Pot and paranoia: Why weed can make you anxious

Someone’s watching you. Or are they? Is your neighbor taking the trash out or trying to get a glimpse in your open door? And is the mail carrier just dropping off bills and letters, or are they snooping into your private correspondence? While cannabis is supposed to help you chill out, loosen up, and sleep really well, it can also make some consumers anxious and nervous. Many people use marijuana every day without negative effects, and some even experience some mental and physical health benefits, but in some cases it can make others certain someone is after them. “Yes there is evidence that cannabis, particularly acute cannabis intoxication, can cause paranoia,” said Dr. Carrie Cuttler, an assistant professor in the psychology department at Washington State University. “In a recent (unpublished) study of college students we found that approximately 50% reported experiencing paranoia at least once when intoxicated on cannabis and that they reported experiencing paranoia on approximately 25% of cannabis use sessions,” she wrote in an email. While researchers still aren’t exactly clear on how marijuana causes paranoia, it appears to be related to THC’s effect on receptors in the brain and is - literally- all in your head. Cannabinoids such as THC bind to receptors throughout the brain, including ones involved in processing emotions. They govern responses like stress and fear, and be can overexcited by THC, leading to anxiety and paranoia. That study on frequency, prevalence and predictors of various adverse reactions to cannabis is currently under review with the Journal of Cannabis Research. Cuttler also published a study in The Journal of Alternative and Complementary Medicine on acute effects of cannabis, including paranoia, in 2019. “In another study we found that 14.5% of a large sample of cannabis users recruited from the community reported experiencing paranoia as a side effect of cannabis use,” Cuttler said. Most everyone has a few relatively mild paranoid thoughts at some point but for some these thoughts become persistent and upsetting. How severe this paranoia is tends to vary by person. “This would likely depend on the person using cannabis. Those with a predisposition toward a psychotic disorder (e.g., schizophrenia) may be more likely to experience paranoia and potentially more severe paranoia,” according to Cuttler. Gender and age also appears to play a role. “Some of my unpublished data (student sample) suggest women may be slightly more likely to report ever experiencing paranoia when intoxicated but they don’t report experiencing it more frequently. In another (published) study we found that older individuals were less likely to report paranoia as an acute effect of cannabis than younger individuals,” And how often you use marijuana can also play into whether you will have a paranoid experience. “Our unpublished research suggests that individuals who use cannabis less frequently may be more likely to experience adverse reactions (although this is not specific to paranoia),” wrote Cuttler. “More specific to paranoia, our data show that those with more symptoms of cannabis use disorder, those with higher stress, and those with higher anxiety sensitivity are more likely to report ever having experienced paranoia when intoxicated.” Which may answer the old “chicken and egg” conundrum about which came first: the pot or the paranoia? “The literature is not entirely clear on this but it is likely bi-directional (people with anxiety and paranoia are more likely to use cannabis and those with paranoia may be more likely to experience it).” So is there an antidote to weed-caused paranoia? While Dr. Cuttler says she isn’t aware of one, some people commenting on online forums on the topic recommend using a low-THC or high- CBD strain of marijuana to cut down on psychological side effects. CBD is a non-intoxicating compound in cannabis that can combat anxiety in some people and provides a relaxing and calm experience. Other suggestions offered are to try an indica strain; sativas generally offer a higher-energy high, while indicas tend to be more relaxing. You can also control how much weed you ingest by smoking or vaping, rather than using oils or edibles, to better measure your dose and manage how high you get. Finally, it’s recommended to consume in a space where you feel comfortable, not a place that stresses you out, and go in with the mindset that you are going to stay put and enjoy the journey.