Cannabis shows promise as treatment for borderline personality disorder (BPD)

The first research of its kind has reported ‘promising’ findings in the treatment of borderline personality disorder (BPD) with cannabinoids. 

When used in a controlled clinical environment, cannabis-based medicines can lead to a ‘substantial improvement’ in symptoms associated with BPD, also known as emotionally unstable personality disorder (EUPD), according to a new study.

The case series, which was published at the end of last year using data from the UK patient registry T21, is thought to be the first medical evidence of the use of cannabis medicines in the treatment of EUPD.

Putting EUPD in context 

EUPD is a common but broad mental health diagnosis and may affect individuals very differently. According to the NHS, some of the signs include emotional instability, ‘disturbed patterns of thinking or perception’, impulsive behaviour and ‘intense but unstable relationships’ with others.

It is also a difficult condition to treat and many with a diagnosis of EUPD report experiencing stigma in medical settings.

According to National Institute for Health and Care Excellence (NICE) guidelines, no drugs have established efficacy in treating or managing EUPD, however, patients are commonly prescribed medications such as antipsychotics, antidepressants and mood stabilisers. 

It is not known what causes the condition, although it is thought to be a combination of genetic and environmental factors. 

The endocannabinoid system (ECS) is thought to play a role in many psychiatric conditions. According to the researchers ‘impaired functioning’ of the ECS in areas of the brain responsible for emotional processing and stress response ‘may underlie the manifestation of EUPD symptoms’.

Exploring the findings 

The case series explores the experiences of seven patients with a diagnosis of EUPD who were prescribed cannabis-based medicinal products through Zerenia Clinics in the UK and Colombia.

The majority of participants were under the age of 30. Six had tried three or more conventional medications and five had previously tried illicit cannabis, with only two reporting that they were ‘cannabis naïve’.

In the UK, patients were prescribed dried cannabis flowers and oral extracts of varying CBD and THC concentrations, while in Colombia only oils are permitted on prescription. 

Participants were given an initial assessment and followed up one month after being issued with their prescription. 

During the follow-up appointment, prescribing psychiatrists rated the patient’s improvement on the Clinical Global Impression Improvement scale (CGI-I), a standardised seven-point scale used to rate the severity of the patient’s illness.

Patients were asked to complete the Patients’ Global Impression of Change scale (PGIC), and to report any side effects they had experienced. 

According to the paper, six participants reported an improvement in symptoms, with five rating their change as a six on the PGIC, which is defined as ‘better, and a definite improvement that has made a real and worthwhile difference’.

The only patient that did not report any benefit was treated with an oral extract alone, suggesting that ‘fast-acting administration of inhaled THC or prolonged accumulation of oral CBD in higher doses’ may be more effective to help EUPD patients cope with symptoms, the authors say.

“Much like other medications used in EUPD, the aim is to achieve rapid symptom relief, allowing the patient to assimilate psychological techniques to manage their condition in the long term,” they state.

“In this way, CBMPs are not intended to supplant important psychological therapies needed for the management of EUPD but, rather, to act as an initial primer towards achieving symptom control and sparking patients with the hope of clinical improvement.”

In general, the treatment was well-tolerated and none of the participants reported any adverse side effects.

Drawing conclusions and next steps

According to those behind the study, cannabinoids present a ‘promising’ alternative treatment for those with EUPD.

However, the findings are limited by the small number of patients involved in the study, and the fact that all those who reported benefit from cannabis flower were already ‘experienced users’. They have called for further investigations before ‘robust conclusions’ can be made. 

The authors concluded: “Cannabinoids may represent a novel, efficacious, and safe treatment alternative for EUPD patients. 

“The neuro- and immune-modulatory effects of THC and CBD seem theoretically well-aligned with cellular and molecular deficits that are currently being investigated as key features underlying the pathogenesis of EUPD. 

“Although preliminary, our results suggest that, when deployed in a rigorously controlled clinical environment, CBMPs can provide substantial improvement in symptoms associated with EUPD thus warranting the need for further research on this therapeutical strategy.”

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