Anxiety is Newly-Approved for PA Medical Cannabis
On July 11, Rachel Levine, MD, PA’s Secretary of Health, posted a press release to physicians credentialed to provide certifications for medical marijuana in PA. It that stated that, as of July 17, patients with moderate-to-severe anxiety may be legitimately certified for medical marijuana. Further guidance provided included recommendations for: short-term use (whatever that means), certification of those 21 years of age or older (due to the need to avoid impeding adolescent brain development), and inclusion of this treatment option after trying first-line conventional treatments, many of which have their own limitations and side effects. Adding to the complexity, there are several unanswered questions making treatment of this new indication with medical cannabis potentially problematic.
We all know many people with anxiety. We may be anxious ourselves, given the current social, economic, and political challenges we face on a regular basis. Yet, what is the threshold of anxiety severity for treatment with cannabis and how should that be determined, especially by the many certifying physicians who do not have strong backgrounds in managing mental health issues?
After researching to answer these questions for myself, I discovered that anxiety may be reliably measured with psychometric tools including patient-completed self-reporting questionnaires. The GAD-7 and the Beck Anxiety Inventory are two such scales which are scientifically valid instruments. However, neither addresses/measures the effects of anxiety on a person’s life, including insomnia, social disruption, and impaired physical function, which are all pertinent negative outcomes upon which physicians base their clinical decisions.
I will look to the PA Department of Health’s Medical Marijuana Program administrators to provide clarification as we physicians need. Until then, I will create my own anxiety questionnaire closely mirroring the questions in the two scales discussed above, yet adding questions about the role a patient’s anxiety plays in disrupting work, daily routines, sleep, and socialization. In the absence of clear scientific evidence and guidelines, I plan to settle on a threshold score that will ethically guide my clinical decisions to certify someone for medical marijuana … or not.
Over this past year, we physicians who have been credentialed to certify people for medical marijuana have been guided by our training (which was quite cursory regarding real-life clinical situations) as well as our own common sense and intuition. While it is a blessing to make medical cannabis available to those suffering with anxiety, as the Cannabis Indica strains have proven to be so effective at reducing anxiety and improving sleep, it remains to be seen how credentialed certifying physicians handle this newly approved indication and population in need of treatment. Stay tuned!
