COVID-19, Anxiety, and Cannabis

30 years as a practicing anesthesiologist comes with some benefits. I am considered by many of my medical colleagues as an “expert’ in managing stress, anxiety, and pain- together with being a master of critical care medicine practiced in the OR. But, inside, I feel my practice has been restricted in large part by the pharmaceuticals upon which I have relied: benzodiazepines for stress, opiates for pain. Enter stage left: COVID-19 pandemic and enter stage right: legalized cannabis in my home state of Virginia. Suddenly it seems that I have another solution for problems I only superficially appreciated before, and without many of the limitations of the drugs upon which I have traditionally relied.

The science of cannabis is still young but rapidly growing. The politically-motivated Controlled Substances Act of 1970 put an end to forward growth for decades. But in states where medical marijuana has now been legalized, research is rapidly proceeding and the evidence is mounting that cannabis can help a wide variety of clinical ailments, both physical and mental. My personal experience with dear friends and family -that cannabis can effectively manage the tragic suffering caused by cancer- was powerful enough for me switch gears and start my medical cannabis practice. But the applications for cannabis are multiple, and anxiety management is a great example.

But social anxiety disorder is a mild complaint, right?

Then came COVID-19…

As the pandemic and measures to curb its devastating spread began to evolve, social norms and responsibilities came into great flux. These uncertainties proved unsettling for everyone- myself included. For people with anxiety disorders, uncertainties like these can have crippling results. The combination of increased anxiety and diminished social opportunities during the pandemic have led to significant challenges for a great many people. Those with social anxiety disorder prior to the pandemic have, in many cases, not fared well at all. With more time at home to absorb the constant media stream of unfolding public health tragedies and the associated social upheavals, we have only fanned the flames of fear and stress.

Why has the pandemic had this effect? For many, there is a lot of uncertainty in how to properly interact with others — whether one should mask, what to do if the other person isn't masking, fear surrounding potentially imposing on someone if you ask them to wear a mask, etc. These are the kinds of social uncertainties that people with social anxiety disorder find especially difficult to navigate and very anxiety-provoking.

Driving the point home, the term “social distancing” -now a familiar mantra- refers of course to physical spacing between people. But for many with anxiety, it has also become associated with the fear of the invisible enemy and escalated discomfort around other people that can add another layer of complexity. For those with significant social anxiety, the results can be devastating. And every time we see “social distancing” on a sign, we are reminded.

So, what do we do? Helping patients with social anxiety focuses on helping them approach their feared social situations with more confidence, armed with coping techniques and strategies. Shopping, eating out, visiting friends: all good examples. Behavioral and psychological therapy helps by allowing people to manage their feelings beforehand and preparing them with strategies to deal with anxiety as it escalates. “Mainstream” medications for anxiety and depression (antidepressants, anxiolytics, etc.) may benefit some people when used preemptively, but the scientific evidence is sparse. Significantly, these medicines are often accompanied by adverse side effects and limitations.

And then there is cannabis. With a growing body of evidence, anxiety has become one of the leading reasons for patients to seek cannabis therapy in this country -particularly during the pandemic- and for good reason. A 2015 review strongly supported cannabis therapy -especially that with higher CBD concentrations- for several anxiety disorders including PTSD, generalized anxiety disorder, obsessive-compulsive disorder and, importantly, social anxiety disorder. Another study in 2018 established that cannabis is effective in easing the symptoms of depression and anxiety, reporting that cannabis users experienced a 58% reduction in anxiety and stress. Cannabis therapy for social anxiety disorder now has a confirmed neurologic basis for its mechanism.

So what does all this mean? Cannabis can help with the psychological fallout of COVID-19 and the pandemic, and it could help you. It can help reduce the anxiety, fear and stress. It is an excellent choice to help manage the often-devastating emotional overlay we experience from this pandemic, and it can do it naturally and safely. If you’re suffering mild, moderate or severe anxiety related to the pandemic, it is worth investigating.

If you do consider cannabis therapy, you should be evaluated and guided by a specialist cannabis physician because cannabis, like all medicines, carries some limitations. If you live in Virginia I would be pleased to help you along that path to success. Our practice, ReThink-Rx, has been developed for just this purpose. We make the intake process easy and comfortable. I will spend the necessary time to learn your story, educate you about choices and develop your therapeutic strategy. We will conduct the doctor visit from the safety and comfort of your home. Our staff will help you get registered with the state marijuana program and help get you started on your therapy with the dispensary.

There is good evidence and general consensus that this pandemic is going to last quite a bit longer and will have lasting impact on rates of anxiety and depression, and perhaps PTSD. For some, these afflictions will certainly linger for years. There will likely be a range of responses as the pandemic finally abates, with some people who will glide right back into their everyday lives seamlessly and others who will find it to be a big adjustment. But for many, the sweeping wave of medical marijuana legalization across our country now offers hope of a viable, safe solution to what could be a long recovery period ahead.