Clearly, research efforts have not been extensive enough to determine whether marijuana and CBD might be helpful or harmful for people with OCD. There’s still a lot of energy around this topic, though, and a few researchers plan to conduct larger-scale surveys of people with OCD—perhaps in preparation for research studies. (For more on these, stay tuned to the NOCD blog.)
Subject to claims of effectiveness for all kinds of conditions, CBD is being marketed far more quickly than it can be researched. Due to its trendiness and a shaky but largely unenforced legal status, US sales grew from $108.1 million in 2014 to an estimated $813.2 million in 2019. By 2022 CBD sales are projected to approach $2 billion. Walgreens sells CBD products in nine states, CVS in eight. A staggering 14% of American adults say they use CBD, primarily for pain, anxiety, and insomnia.
These statistics vary drastically around the world, for many reasons. But in the US, at least, widespread and growing use points to a reality in which cannabis products ought to be part of any discussion about mental health. It also points to a need for these discussions to be based in evidence, not alarmism or anecdote.
A 2016 study sheds additional light on the possible neurobiology of these effects. When CB1 receptors—which are blocked indirectly by CBD—were deleted in specific neurons, mice were not able to shift from “goal-directed” to “habitual” behavior (possibly an analogue to compulsions in humans). Those researchers concluded that mice were switching between goal-directed and habitual behaviors based on activity in their CB1 receptors.
Cannabis products and OCD
Meanwhile, a 2017 clinical trial at the New York State Psychiatric Institute called “Effects of Marijuana on Symptoms of OCD,” has yet to post results. If results do emerge, they’ll come from only 14 participants—a great start, but hardly conclusive. That marijuana remains illegal and stigmatized in so many places limits sample sizes and therefore study progress, and researchers must do what they can with a limited patient population.
Researchers have conducted a few animal studies with cannabinoids, yielding mixed results. Two studies, from 2010 and 2013, linked CBD with a reduction in compulsive-like marble-burying behavior among mice. However, as Dr. Feusner notes, the observed mouse behaviors like marble-burying or pathological grooming aren’t necessarily complete models for OCD in humans.
People say all kinds of things about marijuana and CBD. They range from potentially true to probably nonsensical, and the longtime illegality of cannabinoid products has only made it harder to get any research done. Everyone is confused—especially those with mental health conditions, who might have the same desire to try these substances but a reduced ability to tolerate their effects.
Another substance to worry about?
Unfortunately, this lack of research carries over to substance use as it relates to OCD. As Dr. Jamie Feusner, MD, Professor of Psychiatry at UCLA and NOCD Chief Medical Officer, put it: “There is very little known about marijuana or CBD use in people with OCD, and no clinical studies of these substances in people with OCD have been published.”
Disclaimer: This post is an examination of research on marijuana and CBD usage among people with OCD and other mental health conditions. NOCD does not endorse any study or its results, or recommend the use of marijuana, CBD, or any psychoactive drug.
Background: Preclinical data implicate the endocannabinoid system in the pathology underlying obsessive-compulsive disorder (OCD), while survey data have linked OCD symptoms to increased cannabis use. Cannabis products are increasingly marketed as treatments for anxiety and other OCD-related symptoms. Yet, few studies have tested the acute effects of cannabis on psychiatric symptoms in humans.
Methods: We recruited 14 adults with OCD and prior experience using cannabis to enter a randomized, placebo-controlled, human laboratory study to compare the effects on OCD symptoms of cannabis containing varying concentrations of Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) on OCD symptoms to placebo. We used a within-subjects design to increase statistical power. Across three laboratory sessions, participants smoked three cannabis varietals in random order: placebo (0% THC/0% CBD); THC (7.0% THC/0.18% CBD); and CBD (0.4% THC/10.4% CBD). We analyzed acute changes in OCD symptoms, state anxiety, cardiovascular measures, and drug-related effects (e.g., euphoria) as a function of varietal.
Results: Twelve participants completed the study. THC increased heart rate, blood pressure, and intoxication compared with CBD and placebo. Self-reported OCD symptoms and anxiety decreased over time in all three conditions. Although OCD symptoms did not vary as a function of cannabis varietal, state anxiety was significantly lower immediately after placebo administration relative to both THC and CBD.