Can I get a medical cannabis prescription for anxiety in the UK?

Mental health issues are growing at an alarming rate. As we’re plunged into the bustle of post-pandemic life, the lockdown aftershock lingers – and stress has become second nature to day-to-day life. 

It is becoming increasingly clear that the UK experiencing a mental health crisis. Anxiety disorders are the most prevalent mental health issue, with over 8 million Brits living with some form of anxiety. Current treatment options are limited and there is an urgent need for greater support and alternative therapies. 

In recent years, clinical research has established that patients with anxiety and anxiety-related disorders may benefit from medical cannabis treatments. And for those living in the UK, this isn’t a distant fantasy. Here, leafie take a look at the ins and outs of getting a UK medical cannabis prescription for anxiety. 

Anxiety: an overview

Anxiety is a chronic feeling of stress, worry, and fear. It can be hard to pinpoint the direct cause of anxiety, but common triggers include major life changes, traumatic past experiences, health conditions, or medication. Despite being categorised as a psychiatric disorder, the symptoms of anxiety manifest both mentally and physically. Anxiety looks different for everyone, but common symptoms include: 

• Excessive worrying
• Restlessness
• Heart palpitations
• Headaches
• Problems sleeping

As an innate response to trauma, it is not uncommon for everyone to experience mild anxiety at some point in their life. Clinical anxiety is different; your mind is in a constant state of perceived stress, even when there is no immediate threat. A diagnosis of an anxiety disorder is often given when common stress-relief techniques fail to improve symptoms.

In most cases, a patient with anxiety will be prescribed antidepressants as a first-line treatment. Beta-blockers can also be used to reduce the physical symptoms of anxiety. Alternatively, anxiety disorders can also be treated with psychotherapy, such as cognitive behavioural therapy (CBT). 

The pharmacological treatments for anxiety, however, are often limited by their side effects. CBT can also be expensive, and waiting times for NHS therapy are lengthy. Fortunately, there are alternative options – and medical cannabis is one of them. 

Can I use cannabis to manage my anxiety?

As of November 2018, United Kingdom (UK) law has allowed doctors on the General Medical Council’s specialist register to prescribe cannabis-based medicines. Most people are already aware of the clinical potential of cannabis for conditions such as epilepsy and multiple sclerosis, but medical cannabis has also been shown to effectively manage various psychiatric conditions. Qualifying anxiety-related conditions include:

• Generalised Anxiety Disorder (GAD)
• Panic disorder
• Post-Traumatic Stress Disorder (PTSD)
• Social anxiety disorder (SAD)
• Other conditions that cause anxiety

According to Dr Mikael Sodergren, founder of The Sapphire Medical Clinic, 20-25% of the clinic’s patients use medical cannabis to manage psychiatric conditions, typically “anxiety, post-traumatic stress disorder, a little bit of depression,” Sodergren tells Vice. A 2016 survey carried out for a report by the United Patients Alliance (UPA) also found that anxiety is the second most common condition among those who medicate for mental health reasons, reported by 26.3% of respondents. 

Does it work?

Anecdotally, there is an abundance of evidence that cannabis can help to alleviate stress and anxiety. In one 2011 study published in the Journal of Psychoactive Drugs, 38% of 1,746 patients reported that their medical cannabis relieved anxiety, 17% said the same for panic attacks, and 55% said that it improved relaxation. 

There is now growing clinical evidence to support these claims. A 2018 study conducted by Washington State University found that cannabis containing high levels of cannabidiol (CBD) and low levels of tetrahydrocannabinol (THC) resulted in a 58% reduction in anxiety in patients. Similarly, a recent review conducted by the UK ​​Medical Cannabis Registry found that, in 67 patients with generalised anxiety disorder, cannabis reduced anxiety and improved both sleep and quality of life. 

Whilst the exact mechanisms behind the therapeutic properties of cannabis are still being investigated, there are several theories behind its anxiety-relieving effects. THC, the major psychoactive compound in the Cannabis sativa plant, is known to activate cannabinoid receptors CB1 and CB2 throughout the brain and body. This activation may induce brain changes that help to promote pleasure and attenuate the body’s stress response.

CBD, the plant’s non-psychoactive cannabinoid, is believed to enhance the signalling of our brain’s “happiness chemical”, serotonin. Since serotonin is the neurotransmitter responsible for stabilising our mood, it is thought that CBD can help to reduce stress and anxiety via this mechanism. 

Doesn’t cannabis cause anxiety?

In the UK, the majority of people who use cannabis only have access to the illicit market. As a result of drug prohibition, this market is dominated by more “potent”, high-THC, low-CBD cannabis that can differ from the flowers prescribed clinically. In some people, high-THC cannabis can cause anxiety. 

This is largely due to a lack of CBD, which has been shown to protect against many of the adverse effects of high concentrations of THC. When THC floods the brain, this can often overstimulate the amygdala, the brain region responsible for initiating our body’s stress response. This, in turn, can heighten feelings of fear, which is why some people find that cannabis makes them feel anxious or paranoid. 

Unlike some cannabis strains that circulate on the illicit market, medical cannabis prescriptions are tailored to the individual dependent on their symptoms, and may have a higher CBD content. Whilst cannabis-based products may not work for everyone, you are much less likely to experience this THC-induced anxiety. Instead, the high is more mellow – or “fuzzy and light,” as Ross Buchanan described in his article for Vice about getting a private UK medical cannabis prescription for his anxiety.

Is medical cannabis safe?

As with any medication, there are some risks and side effects that come with using cannabis. That said, adverse outcomes are much less common with cannabis-based medicines than with unregulated cannabis products. In the UK Medical Cannabis Registry study, 39% of patients experienced adverse events. These included dry mouth, drowsiness, and headache, among others. Despite this, the study concluded that cannabis is “a potentially safer and more cost-effective alternative to many mental health treatments currently offered.”

If we compare the safety profile of existing anti-anxiety medications to cannabis, the latter is the clear winner. In particular, antidepressants come with a risk of tolerance and dependence, and can also cause significant sleep disturbances. Medical cannabis, however, has a very low potential for abuse and can even help to improve sleep quality. This is hugely beneficial for the astonishing 82% of people who say that anxiety negatively impacts their sleep. 

I think I’m eligible – what next?

Currently, the eligibility criteria for receiving a medical cannabis prescription on the NHS are strict. A patient is unlikely to be prescribed any cannabis-based products unless other treatments have been unsuccessful and they are living with any of the following conditions:

• Rare, severe forms of epilepsy
• Vomiting or nausea caused by chemotherapy
• Muscle stiffness and spasms caused by multiple sclerosis (MS)

That said, any eligible patients with a qualifying condition can receive a private medical cannabis prescription, including those with anxiety. Costs will vary between clinics, with consultations ranging between £50 and £200, and the average prescription being around £150-£250 per month. For patients involved in schemes such as Project Twenty21, prescriptions are capped at £150 per product per month in exchange for participating in ongoing studies. 

For more information about getting a medical cannabis prescription in the UK, take a look at our comprehensive guide.