Large Prospective Study Finds Cannabis Use Is Not Linked to Most Anxiety Disorders | Research

The takeaway

In a nationally representative 3-year follow-up study, cannabis use was not associated with developing most anxiety disorders, and most anxiety disorders did not predict future cannabis use.

Read this if you use cannabis and worry about whether it might cause long-term anxiety problems.

No significant link between cannabis use and anxiety disorder onset over 3 years

What the researchers found

This study followed thousands of Americans over three years to test whether cannabis use leads to anxiety disorders or vice versa. The results were largely negative on both fronts.

Cannabis use did not increase the risk of developing generalized anxiety, social anxiety, panic disorder, or specific phobias. Similarly, having an anxiety disorder at baseline did not predict future cannabis use or cannabis use disorders.

One notable exception emerged: people with panic disorder at baseline were significantly more likely to start using cannabis during the follow-up period, suggesting possible self-medication. And heavy cannabis use showed a trend toward increased social anxiety risk, though this did not hold up in the final adjusted analysis.

Why it matters

The relationship between cannabis and anxiety is one of the most debated topics in cannabis research. This study provides some of the strongest prospective evidence to date suggesting that for most people, cannabis use does not trigger anxiety disorders. The panic disorder finding adds nuance, suggesting some people may turn to cannabis to manage panic symptoms.

The numbers in context

Cannabis use was not associated with any anxiety disorder incidence (AOR = 1.12). Heavy use showed a trend toward social anxiety (AOR = 1.98) but was not significant in the final model. People with baseline panic disorder were 2.2 times more likely to initiate cannabis use (AOR = 2.2, 95% CI 1.15-4.18).

How the study worked

Data came from waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large nationally representative prospective study. The researchers controlled for baseline anxiety disorders and used adjusted odds ratios to examine bidirectional associations between cannabis use and anxiety outcomes over three years.

What this study cannot tell us

The 3-year follow-up period may be too short to capture long-term effects. Cannabis use was self-reported and may have been underreported. The study could not account for specific cannabis products, doses, or THC/CBD ratios, all of which may influence anxiety outcomes differently.

How to read the evidence

Nationally representative prospective cohort with 3-year follow-up, controlling for baseline anxiety disorders. Strong design for examining longitudinal associations.

When this study was published

Published in 2016 using NESARC data. Cannabis potency and product availability have changed substantially since data collection.

The bigger picture

This study challenges the common narrative that cannabis causes anxiety disorders. While acute cannabis-related anxiety is well documented, the longitudinal evidence here suggests that repeated use does not set people on a path toward clinical anxiety diagnoses. The self-medication finding with panic disorder aligns with what many patients report anecdotally.

Questions still open

Does the relationship between cannabis and anxiety differ based on THC concentration or consumption method? Is the self-medication pattern seen with panic disorder ultimately helpful or harmful for those individuals?

Common questions

Does cannabis use cause anxiety disorders?

This large prospective study found no association between cannabis use and the development of generalized anxiety, social anxiety, panic disorder, or specific phobias over three years.

Can anxiety lead people to start using cannabis?

Most anxiety disorders did not predict future cannabis use, but people with panic disorder were 2.2 times more likely to begin using cannabis, possibly as self-medication.

Read the original research

The association between cannabis use and anxiety disorders: Results from a population-based representative sample.

European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 26(3), 493-505

View on PubMed ↗Publisher’s paper ↗

Citation

Feingold, Daniel; Weiser, Mark; Rehm, Jürgen; Lev-Ran, Shaul. (2016). The association between cannabis use and anxiety disorders: Results from a population-based representative sample.. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 26(3), 493-505. https://doi.org/10.1016/j.euroneuro.2015.12.037