How do CBD and marijuana affect OCD?

August 21, 2019

WRITTEN BY

Patrick Carey

Patrick joined our team to help people get better information about mental health. He drinks coffee and wishes he had a dog.

Disclaimer: This post is an examination of research on marijuana and CBD usage among people with OCD and other mental health conditions. NOCD does not endorse any study or its results, or recommend the use of marijuana, CBD, or any psychoactive drug.

In 2015, the National Survey on Drug Use and Health revealed that 22.2 million people had used marijuana in the past month—7% of the population. This made it the most commonly used drug in the United States, and usage was trending upward. As states continue to battle over medical and recreational legalization, marijuana is becoming an increasingly typical part of life in the United States. So far, recreational use has been legalized in ten states and in Washington D.C. Medical use, restricted to those with certain conditions, is now partially or completely legal in 36 states

These statistics vary drastically around the world, for many reasons. But in the US, at least, widespread and growing use points to a reality in which cannabis products ought to be part of any discussion about mental health. It also points to a need for these discussions to be based in evidence, not alarmism or anecdote. 

The short-term effects of cannabis can interact with mental health conditions in complex ways—exacerbating anxiety or encouraging mania, for example. And the long-term effects of these substances are the subject of never-ending, often aggressive debate. A few years ago, the National Academies of Sciences, Engineering, and Medicine convened an expert committee to take a thorough look at huge amounts of research. Their fascinating 2017 report draws over 100 conclusions, among them: 

  •  “There is substantial evidence of a statistical association between cannabis use and the development of schizophrenia or other psychoses” 
  • “There is moderate evidence of a statistical association between cannabis use and… a small increased risk for the development of depressive disorders; increased incidence of suicidal ideation, attempts, completion; increased incidence of social anxiety disorder” 
  • “There is limited evidence that cannabis or cannabinoids are effective for… improving symptoms of Tourette syndrome; improving anxiety symptoms in individuals with social anxiety disorder; improving symptoms of PTSD” 
Source: Shayanne Gal/Business Insider

Another substance to worry about?

The term cannabinoids encompasses marijuana and other substances that work on the same receptors in our brain. In the past few years, a different kind of cannabis product has grown explosively in popularity. Cannabidiol, or CBD, is the second most abundant chemical compound in marijuana. But when extracted from hemp—a cousin of the marijuana plant—CBD is isolated from THC, the compound in marijuana that causes a high and other psychoactive effects. However, many CBD products actually do contain some proportion of THC. 

Subject to claims of effectiveness for all kinds of conditions, CBD is being marketed far more quickly than it can be researched. Due to its trendiness and a shaky but largely unenforced legal status, US sales grew from $108.1 million in 2014 to an estimated $813.2 million in 2019. By 2022 CBD sales are projected to approach $2 billion. Walgreens sells CBD products in nine states, CVS in eight. A staggering 14% of American adults say they use CBD, primarily for pain, anxiety, and insomnia. 

People say all kinds of things about marijuana and CBD. They range from potentially true to probably nonsensical, and the longtime illegality of cannabinoid products has only made it harder to get any research done. Everyone is confused—especially those with mental health conditions, who might have the same desire to try these substances but a reduced ability to tolerate their effects.  

On the other hand, countless people with or without psychiatric disorders say that marijuana and/or CBD help them feel better. Much research, though in its early form, supports the effectiveness of both medical marijuana and CBD for specific conditions. But, as stated in the National Academies report, there’s only limited evidence for a small number of conditions.

Very little or no research has been conducted on most mental health conditions in relation to the effects of cannabis products. Confusion is the status quo with both substances, although the fact that CBD typically has milder effects and isn't exactly illegal in most places has allowed manufacturers to shape public opinion significantly.

People with mental health conditions, prone to distress, are often in search of relief. Whether illegally or legally, in moderation or excess, they're more likely to use substances than the general population. Studies have found that 27-39% of people with obsessive-compulsive disorder met lifetime criteria for substance use disorder (involving any substance), and general usage rates are certainly higher. So, how do the most prevalent illicit drug and its nonintoxicating counterpart affect people with OCD? 

Cannabis products and OCD

Although 2-3% of the population has OCD, it doesn't get enough attention from researchers around the world. This is reflected in the fact that no new medication for OCD has been developed since 1997. Research gravitates toward conditions that are more prominent in our media, already receive better funding, and are at least a bit better understood—think depression and PTSD. There is always remarkable research emerging on OCD, but typically not on the same scale. 

Unfortunately, this lack of research carries over to substance use as it relates to OCD. As Dr. Jamie Feusner, MD, Professor of Psychiatry at UCLA and NOCD Chief Medical Officer, put it: "There is very little known about marijuana or CBD use in people with OCD, and no clinical studies of these substances in people with OCD have been published." 

A 2017 study at Washington State University showed that OCD are "was positively associated with cannabis misuse, but not frequency of cannabis use or quantity." But, as with other studies along the same lines, the researchers didn't look at the effects of marijuana on their subjects.

Meanwhile, a 2017 clinical trial at the New York State Psychiatric Institute called "Effects of Marijuana on Symptoms of OCD," has yet to post results. If results do emerge, they'll come from only 14 participants—a great start, but hardly conclusive. That marijuana remains illegal and stigmatized in so many places limits sample sizes and therefore study progress, and researchers must do what they can with a limited patient population. 

Researchers have conducted a few animal studies with cannabinoids, yielding mixed results. Two studies, from 2010 and 2013, linked CBD with a reduction in compulsive-like marble-burying behavior among mice. However, as Dr. Feusner notes, the observed mouse behaviors like marble-burying or pathological grooming aren't necessarily complete models for OCD in humans. 

A 2016 study sheds additional light on the possible neurobiology of these effects. When CB1 receptors—which are blocked indirectly by CBD—were deleted in specific neurons, mice were not able to shift from “goal-directed” to “habitual” behavior (possibly an analogue to compulsions in humans). Those researchers concluded that mice were switching between goal-directed and habitual behaviors based on activity in their CB1 receptors.

Clearly, research efforts have not been extensive enough to determine whether marijuana and CBD might be helpful or harmful for people with OCD. There's still a lot of energy around this topic, though, and a few researchers plan to conduct larger-scale surveys of people with OCD—perhaps in preparation for research studies. (For more on these, stay tuned to the NOCD blog.)

For the time being, it's advisable to stay away from psychoactive substances, particularly if one has a mental health condition. 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.

Disclaimer: This post is an examination of research on marijuana and CBD usage among people with OCD and other mental health conditions. NOCD does not endorse any study or its results, or recommend the use of marijuana, CBD, or any psychoactive drug.