Anxiety is the primary reason given by patients for use of medical cannabis

Anxiety has moved to the top of the list of reasons why people enroll in medical cannabis programs. The shift is forcing a hard look at what the science actually shows and what the policy change might signal to patients.

The state of Pennsylvania added anxiety disorders and Tourette syndrome to its list of qualifying conditions, and that timing now matters a lot. The decision came through a formal Department of Health notice.

Anxiety and medical cannabis policy

Coleman Drake, an associate professor at the University of Pittsburgh School of Public Health, led a team that set out to measure what happened after that policy change.

The team collected and analyzed certification records covering years before and after the new rules took effect.

The work focused on the real world program, not a lab exercise. It asked how a single addition to the qualifying list reshaped who gets certified and why.

The project did not try to judge patient motives or second guess doctors. It stuck to counts, timing, and diagnoses that appear on official certificates.

What the numbers show

Across more than 1.7 million medical cannabis certifications, anxiety rose to the top diagnosis while the number of certifications issued each month nearly tripled over the study window, and chronic pain’s share fell.

Those results come from a peer reviewed study of Pennsylvania’s records.

Before the change, chronic pain dominated. After the change, anxiety accounted for about 60 percent of certifications while chronic pain and post traumatic stress disorder made up smaller shares.

The data set could not tag whether patients were brand new to the program or simply added anxiety to an existing record.

That gap means the analysis cannot say how much the overall patient count grew because of the rule change.

What science actually knows

Evidence for cannabis as a treatment for diagnosed anxiety disorders, conditions that involve excessive fear or worry that disrupts daily life, remains limited and mixed.

A 2021 systematic review of controlled trials found insufficient evidence for either THC or CBD to treat anxiety disorders.

Research on specific cannabinoids, the active chemicals in cannabis such as THC and cannabidiol, continues to evolve.

A 2024 systematic review of randomized trials suggested CBD may reduce anxiety compared with placebo in some studies, but sample sizes were small and results conflicted across disorders.

Randomized evidence is still thin, and most studies track short term symptoms rather than long term functioning. That leaves clinicians and patients without clear guidance on product type, dose, and duration.

Why policy choices matter

“Adding anxiety to the program may inadvertently signal to patients that cannabis is effective for treating it, despite the lack of evidence, which is concerning,” said Drake.

The environment around cannabis is changing fast, and use is common in the United States. In 2022, about 22 percent of people aged 12 or older used marijuana in the past year, according to a national report.

When a state lists a condition, many people read that as a signal of efficacy. Clinicians then face questions about efficacy that the evidence cannot yet resolve.

Regulations on anxiety and cannabis

Pennsylvania was only the third state to add anxiety as a qualifying condition in 2019, but others have since followed.

States such as New Jersey and North Dakota now allow anxiety disorders in their medical cannabis programs, though the rules differ on which subtypes of anxiety qualify and how certifications are monitored.

Policies vary widely across the country, with some states listing specific psychiatric conditions while others exclude them entirely.

These differences reflect the ongoing debate among regulators about whether evidence is strong enough to justify including anxiety in medical cannabis programs.

What this means for patients

If you are considering medical cannabis for anxiety, begin with a full evaluation and a candid talk about goals and risks.

Ask about interactions with current medications, potential adverse effects, and how progress will be measured over time.

There are established treatments with strong evidence for many forms of anxiety, including cognitive behavioral therapy and certain medications.

Discuss how any trial of cannabis would fit into a broader care plan rather than replace proven options outright.

For those already enrolled, track your own outcomes with simple notes on sleep, panic symptoms, and daily functioning. Share those notes at follow up visits so that care can adjust based on actual results, not hopes.

Cannabis, anxiety, and mental health

Future studies need well designed randomized controlled trial methods, which compare a treatment to a matched placebo while balancing key patient features across groups.

Trials should test defined products with known THC and CBD content, steady dosing, and follow people for months, not days.

States could also help by modernizing reporting systems that anonymize and link certifications to outcomes. With better data, policymakers would not have to guess at how rule changes affect care and safety.

The study is published in Annals of Internal Medicine.

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