppressive foreboding is infrequently seen, usually giving way to an increasing sense of calmness to euphoria'. 

Grinspoon refers to the initial state as a 'happy anxiety' where the experience is internally redefined as pleasurable.

Rosentha l reports that panic reactions and anxiety are rare, and most commonly found with overdose (particularly from oral preparations), in naive users, or in those who do not like the effects of marijuana, and attributed the incidence of anxiety reports with Marinol (dronabinol – pure THC) to the lack of CBD within the preparation. 

Mikuriya considered that 'the power of cannabis to fight depression is perhaps its most important property'.  Patients were reported to self-medicate with cannabis rather than use benzodiazepines as the former produced less dulling of mental activity.  The authors cited one study where marijuana was found to increase anxiety in naive users,  but to decrease anxiety in experienced users,  and another of 79 psychotics who used marijuana recreationally and reported less anxiety, depression, insomnia or physical discomfort,  and concluded that natural marijuana containing CBD and THC  appeared more effective than THC alone in treating depression, and that patients suffering stress as a result of pain or muscle spasms would be most likely to be helped by the drug.  They differentiated the use of cannabis to cope with everyday life stresses from the use of benzodiazepines in treating 'severe anxiety disorders' with an organic aetiology.

  • Bello in a passionate treatise on the benefits of cannabis for physical and mental health, likened the anxiolytic effect of marijuana to a state of relaxed alertness brought on by 'balancing' the autonomic nervous system.

Explanations of the panic and anxiety experienced by some naive users exposed to cannabis would include 'set and setting' i.e. a drug taken in the course of a laboratory experiment would provide different expectations of an experience to an informal party or gathering of friends,  secondly the increase in heart rate can be interpreted by some older users as a heart attack and cause panic attacks,  this 'tachycardia' is normally associated with a reduction in blood pressure, the combined effect is analogous to changing down a gear in a motor vehicle.  Some individuals may be more susceptible to the effects of cannabis than others, and those whose initial experience is unpleasant may be more likely to discontinue use of the drug.  By contrast, many first-time users fail to notice the influence of the drug.

  • Thompson & Proctor,  treating withdrawal conditions, noted the synthetic cannabinoid pyrahexyl to produce significant increases in alpha brain waves, indicating increased relaxation, and Adams reported similar results.  However,  Williams found no significant increase in alpha activity either with parahexyl or smoked marijuana.
  • Davies,  in a study of cancer patients, considered the management of stressful patients to have been improved by oral THC.  However a study of intravenous THC used as a premedication for oral-facial surgery found that patients showed pronounced elevation of anxiety, and considered noxious stimuli to be more painful.  Mechoulam, considered a number of synthetic cannabinoids to be worthy of investigation as potential sedative-relaxants.
  • In laboratory animals, the cannabinoid receptor has been linked to modulation of emotional behavior reinforcement,  learning and memory .  Musty   compared the effects of THC, CBD (cannabidiol) and diazepam (valium) on anxiety-related behaviours in mice.  THC produced similar reductions in anxiety behaviours to diazepam, however the effect of CBD was more pronounced than either in measures of shock-avoidance, grooming and reduction of delerium tremens in alcohol-withdrawn mice.  Both THC and CBD produced dose-related reductions in ulcer formation in stressed mice.  However in all tests the CBD dosages used were higher than THC dosages.
  • Mechoulam reviewed studies of Nabilone (synthetic cannabinoid) on anxiety, finding two studies which suggested a superior effect on anxiety,  mood and concomitant depression,  whereas two other studies found little or no effect.  Benowitz & Jones reported initial tachycardia and hypertension in volunteer subjects administered up to 210mg THC per day,  but found development of tolerance to tachycardia and CNS effects over the 20 day experiment, with blood pressure reduced and stabilised at around 95/65.  Fabre & McLendon  reported a dramatic improvement in anxiety in the nabilone-treated group compared to placebo.  Nakano reported anti anxiety effects of nabilone and diazepam in a controlled trial of experimentally-induced stress, but was unable to conclude which was more effective due to differences in dosage and metabolism.  Hollister reported these and other nabilone studies indicating significant anti-anxiety effects of low doses, and commented on the scarcity of studies of potential anti-anxiety effects of cannabinoids.

Post-Traumatic Stress Disorder:

I am unaware of any controlled scientific studies in published journals which investigate the use of cannabis as a treatment option for post-traumatic stress disorder, although several studies of this condition make reference to cannabis use by patients.  In a study of female drug clinic patients with histories of post-traumatic stress disorder following physical or sexual abuse,  Gil-Revas reported  "contrary to expectation, PTSD is not associated with relapse to drug use".   Clark  found PTSD to be a common diagnosis among a group of alcoholic adolescents, who also showed high rates of cannabis and hallucinogen use,  considering the relationship to reflect a comorbid disorder.  DeFazio studied Vietnam veterans, finding a higher incidence of PTSD symptoms among combat, compared to non-combat groups,  the relationship to cannabis use is unclear,  but may reflect a coping strategy, where the use of marijuana by US troops during combat has been widely-documented,  which typically ceased upon return to civilian life.

Dr. Sue Sisley of St. Joseph's Hospital:

To deny those with PTSD suffering from psychological trauma and terrifying flashbacks access to a natural herb that is scientifically proven to provide them with relief is simply outrageous.
By allowing PTSD to be treated with medical marijuana, physicians can help patients treat their condition with cannabis and assist the patient in using cannabis in a manner that is safe and most effective for the particular patient.
Physicians can be re-assured that there is an ample body of medical literature that supports the beneficial use of cannabinoids.   Studies teach us that we have our own cannabinoid receptors in our internal cannabinoids, and these should be modulated as they are proven to reverse effects of stress and help with retention of aversive memories,  promote neurogenesis,  and can reduce nightmares,  fear,  anxiety,  mood disorders and other PTSD symptoms.

Study by Dr. Akirav:

According to Dr. Akirav, the results of this study show that cannabinoids can play an important role in stress-related disorders.

Refining the results of this study, the researchers then administered marijuana injections at different points in time on additional groups of rats, and found that regardless of when the injection was administered,  it prevented the surfacing of stress symptoms.
Dr. Akirav and Ganon-Elazar also examined hormonal changes in the course of the experiment and found that synthetic marijuana prevents increased release of the stress hormone that the body produces in response to stress.


Phoenix Sun Times 

St. Joseph's Hospital in Phoenix Arizona

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