By Grace Jiang
A Lancet Psychiatry study found no evidence cannabinoids treat anxiety, PTSD, psychotic disorders or depression. In New York, any practitioner can certify a patient for medical cannabis for any condition they deem appropriate, with no restricted diagnosis list. (Will Waldron/Times Union) (Will Waldron/Times Union)
ALBANY — The first time Kobi Russell got high, the city of Jerusalem moved.
He was 18, on a rooftop overlooking the Old City in Israel during a gap year program. The nighttime view, ancient stone buildings lit up against the dark, pulsed and blurred. His anxiety, the shapeless dread of an uncertain future, lifted for the first time he could remember.
“A lot of my anxiety had lifted,” he said. “That was a big reason I stuck with weed for as long as I did.”
He smoked every day by the end of that year. A year later, at 19, he was psychotic.
Cannabis did not treat his anxiety. It masked it.
A major review published in Lancet Psychiatry this month found no significant benefit that cannabinoids effectively treat anxiety, PTSD or psychotic disorders. For depression, one of the most common reasons patients seek medical cannabis, researchers found no randomized controlled trials at all.
The review also found that cannabinoids carried measurable risks. For every seven people treated, one experienced a side effect such as nausea or dizziness compared with those given a placebo, though rates of serious adverse events did not differ significantly between the two groups.
In New York, that gap between science and policy is wide.
Under state law, practitioners may certify patients for medical cannabis for any condition they deem appropriate, with no restricted list of qualifying diagnoses. Officials with the Office of Cannabis Management said the decision is meant to be individualized.
“The decision to pursue medical cannabis certification is collaboratively made between patient and practitioner based on individual circumstances, treatment history, and clinical judgment,” the agency said in a statement. “We encourage open dialogue between patients and their providers about the risks and benefits of all treatment options, including medical cannabis, considering the most current available evidence.”
The Lancet authors were more direct.
“The routine use of cannabinoids for the treatment of mental disorders and substance use disorders is currently rarely justified,” they wrote.
Kobi, now 25 and residing in Boston, said the relief he felt on that Jerusalem rooftop was real but temporary.
“Cannabis did make my anxiety worse,” he said. “It basically pulled me out of my life, allowing me to pretend like everything was fine. So then when I got sober, my anxiety was even worse.”
His path from that rooftop to a psychiatric ward took less than two years. After returning to the United States, he enrolled at Carleton University in Ottawa in fall 2018, the same year Canada federally legalized cannabis. Dispensaries opened across that city. High-potency concentrates, including wax, shatter and dabs with THC concentrations he estimated at 70% to 90 %, became widely available and largely unregulated. Kobi, already smoking daily, began chasing higher highs.
When he underwent oral surgery that October, his parents, aware he occasionally smoked, suggested cannabis might help manage his pain. They did not know how dependent he had become.
“My parents were like, ‘This would be a really good time for you to smoke some weed to reduce the pain,’” he said, “not knowing how much I was kind of hooked on it.”
Within weeks he stopped sleeping. He stopped eating. In October 2018, he called his mother convinced he was going to die. His uncle, a psychiatrist, recognized the symptoms immediately: cannabis-induced psychosis. He was hospitalized in Canada, then again in Boston. Recovery took years.
The review highlighted a basic disconnect: the products tested in clinical trials are not the products people are actually buying. Most trials used pharmaceutical-grade cannabinoids. The products on dispensary shelves — and illicit shops — are another matter.
In New York, the regulated market has guardrails. Edible products are capped at 10 milligrams of THC per serving and 100 milligrams per package.
Though those safeguards do not resolve the larger question raised by the review: whether cannabis works as a treatment for the mental health conditions for which many patients use it.
Outside controlled settings, that uncertainty is even greater for young people, said Dr. Madeline Renny, an assistant professor of emergency medicine at Mount Sinai who studies adolescent substance use and emergency department interventions for youth.
“When any teenager is using cannabis, it’s very different from a physician prescribing cannabis in a certain amount and being closely monitored,” Renny said. “Teenagers are getting their substances from unregulated places and may not be aware of the amount of THC, the different products, how they’re using it. They’re not being monitored.”
Youth who self-medicate with cannabis for anxiety typically do so outside parental awareness and without any clinical oversight, a situation the Lancet study’s controlled trial framework does not capture.
The study’s authors called for stronger regulatory oversight and better training for health workers recommending cannabinoids. They also raised a concern beyond efficacy: that medical cannabis, prescribed without adequate evidence, may delay patients from accessing treatments that actually work, including cognitive behavioral therapy, which has shown large effect sizes in treating both anxiety and depression.
Kobi does not smoke anymore. When he visits New York and sees what dispensaries are selling, he feels something closer to fear than temptation.
“I feel like I’d be throwing away so much progress,” he said.
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