Some doctors object to treating anxiety with marijuana
Medical pot option will begin Saturday
It’s the most common mental illness in the United States.
And starting Saturday, those with anxiety disorders will have a new option for treatment in Pennsylvania: medical marijuana.
“I do not take this decision lightly,” said state Secretary of Health Rachel Levine, announcing the decision last week to add both anxiety and Tourette syndrome to the list of 21 qualifying conditions “and do have recommendations for physicians, dispensary pharmacists and patients in terms of medical marijuana to treat these conditions.”
The state Medical Marijuana Advisory Board voted in February to recommend anxiety and Tourette as qualifying conditions. Tourette is a neurological disorder characterized by repetitive involuntary movements and vocalizations called tics.
Dr. Levine went on to say in a statement that marijuana should be used only in addition to existing therapies, such as counseling for anxiety patients, and should not be used by children, adolescents or pregnant women.
But local doctors are cautioning that it should be used only as a last resort — if at all.
“There is really no clear evidence for the therapeutic benefits of cannabis for anxiety disorders,” said Dr. Antoine Douaihy, senior academic director of UPMC addiction medicine services and a member of the state medical marijuana advisory board. “For people who have an anxiety disorder, there are so many good treatments — adding medical marijuana is more of a last- resort approach.”
Dr. P. V. Nickell, chair of the psychiatry and behavioral health institute for Allegheny Health Network, also expressed
concerns. “Based on my limited knowledge, I’m not convinced it was a good idea,” he said. “It’s kind of the Wild West out there because we’re not getting good data and people are doing stuff anyway.”
Dr. Levine, who was interviewed Tuesday on WESA- FM’s “The Confluence,” said she believed there is “significant evidence in the medical literature that medical marijuana can be beneficial for patients with anxiety disorders and for patients with Tourette syndrome,” but she added that it is not to be used as a first- line treatment.
For Corinne Ogrodnik, CEO and co- founder of the Maitri medical marijuana dispensaries in East Liberty and Uniontown, the addition is a welcome one.
Ms. Ogrodnik said she has already heard anecdotally from patients who are being treated with medical marijuana for currently qualifying conditions that their anxiety symptoms have improved as well. Since Dr. Levine announced last week that anxiety would be approved as a qualifying condition, Ms. Ogrodnik said her dispensaries have fielded calls from several doctors checking on the procedures to get their patients approved.
“If this product can help them, we are very happy,” she said, noting that one patient with a chronic pain condition told her that she has reduced her anxiety medication since starting treatment with marijuana. “For those people who feel like this product can help them, whether their condition is severe or minor, it’s important to be able to provide them with a safe alternative.”
In Pennsylvania, patients who wish to use medical marijuana must see a physician certified by the state specifically to recommend medical marijuana. Pennsylvania law allows patients to vape medical marijuana or to ingest it in oil form, but it does not permit smoking the drug or the sale of edibles.
Because anxiety disorders are so common, Ms. Ogrodnik is expecting to see some increase in demand. “We expect to see a small bump,” she said. “I’m not sure if we’ll see a significant bump; it’s hard to say. That’s part of the mystery and fascination of being involved in this industry.”
Nationally, patients with anxiety are not a large proportion of those using medical marijuana. A study published in March in the journal Health Affairs analyzed data from states that publish statistics on marijuana use by condition and found that chronic pain accounts for 62.2% of use, followed by muscle spasms in multiple sclerosis patients and chemotherapyinduced nausea and vomiting.
According to the website, Leafly. com, only one other state, New Jersey, has specifically approved anxiety as a qualifying condition for medical marijuana, although some states do have a catchall provision approving marijuana as a treatment for all diseases deemed beneficial by a physician.
In Ohio, the topic has become controversial. In May, a four- member committee of the Ohio Medical Board voted to approve anxiety and autism as qualifying conditions. Last month, however, the full board decided to delay the decision after receiving a letter from physicians at Nationwide Children’s Hospital noting the lack of scientific research and citing the potential that cannabis use could worsen psychiatric disorders.
It is the potential for medical marijuana to harm patients with anxiety that concerns Dr. Nickell as well. “We don’t know if it will help or hurt,” he said. “Anxiety can be from a lot of things. It can be from too much Starbucks. It can be from medical problems like hypothyroidism. I don’t know the discipline that people would bring to the assessments, and it concerns me about people being not appropriately diagnosed, much less whether it’s an appropriate treatment.”
Dr. Douaihy declined to say what his official position on the subject was as a member of the state advisory board, noting that he appreciated Dr. Levine’s willingness to listen and was pleased with how the state’s medical marijuana program was running generally. But as an expert on addiction, he said he was concerned about marijuana use for people with mental illness who may already be predisposed toward addiction or substance abuse.
“There is a very strong disconnect between public perspectives and scientific evidence that does not exist and the public policies that are generated,” he said. “There’s very much a mismatch between these three pieces. You know, it could work, it could not work.”