A recent report indicating anxiety disorders were a factor in more than half of the medical marijuana certifications in 2021 came as no surprise to professionals in the business in Butler County.

According to Spotlight PA, anxiety disorders were a factor in 60% of the more than 385,000 medical marijuana certifications allowed by doctors in 2021, which is the most recent full year of data.

Often, it was the sole qualifying condition. Over that same time period, nearly 40% of certifications — or more than 151,000 — listed anxiety disorders as the sole qualifying condition, ranking well ahead of others such as chronic pain and cancer, Spotlight PA reported.

Dr. Bryan Doner, of Compassionate Care Consultants in Butler, said he wasn’t surprised that anxiety has passed chronic pain as reasons for seeking certification for medical marijuana.

“Whenever the medical marijuana program started, by far, chronic pain was the most common,” Doner said. “Once anxiety was introduced, that really, really made a significant difference (in certification requests.)”

He said medical marijuana can be a safe and effective alternative to drugs such as Valium or Ativan for those diagnosed with anxiety.

“We have seen tremendous results,” Doner said. “In my opinion, cannabis has offered a more effective and a safer alternative.”

Medical marijuana products work for many types of anxiety, including post-traumatic stress disorder, he said.

“Generally speaking, it works across the spectrum for … anxiety disorders,” Doner said.

He said the body’s endocannabinoid system works in concert with serotonin, dopamine and norepinephrine in the brain, which research shows can be enhanced with medical marijuana.

“It’s really (operating) on a biochemical level for anxiety,” Doner said.

He said he has seen a general increase in certification requests since the beginning of the coronavirus pandemic.

“During the pandemic, telehealth visits became available, so that’s really helped provide people with ease of access,” Doner said.

He said many of those who were predisposed to anxiety before the pandemic saw their symptoms exacerbated during the lockdown.

“As life comes back to normal, that exacerbation should decrease as well,” Doner said. “Really, it all depends on the individual.”

Various forms and strengths of medical marijuana are recommended for patients with anxiety, and the dose and type of product a patient ends up using usually is the result of a collaboration between the physician, patient and pharmacist at the dispensary.

Some take an oral dose before bed to help them sleep, some use it more frequently.

“It depends on how it’s administered,” Doner said.

Oral forms of medical marijuana can have a slower onset of effectiveness and are longer acting, while inhaled products work fast and are effective for acute situations, he said.

“The patient is often given information on how to self-titrate based on symptoms,” Doner said. Titrating is a process where patients start with a low dose of medication which is adjusted over time until an effective dose is reached without side effects, according to the Cleveland Clinic.

Lauren Vrabel, pharmacist for Verano’s Pennsylvania retailer, Zen Leaf, agreed that in her experience, anxiety is one of the most common qualifying conditions in her patients.

Zen Leaf has a dispensary in Cranberry Township.

She said many cannabinoid products exist to help ease anxiety.

“I like to begin by asking the patient which dosage formulation they prefer,” Vrabel said. “Some are more comfortable with the feeling of intoxication that accompanies THC-dominant products, but it can actually cause or worsen anxiety, especially in higher doses.”

She said CBD may help to ease anxiety in patients who want relief, but not the feeling of being high.

“And it can actually reduce some of the negative side effects of THC,” Vrabel said.

She typically recommends a vape cartridge containing CBD or a tincture with an equal ratio of THC to CBD for anxiety.

“I have seen a lot of patients experience success in treating social anxiety, racing thoughts and restlessness, as well as sleep issues related to anxiety,” Vrabel said. “We always recommend to start with low doses and increase slowly to avoid side effects.”

Medical marijuana was legalized in Pennsylvania in 2016 under Gov. Tom Wolf. The first medicinal sales occurred in 2018.