Cannabis use did not significantly worsen anxiety disorder outcomes after accounting for baseline differences | Research

The takeaway

A 3-year population study of 3,723 people with anxiety disorders found that while cannabis users had lower remission rates in raw numbers, these differences disappeared after adjusting for baseline factors, suggesting pre-existing characteristics rather than cannabis use explain poorer outcomes.

Read this if you have an anxiety disorder and use cannabis, or if you are interested in whether cannabis affects anxiety outcomes.

Cannabis-anxiety association disappeared after adjusting for baseline factors

What the researchers found

Researchers analyzed data from 3,723 individuals with diagnosed anxiety disorders (social anxiety, panic disorder, generalized anxiety disorder, specific phobias) from the National Epidemiologic Survey on Alcohol and Related Conditions.

In unadjusted analysis, remission rates from anxiety disorders decreased with increasing levels of cannabis use, suggesting cannabis worsened outcomes.

However, after adjusting for baseline confounders, the association between cannabis use and lower remission rates was no longer statistically significant. This means that pre-existing differences between cannabis users and non-users, not cannabis itself, likely explained the poorer outcomes.

Two specific exceptions emerged: individuals with cannabis use disorders were significantly more likely to report breaking up from a romantic relationship (OR 3.85) and repeatedly quitting school (OR 6.02) compared to non-users, even after adjustment.

Why it matters

This finding challenges the assumption that cannabis use worsens anxiety disorders. The disappearance of the association after controlling for baseline factors suggests that people who use cannabis already differ from non-users in ways that predict worse outcomes, independent of their cannabis use.

The numbers in context

3,723 individuals with anxiety disorders. Unadjusted: lower remission with more cannabis use. Adjusted: no significant difference in remission. Cannabis use disorder linked to relationship breakup (OR 3.85) and quitting school (OR 6.02).

How the study worked

Longitudinal analysis of Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Focused on 3,723 individuals with any anxiety disorder at Wave 1. Cannabis users and those with cannabis use disorders compared to non-users on remission, functioning, and quality of life at Wave 2 (approximately 3 years later), controlling for baseline confounders.

What this study cannot tell us

Observational design cannot fully rule out residual confounding even after adjustment. Self-reported cannabis use and diagnostic assessments are subject to bias. The 3-year follow-up may be too short to detect longer-term effects. Cannabis use patterns (frequency, potency, cannabinoid profile) were not detailed.

How to read the evidence

Large population-based longitudinal study (NESARC) with baseline confounder adjustment provides moderate evidence, though observational design limits causal inference.

When this study was published

Published in 2018 using NESARC data. Cannabis potency and use patterns have changed since the original survey.

The bigger picture

This adds to a growing body of research suggesting that many observed associations between cannabis use and psychiatric outcomes may reflect shared vulnerabilities rather than direct cannabis effects. The methodology of adjusting for baseline confounders is critical for interpreting observational studies on cannabis and mental health.

Questions still open

What specific baseline factors account for the apparent cannabis-anxiety association? Would longer follow-up reveal effects not captured in 3 years? Does the type of anxiety disorder matter for cannabis effects on outcomes?

Common questions

Does cannabis make anxiety disorders worse?

In raw numbers, cannabis users had lower remission rates. But after accounting for pre-existing differences between users and non-users, the association disappeared. This suggests it is the characteristics of people who use cannabis, not the cannabis itself, that predict worse outcomes.

Were there any negative effects found?

Yes. People with cannabis use disorders (problematic, heavy use) were nearly 4 times more likely to break up from a relationship and 6 times more likely to repeatedly quit school, even after adjustment.

Read the original research

Clinical and functional outcomes of cannabis use among individuals with anxiety disorders: A 3-year population-based longitudinal study.

Depression and anxiety, 35(6), 490-501

View on PubMed ↗Publisher’s paper ↗

Citation

Feingold, Daniel; Rehm, Jürgen; Factor, Hagai; Redler, Avigayil; Lev-Ran, Shaul. (2018). Clinical and functional outcomes of cannabis use among individuals with anxiety disorders: A 3-year population-based longitudinal study.. Depression and anxiety, 35(6), 490-501. https://doi.org/10.1002/da.22735