Accurate Education – Marijuana (Cannabis): Combating Cannabis-Induced Anxiety, Panic and Paranoia

Combating Cannabis-Induced Anxiety, Panic and Paranoia


The medical information on this site is provided as a resource for information only, and is not to be used or relied upon for any diagnostic or treatment purposes and is not intended to create any patient-physician relationship.  Readers are advised to seek professional guidance regarding the diagnosis and treatment of their medical concerns.


Aside from sedation and drowsiness, possibly the most common and most disturbing side effect from the use of marijuana-based products is anxiety. Anxiety may manifest as a mild uneasiness but can also become quite unpleasant and even severe with panic and paranoid ideation. This section addresses why this may happen, what can be done to avoid it in the first place and what to do if it happens.



Marijuana – Medical Use Overview

“Medical Marijuana” – Getting Started

Marijuana (Cannabis): Potential for Harm 

Marijuana (Cannabis): Side Effects and Drug Interactions

Marijuana (Cannabis): Dosing

Marijuana (Cannabis) – Dosing: “Pot” vs. Pharmaceutical Products


Cannabis-Based Medications:

Over-the-Counter Cannabinoid Medications:

Cannabidiol (CBD) – Introduction

Cannabidiol (CBD) – Clinical Use

Cannabidiol (CBD) – Drug Actions & Interactions


Prescription Cannabis-Based Medications:

FDA-Approved Prescription Cannabis-Based Medications

Louisiana Prescription Cannabis-Based Products – “Medical Marijuana”


Clinical Applications of Cannabis:

Cannabis – Anxiety (coming soon)

Cannabis – Fibromyalgia

Cannabis – Headaches (coming soon)

Cannabis – Inflammatory Bowel Disease (coming soon)

Cannabis – Neuroinflammation (coming soon)

Cannabis – Pain (coming soon)

Cannabis – Sleep (coming soon)


The Medical Science of Cannabis:

The Endocannabinoid System

Marijuana – Botanical

Marijuana – Pharmacokinetics

Marijuana – Inhaled (Smoked and Vaporized)

Marijuana – Cannabinoids and Opioids


Cannabinoids and Terpenes:

Cannabinoids & Terpenes – An Overview (coming soon)


Marijuana – Cannabidiol (CBD)



Terpenes – An Overview


See also:

Marijuana – Discontinuing Use

Marijuana Addiction – Cannabis Use Disorder (CUD)


Key to Links:

Grey text – handout

Red text – another page on this website

Blue text – Journal publication

Combating Cannabis-Induced Anxiety, Panic and Paranoia

To start with, experiencing anxiety whether mild or severe with use of marijuana-based products is not uncommon, it is not abnormal and it will always go away. While it can often be avoided, it may occur with even seasoned users of marijuana-based products, especially when there is a change in dose or form of administration.


So, if this happens:


Remember, marijuana and marijuana-based products are safe and there is no record of overdose directly resulting in any deaths.


Why does it happen?

The constituents in marijuana, especially THC and CBD, work on the emotional centers in the brain. THC is the primary cause of triggering anxiety and panic while CBD can reduce this side effect of THC as well as reduce anxiety coming from other causes. Cannabinoids bind to receptors throughout the brain, many of which are in the amygdala, the area of the brain involved in emotional processing, modulating such responses as fear, stress, and paranoia. THC can overstimulate these neural pathways, especially in individuals who are new and unaccustomed to the use of cannabis.


Additionally, those with pre-existing anxiety disorders may be more vulnerable to experiencing anxiety side effects. In this population it is especially important to understand that these side effects may occur and be prepared to address them.


How does one avoid these side effects?

The adage, “Start Low, Go Slow,” is the perfect answer to this question. Whenever starting a cannabis-based product, begin with a low dose and always increase the dosage slowly when there is a need to increase. Also, since THC is the major contributor to these side effects and CBD reduces these side effects, it is best to start a cannabis-based product with a low THC content also containing CBD. Once one builds experience with a product, one can slowy adjust doses and ratios of constituents based on the individual’s response.


When using cannabis-based products for the first time, do so in a comfortable, low stress environment accompanied by a friend or family member. Avoid starting with “edibles” due to their greater complexity in dosing. “Edibles” are not permitted in Louisiana. Always feel free to contact your physician guiding you in your use of cannabis-based products with any concerns regarding any side effects from their use.


What to do when it happens

Understand first that most symptoms of anxiety will dissipate within minutes to hours, with no lasting effects. With a little time, these feelings will eventually pass, always. To speed up the resolution of anxiety and panic symptoms, put yourself in a familiar and comfortable emvironment with low levels of stimulation and noise. When able, lie down and if possible go to sleep. It is likely upon awakening the symptoms will have passed. Otherwise, consider a warm shower or bath. light some candles.


Distracting one’s self by playing music or watching television. Consider calling a friend if you feel overwhelmed. Drink plenty of fluids but avoid alcohol and caffeine products as these may aggravate the situation.


Special Tips

Don’t forget, CBD reduces the anxiety associated with THC. It is recommended, especially with people first starting out with cannabis-based products, to keep extra CBD products around in addition to recommended THC-based products. Supplememting with CBD can not only reduce anxiety but also can enhance sleep, relaxation and muscle tightness.


Also, understand that other constituents found in marijuana plants that are not necessarily present in cannabis-based medicinal products. These constituents include other cannabinoids, which for the most part are not commonly available independently. But terpenes, the aromatic constituents also found in varying amounts in different strains of marijuana plant, are independently available, possibly in your kitchen.



Terpenes (and terpenoids) are chemically related to the cannabinoids. They are organic chemicals produced by most plants and  are volatile aromatic molecules, meaning they evaporate easily, providing flavor and fragrance to fruits and spices commonly found in a normal diet. But there is growing research demonstrationg that they exert therapeutic effects in combination with the cannabinoids, including reducing anxiety.


Black Pepper

Black pepper, a popular home remedy for THC-induced anxiety, contains several terpenes including a-pinene, b-caryophyllene and myrcene that reduce anxiety. Chewing a few black pepper corns was popularized by Neil Young as a means of reducing THC-induced anxiety. Others have found simply smelling freshly ground pepper provides a rapid response.



Lemon peels, with a high content of the terpene, limonene, has been demonstrated to reduce anxiety with inhaling or chewing. The use of lemon in the 1800’s in Tunis and Morocco was documented as a cure for overdoses of cannabis.


The use of aromatic substances is the basis of aromatherapy, an alternative medical therapy that has enjoyed growing traction recently. The olfactory nerve in the nose is directly connected with the brain and is connected with emotional and memory areas of the brain, believed to be the mechanism by which terpenes exert their rapid and effective therapeutic responses.

See: Terpenes






National Academy of Sciences

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research

This website appears to be good resource for exploring medical marijuana.




Terpenes – Overviews:

  1. Taming THC – potential cannabis synergy and phytocannabinoid-terpenoid entourage effects – 2011
  2. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. – PubMed – NCBI

Terpenes: Caryophyllene:

  1. (−)-β-Caryophyllene, a CB2 Receptor-Selective Phytocannabinoid, Suppresses Motor Paralysis and Neuroinflammation in a Murine Model of Multiple Sclerosis – 2017
  2. Antiallodynic effect of β-caryophyllene on paclitaxel-induced peripheral neuropathy in mice. – PubMed – NCBI
  3. Acute administration of beta-caryophyllene prevents endocannabinoid system activation during transient common carotid artery occlusion and reperfusion – 2018
  4. Antiallodynic effect of β-caryophyllene on paclitaxel-induced peripheral neuropathy in mice. – PubMed – NCBI
  5. Cannabimimetic phytochemicals in the diet – an evolutionary link to food selection and metabolic stress adaptation? – 2016
  6. The anxiolytic-like effect of an essential oil derived from Spiranthera odoratissima A. St. Hil. leaves and its major component, β-caryophyllene, in male mice – 2012
  7. β‐caryophyllene and β‐caryophyllene oxide—natural compounds of anticancer and analgesic properties – 2016
  8. β-Caryophyllene, a CB2 receptor agonist produces multiple behavioral changes relevant to anxiety and depression in mice – 20214
  9. Toxicological Evaluation of β-Caryophyllene Oil: Subchronic Toxicity in Rats. – PubMed – NCBI 2016
  10. The cannabinoid CB₂ receptor-selective phytocannabinoid beta-caryophyllene exerts analgesic effects in mouse models of inflammatory and neuropathic… – PubMed – NCBI – 2014
  11. The cannabinoid CB2 receptor-selective phytocannabinoid beta-caryophyllene exerts analgesic effects in mouse models of inflammatory and neuropathic pain – 2013


Terpenes: Linalool:

  1. An olfactory stimulus modifies nighttime sleep in young men and women. – PubMed – NCBI
  2. Lavender and sleep – A systematic review of the evidence
  3. Lavender and the Nervous System – 2013
  4. Effects of odorant administration on objective and subjective measures of sleep quality, post-sleep mood and alertness, and cognitive performance – 2003
  5. In-vitro inhibition of human erythrocyte acetylcholinesterase by salvia lavandulaefolia essential oil and constituent terpenes. – PubMed – NCBI – 2000


CBD – Anxiety

  1. Overlapping Mechanisms of Stress-Induced Relapse to Opioid Use Disorder and Chronic Pain – Clinical Implications – 2016
  2. Cannabidiol Modulates Fear Memory Formation Through Interactions with Serotonergic Transmission in the Mesolimbic System – 2016
  3. Cannabidiol regulation of emotion and emotional memory processing: relevance for treating anxiety-related and substance abuse disorders. – PubMed – NCBI
  4. Review of the neurological benefits of phytocannabinoids – 2018
  5. Plastic and Neuroprotective Mechanisms Involved in the Therapeutic Effects of Cannabidiol in Psychiatric Disorders – 2017
  6. Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report. – PubMed – NCBI
  7. Evidences for the Anti-panic Actions of Cannabidiol – 2017
  8. Cannabidiol, a Cannabis sativa constituent, as an anxiolytic drug – 2012
  9. Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Naïve Social Phobia Patients – 2011


CBD – Interaction with THC

  1. Cannabidiol: a promising drug for neurodegenerative disorders? – PubMed – NCBI
  2. Oral Cannabidiol does not Alter the Subjective, Reinforcing or Cardiovascular Effects of Smoked Cannabis – 2015
  3. Taming THC – potential cannabis synergy and phytocannabinoid-terpenoid entourage effects – 2011
  4. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. – PubMed – NCBI




Medical Marijuana –Misc

  1. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. – PubMed – NCBI
  2. Cannabis and cannabis extracts – greater than the sum of their parts? – 2001
  3. Medical cannabis and mental health: A guided systematic review. 2016 – PubMed – NCBI
  4. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. – PubMed – NCBI
  5. Cannabis-conclusions – 2017 National Academy of Sciences
  6. Cannabis-chapter-highlights – 2017 National Academy of Sciences
  7. Cannabis-report-highlights – 2017 National Academy of Sciences
  8. Clinical Endocannabinoid Deficiency (CECD): Can this Concept Explain Therapeutic Bene ts of Cannabis in Migraine, Fibromyalgia, Irritable Bowel Syndrome and other Treatment-Resistant Conditions?-2004
  9. Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study. – PubMed – NCBI
  10. Cannabis use and cognitive function: 8-year trajectory in a young adult cohort. – PubMed – NCBI
  11. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. – PubMed – NCBI
  12. Cannabinoids and Cytochrome P450 Interactions. – PubMed – NCBI Pharmacogenetics of Cannabinoids – 2018
  13. Systematic review of systematic reviews for medical cannabinoids – 2018
  14. Adverse effects of medical cannabinoids – a systematic review – 2008
  15. Cannabimimetic effects modulated by cholinergic compounds. – PubMed – NCBI
  16. Antagonism of marihuana effects by indomethacin in humans. – PubMed – NCBI
  17. Pharmacokinetics and pharmacodynamics of cannabinoids. – PubMed – NCBI
  18. Clinical Pharmacodynamics of Cannabinoids – 2004
  19. Affinity and Efficacy Studies of Tetrahydrocannabinolic Acid A at Cannabinoid Receptor Types One and Two. – 2017
  20. Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016
  21. Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: a systematic review. – PubMed – NCBI
  22. Pharmacology of Cannabinoids
  23. Current-status-and-future-of-cannabis-research-Clin-Researcher-2015
  24. Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems – A Clinical Review – 2015


Medical Marijuana – Product Evaluation

  1. The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products – 2018
  2. Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016

Emphasis on Education


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