Marijuana for Medical Use May Result in Rapid Onset of Cannabis Use Disorder

Medical marijuana use continues to be decriminalized across the country, as marijuana is now legal for medical use in 38 states. A new study published in JAMA Network Open, however, found that marijuana use to treat pain, anxiety, and depression doubled the risk of developing Cannabis Use Disorder (CUD).

This research found that individuals who used medical marijuana for anxiety and depressive symptoms were at the greatest risk of developing CUD, while it failed to treat those mental health conditions or pain.

With medical marijuana use, individuals often select their own dosages and strains to address pain, depression, and anxiety, but this study's findings suggest the need for further outreach services.

Understanding the Research

This randomized clinical trial included 186 participants, whereby immediate acquisition of a medical marijuana card (rather than waiting and assessing the client for fit over a 12-week period) increased the incidence and severity of CUD, with minimal improvement with pain, anxiety, or depression.

Researchers found that participants did report improved sleep, but recommend further investigation of medical marijuana regarding the risk of developing CUD.

A limitation of this study was a lack of diversity regarding race, ethnicity, education levels, and more.

Physician Oversight Can Support Beneficial Medical Marijuana Use

Julian Lagoy, MD, a psychiatrist with Mindpath Health, says, “We should be more careful about distributing medical marijuana for those who are using it for depression, anxiety, and pain."

Dr. Lagoy explains, "Cannabis has a very relaxing effect on the body which can be beneficial for anxiety. Cannabis also increases dopamine in the brain which helps one feel pleasure and this is why it is used to treat depression."

To prevent CUD, Dr. Lagoy recommends more regulation and oversight from treating physicians. "I would encourage those who are using cannabis to treat anxiety and depression to urge their physician to help them with the appropriate dosing and strains of the cannabis treatment," he says.

Dr. Lagoy highlights, "Cannabis, just like any medication, needs to be distributed safely in order to have maximum benefit. If we let those who use cannabis choose their dose and strain, it is more likely to be misused."

Given these research findings, Dr. Lagoy notes that physicians need to think twice about recommending cannabis to treat anxiety, depression, and pain. "If patients do use cannabis for this purpose there needs to be more oversight by physicians so patients get the most out of the treatment and patients are less likely to develop cannabis use disorder," he says. 

Dr. Lagoy explains that marijuana, like many medications, can be most beneficial when prescribed safely with physician oversight; however, they can be abused and lead to problems if they are not used correctly.

Having had patients benefit from marijuana, Dr. Lagoy highlights the need for physician oversight to minimize the risk of developing CUD. "Cannabis can be very helpful medically; however, it needs to be used safely with instruction from professionals in order to have maximum benefit," he says.

Assessing Whether Cannabis Treatment May Be Appropriate

Matt Glowiak, PhD, LCPC, a therapist and advanced addiction specialist who is an expert in addiction, substance and alcohol abuse, recovery and treatment, says, "The findings are clinically consistent with what might be anticipated given symptomology for affective disorders and cannabis use."

Glowiak explains, "When administering cannabis to an individual, it is important to consider one’s physiology, the extent of the diagnosable condition for which it is being prescribed, one’s addiction potential/history of substance use, and what would prove an efficacious dose."

Alleviating an individual’s symptoms without experiencing a substantial euphoric high is ideal, according to Glowiak. "For those where cannabis is an appropriate treatment, they may find reduced symptoms to the extent of feeling more relaxed, worrying less, and not dwelling on the past," he says.

Glowiak highlights, "It may also help increase appetite and improve sleep. For those where cannabis is not an appropriate treatment, the opposite may happen. Effectual symptoms of anxiety and depression heighten."

In some cases, Glowiak notes that individuals may believe that the dose prescribed is inappropriate and begin using more or less. "For those who use more, there is an increased risk of CUD," he says.

Glowiak explains, "Though individuals should exercise caution when using cannabis recreationally, medical professionals are and should be on the line for the administration of any drug treatment program."

If administered and taken as intended, the likelihood of positive outcomes increases, but if not, Glowiak notes that further problems can arise, especially when providing a medical marijuana card immediately.

Glowiak highlights that although cannabis is less dangerous than many other substances, it still poses risk, especially for those who seek a “high” and continue to use cannabis while integrating other drugs and/or alcohol.

As with any mental health concern, Glowiak recommends therapy. "Although medication can do wonders insofar as curbing symptoms to help put an individual at ease, it does not always solve problems," he says.

Addiction May Stem from Avoiding Pain

Hailey Shafir, LCMHCS, LPCS, LCAS, CCS, a licensed clinical mental health counselor and addiction specialist who specializes in addiction, recovery, psychedelic therapy, and trauma, says, "This study is further proof that addiction is more about avoiding pain than it is about seeking pleasure."

Shafir explains that most people who develop addictions have been using drugs or alcohol to escape some form of physical or psychological pain, instead of for social, recreational, or enjoyment purposes.

Since both physical and emotional pain, as linked to chronic health or mental health issues, can cause additional stress, Shafir explains that it can cause people to develop a physical or psychological dependence on a drug.

Shafir highlights, "Cannabis can have very different effects on each individual. For some, marijuana can actually increase symptoms of anxiety, even causing paranoid thoughts or psychosis."

In chronic or heavy users, Shafir notes that marijuana can have a sedating effect, which can mimic or worsen symptoms of fatigue, low motivation, and loss of interest common in people who are depressed.

While some people do report an improvement in their mental health when they use marijuana, Shafir underscores that there is no guarantee that marijuana will help anxiety or depression, and may make it worse.

Shafir explains, "Different strains and doses can definitely cause different effects, but these can still vary. For example, a person's personality traits, neurobiology, and genetics can all change the way they respond to a substance, as well as their individual risk of becoming addicted."

Most people correlate the word addiction to a physical dependence on a substance, but Shafir cautions against discounting the role of psychological addiction, as a regular user of marijuana may not have physical withdrawals when they cut back but can still experience cravings, irritability, etc.

Shafir explains, "When people consider that addiction is more about avoiding or escaping pain than seeking pleasure, it helps to reduce some of the stigmas against 'addicts' in society, who are often people trying to cope with stress or symptoms of a physical or mental health disorder." 

Some people get confused between CBD and cannabis or marijuana, so Shafir notes that CBD is a compound of marijuana that has been found to have therapeutic and medicinal value in treating a variety of issues.

The difference between CBD products and cannabis is that CBD does not contain THC, which Shafir explains is responsible for the "high" users feel, that is known to alter a person's mood, thinking, decision-making, and so on.