Between January 1, 2018, and November 1, 2020, there have been more than 9,000 sessions of patients consuming medical cannabis for obsessive-compulsive disorder (OCD) within the RYAH Data ecosystem. This evidence adds to the chorus of anecdotal reports, case studies, and several hypothetical scientific reviews on the subject. Could medical cannabis improve functional impairment caused by OCD by targeting fear, anxiety, and even repetitive behaviors?
Patients with OCD have access to several evidence-based pharmaceutical treatments, which may be delivered in tandem with exposure and response prevention (ERP) therapy. Together, the success rate of these therapies is actually quite good — in the short-term. As a 2012 review in the World Journal of Psychiatry noted, relapse rates and long-term success stories are not always as favorable.
Researchers are exploring new ideas about the role of the endocannabinoid systems in the development and severity of OCD, which in turn is creating new approaches to treatment. Instead of serotonin receptor inhibitors (SRIs) and antipsychotics, could endocannabinoid therapies like medical cannabis solve the lingering issues with OCD treatment?
A Novel Idea: The Endocannabinoid System and OCD
The current medical model defines OCD as an imbalance of neurological firing between the lateral and medial orbitofrontal cortex. The lateral region is responsible for ritualized behaviors, and the medial is in charge of emotional regulation and reward processing. One area becomes hyperactive, while the other is underactive.
But, with so many reports of patients self-treating OCD with cannabis, it’s natural to assume the endocannabinoid system could play a role. Cannabis works within the endocannabinoid system for therapeutic impact. Logically, doesn’t that allude to the endocannabinoid system managing the systems of OCD?
In 2019, “The Endocannabinoid System: A New Treatment Target for Obsessive Compulsive Disorder?” laid out a new argument and one which could explain why so many patients are already using cannabis for symptom reduction. As per the article published in Cannabis and Cannabinoid Research, there are three strong indications of why the endocannabinoid system is involved.
In the areas of the brain already associated with obsessive-compulsive behaviours, there is evidence of high concentrations of the CB1 receptor. This is one of the two endogenous cannabinoids receptors in the human body and one whose activity is influenced by cannabinoids like THC.
Animal studies indicate that cannabinoid therapy helps regular fear-extinction and other OCD-relevant neurocognitive functions. As per the authors, “cannabinoids can improve symptoms in animal models of anxiety and compulsive behavior.”
A growing body of preliminary clinical research suggests cannabinoid treatment is well tolerated and therapeutically valuable for people with OCD and other similar conditions.
Although there is a lot to unpack in this summary of findings, a few points stand out. Researchers have already shown that cannabinoid therapy improves extinction learning (or the recovery of fear) during small clinical trials. A 2013 study of fear extinction in patients with OCD clearly demonstrated the impairment of this demographic’s neurological behavior. Targeted research is needed to examine whether cannabinoid therapy would improve the fear-extinction capacity, specifically for those with OCD.
Another fascinating point: the growing evidence supporting cannabinoids for the treatment of anxiety and post-traumatic stress disorder (PTSD), and reduction of the repetitive behaviors of Tourette’s syndrome. If cannabis can effectively treat similar conditions and common comorbid conditions, there is a strong assumption it could improve the quality of life for those living with OCD.
Treating Comorbid Disorders Alongside OCD
According to the World Journal of Psychiatry paper cited above, 75 percent of people diagnosed with OCD also present with a comorbid disorder. The most common conditions experienced in tandem with OCD include social anxiety, major depression, and alcohol abuse. Across the spectrum of people with OCD, there is a significantly lower reported quality of life than controls. Even on their own, obsessive-compulsive behaviors often trigger severe distress.
It’s here where medical cannabis could deliver powerful holistic results, considering the amount of research already exploring cannabis as a treatment for these common comorbidities.
As one example, cannabidiol (CBD), the predominant non-intoxicating cannabinoid, is known to reduce anxiety, with impressive preliminary results for experimentally induced anxiety among participants with social anxiety. There is also a strong suggestion that cannabinoid therapy is useful for the symptoms of PTSD. So far, cannabinoids seem effective for reducing the severity of insomnia, reducing nightmares, and improving fear extinction.
Although the studies used pharmaceutical cannabinoids (dronabinol and nabilone), it’s a start. Future investigations will need to look at medical cannabis more broadly to match patients’ self-treatment environment today.
A Discrepancy in the Research on Cannabis and OCD
One of the most commonly reported comorbid disorders with OCD is alcohol abuse. Another may be cannabis misuse, although, as with most cannabis research, the line between cannabis for therapeutic value and cannabis misuse is blurry.
“Symptoms of obsessive-compulsive disorder predict cannabis misuse” explored this relationship in 2017. According to authors Alexander Spradlin, Dakota Mauzay, and Carrie Cuttler, “Severity of OCD (as indexed by higher scores on the Obsessive-Compulsive Inventory-Revised) was unrelated to frequency and quantity of cannabis use, but it was significantly, positively related to increased cannabis misuse.”
This means that OCD patients didn’t use cannabis more frequently to treat their symptoms, but severe symptoms predicted an increased risk of cannabis use disorder. Importantly, this study was conducted using an online survey, but it controlled for anxiety, depression, and other related issues.
What does this mean for patients already using medical cannabis to reduce fear, anxiety, and obsessive, repetitive behaviors? Even in the opinion of Spradlin, Dakota and Cuttler, there is a “paucity” of research available on this topic. Do people seek cannabis to reduce the challenging obsessive, anxious symptoms, making them more at risk for cannabis misuse? Or does OCD make it easier to fall into patterns of misuse with cannabis, no matter the effect on symptoms? It’s impossible to make any conclusions about the relationship between cannabis use and OCD until targeted scientific investigations conclude.
Further Hints from the Case Studies on Cannabis for OCD
Finally, while there are no expansive clinical or even preclinical trials looking at how cannabis affects the symptoms of OCD, there are three supportive case studies. In each case, the study used the Yale-Brown Obsessive-Compulsive Scale (YBOCS) to compare symptoms before and after treatment with dronabinol (synthetic THC). Patients received the treatment as a last resort after conventional treatments had failed (and in one case, before corrective surgery). Two patients treated OCD in conjunction with another psychiatric condition (major depression and schizophrenia).
In each of the three case studies, patients saw a substantial improvement to their YBOCS score in just a two-week period. Importantly, cannabinoid therapy was well-tolerated. Researchers pointed out measurable improvements to their patients’ quality of life. In some cases, there was such an improvement that patients could begin cognitive behavior therapy. Cannabinoid therapy did not trigger increased psychotic episodes, nor changes to mood.
Medical cannabis for OCD doesn’t seem that far fetched, considering the interesting relationship between OCD and endocannabinoid function. Notably, researchers are already studying medical cannabis for its ability to tackle many of OCD’s associated mental health conditions (anxiety, depression, etc.). With the three powerful case studies layered on top, cannabinoid therapy for OCD is a very real possibility.