There’s no doubt that attitudes towards cannabis are shifting. Recreational marijuana use is now legal in 24 U.S. states, and claims around what it can do for your health and well-being are everywhere. “There’s been an explosion in the marketing of cannabis products as potential treatments for all sorts of different conditions, including mental health problems like anxiety and obsessive-compulsive disorder (OCD),” says psychiatrist Dr. Reilly Kayser, MD.
Kayser says he and his colleagues became interested in the topic of weed and OCD “because we were hearing vastly different stories from our patients: some told us that cannabis helped to control obsessions, compulsions, or anxiety; others told us that it did nothing; and still others described the ways it worsened their symptoms,” he says.
If you’re struggling with OCD, a debilitating disorder that affects 1 in 40 people in the U.S., it’s understandable that you may be looking for alternative treatments to end the unrelenting intrusive thoughts and compulsions you do to find relief. Read on to understand what’s proven to help, what isn’t, and where the jury is still out.
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Weed and OCD: What the research says
Before we go any further, let’s clear up any potential confusion about terminology. Cannabis is the name of the plant. Weed, or marijuana, refers to the products made from the plant. Often, these terms are used interchangeably.
Whatever you call it, there are indicators that plenty of OCD sufferers dabble in its use, possibly as a means of coping with their symptoms. “A large residential treatment facility for OCD reported that around 30% of adults with OCD who sought treatment in their program said they had used cannabis at least once,” notes Dr. Kayser. “But although we know that many people do use cannabis, how it interacts with symptoms of OCD and other mental illnesses is less clear.”
although we know that many people do use cannabis, how it interacts with symptoms of OCD and other mental illnesses is less clear.
The studies that have been done are limited, and the results are often mixed or inconclusive. Case studies on cannabis have found some evidence for symptom reduction, but they’re based on very small sample sizes. Sometimes only one person is observed in a case report, which means you can’t apply the findings to all people with OCD.
Older studies on rodents, from 2010 and 2013, linked CBD (or cannabidiol, which is the second most prevalent active ingredient in cannabis) with a reduction in compulsive-like marble-burying behavior among mice. “However, the observed mouse behaviors like marble-burying or pathological grooming aren’t necessarily complete models for OCD in humans,” points out Dr. Patrick McGrath, Chief Clinical Officer at NOCD, the leading telehealth provider of specialized OCD treatment. (Marble-burying might seem random, but it’s actually a widely-used animal model used in scientific research to depict anxiety or OCD behavior.)
One of the studies that made its way into news headlines with titles like “Marijuana can calm OCD” almost a decade ago was—notably—also performed on rodents. The findings, appearing in a 2016 issue of “Neuron”, suggested that overactive CB1 receptors may make it more difficult for people with OCD to break cycles of compulsive behavior. (CB1 receptors are what respond to the presence of THC, the main compound in cannabis that produces the “high” feeling.) By blocking CB1 receptors, researchers were able to essentially turn off the mice’s ability to create habits. The possible takeaway? When habits are too ingrained—and you might call compulsions in OCD an example of that—habit-breaking is essential. However, more research (on humans) is needed to confirm this hypothesis.
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Why self-medicating with cannabis is not considered treatment
In any discussion about weed and OCD, it’s important to draw a distinction between short-term relief (which is also called “self-medicating”) and a long-term solution.
One study by the Department of Psychology at Washington State University on the effects of cannabis on OCD looked at short vs. long-term effects of cannabis on OCD. While study participants reported approximately 50% reductions in OCD symptoms, this effect went away shortly after they inhaled cannabis and the immediate effects of the drug wore off. Over time, intrusive thoughts and compulsive behaviors remained consistent.
“I refer to cannabis as a bit of a band aid,” says Carrie Cuttler, PhD., psychology professor at Washington State University and one of the researchers of the study. “It’s temporarily masking the symptom, just generally reducing people’s level of distress…but it’s not actually addressing the root core issue underlying any of these symptoms.” This leads to a sense that you have to constantly chase relief. “When the high wears off and after a couple of hours the symptoms return, they need to use more cannabis, and that puts them at risk for cannabis use disorder,” adds Cuttler.
If weed can’t help my OCD symptoms go away, can it at least help my anxiety?
“There’s definitely a relationship between OCD and anxiety,” says McGrath. “Many people get very anxious when they experience an obsession, and they try to ameliorate that anxiety with a compulsion.” Naturally, the question on some people’s minds isn’t, “Can weed help my OCD symptoms go away?” but, rather, “Can weed help with my OCD-related anxiety?”
Unsatisfying but true: It’s a big gamble. “There are still more questions than answers regarding how exactly cannabis use affects anxiety symptoms,” says Dr. Kayser. It leaves some people calmer and others even more anxious, research shows. Your age, how frequently you use cannabis, and how sensitive you are to THC are all among the factors that determine how the drug will affect you.
“Someone who has never used cannabis might be more likely to experience anxiety after using, compared to someone who has tried it many times in the past,” says Dr. Kayser. “Similarly, using cannabis with very high concentrations of THC probably increases the chance that a person will experience anxiety and other adverse effects.”
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CBD for OCD: Is it worth trying?
As mentioned earlier, cannabidiol, or CBD, is the second most abundant chemical compound in marijuana. Part of CBD’s popularity is that it purports to be “nonpsychoactive,” meaning that you can get the benefits without the high. But before you jump on the CBD for OCD bandwagon, know this: “Unfortunately, there are many exaggerated or misleading claims about CBD that do not reflect what is actually known scientifically. In reality, there have only been a few small studies in humans,” says Dr. Kayser. “Though these have given us some hints that CBD may help with certain anxiety symptoms, the results are far from conclusive. We are even more in the dark in terms of how CBD affects obsessions and compulsions, as there have been no studies at all in humans with OCD.”
The bottom line on cannabis and OCD
Ultimately, there is a dearth of research on OCD patients, and this means it’s impossible to determine definitively whether cannabis might be helpful or harmful for people with OCD. There’s still a lot of interest around this topic, though, and a few researchers plan to conduct larger-scale surveys of people with OCD—perhaps in preparation for clinical studies.
“For the time being, it’s advisable to stay away from psychoactive substances, particularly if one has a mental health condition,” says Dr. McGrath. “The reality is that we still know very little about what happens to the human brain on marijuana and CBD. And with psychiatric conditions already complicating things, there’s good reason to wait for further research to emerge.”
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What can you do to treat OCD instead of using cannabis?
While cannabis isn’t a cure-call for OCD, there’s no reason to feel discouraged or feel hopeless. Proven treatments and strategies for managing OCD do exist—and they’re backed by decades of research.
The main form of psychotherapy for OCD is a specific form of behavioral therapy called exposure and response prevention (ERP) therapy. It’s highly effective on its own for most people with OCD. Although for some people, relief is found by combining medication(s) and ERP.
It’s imperative that you seek specialized therapy for OCD, with a therapist trained specifically in ERP. While some other mental health conditions benefit from standard talk therapy, or general cognitive behavioral therapy (CBT), these modalities usually don’t improve OCD—and research shows they can even make it worse.
ERP works by gradually exposing you to what triggers your intrusive thoughts, and teaching you response prevention techniques to prevent compulsions. In other words, you’ll learn that there’s a different way to cope with your discomfort than immediately trying to get rid of it. You will never be forced into anything before you’re ready, but you will be encouraged to take steps that move you toward recovery.
This leads to long-term recovery because you become desensitized to your fears, and learn that nothing horrible happens by not doing compulsions. In short, it frees you from the grip of OCD. “Not even a year ago, I had a constant feeling of impending doom that controlled every move I made,” says Erica, a NOCD member. “Now I can do pretty much anything I want to do.”