Abstract
BackgroundAn observational research design was used to evaluate which types of commonly labeled Cannabis flower product characteristics are associated with changes in momentary feelings of distress-related symptoms.MethodsWe used data from 2306 patient-directed cannabis administration sessions among 670 people who used the real-time Cannabis effects recording software, Releaf App, between June 6, 2016, and February 23, 2019, for tracking the effects of Cannabis flower consumption. Fixed effects multivariable panel regression techniques were used to establish overall relief by symptom type and to determine which labeled product characteristics (e.g., subspecies/subtype, inhalation method, and major cannabinoid contents) showed the strongest correlation with changes in momentary feelings of agitation/irritability, anxiety, and stress, along with experienced side effects.ResultsIn total, a decrease in symptom intensity levels was reported in 95.51% of Cannabis usage sessions, an increase in 2.32% of sessions, and no change in 2.16% of sessions. Fixed effects models showed, on average, respondents recorded a maximum symptom intensity reduction of 4.33 points for agitation/irritability (SE = 0.20, p < 0.01), 3.47 points for anxiety (SE = 0.13, p < 0.01), and 3.98 for stress (SE = 0.12, p < 0.01) on an 11-point visual analog scale. Fixed effects regressions showed that, controlling for time-invariant user characteristics, mid and high tetrahydrocannabinol (THC) levels were the primary independent predictor of increased symptom relief, and that when broken out by symptom type, this effect was only statistically significant for our largest sample of users, those reporting anxiety rather than agitation/irritability or stress. Cannabidiol (CBD) levels were generally not associated with changes in symptom intensity levels. In a minority of cannabis use sessions (< 13%), cannabis users reported anxiogenic-related negative side effects (e.g., feeling anxious, irritable, paranoid, rapid pulse, or restless), whereas in a majority of sessions (about 66%), users reported positive anxiolytic side effects (e.g., feeling chill, comfy, happy, optimistic, peaceful, or relaxed).ConclusionsThe findings suggest the majority of patients in our sample experienced relief from distress-related symptoms following consumption of Cannabis flower, and that among product characteristics, higher THC levels were the strongest predictors of relief.
Highlights
An observational research design was used to evaluate which types of commonly labeled Cannabis flower product characteristics are associated with changes in momentary feelings of distress-related symptoms
Rather than including a wide range of formulated and natural cannabis products and treating THC and CBD potency levels (%/dry wt.) only as continuous measures, we focused exclusively on Cannabis flower and allowed the effects of THC and CBD to vary both linearly and nonlinearly, while controlling for baseline symptom intensity, given that individuals with higher baseline symptom levels have a greater potential for symptom relief, while individuals with lower baseline symptom levels have a greater potential for symptom exacerbation
Because we find THC to be a primary driver of symptom relief in the results and it might vary with the other product characteristics, we test for whether plant subspecies or inhalation method influences the effect of THC on symptom relief, by interacting our continuous measure of THC with those product characteristics
Summary
An observational research design was used to evaluate which types of commonly labeled Cannabis flower product characteristics are associated with changes in momentary feelings of distress-related symptoms. Stress and anxiety are among the most common health symptoms for which pharmaceutical medications are prescribed—often for extended periods of time—and are core features of numerous mental and physical health conditions, including depression, addiction, eating disorders, schizophrenia, autism, attention-deficit/hyperactivity disorder, and acute and chronic physical illness and pain (Bandelow et al 2017; Gureje 2008; De Heer et al 2014). The most commonly prescribed pharmaceutical medications for symptoms of anxiety include sedatives (e.g., benzodiazepines), antidepressants (SSRIs, SNRIs), antihistamines, and anticonvulsant medicines, with many people seeking relief through the use of alcohol and illicit drugs (Bandelow and Michaelis 2015; Man et al 2015; Slee et al 2019). According to National Academies of Sciences, E. and M (2017) Committee on the Health Effects of Marijuana, there remains limited clinical evidence that cannabis products offer effective treatment for the improvement of anxiety symptoms, while acknowledging the scarcity of information regarding routes of administration, dose, efficacy, or side effects of common, commercially available cannabis products in the U.S This lack of information arises primarily from historical federal regulatory barriers to assessing the Cannabis plant’s medicinal potential, which have largely limited investigations to cannabisderived formulates or synthetic analog therapies not widely generalizable to the vast range of common, commercially available products used by millions of people every day
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