Marijuana and Anxiety: A Complicated Relationship

September 9 Jake Irl Park, M.S.

In my graduate program, I began seeing clients in the University’s psychology clinic in my second year. My first client was a gargantuan man with an exceptionally violent history. 

When I opened the door to the waiting room before our first session, his eyes instantly locked with mine. Before greeting each other, he was visibly agitated: His legs were bouncing and his fingers couldn’t seem to find a comfortable position. 

After we exchanged names, we started walking to our room to begin. It was a short walk, but apparently the session couldn't wait.

“I’m having a f*#%ing panic attack,” he said. If you’ve had a panic attack, you know that they're no joke. For those who aren’t familiar, a common symptom is to feel as if you are literally dying. Rational thoughts go out the window and your mind and body are dead set on surviving a threat that you cannot see, hear, or touch. It is complete and utter helplessness, especially if you don’t have the tools to combat them. 

I was now having my own brush with panic. 

“Okay, let’s get to the room and we’ll take care of it.” My walk became a light jog. 

When we sat down, my client immediately reached into his pocket, pulled out a battered Altoid tin, ate a couple of “mints,” then stared at me, emotionless.

“You said you were having a panic attack?”

“No, I’m good now.” He said.

“What was that in your tin?”

“My Klonopin. It helps when that happens.”

I was relieved and horrified. He had ingested God knows how many milligrams of clonazepam and it managed to control his panic attack before it hit his stomach. Clozepam takes about 45 minutes to take full effect. 

The prescription medication acted as an extreme example of what’s called a “safety signal.” Almost anything can be a safety signal: A person, a clinician, drugs, even food or drink. They become indicators that you are going to be “safe” from whatever fear that precipitates panic. These signals are very effective at alleviating anxiety or panic in the moment, but with a significant caveat:

If the safety signal is removed, the fear and anxiety come back with a vengeance. 

Frequent use of safety signals can often lead to unintended effects. They offer a way to avoid or reduce anxieties directly as opposed to tolerating negative emotions. If we always reach for a pill when we’re anxious, our brain adapts. As soon as anxiety hits, our brain expects a pill. If there is no pill and we have no alternatives, panic sets in and the brain enters a state of “fight-or-flight.”

Marijuana as a safety signal is rarely discussed, but it’s use as such is pervasive. Every cannabinoid from THC to CBD to CBN to CBG, all of them are said to relieve anxiety. By extension, every single strain of marijuana I’ve seen in dispensaries is described as an effective treatment for anxiety. 

Oklahoma’s “pay-to-play" medical marijuana program has made the drug almost infinitely accessible, and medical misapplication of the wonder drug is inevitable. 

When we talk about reducing anxiety with a tool like medical marijuana, there is a tendency to assume a lack of anxiety indicates that the problem has been solved. The problem is not the presence of anxiety. Anxiety is an inevitability, and often serves us well. The issue is pathological anxiety, or anxiety that impedes otherwise healthy functioning. At this point, anxiety is no longer serving its purpose.

If we use marijuana as a hedge against our anxiety, we’re relying on an external stimulus to control our negative feelings. Over time, marijuana becomes a safety signal. This is especially true if one uses marijuana as their sole method of anxiety reduction. In therapy, if a safety behavior is utilized too often (even breathing techniques!), it is supposed to be discouraged

This is not to say that using marijuana to alleviate anxiety is bad. This is to say that if the thought of not being able to use cannabis to manage your anxiety gives you anxiety, you may want to reconsider your use of medical marijuana as a safety signal. 

Marijuana can be addictive, but it does not have to be.

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