A psychiatric perspective on cannabis

The past few decades have seen a massive shift in the legal status of cannabis throughout the U.S. Along the way, cultural attitudes about the substance have evolved as well. As of 2021, tens of millions of Americans — about 19% of the population — reported using cannabis at least once that year. But questions remain about what place, if any, cannabis may have in psychiatric care. 

Cannabis isn’t a prescription medication, and it’s still illegal at the federal level. So it’s not something that a psychiatric provider can technically prescribe. There may be times when a licensed physician may recommend medical marijuana for certain medical conditions. For example, it can help reduce symptoms of cancer, HIV/AIDS, multiple sclerosis (MS), glaucoma, seizures/epilepsy, and chronic pain. 

Some people with mental health conditions may find that cannabis seems to lessen their symptoms. However, research shows that, for others, cannabis can be harmful to their mental health. 

Depending on your situation and diagnosis, your psychiatric provider may caution against it. Learning more about cannabis and psychiatry can help you make a more informed decision about how it may (or may not) fit into your mental health treatment plan.

A note on terminology: Technically, the term “cannabis” refers to all products derived from the plant cannabis sativa. However, many people use words like “cannabis,” “marijuana,” and “weed” interchangeably. Throughout the following article, we’ll be using these terms to refer to any substance containing THC (tetrahydrocannabinol). THC is the main ingredient in marijuana that produces the psychoactive effect called a “high.”

Does cannabis have a place in psychiatric care?

One of the challenges in determining whether cannabis has a place in psychiatry is that there’s limited research on the topic. While people have used cannabis for millennia, it hasn’t been studied as a medical or mental health treatment for long. The data we currently have has provided mixed results. And much of what we know about cannabis’ potential benefits is based on anecdotal evidence.

For example, if you use cannabis, you might be at greater risk of some serious mental health concerns (see below). But in some cases, cannabis use may have a positive effect. There have been some studies that show cannabis having a positive effect on learning and memory for people with schizophrenia and psychosis. However, other research proves otherwise. 

When it comes to assessing the potential benefits and risks, it’s important to take information with a grain of salt. Just because someone uses cannabis doesn’t mean they’re going to develop a mental health condition.

The bottom line is that we simply don’t yet have enough information to know if and when weed might be a safe and effective psychiatric treatment. But that hasn’t stopped people from using it as a form of self-care. 

Around 10% of cannabis users say they use it for things like stress management and relaxation and to reduce mood and anxiety disorder symptoms. This decision is a highly personal one, but a psychiatric provider can help you determine what’s best for you and your mental health.

Mental health risks of marijuana use

Not everyone who smokes weed or uses cannabis will develop a mental health condition. However, if you’re a cannabis user, it’s important to understand its potential negative effects on your mental health. 

Research shows that, in some people, cannabis use can lead to:

• Increased anxiety and panic attacks (especially with high-potency THC products)

• Schizophrenia and other forms of psychosis

• Suicidal thoughts and/or violent behavior (increased risk for heavy users and people who use synthetic cannabis products)

• Worsening symptoms of existing mental health conditions (like bipolar disorder or depression)

• The development of cannabis use disorder, a physical and psychological dependence on cannabis

Talking to a psychiatrist about cannabis

Different psychiatrists can have different views on cannabis. But all providers should be willing to have a nonjudgmental discussion with you about how it might affect your well-being. 

If you want to talk to a psychiatrist about cannabis, you can start by:

• Being direct: If you’re curious about how cannabis might impact your treatment, ask your provider for some guidance. You can say something like, “I’ve read some different things about cannabis, and I’m curious if you think it might help me.” If you’re already using cannabis, be open about that too. The more accurate information your psychiatric provider has, the better they’ll be able to support you.

• Asking questions: If you’re looking for a cannabis-friendly psychiatrist, it’s OK to bring that up during your first consultation. Ask the provider about their views on the role of cannabis in mental health treatment and self-care. If their responses don’t feel like a fit for you, you can always get a second opinion from another psychiatric provider.

• Keeping an open mind: If you’ve found relief with cannabis in the past, you may hope to find a provider who supports its use. But if providers consistently tell you that cannabis could compromise your well-being due to worsening mental health symptoms or interactions with your current medications, try to keep an open mind. There may be safer alternatives that can help you manage your mental health.

Clinician's take

A common misconception is that excessive, regular, and/or unhealthy cannabis use is not considered a substance use disorder (SUD) if you’re using it for mental health symptoms. However, it can be considered a SUD if you’re using cannabis excessively or as a coping mechanism.

Halee Fullerton, PMHNP-BC

Clinical reviewer

Find care with Rula

Today, cannabis is becoming increasingly accessible, and many people use it as a form of self-care. However, while there’s some evidence that it can help with stress, anxiety, and other mood concerns, cannabis isn’t considered a psychiatric treatment. And, in some cases, it can make mental health symptoms worse. 

If you’re interested in using cannabis to support your well-being, a psychiatrist can help you understand the potential risks and benefits. While they can’t prescribe cannabis like other medications, they can help you explore how it might affect your mental health. 

At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best. 

Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we're here to help you make progress — wherever you are on your mental health journey.