A new study published in sheds light on the complex relationship between cannabis legalization and the use of prescription medications for mental health disorders. The research, led by Dr. Ashley Bradford and her colleagues, investigates how access to medical and recreational cannabis impacts the dispensing of medications used to treat anxiety, depression, psychosis, and sleep disorders in a large population of commercially insured Americans.
The study analyzed data from over 10 million individuals across the U.S., tracking prescription fills for five classes of psychotropic drugs: benzodiazepines, antidepressants, antipsychotics, barbiturates, and sleep medications. Researchers used a synthetic control model to examine how cannabis laws and dispensary openings affect prescription patterns for these drugs from 2007 to 2020.
The most striking finding was that access to both medical and recreational cannabis was associated with a significant reduction in the use of benzodiazepines, a class of drugs primarily used to treat anxiety. Medical cannabis laws led to a 12.4% drop in the rate of benzodiazepine prescriptions, while recreational cannabis laws saw an even greater reduction of 15.2%. These findings suggest that as cannabis becomes more accessible, some individuals may be substituting it for traditional anxiety medications, which have a high potential for dependence and misuse.
However, while the decline in benzodiazepine use presents a promising avenue for safer treatment alternatives, the study also found a concerning trend: the use of antidepressants and antipsychotics increased following cannabis legalization. Medical cannabis laws were associated with a 3.8% rise in antidepressant fills, and recreational cannabis laws were linked to similar increases. For antipsychotics, the number of prescriptions per patient also rose slightly following the implementation of cannabis policies.
These mixed results highlight a broader public health dilemma. On one hand, cannabis may offer a safer alternative to certain medications like benzodiazepines, which are linked to severe withdrawal symptoms and can be deadly when combined with opioids. On the other hand, the rise in antidepressant and antipsychotic use may suggest that cannabis access is not a straightforward substitute for all psychotropic drugs, and could, in some cases, worsen mental health outcomes—especially for individuals with depression or psychotic disorders.
The study authors note that while cannabis use is associated with short-term relief of anxiety and pain, its effects on other mental health conditions remain less clear. Some studies have linked cannabis use to an increased risk of developing psychosis or experiencing worsening symptoms in individuals already diagnosed with schizophrenia. Other research points to a complex relationship between cannabis and depression, where it may help alleviate symptoms for some but exacerbate them for others.
Given the growing popularity of both medical and recreational cannabis, these findings carry significant implications for healthcare providers, policymakers, and patients. Clinicians may need to be cautious when recommending cannabis, particularly for individuals with a history of depression or psychosis, as the long-term effects on mental health remain uncertain. Additionally, the study highlights the need for further research to better understand how cannabis interacts with other medications and mental health conditions.
This research underscores the importance of personalized approaches to mental health care in an era of evolving cannabis legislation. As more states continue to legalize cannabis, it is crucial for healthcare systems to adapt and ensure that patients are receiving the best possible treatment for their mental health needs.
To read the full study, visit JAMA Network Open (clearnet).
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