Can Cannabis Replace Xanax As an Anti-Anxiety Drug?

Ouch! You can’t ask questions like this. This really takes us out on a limb. We do not pretend to be doctors, neurologists, psychiatrists, or pharmaceutical researchers. Any opinion here requires a load of disclaimers. But maybe we can discuss the claims out there.

The anecdotal history covering at least two millennia records millions claiming cannabis has relieved their anxiety. Xanax has been around a relatively few years, but doctors and patients swear to its value. All we can do is keep our minds open.

What you need to know about anxiety

“Anxiety” may be a modern label, but it has a history. It’s at least as old as the apes in Stanley Kubrick’s “2001: A Space Odyssey.” They didn’t learn it from parent apes; animals are wired with some fright or flight mechanism. Scriptures, legends, myths, folklore, and fairytales all recount come version. But fright or flight would not be diagnosed until the 1920s.

Sheryl Ankrom, writing for Very Well Mind, explains, “the fight or flight response is the first part of the involuntary general adaptation syndrome. In the fight or flight response, stimuli result in stimulation of the sympathetic nervous system. The sympathetic nervous system then sends a message to the adrenal glands which results in the release of the stress hormones, epinephrine (adrenaline,) norepinephrine (noradrenaline,) and cortisol, among others. These hormones, in turn, lead to the symptoms associated with the response.”

This may lead to Increased heart rate, heavy and rapid breathing, dilated pupils, loss of hearing and peripheral vision, sweating and shaking. Multiple factors influence the degree of response:

The nature of the predator or fear force
The proximity to the predator or fear force
The duration of the pressure

The reaction to a standing and growling grizzly bear will be much stronger than that created by a similar bear pacing in its zoo cage. The fear will escalate if you see a car speeding toward you, but you won’t feel fear if the car mows you down without your seeing it coming. If fright is a bit of subjective experience, its effects are real, nonetheless.

Types of anxiety

Health and Human Services lists five types of anxiety disorders:

Generalized Anxiety Disorder (GAD) is mild to serious physical and psychological concern about personal health, work and social interactions, and routine life. Symptoms include a general feeling of restlessness. Being on-edge and wound-up, you tire easily, blow up at small incidents, and sleep poorly.
Obsessive Compulsive Disorder (OCD) manifests itself as recurrent involuntary thoughts and/or behaviors. The behaviors may be minor or major, ritual habits like cleaning, checking or counting repeatedly as if to ward off or control the fear. People may obsess about germs, sex, other people, or unsymmetrical things. Compulsions may take the form of excessive handwashing, counting, or arranging and ordering things. In serious cases, patients may develop physical tics or detach from reality.
Panic Disorders turn ordinary concerns about school, work, or family into long and worsening concerns. Panic attacks may produce heart palpitations, trembling and shaking, and feelings of abandonment and impending disaster. People with panic disorders even worry about their next attack leading them to avoid people, places, and events that might lead to panic.
Post-Traumatic Stress Disorder (PTSD) occurs naturally in people exposed to extreme events in military combat, personal assaults, and natural- or human-caused events. They may or may not have suffered a physical injury to internalize the threat and trauma. All traumatic events do not lead to PSTD, but the effects may be chronic. Among the symptoms are repeated flashbacks, bad dreams, violence, and dependency issues.
Social Anxiety Disorder may be a mild case of stage fright or fear of public speaking. But it may accelerate to overwhelming anxiety and excessive self-consciousness affecting the quality of life.

Anxiety is best diagnosed and treated by doctors, psychiatrists, and neurologists.

What you need to know about Xanax

Xanax (alprazolam) is a benzodiazepine, the single most prescribed psychiatric medication in the U.S. According to Medical News Today, “Xanax slows down the movement of brain chemicals that may have become unbalanced, resulting in a reduction in nervous tension and anxiety. Xanax works by boosting the effects of a natural chemical made in the brain called gamma-aminobutyric acid (GABA).”

It is not recommended for those with allergies to benzodiazepines, narrow-angle glaucoma, alcoholism-related liver disease, impaired hepatic or renal functions, and older or obese adults. And, it is counter-indicated for patients treating with Sporanox or Nizoral.

Xanax is routinely abused by people with or without diagnosis and prescription. Medical News Today reports, “According to the Treatment Episode Data Set, the number of individuals seeking treatment for benzodiazepine abuse almost tripled from 1998-2008. Long-term abuse and addiction to Xanax are associated with depression, psychotic experiences, and aggressive or impulsive behavior. According to the Substance Abuse and Mental Health Services Administration, in 2011, there were over 1.2 million emergency department (ER) visits overall related to the nonmedical use of prescription drugs – Xanax was involved in 10 percent of those visits.”

What you need to know about cannabis and anxiety

U.S. Government restrictions on the cultivation and research of cannabis, we have no scientific way of comparing Xanax and Cannabis on an oranges-to-oranges basis.

A 2012 study published in Recent Patents on CNS Drug Discovery asserted, “The main psychoactive ingredient of hemp, Δ9-tetrahydrocannabinol (THC), and its synthetic cannabinoid analogs have been reported to either attenuate or exacerbate anxiety and fear-related behaviors in humans and experimental animals.” That is, the potency of THC may increase anxiety to the point of panic attacks and hallucinations. The CBD, however, is known to offset THC and to positive affect imbalances contributing to anxiety.

Neurotherapeutics (2015) reviewed studies confirming, “existing preclinical evidence strongly supports CBD as a treatment for generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive compulsive disorder, and post-traumatic stress disorder when administered acutely.”

Lacking the final scientific word on human testing, it appears cannabis triggers a mechanism of action like Xanax in several ways:

CBD facilitates the effects of the natural chemical made in the brain called gamma-aminobutyric acid (GABA).
CBD modulates the natural reabsorption of anandamide, a fatty acid neurotransmitter found in the brain. This molecule is credited with regulating many of the body’s biological functions and sustaining the body/brain homeostasis. Nicknamed “the bliss molecule,” anandamide flows naturally, but when it is taxed by negative stimuli, it will absorb too quickly exacerbating other problems.
Working in concert with THC, CBD contributes to an “entourage effect” in which the results of the whole impact exceed the impact of parts

The way I see it

Xanax could silence me in a minute. They have lawyers enough to keep me in my place. But, given the potential addiction, negative side-effects, and adverse drug interactions, Xanax might be the remedy of last resort.

Cannabis, on the other hand, has a low addiction profile, minor negative side-effects, no reported related deaths, and no known drug interactions except advice that it should not be smoked during pregnancy. That’s enough to make it the therapy of first resort.