Rise in patients with ‘unmet’ mental health needs seeking medicinal cannabis

The number of patients seeking medicinal cannabis prescriptions for anxiety and other psychiatric conditions is on the rise, according to experts.

Researchers and clinicians report seeing an increase in patients looking to manage anxiety, depression and neurodevelopmental conditions, including ADHD and autism, with medicinal cannabis.

Mounting real world evidence is also reporting significant benefits of cannabis in these conditions, despite a lack of robust clinical trial data.

Researchers in Australia recently analysed records of medicinal cannabis prescribed to patients through Special Access Scheme B (SAS-B), using data supplied by the Australian Therapeutic Goods Administration (TGA).

Prescriptions through this scheme have been increasing annually since cannabis was legalised for medicinal use in Australia in 2016. According to the researchers, from February 2021 to September 2022, the number of prescriptions rose from 100,000 to 300,000.

After treatment for chronic pain, analysis by researchers at the Lambert Initiative for Cannabinoid Therapeutics, shows anxiety is the second most common condition being treated with prescribed medicinal cannabis in Australia, making up just under a quarter of all SAS-B prescriptions.

There is also increasing prescribing for conditions such as depression, ADHD and autism. According to their analysis, psychiatric prescriptions, used to treat mental, emotional, developmental and behavioural disorders, make up over third of total approvals.

“These data confirm many Australians have unmet needs around their mental health and that medicinal cannabis is now frequently being trialled as an alternative to conventional therapies,” said Dr Elizabeth Cairns from the Lambert Initiative for Cannabinoid Therapeutics at the Brain and Mind Centre, who led the study.

“Medicinal cannabis is not typically prescribed as a first-line therapy, so those using it for conditions such as anxiety and depression likely have not had success with other treatments.”

Parallels with UK data on medicinal cannabis and anxiety 

It is a similar picture in the UK, where anxiety is also the second most common indication for which cannabis is prescribed, following chronic pain. 

According to Michael Lynskey, head of research at Drug Science, around a third of patients enrolled on the organisation’s patient registry, T21, have an anxiety disorder as their primary condition.

Another 10% have other diagnosed psychiatric conditions, the second most common being post-traumatic stress disorder (PTSD), followed by depression and ADHD. 

“I found a lot of similarities in the research from Australia with what we have seen in T21,” said Lynskey.

“We are also working with an Australian partner who is collecting data in a similar way to us and from their reports, the number of people with anxiety disorders is about the same as the number of people with chronic pain.”

But Lynksey says the numbers are actually not that surprising when you look at the wider context. 

The number of people being diagnosed with mental health conditions is on the rise, particular anxiety-related disorders. According to the World Health Organisation (WHO) there has been a 25% increase in anxiety and depression since the Covid-19 pandemic, with almost 4% of the global population now thought to have an anxiety disorder. 

First-line treatment for anxiety is usually talking therapies, but services are becoming increasingly stretched, with patients reporting lengthy waiting lists to access secondary mental health care. 

Other treatments include medication to manage the symptoms, such as selective serotonin reuptake inhibitors (SSRIs), which are commonly prescribed for depression and generalised anxiety disorder (GAD), although they are not always effective for everyone. 

“It’s not actually that surprising when you think about the fact that anxiety disorders are very common,” Lynskey continued.

“For many people, anxiety disorders are chronic and recurring, and often [patients] are not overwhelmed with an effective set of treatment options. A large number of people are having trouble accessing treatment, and medications, while effective for some – and I’m not trying to criticise those treatments – the reality is that a lot of people do not receive sufficient benefit from them.”

Rise in ADHD patients seeking medicinal cannabis

Dr Niraj Singh, a consultant psychiatrist who has been prescribing cannabis in the UK for over three years, has also seen a rise in the number of patients with neurodevelopmental conditions, including ADHD and autism, seeking prescriptions.

The prevalence of diagnosis of these conditions has also been on the rise in recent years, with 2.6 million people in the UK now diagnosed with ADHD, while more than 700,000 are thought to be autistic. 

Often these patients will also experience comorbidities, particularly anxiety and sleep disorders, related to their primary diagnosis. Data published by T21 in 2022 showed secondary anxiety disorders more common in patients with ADHD (68.3%) than the rest of the sample with a primary condition other than an anxiety condition (40.6%).

Speaking about the research from Australia, Dr Singh said: “In my opinion, it parallels the UK experience, although we have less prescriptions, anxiety does remain the main psychiatric indication. I’ve certainly noticed a rise in use of medicinal cannabis for people with neurodevelopmental conditions, which includes anxiety associated with autism, ADHD and less commonly OCD and Tourette syndrome.”

He continued: “Autism and ADHD have been increasingly diagnosed over recent years and continue to be so. For many people, medicinal cannabis can offer a great opportunity to improve executive functioning, attention, concentration, as well as emotional regulation alongside reducing anxiety and sleep problems, which are very common in people with neurodevelopmental conditions, as well as in those with other psychiatric conditions. Medicinal cannabis can be effective where there are very few existing treatment options.”

Is the lack of ‘high quality’ evidence cause for concern?

But the researchers Australia have expressed concern about the lack of ‘high quality evidence’ for the use of cannabis in psychiatric conditions, particularly, the ‘high prevalence of THC-containing products being prescribed’.

“The researchers are right in that there isn’t a large number of randomised control trials (RCTs) demonstrating efficacy, but there is a consistent body of real world evidence emerging that says people benefit quite substantially,” said Lynskey.

“Increasingly, studies like T21 are showing that people prescribed cannabis for a primary condition related to anxiety, report quite substantial benefits in regards to reductions in anxiety and improvements in quality of life.”

One paper, published by researchers at Drug Science and Khiron Life Sciences, found that patients on T21 being treated with high-THC cannabis flower actually reported significant reductions in anxiety. T21 data also suggests that patients with ADHD report improvements in quality of life, with reductions in anxiety and improved sleep and mood. 

Elsewhere, clinical outcome data from the UK Medical Cannabis Registry, published this month by researchers at Sapphire Medical Clinics, shows that the prescription cannabis medicines in those with GAD is associated with ‘clinically significant’ improvements in anxiety. 

Lynskey argues that the lack of RCTs shouldn’t be used as a reason not to prescribe something which many patients are reporting benefits from. 

“We’re aware of the [evidence] gaps, but given the current state of knowledge, and particularly with the accumulating real world evidence, we certainly shouldn’t sort of hold back and not prescribe cannabis for anxiety disorders until all these very lengthy trials have been done,” he said.

“It is important that we keep doing the research to refine our understanding, but do I think that [regulators] need to listen more to real world evidence.“

The complexities of psychiatric conditions, as well as the many compounds that make up cannabis-based medicines also make it difficult to study in a clinical trial, Dr Singh points out.

“I agree with the authors of the paper that the research evidence base does need to be built in relation to individual psychiatric disorders. Conducting RCTs, however, is hugely problematic because a plant is not a single molecule but has hundreds of components within it,” he added.

“Real world evidence continues to be of paramount importance, such as the work that Drug Science is doing through T21, the results of which continue to be very encouraging.”

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