Overview 

Anxiety and related disorders are the most prevalent mental conditions among university students, due to the pressures of academic, social and personal demands.^1,2 Despite their proven effectiveness, first-line antidepressant medications have severe side effects, causing many affected individuals to look for alternative options. Many individuals consider cannabis to be an alternative treatment for a range of diseases and psychological issues. This article outlines the potential benefits, risks, and considerations of using cannabis for anxiety relief in university students.¹ 

Understanding anxiety in university students

The number of mental illness cases among university students is considered a public health problem, as several studies have shown that 86.74% were found to have generalised anxiety; 75% had trait anxiety, and 80.22% experienced state anxiety.² Entry into higher education is part of the transition to adulthood and can result in an overload of anxiety, due to academic stress, financial stress, peer support and family support, with symptoms such as restlessness, low concentration, and trembling.³

Generalised anxiety disorders can lead to the use of cigarettes and illicit drugs, including self-medication with drugs such as cannabis to minimise the symptoms.²

Cannabis as a potential tool for anxiety relief

Cannabis is a complex plant that consists of major compounds such as delta-9-tetrahydrocannabinol(d-9-THC) and cannabidiol(CBD), which have opposing effects. The discovery of these compounds has led to the determination of an important neurotransmitter system known as endocannabinoid receptor system.⁴ This system is widely distributed in the brain and in the body, and is considered to be responsible for numerous significant functions.⁴

The endocannabinoid receptor system is the binding site for d-9-THC in the brain, followed by the cloning of cannabinoid 1 receptor (CB1R). CB1Rs are located at the terminals of the central and peripheral neurons, where they primarily mediate the excitation or inhibition of the dopaminergic, gamma-aminobutyric acid(GABA), serotonergic, glutamatergic, noradrenaline and acetylcholine neurotransmitter systems.⁵ When cannabis is used, d-9-TH, a partial agonist binds to CB1R and inhibits the release of neurotransmitters that are typically controlled by endocannabinoid.

According to some studies, it may further increase the release of dopamine, glutamate and acetylcholine in specific brain regions by preventing the release of an inhibitory neurotransmitter such as GABA onto neurons that release these hormones, which play a crucial role in influencing mood and anxiety.⁵ 

Cannabis use trends among university students 

Cannabis use among university students is prevalent, with a large portion of the students participating in both recreational and medicinal use. A study conducted on 400 students showed that 11% of the students use cannabis for medicinal purposes and 38% were replacing traditional medicine with cannabis.⁶ Medical cannabis is common among university students, with common disorders being anxiety, sleep problems, depression and pain.⁶

Many of these students resort to cannabis for various reasons, such as the perception that cannabis is a natural substitute for traditional therapies, which are frequently linked to serious adverse effects.¹ Some students reported to strongly believe that cannabis would help them fit in with their friends, feel calm, forget their concerns and enjoy themselves.⁷ However, these students use cannabis without being aware for the benefits and risks. 

The evidence: benefits and risks 

Benefits

Studies have suggested that CBD affects the neurotransmitters involved in mood and stress response regulation by interacting with the body’s endocannabinoid system.⁸ Preclinical evidence strongly supports CBD as a treatment for generalised anxiety disorder, panic disorder, social anxiety disorder, obsessive–compulsive disorder, and post-traumatic stress disorder when administered acutely.¹¹ Due to the growing interest in the cannabis consumption and research, it is beneficial to understand the side effects and benefits associated with cannabis use.

Risks

While CBD appears to be harmless, studies have shown that high doses of THC can make users feel more anxious and paranoid. The compounds present in cannabis have complicated effects on anxiety and users should be cautious of the potential risks which include:¹ 

• Exogenic effects: anxiety, panic, paranoia, and psychosis
• Behavioural effects: impaired cognition, motivation, and psychosocial functioning⁹
• Physical effects: increases in heart rate and blood pressure, persistent restlessness and palpitations

Students should be aware that researchers suggest that the ratio of CBD to THC in cannabis products can alter how it affects anxiety. However, individual responses can vary, and further research is needed to fully understand the correlation between the various cannabinoids and their impact on anxiety and further look into how alternative treatments may help.

Alternative treatments and lifestyle strategies

Although cannabis has been seen to assist students in managing anxiety, students should be educated on alternative treatment options and lifestyle strategies that may reduce anxiety, some of which include treatment programs based on self-development and mindfulness considerably reduce levels of stress, anxiety, and depression among the student body.

Cognitive Behavioural Therapy (CBT)

CBTs are one of the most popular types of psychotherapy because of their effectiveness for anxiety disorders and emotional stress.¹⁰ Research has shown that this type of therapy has a positive effect on self-efficacy and commitment. Emotional self-regulation tools that seek to increase emotional self-awareness and improve stress management are noteworthy, as they are effective in reducing negative emotions and anxiety in students.¹¹

Exercise

Exercise and regular physical activity can help students manage their anxiety, through the release of endorphins and the relaxation of tense muscles. Exercise has been shown to reduce the symptoms of anxiety and enhance mood.¹² Some research indicates that for several people, exercise may even be just as beneficial as the traditional treatments.¹²

Sleep management

Managing and maintaining good sleep is essential for students struggling with anxiety.¹³ Getting good quality sleep can help reduce anxiety symptoms, while minimal sleep can make them worse. Creating a relaxing environment and maintaining a regular sleep schedule, and avoiding stimulants such as caffeine and nicotine before sleep are ways to improve sleep quality.¹⁴

Summary

Anxiety disorders are quite common among university students, who suffer from serious mental health issues. Many students are looking for alternative options, such as using cannabis, because typical first-line therapies for anxiety can have serious adverse effects. Research indicates that by interacting with the body's endocannabinoid system, the cannabis component CBD may have therapeutic benefits for lowering anxiety symptoms.

The association between cannabis use and anxiety is complicated, though, as some users may experience increased anxiety or paranoia due to the psychoactive ingredient THC, especially when using greater dosages. The university students should be cautious and seek medical advice before taking cannabis as a remedy for anxiety due to the conflicting research results and individual differences in reaction to the drug. Exercise, better sleep management, cognitive behavioural therapy, and other evidence-based strategies might be safer and more efficient options.

More research is required to completely comprehend the possible advantages and disadvantages of cannabis use for anxiety, particularly among college students. While looking at possible treatments for this serious mental health issue, a well-rounded, knowledgeable, and individualised approach is recommended.