Cannabis and OCD

Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder that causes repeated unwanted thoughts and actions. Whether repeatedly washing one’s hands, experiencing repetitive and uncontrollable thoughts, or perhaps counting or tapping to reduce feelings of anxiety, OCD symptoms can be exceedingly challenging, as the obsessions and compulsions typically interfere with daily living. The primary treatments for OCD have generally included psychotherapy and medications. Now, however, cannabis may be offering new hope. A study published in the Journal of Affective Disorders found that acute cannabis use—particularly cannabis with higher levels of CBD—was associated with a reduction in OCD symptoms.

The researchers from Washington State University (WSU) found that on average, intrusions were reduced by 49% after cannabis use, compulsions were reduced by 60%, and anxiety was reduced by 52%.

“This indicates that acute cannabis use is associated with a roughly 50% reduction in symptoms of OCD,” says Carrie Cuttler, PhD, the study’s senior author and a WSU assistant professor of psychology. “With respect to predictors of these changes, we found that higher concentrations of CBD were associated with larger reductions in compulsions specifically, which is consistent with some previous animal studies.”

The study also found that, as people continued to use cannabis over time, the cannabis-related reductions in intrusions became somewhat smaller, Cuttler says, suggesting people may start to develop tolerance to the acute effects of cannabis on intrusions. “In contrast, it appeared that the acute cannabis-related reductions in compulsions and anxiety remained pretty constant over time,” she adds.

These findings are promising, Cuttler says, but she cautions that the results overall indicate that cannabis may have short-term, but not long-term, beneficial effects on the symptoms of OCD. In other words, while people with OCD may experience temporary reductions in their symptoms when under the influence of cannabis, these symptoms are likely to return once the effects of the cannabis wear off. This could lead them to need to use more cannabis, which could potentially increase their risk of developing a problem with cannabis use, Cuttler adds.

Thus, she observes, “it is still important for people to seek out more traditional psychotherapy to address the root core of their issues.” Cognitive behavioral therapy, including exposure and response prevention therapy, has been shown to produce longer-lasting results that extend beyond the period of therapy, she adds.

“The most surprising and encouraging finding was that higher doses of CBD were associated with larger reductions in compulsions,” Cuttler says. “This is promising because, unlike THC, CBD is nonintoxicating and as such has a lower addiction potential.”

A Close Look at the Research

In the WSU study, the data were drawn from more than 1,800 cannabis sessions that 87 individuals logged on a cannabis tracker app from Strainprint. The study participants were those who self-identified as having OCD. Data were logged for a period of more than 31 months, allowing researchers to look at the longer-term effect of cannabis use. The cannabis was inhaled, either by vaping or smoking, and patients tracked its impact on their symptoms of intrusions, compulsions, and anxiety by rating the severity of each symptom on a 0 to 10 scale both before and after use. The respondents also provided information about the strain of cannabis used (from which data on THC and CBD were garnered) and the dose inhaled.

According to Cuttler, the study has some potential limitations. “It is important to note that there was significant variability in the results, suggesting that not everyone will find cannabis equally beneficial in reducing their symptoms,” she explains. “Indeed, it is likely that our sample overrepresents people who find cannabis beneficial for managing OCD, since people who don’t find it beneficial would be unlikely to use it and/or track such use on the app. Also, this is a self-selected sample of cannabis users who are self-reporting having OCD, so we could not verify their diagnoses. Regardless, OCD symptoms occur on a continuum of severity, so we are not too troubled about this latter concern.”

The researchers were also unable to obtain a placebo control group, she says, so some of the reductions in symptoms may be a function of expectancy effects—that is, when people expect to feel better from something, they generally do. Simply the belief that cannabis is helping may contribute to its positive impact.

“In fact, shortly before our paper was published, a rather small clinical trial was published that revealed that the reductions in OCD symptoms were no larger after cannabis use than placebo use,” she adds. “However, the study relied on only 12 participants and very low potency cannabis flower, which may have rendered it underpowered to detect significant effects.”

Still, the results of Cuttler’s research are promising in that they present another potential treatment opportunity for OCD. This is significant because antidepressants, a primary medication utilized for OCD treatment, do not work well for every patient.

Looking to the Future

To date, there’s been very little research on OCD and cannabis. This study, however, is one of five studies Cuttler has published to examine the short- and long-term effects of cannabis on mental health and pain using Strainprint data.

“In the other studies, we examined effects of cannabis on negative affect (depression, anxiety, stress) symptoms of PTSD, including intrusions, flashbacks, irritability, and anxiety; headache and migraines; and other forms of pain like muscle, nerve, and joint pain,” she says. “In all cases, we find roughly 50% reductions in symptoms from before to after use. The results of all studies further indicate that cannabis may acutely reduce these symptoms, but it is not reducing them in the longer term. In this way cannabis serves as a bit of a band-aid in that it temporarily masks the symptoms, but these symptoms are likely to reemerge once the acute effects of the drug wear off.”

In terms of OCD and cannabis research, Cuttler says that this is definitely an area that warrants further investigation. OCD impacts as many as 2.2 million adults—or 1% of the population.

“We really need larger sized clinical trials that examine these effects in a longitudinal manner—particularly the effects of CBD on compulsions,” Cuttler says. “However, the restrictions the Schedule I classification of cannabis imposes on researchers does make this difficult. I was fortunate to be able to bypass these restrictions with the generous support of Strainprint, which freely provided the anonymous naturalistic data for us to analyze.”

Cuttler says high-quality clinical trials that use larger samples and whole plant cannabis from medical or recreational dispensaries will be key to better understanding the medicinal properties of cannabis.

“The cannabis that is provided for most clinical trials comes from the National Institute on Drug Abuse (NIDA) drug supply and it is not representative of the cannabis sold in dispensaries,” she explains. “That’s because the cannabis from the NIDA drug supply is very low potency, in part because it contains the entire plant rather than just the flower. It would also be good to look at the effects of orally consumed cannabis as smoking and vaping are associated with some adverse health effects.”

To clinicians who may be considering recommending cannabis to any patient with an anxiety disorder, Cuttler cautions that it’s important to remember that despite the fact that some individuals find that cannabis reduces their symptoms of anxiety, others actually find it an anxiogenic. It’s important to know your patients and what will work best for them.

“Physicians who want to recommend cannabis to their patients may consider having them track their use and their symptom reduction using the Strainprint app,” Cuttler adds. “This will help to determine the strains and doses that are most beneficial to their patients.”

— Lindsey Getz is an award-winning freelance writer in Royersford, Pennsylvania.