Cannabis can be used as a psychedelic in therapy, but it's not for everyone, some mental health providers say
Less established than psychedelics like psilocybin, doctors warn research is still in its infancy
Some Canadians who suffer from mental illness are turning to psychedelic therapy that utilizes cannabis instead of better-known psychedelics such as psilocybin.
In psychedelic therapy — an emerging field, no matter the substance — patients use drugs that alter their consciousness, under supervision of a trained therapist, to try to help with hard-to-treat conditions.
Under the right conditions, cannabis can be a useful tool in therapy, says Vancouver registered psychologist Hillary McBride, including that it is easier to access than some psychedelics.
Not only is cannabis legal in Canada for people 19 and over, but there is familiarity with prescribing it, she says, "which means that people can go to their doctor … and talk about drug interactions and talk about health risks."
In contrast, to access psilocybin or MDMA for psychedelic therapy, a health care professional must apply to Health Canada's Special Access Program (SAP) on behalf of the patient.
McBride hosts the CBC podcast Other People's Problems, which takes listeners into therapy sessions with her clients. The show's new season focusses exclusively on psychedelic psychotherapy sessions, the majority using cannabis.
"The hope is that in letting people hear a little bit about what this sounds like, that we're … creating some demystification around this process," said McBride, who holds a PhD in counselling psychology.
But therapists and researchers warn this approach is not suitable — or safe — for everyone, and research is still in its infancy.
What treatment looks like
While humans have grown and used cannabis for thousands of years, medical research into its uses is much newer.
Compared to other psychedelics used in therapy, there's much less research on the psychedelic effects of cannabis, let alone its use in psychotherapy, says Dr. David Wolinksy, an addiction psychiatrist and assistant professor in the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins School of Medicine in Baltimore.
But he says cannabis's psychedelic effects as reported in the literature show enough potential promise to merit further research.
Wolinsky is the lead author of a literature review on the psychedelic effects of cannabis published in the Journal of Psychopharmacology in January 2024.
With cannabis as well as other psychedelics — in the right therapeutic setting, with a properly trained mental health provider — McBride says she and others are seeing good outcomes for treatment-resistant cases, particularly of trauma, depression, anxiety and obsessive-compulsive disorder.
She says cannabis may act on the brain and body in a way that makes it easier to access some of the feelings and sensations key to working through difficult stuff in therapy.
"Ultimately, what we're trying to do … is help people feel some of their emotion, resolve some of the dissociation that might disconnect them from the sensation their body is giving them," she said.
To an outside observer, a psychedelic assisted therapy session might not look that different than a regular therapy session, "except there's more conversations about consent, safety and choice and readiness," said McBride. "And people are obviously not driving home from appointments."
Conversations will occur about who is dropping off or picking up the person, and there may be a nurse or other additional health care provider in the room, she says.
'Risk factor' for mental health conditions
But while cannabis is easier to access than other psychedelics, it still carries risks.
Dr. Jennifer Swainson, a psychiatrist and associate clinical professor in the Department of Psychiatry at the University of Alberta in Edmonton, cautions against cannabis in psychotherapy.
Swainson is chair of the College of Physicians and Surgeons of Alberta psychedelic psychotherapy accreditation committee, which develops and revises the standards that clinics need to meet in order to offer this kind of therapy in the province.
"Cannabis actually is very strongly not recommended for use in people with mood disorders or anxiety disorders. And in general, in medicine, we consider it to be a risk factor for development of mental health conditions," said Swainson.
That risk is compounded for young people, given the brain is still developing until age 25, she said.
Alberta is the first province to create mandatory accreditation for clinics that provide psychedelic or ketamine-assisted psychotherapy, "and hopefully other provinces will follow," said Swainson.
"But I've been out to accredit a number of these facilities and have never encountered one that wants to use cannabis yet. And I think, within Alberta, that would probably not meet accreditation standards."
McBride says the treatment is definitely not appropriate for all patients.
"Particularly with cannabis, there is a risk of psychotic episodes; there's a risk of worsening health conditions, and so just like with any medication, it's not right for everybody," she said.
"And the more thoughtful we can be, I think the better outcomes we can have."
Not for therapy newbies
In an episode of Other People's Problems, a patient referred to using the pseudonym Brandi said therapy using cannabis has helped address some of her mental health struggles stemming from her upbringing in a religious cult.
"The biggest thing that changed for me with this particular kind of therapy was this vast reduction in my social anxiety," she said. "This work has been the most transformational, and I've done many, many different types of therapy."
About a year and a half after the session was recorded, she said, "There's just been this steady progress in a positive direction around my social anxiety, and I would say at this point it's, I am unrecognizable really to the person I was then."
But an even bigger part of her improved well being, she says, is the strong therapeutic relationship she has with McBride, who she has been working with for more than seven years.
That's key, says McBride. She says the best outcomes seen clinically are with people who have an established history in therapy, she says.
"This is not something that we are offering for people who have said, 'Oh, my friend went to a therapist and they felt better and I want to go to a therapist, too.'"
Likewise, psychedelic cannabis therapy is not something a person should take a do-it-yourself approach to either.
"Trauma therapy is not what you're supposed to be doing when you're on the bus or in the car or at home at the kitchen table, right? These are specific sets of techniques that we use in certain contexts. But the point is to get closer to the place where the unresolved experience is."
Limited research
At Johns Hopkins, Dr. Wolinsky says some of the research he looked at was geared to establishing if cannabis can elicit so-called mystical experiences, a psychological mechanism thought to at least in part explain why some people have success in psychedelic psychotherapy.
Wolinksy says while that's a compelling area for further study, existing research was limited to the retrospective kind where people respond to questionnaires after their experience, an approach limited by what people can remember.
As for how cannabis affects the way parts of the brain talk to one another, Wolinsky said some neuroimaging studies "did at least suggest that maybe cannabis could influence the way that we process information." It could disrupt what's known as "the default mode network, which is kind of like our more rigid, reflexive way of thinking."
However, at the time his review was published, neuroimaging findings for both classic psychedelics and cannabis had been "far too inconsistent" and there hadn't been any studies that compared the two, he said.
That said, his examination of the research did conclude there is merit in further study of cannabis as a psychedelic therapy.
"I think it's good that people are looking at these substances as potential novel treatments, and continue to look at it in a rigorous manner," said Wolinksy.
No magic bullet
Both he and McBride were clear that any sort of psychedelic medicine shouldn't be viewed as a magic bullet.
"I think a lot of psychiatry, for most cases, it's not just medication," said Wolinksy. "It's also engagement in therapy. It's developing healthier lifestyle choices, exercise, healthy diet, connections with others."
McBride said just as this therapy isn't right for everyone, it's also "not appropriate to say this is bad for everybody and dangerous for everybody."
"In some cases this is saving people's lives."