Is cannabis approved for treating post-traumatic stress disorder (PTSD) or anxiety in North Dakota or Minnesota?

Cannabis Approval Status for PTSD and Anxiety in North Dakota and Minnesota

Cannabis (medical marijuana) is NOT FDA-approved for PTSD or anxiety in any U.S. state, including North Dakota and Minnesota, though both states may have medical marijuana programs that list these conditions as qualifying diagnoses under state law—which operates entirely separately from FDA approval. 1, 2

Critical Distinction: State Programs vs. FDA Approval

• Medical marijuana itself has never received FDA approval for any medical indication whatsoever, despite legalization in numerous state medical cannabis programs 1, 2
• Cannabis remains federally classified as a Schedule I controlled substance, defined as having "no currently accepted medical use" and "high potential for misuse" 1, 2
• The only FDA-approved cannabinoid medications are Epidiolex (CBD) for rare epilepsy syndromes, and dronabinol/nabilone (synthetic THC) for chemotherapy-induced nausea and AIDS-related anorexia—none are approved for PTSD or anxiety 1, 2

State-Level Medical Marijuana Programs

• As of 2017,25 states plus DC, Guam, and Puerto Rico had comprehensive medical marijuana programs, with individual states determining their own qualifying conditions 3
• Some states have recognized PTSD as a qualifying condition for medical cannabis access despite lack of FDA approval and inconsistent research findings 4
• In North Dakota specifically, possession of less than half an ounce carries a maximum $1000 fine (decriminalization status), but this does not constitute medical approval 3
• State medical marijuana programs operate independently of FDA approval processes and do not represent evidence-based medical endorsement 1, 2

Evidence Status for PTSD and Anxiety

Potential Harms Outweigh Uncertain Benefits

• Cannabis can paradoxically cause or exacerbate anxiety disorders rather than improve them, particularly in vulnerable populations 1
• Older adults using cannabis face higher risk for behavioral health issues including anxiety and depression, plus sedation, obtundation, and myocardial ischemia 1
• Known risks of marijuana currently outweigh unknown benefits for PTSD, with stronger evidence for harmful effects on psychosis and substance misuse than for therapeutic benefits 5

Mixed Research Findings

• One 2022 prospective study found cannabis users showed greater PTSD symptom reduction over one year and were 2.57 times more likely to no longer meet PTSD criteria, but this was observational without placebo control 6
• A 2020 study of 404 medical cannabis users found >50% immediate symptom reduction, but baseline symptoms remained constant over time and anxiety dosing increased (suggesting tolerance development) 7
• Treatment outcome studies of whole plant marijuana for PTSD are limited and not methodologically rigorous, precluding conclusions about therapeutic effects 5

Complex PTSD Considerations

• While some PTSD symptoms (anxiety, insomnia, nightmares) may potentially benefit, symptoms more characteristic of complex PTSD (dissociation, reckless behavior, substance abuse) may be aggravated by cannabis use 4
• Marijuana use is associated with worse treatment outcomes in naturalistic studies and maladaptive coping styles that may maintain PTSD symptoms 5

High-Risk Populations Requiring Absolute Avoidance

• Pregnant and breastfeeding individuals must avoid all cannabis products due to fetal brain development risks and increased premature birth risk 1, 2
• Adolescents face elevated risks including neurodevelopmental decline, psychotic disorders, depression, and suicidal ideation with cannabis use 1, 2
• Elderly patients (≥65 years) are at higher risk for behavioral health issues, sedation, and cardiovascular events 1, 2

Clinical Bottom Line

For patients in North Dakota or Minnesota asking about cannabis for PTSD or anxiety, clarify that no FDA-approved indication exists, state medical marijuana programs do not constitute medical approval, and current evidence shows known psychiatric and cardiovascular risks that outweigh uncertain therapeutic benefits. 1, 5 If patients are already using cannabis through state programs, carefully assess specific symptom impacts and monitor for worsening anxiety, dissociation, substance use disorder development, and cardiovascular complications 4, 1.