Can a Psychiatrist Prescribe Medical Marijuana?
Article written by
Elena Schmidt
Content reviewed by
Dr. Lewis Jassey
Psychiatrists can’t formally prescribe marijuana anywhere in the country because the plant is still a Schedule I controlled substance. However, licensed physicians can recommend marijuana for medical use.
Only a medical doctor (MD), osteopathic doctor (DO), or naturopathic doctor (ND/NMD) can write qualifying recommendations for medical marijuana. In many states, medical cannabis laws stipulate that doctors must register with the state’s cannabis management office or apply for a special license to recommend medical cannabis to patients in compliance with the law.
Psychiatrists are medical doctors (MDs and DOs) specializing in diagnosing, treating, and preventing mental illnesses and emotional disorders. As such, psychiatrists can write recommendations for medical marijuana cards in the states they are licensed to practice in.
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How to Talk to Your Psychiatrist About Medical Cannabis
Getting a psychiatrist’s recommendation for medical marijuana use can be taxing. You can make it easier by preparing to discuss the following:
- Your medical history (and treatment failures)
- Objections your doctor may have
- How your doctor can learn more about cannabis
You can approach these conversations with a few simple facts about medical marijuana, such as:
- Medical cannabis is a legal medicine in most of the United States.
- Medical marijuana has a lower risk of mental and physical side effects than other pharmaceutical drugs.
- Randomized controlled trials, clinical scenarios, longitudinal studies, and anecdotal evidence from patients indicate that the medicinal use of marijuana can help people with depression, anxiety, PTSD, and OCD, among other conditions.
Using Cannabis for Mental Health Conditions
Scientists theorize that cannabis helps improve mental health by enhancing the body’s endocannabinoid system function.
The endocannabinoid system (ECS) is a complex cell-signaling system that regulates physiological and cognitive processes, including mood, appetite, pain sensation, and sleep, among other key bodily functions. It consists of endocannabinoids, receptors, and enzymes that work together to maintain a state of balance in the body known as homeostasis.
Medicinal cannabis is biochemically rich in various compounds (e.g., cannabinoids, terpenes, flavonoids). Cannabinoids like delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) interact with the ECS and may improve mood and support mental health.
Delta-9 THC, the primary compound in the cannabis plant with psychoactive properties, binds with ECS receptors in the brain that affect neurotransmitters associated with mood regulation.
Non-psychoactive CBD binds to the 5-HT1A receptor, a serotonin receptor linked to mood. This effect is similar to the serotonin produced by conventional SSRI medications, a widely used class of antidepressants. CBD also indirectly interacts with the ECS to boost endocannabinoids associated with mood elevation, like anandamide (i.e., the “bliss molecule”).
Mental Health Conditions and Medical Cannabis
Medicinal marijuana is used for many different mental health disorders. Some research supports the claim that medical cannabis may help offer symptom relief to psychiatric conditions that are often unresponsive to standard therapies.
Depression
Both THC and CBD have mood-boosting properties. THC stimulates the release of dopamine, the brain’s “feel-good” chemical that causes euphoria and happiness. CBD influences the brain to release serotonin, which keeps emotions in balance.
Research shows that cannabis can reduce self-reported psychiatric symptoms of anxiety, depression, and stress in the short term. However, chronic use, especially at high doses, can exacerbate depressive symptoms.
Anxiety
CBD has well-documented anxiolytic (i.e., anti-anxiety) effects. Studies also reveal that people with anxiety are deficient in the endocannabinoid anandamide, likely contributing to decreased happiness and self-esteem. CBD can boost anandamide levels.
THC has a similar chemical structure to anandamide and can yield similar effects. One controlled trial focused on THC showed increased relaxation among daily users. Marijuana can also ease muscle tension and even motivate people to exercise, which helps further relieve anxiety.
PTSD (Post-traumatic Stress Disorder)
One systematic review of compiled research on PTSD and cannabinoids concluded that cannabinoids might decrease symptoms of PTSD, such as nightmares and sleep disturbances. Another study exploring marijuana’s potential to treat PTSD found that Nabilone, a cannabinoid medication, showed many beneficial effects on PTSD symptom severity, sleep quality, frequency of nightmares, and hyperarousal.
Additionally, researchers believe CBD’s anti-inflammatory effects may be helpful in psychological conditions such as PTSD that involve elevated inflammatory processes within the brain.
Eating Disorders
Research shows that the therapeutic use of marijuana can help increase appetite and treat nausea and vomiting. There is some evidence that people with cancer or HIV that use cannabis to reduce nausea and cachexia have seen positive outcomes. It could also benefit those working through eating disorders.
One randomized control trial studied the effects of delta-9 THC or dronabinol in people with anorexia nervosa. The results showed a weight increase of one kilogram over four weeks over a placebo. However, the systematic review that identified this study cautioned that few studies exist, the evidence remains low, and more research is needed to definitively state whether cannabis can be used as a treatment for anorexia nervosa.
OCD (Obsessive-compulsive Disorder)
A new study by Washington State University published in the Journal of Affective Disorders found that smoking cannabis, especially strains with higher concentrations of CBD, quickly and temporarily reduced OCD symptoms, such as anxiety, repetitive behaviors, and intrusive thoughts.
A case report and review of the current literature concluded that cannabis might improve OCD, citing the increasing evidence that modulating the endocannabinoid system may be the key to treatment.
Substance Abuse Disorders
There is some evidence that medical cannabis may help treat substance use disorders such as opioid dependency. Prescription opioid use and rates of opioid-related deaths have decreased in states with legalized medical marijuana.
Also, approximately two-thirds of people diagnosed with anxiety disorders decreased their use of anti-anxiety medications after substitution with medical cannabis. Additionally, one systematic review found that cannabis may help alleviate opioid withdrawal.
Potential Risks of Medical Cannabis for Mental Health Disorders
Medical marijuana does come with some risks. In a systematic review, high-potency cannabis correlated with increased anxiety symptoms, and researchers indicated it could negatively affect psychotic disorders such as schizophrenia.
Short-term benefits are well documented. But some point to limited evidence in medicinal marijuana and cannabis products for treating mental disorders long term.
In adolescent psychiatry, reports show cannabis use topped 43% in young people in the past year, indicating there might be an increased risk for disorders such as cannabis use disorder and other substance use disorders in young adults.
The Bottom Line
Psychiatrists are qualifying doctors who can write medical marijuana recommendations. Psychiatrists often recommend medical marijuana to treat many mental disorders and their symptoms.
Current treatments for these conditions primarily involve pharmaceutical drugs, many of which are ineffective or have adverse side effects like causing secondary medical conditions. Medical marijuana could be an excellent alternative for many patients. It’s important to discuss medical cannabis and your treatment plan with your doctor.
To see if you qualify for medical marijuana, connect with a Leafwell virtual clinic team member. They can answer any questions you have and potentially register you for an MMJ card today.
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