Dear Dr. Grinspoon,

Recently, I have had 3 different patients who have been difficult to stabilize their anxiety tell me that small doses of pot has been the only effective pharmaceutical to reduce their anxiety and allow improved capacity to function.

The first case is a man in his late 50s who suffers from PTSD from family of origin abuse. He would experience profound dissociative lapses and suffered severe anxiety and depression. In his early adult life, he used alcohol, pot and cocaine to quiet his symptoms. Though the decades I have tried multiple combinations of various psychotropic medications. I would stabilize his depression and get him to sleep but despite Effexor 225mgs, Xanax 3mgs, Trazadone 200 mgs, as well as trails on various atypical antipsychotics, his anxiety and dissociative withdrawals persisted.

He did not see me for over 6 months and apparently achieved a new stability. When I saw him, he confessed that he added a glass of whiskey followed by smoking one bowl of pot to his medication regimen. He would have gladly foregone the whiskey but he could not afford more pot than he was using. He indicated after taking that morning regimen, he felt a greater sense of calm and the would go out for a morning walk and feel comfortable socializing with neighbors. Prior to this regimen, he would simply sit in a chair in his kitchen and stare vacantly until his wife returned home at 5 pm. Clearly, the THC had a remarkable impact on his anxiety. He was not stoned or dysfunctional, quite the opposite, he became social, motivated and productive.

The second case is a late 20 something male who struggles with severe anxiety with panic, insomnia and rage. He went through a period of abusing pot and alcohol. When drunk, he would become rageful and belligerent. He was finally stabilized on 300 mgs of Seroquel and 3 mgs of Klonopin for sleep. Recently, I spoke with him after he moved to Florida. He informed me that he has now been smoking a small amount of pot each evening before bedtime. He requires no Seroquel and uses 1-2 mgs of Klonopin to go to sleep. If he smokes larger amounts of pot, he needs 3 mgs of Klonopin to fall asleep. He is feeling better through the next day and recently has been accused of being too mellow!

The 3rd case is a 65 yr old woman with a history of trauma and lifetime of turmoil. She also has been on multiple medication trials. She has smoked pot but during a psych hospitalization, was told that she had an addiction problem and was encouraged to stop. Since abstaining from pot, she has returned to a baseline state of being globally anxious and insecure. Despite repeat trials on multiple agents, her symptoms persisted. Once she started smoking a small amount of pot, her symptoms remitted and she felt motivated and energized.

I am convinced if we had the capacity to genetically profile these patients, we would determine a common genetic link that would support the validity of their responses. They are not simply "getting stoned". I perceive a real pharmacological response not dissimilar to the SSRIs. In these cases, SSRIs have been minimally helpful. If you are aware of anyone investigating THC in treating anxiety, I would be very interested in engaging these patients in a study.

Thanks,

Ken Cohen