COVID-19 has seen people locked indoors worldwide most of the day. Unsurprisingly, many of us felt greater anxiety during these uncertain times. Fear, worry, and concern are now everyday emotions. Levels of loneliness, depression, and alcohol and drug abuse are expected to rise. [1] These effects aren’t likely to be short-term, either.  COVID-19 has spread worldwide. We are far from having this public health crisis under full control. No one can truly predict when lockdown will finally be over, at least on a global scale.

The question now is, “Can cannabis help treat an anticipated  rise in public mental health issues?”

Leafwell asked our patients why and how they’ve used cannabis since COVID-19 began. Here’s how 375 respondents answered.

Medical Cannabis & Why It Was Used During COVID-19

Key Stats & Findings

• 375 people surveyed
• 143 (38.1%) of respondents  obtained a medical card because of COVID-19
• Pennsylvania responded most (68, 18.36%), followed by California (50, 13.3%) and Massachusetts (45, 12.15%)
• Most common health issues medical cannabis was used for during COVID-19:
  – Anxiety Disorders – 259 (69.1%)
  – Stress – 240 (64%)
  – Depression – 212 (56.5%)
  – Insomnia – 208 (55.5%)
  – Chronic Pain – 200 (53.3%)
  – Headaches / Migraine 119 (31.7%)
• Many in the survey used cannabis to reduce/replace alcohol (73 respondents, 19.5%) and NSAIDs  (78 respondents, 20.8%)
• THC-containing products are the most popular:
  – THC-Rich Flower – 268 (71.5%)
  – THC-Rich Edibles – 200 (53.3%)
  – THC-Rich Vapes – 194 (51.7%)
• Within CBD products, CBD-Rich Flower (59 (15.7%)) and CBD-rich edibles (58 (15.5%)) are most popular
• Most common times to use cannabis:
  – Evening – 307 (82%)
  – Bedtime – 296 (79%)
• An equal number of people used medical cannabis in the morning and afternoon, 179 (47.73%)
• 112 (30%) used medical cannabis morning, afternoon, evening, and bedtime

Other Interesting Findings

• Some people used cannabis for COVID/post-COVID-19 symptoms. There is some suggestion that CBD and other cannabinoids’ ability to modulate the immune system can potentially treat cytokine storms (when the immune system goes haywire and attacks healthy as well as infected cells), [2]  lung inflammation, and post-viral chronic fatigue syndrome
• Cannabis could be a great treatment for arthritis & arthritic pain
• Perhaps unsurprisingly, many reported an increase in stress and anxiety. One person reported feeling an “impending sense of doom”
• Breast cancer, fibromyalgia, IBS, Polycystic Ovarian Syndrome (PCOS) and multiple sclerosis (MS), neuropathic pain and post-surgery pain, HIV, lowering blood pressure, and appetite loss were also cited as reasons for medical cannabis use

Medical Cannabis and Anxiety, Stress, Depression, and Insomnia

Out of 375 respondents:

• 259 (69.1%) used medical cannabis for anxiety disorders
• 240 (64%) used medical cannabis for dealing with stress
• 212 (56.5%) used medical cannabis for depression
• 208 (55.5%) used medical cannabis for insomnia

Many of the people surveyed reported an increase in anxiety. One even reported feeling a sense of impending doom. Even though one person only uses this description, it is not necessarily an uncommon feeling during other pandemics throughout history. [3]

There are several established reasons why medical cannabis works so well for stress, anxiety, depression, and insomnia, conditions that are often comorbid with one another, including:

• Low doses of tetrahydrocannabinol (THC) have anti-anxiety effects. Compounds that affect CB1 receptors in the brain can reduce the concentration of adrenaline available in the body. [4]
• Targeting the same CB1 receptors with THC has sedative effects, making it great for treating insomnia and aiding sleep. Cannabinol (CBN) also has sedative effects.
• Cannabidiol (CBD) interacts with serotonin receptors, making it a great alternative to replace or reduce the need for antidepressants. [5]
• Cannabis is full of stress-busting terpenes such as linalool and pinene.

Medical Cannabis and Chronic Pain and Headaches / Migraine

200 (53.3%) used medical cannabis during the COVID-19 crisis for chronic pain, while 119 (31.7%) used medical cannabis for headaches/migraines.

Stress and anxiety can feed into chronic pain and make it pain worse. Being in constant pain leads to greater levels of anxiety and depression. Several established reasons why medical cannabis is great for treating chronic pain and headaches/migraine include:

• A combination of many anti-inflammatory compounds, including cannabinoids like THC, CBD, and CBC (cannabichromene) and terpenes like beta-caryophyllene, myrcene, and humulene.
• CBD is an allosteric modulator of the mu- and delta- opioid receptors. This means CBD changes the way pain signals are processed by changing the shape of receptors, causing them to process signals differently. [6]
• Cannabis is one of few medications that can treat total pain, combining physical, mental, emotional, and spiritual pain. Cannabis contains hundreds of compounds that can target different receptor systems. [7]
• Cannabinoids may be useful for remedying hard-to-treat conditions such as fibromyalgia and neuropathy.

Medical Cannabis for Drug and Alcohol Reduction

Many people turned to alcohol to deal with the stress and anxiety (and the cabin fever) during the shelter-in-place orders of 2020. There is a lot of interest in cannabis as an alternative to alcohol and addictive prescription drugs such as opioids and sedatives. Our survey showed some interesting numbers about this.

• 78 (20.8%) of study participants used medical cannabis to reduce/replace NSAID intake (e.g. ibuprofen, aspirin)
• 73 (19.5%) used medical cannabis to reduce/replace alcohol
• 38 (10.1%) used medical cannabis to reduce/replace opioid intake
• 30 (8%) used medical cannabis to reduce /replace sedative intake (benzodiazepines, barbiturates)
• 37 (9.9%) used medical cannabis to reduce/replace intake of another prescription drug
• 16 (4.3%) used medical cannabis to reduce/replace intake of other recreational drugs

As stated above, cannabinoids can target multiple receptor sites, including dopamine, serotonin, and opioid receptors. This can help reduce or eliminate the need for more addictive and/or harmful drugs and medications. Chances of overdose are also dramatically reduced, as natural cannabinoids are broken down by the body too rapidly for a deadly buildup.

Other reasons why medical cannabis can help reduce drug and alcohol intake include:

• CB1 receptors are found in the same brain areas as opioid receptors, suggesting that CB1 receptors can “talk” to and influence how opioid receptors behave. [8]
• The terpene-cannabinoid beta-caryophyllene, which targets CB2 receptors in the immune system, can help reduce alcohol, opioid, and recreational drug intake. CB2 receptors are overexpressed on dopamine receptors in alcoholics and those suffering from depression, and beta-caryophyllene can activate CB2 receptors and reduce the need for alcohol, opioid, or cocaine. [9]
• CBD and CBDA’s anti-inflammatory effects are partly due to their selective COX-2 enzyme inhibitors, [10] which is similar to how NSAIDs such as ibuprofen work, with the added advantage of an increased safety profile.

Did People Get an MMJ Card Because of COVID-19?

The COVID-19 crisis prompted many people to seek certification for medical marijuana and obtain their MMJ cards. 143 (38.1%) respondents got a medical card because of COVID-19.

What Type of Medical Cannabis Products Did People Use?

Products containing THC were generally more popular during the pandemic.

• THC-Rich Flower – 268 (71.5%)
• THC-Rich Edibles – 200 (53.3%)
• THC-Rich Vapes – 194 (51.7%)
• THC-Rich Concentrate – 85 (22.7%)
• 1:1 THC:CBD Edibles – 79 (21.1%)
• Within CBD products, CBD-Rich Flower (59 (15.7%)) and CBD-Rich Edibles (58 (15.5%)) were most popular.

What Time of Day Did Most People Use Medical Cannabis?

Evenings and bedtimes were the times when most respondents preferred dosing – 307 (82%) and 296 (79%), respectively.

An equal number of people used medical cannabis in the morning and afternoon, at 179 (47.73%).

112 (30%) used medical cannabis morning, afternoon, evening, and bedtime.

How Many Patients Suffered From COVID-19?

143 (38.1%) of patients surveyed contracted COVID-19 sometime during 2020 or the first quarter of 2021.

Medical Cannabis Use During the COVID-19 Crisis: Overall

There is little doubt that cannabis use increased for many during the first wave of the COVID crisis. [11] This is not necessarily a cause for alarm, especially when cannabis is being used by medical patients who are reducing their intake of addictive drugs and alcohol.

Moreover, CBD could be useful in treating over-inflammation caused by cytokine storms, helping to reduce lung damage. [12] Medical cannabis could greatly reduce post-COVID-19 stress and anxiety, harmful drug or alcohol consumption, and the lingering symptoms of long-COVID.

Medicinal cannabis could very much be the ideal alternative needed in these trying times.

References

[1] ‘Mental health and COVID-19’, World Health Organization, Europe.

[2] ‘Use of Cannabinoids to Treat Acute Respiratory Distress Syndrome and Cytokine Storm Associated with Coronavirus Disease-2019’, Prakash Nagarkatti, Kathryn Miranda and Mitzi Nagarkatti, Front. Pharmacol., 06 November 2020 | https://doi.org/10.3389/fphar.2020.589438

[3] ‘The End of the World: Interpreting the Plague’, Joan Acocella, The New Yorker, March 13, 2005

[4] ‘Effects of cannabinoids on adrenaline release from adrenal medullary cells’, Nathalie Niederhoffer, Henrik H Hansen, Javier J Fernandez-Ruiz, and Bela Szabo, Br. J Pharmacol. 2001 Nov; 134(6): 1319–1327. doi: 10.1038/sj.bjp.0704359

[5] ‘Cannabidiol modulates serotonergic transmission and reverses both allodynia and anxiety-like behavior in a model of neuropathic pain’, Danilo De Gregorio,a Ryan J. McLaughlin,b Luca Posa et al., Pain. 2019 Jan; 160(1): 136–150. Published online 2018 Dec 28. doi: 10.1097/j.pain.0000000000001386.

[6] ‘Cannabidiol is an allosteric modulator at mu- and delta-opioid receptors’, Markus Kathmann, Karsten Flau, Agnes Redmer, Christian Tränkle, Eberhard Schlicker. Naunyn Schmiedebergs Arch Pharmacol. 2006 Feb;372(5):354-61. doi: 10.1007/s00210-006-0033-x. Epub 2006 Feb 18.

[7] ‘‘Total pain’: the work of Cicely Saunders and the maturing of a concept’, David Clark, The University of Glasgow, End of Life Studies. September 25, 2014.

[8] ‘Opioid and cannabinoid receptors: friends with benefits or just close friends?’, MacDonald J Christie, Br. J Pharmacol. 2006 Jun; 148(4): 385–386. Published online 2006 May 8. doi: 10.1038/sj.bjp.0706756.

[9] ‘Brain Neuronal CB2 Cannabinoid Receptors in Drug Abuse and Depression: From Mice to Human Subjects’, Emmanuel S. Onaivi, Hiroki Ishiguro, Jian-Ping Gong et al. PLOS One, February 20, 2008. https://doi.org/10.1371/journal.pone.0001640

[10] ‘Cannabidiolic acid as a selective cyclooxygenase-2 inhibitory component in cannabis’, Shuso Takeda, Koichiro Misawa, Ikuo Yamamoto, Kazuhito Watanabe. Drug Metab Dispos. 2008 Sep;36(9):1917-21. doi: 10.1124/dmd.108.020909. Epub 2008 Jun 12.

[11] ‘Half of cannabis users increased consumption during first wave of COVID-19’, The Centre for Addiction and Mental Health (CAMH), January 13, 2021.

[12] ‘Cannabis for COVID-19: can cannabinoids quell the cytokine storm?’, Emmanuel Shan Onaivi and Venkatanarayanan Sharma. Future Sci OA. 2020 Sep; 6(8): FSO625. Published online 2020 Aug 13. doi: 10.2144/fsoa-2020-0124