National stress day: Exploring stress management with medical cannabis

The 1st of November 2023 is an important day for many in the medical cannabis community, because it marks five years of its legalisation in the UK. But, what you may not have known is that November the 1st is also the day dedicated to raising awareness of stress – a condition medical cannabis has shown potential in alleviating.

As the leading professional body for stress management, The International Stress Management Association (ISMA) have organised events to celebrate National Stress Day every year since the late 1990’s, shedding light on this widespread issue, and developing  strategies to address it. 

Specifically focussing on workplace stress, National Stress Day serves as a reminder of how prevalent this issue is in modern society, and aims to teach people how to spot the signs, and manage the symptoms of stress.

The stress epidemic in the UK

The most common type of stress experienced in the UK is work related, and between 2021 and 2022 a staggering 914,000 workers were estimated to be suffering from work-related stress. This contributed to the loss of around 17 million working days in the space of just one year.

Monetary or financial concerns are other common causes of stress, and personal factors such as health, family, and relationships can also often cause distress, which can manifest itself in a number of destructive or debilitating ways. 

Regardless of what causes a person to feel stressed, its ability to become ‘all-consuming’ is a serious and widespread issue. The largest ever stress survey in the UK shed more light on this, discovering almost three quarters of the population (74%) have felt so overwhelmed or unable to cope at some point in their lifetime due to stress. 

As well as contributing to serious declines in mental health, stress can exacerbate existing physical conditions. In the UK during 2019, 943,374 people were admitted to hospital because they were experiencing chest-pains related to stress, and a further 153,347 people attended the hospital because of stress-related circulatory issues the same year. 

But, what actually is stress?

In simple terms, stress is our bodies’ natural way of reacting to the pressures, challenges, and threats we encounter throughout our lives. 

As we experience stress, we often subconsciously onboard it, which can then be manifested biologically in a number of ways. This can include, but isn’t limited to:

• Physical symptoms such as nausea, headaches, muscle aches, dizziness, and chest pains.
• Emotional symptoms including feeling restless, scared, overwhelmed, irritable or angry
• Cognitive symptoms like experiencing racing thoughts, lapses in memory, and periods of indecisiveness
• Behavioural symptoms which can manifest as a change in routine or eating habits, withdrawal from normal activities, becoming avoidant, and using alcohol.

Although low levels of stress have been proven to be beneficial, it is not uncommon for stress to feel overwhelming because of these symptoms, and so, it is important that we learn how to manage it. 

However, what can make this tricky is: what triggers our stress, how our stresses manifest themselves, and how we respond to them in turn, which is completely subjective and personal to each of us as individuals. 

There is no one-size fits all, or blanket approach to treating and managing stress, but there are a large variety of useful coping mechanisms and treatment options available to those struggling with stress. 

Managing stress: conventional approaches

Mind, a well-known UK Mental Health Charity, advise that there is no actual ‘cure’ for stress, but its symptoms, manifestations, and side effects can be managed or alleviated. 

Certain ‘social prescribing’ methods are usually tried first, this includes recommending any relevant community support groups, financial support, or relaxation tips perhaps involving self-care or a hobby or physical activity enjoyed by the individual.

Breathing and thinking exercises are also typically recommended to help people cope when under pressure, and GPs typically advise patients to create a list of priorities to help them deal with stress productively and with perspective. 

Talking therapies are another option offered to some, but there are often long waiting lists for NHS counselling practices, and so this may not be an appropriate option for everyone. 

Currently, there is no medication or pharmaceutical specifically designed for patients struggling to deal with their stress. However, it is not uncommon for people in the UK to be prescribed a number of different medications to deal with the symptoms of stress. 

Sometimes GP’s prescribe sleeping tablets, minor tranquillisers, antidepressants, or antianxiety medications, to patients who are suffering from sleeping or mood related issued because of the amount of stress they are under. 

In other circumstances, patients are treated using medication designed to manage the physical symptoms of stress they are encountering, such as high blood pressure or irritable bowel syndrome. 

Mind also explain that some people find alternative and complementary therapies useful in managing the signs and symptoms of stress. Here they list practices like aromatherapy, massage, yoga, acupuncture, and some cannabis based medicines. 

Exploring the alternative: The endocannabinoid system and stress

While it's important to emphasise that medical cannabis should only be considered under the guidance of an expert clinician, it's worth noting that research is uncovering the potential of cannabis-based products in stress management. 

As previously explained, stress can exacerbate underlying psychiatric and physical medical conditions. It’s believed to have these effects because of the way stress impacts the endocannabinoid system. 

The endocannabinoid system (ECS), as well as being responsible for regulating mood, memory, pain perception, immune responses and inflammation, is also responsible for regulating stress itself. When a person experiences stress, the ECS orchestrates the release of various neurotransmitters and hormones to boost a calming effect, reduce stress induced responses, and make more reasoned decisions. 

Unfortunately, the endocannabinoid system does not always regulate stress effectively, and because it is able to influence so many other biological processes and responses, when stress does hijack the ECS, it can cause a plethora of problems. 

If a person experiences or encounters something they find extremely stressful, their endocannabinoid system can become overwhelmed. When this happens, a type of endocannabinoid called 2-AG is weakened in its ability to block the release of anxiety-inducing chemicals.

When all is running smoothly, 2-AG helps to create stress-related chemicals and allows them to move from the amygdala, which handles emotions, along a path in the brain to the prefrontal cortex, which helps to process decisions. But, when a substantial stress is encountered, the production and ability of 2-AG is severely compromised. 

However, increasing evidence is emerging to suggest that cannabis could be a useful component in the treatment or management of stress, because of its ability to interact with this same network. Now, it's believed that certain chemicals, or cannabinoids, contained within the cannabis plant, like CBD and THC, could help to rebalance and regulate the endocannabinoid system when it becomes overwhelmed with stress. 

Research has shown that CBD can have anxiolytic, or antianxiety- like, effects because of its ability to boost the natural availability of anandamide in the brain, which in turn evokes a calming effect, and calms the feeling of anxiety. 

On the other hand, THC, the psychoactive component in cannabis, is believed to modulate the responses that are triggered by stress when it is administered in low doses, but it has also shown to increase anxiety when consumed in excess. This emphasises how important it is to calculate and administer the right dose, especially if consuming cannabis to alleviate stress. 

In the UK, specialist doctors help to design a treatment plan for the patients managing their stress with medical cannabis to explain which cannabis strains would be most effective for managing stress because of their CBD to THC ratio, and terpene profile. 

Scientific research: Cannabis for stress

One well cited study in this area is a public speaking test conducted back in 2011 in Brazil. Here researchers gave healthy, white males either 150 mg, 300 mg or 600mg of CBD, or a placebo, in a double-blind randomised controlled setting to observe how this affected their anxiety and stress levels during a public speaking test. 

The researchers in this trial concluded that 300mg of CBD proved most effective for managing stress, and significantly reduced the anxiety experienced by those involved in comparison to the other CBD and placebo groups. 

A later study analysed the effects of CBD’s psychoactive counterpart: THC. Here researchers at the University of Illinois Chicago (UIC) gave 42 healthy volunteers a capsule filled with either 7.5mg of THC, 12.5mg of THC, or a placebo. Participants relaxed for two hours to allow the cannabinoid to absorb into the blood stream, and then underwent a series of stress tests. 

In this study, patient responses, blood pressure, heart rate and cortisol levels were all recorded before, during, and after, a mock job interview, a task involving mathematical equations, playing a game of solitaire, and participating in small talk. 

In 2017, the researchers concluded that low levels of tetrahydrocannabinol did reduce stress, but very much in a dose-dependent manner. They found that the higher dose of THC, which was enough to produce a slight ‘high’ for some, increased these features of anxiety and stress, whilst the participants who received 7.5mg of THC experienced fewer jitters.

Another paper of interest here is a 2018 review of data from StrainPrint - a Canadian app for medical cannabis patients to record how their symptoms react and respond to different types of cannabis with varying concentrations of THC and CBD. 

In total there were 3,717 data entries that contained information on how patients felt their stress had been impacted by different medical cannabis strains, and on average stress was reduced in 93.3% of administration sessions. There was a very small proportion of patients who said a particular strain had increased their stress (2.7%), and very few said their stress was unaffected when they consumed cannabis (4%). 

From these studies it appears the general trends suggests that when used in appropriate concentrations, cannabis chemicals like CBD and THC can help to reduce and lessen the feeling of being stressed or overwhelmed. However, these findings also propose the reverse effect can be accomplished a high dose of THC is consumed, emphasising the need to be precise with cannabis dosing and adopt the ‘start low, go slow’ policy. 

Closing considerations

Like every other year, National Stress Day 2023 has a calendar packed full of online seminars, summits, events and interactive chats organised by ISMA, and tickets for these can be purchased online. 

This year, the title of five summits have been released, they are:

• Why do men find it hard to talk about their mental health?

• Why conversations about money are so difficult

• Using the power of music to reduce stress and improve wellbeing 

• A father daughter journey with bipolar disorder

• Navigating the future of work

We, too, feel it is important to improve stress-management in the UK, and reduce common stressors in our everyday environments, and hope that this article may have helped offer some new insight or information. 

If you are struggling to cope with stress, it is important to know that there are services available to help. 

Speak to your healthcare provider, or GP, for more advice or information about the techniques or treatment plans that may work best for you, and always reach out to friends and family when you are feeling overwhelmed. 

We know that sometimes stress can’t wait, and so if you need to speak to someone right away, please contact one of the support services or helplines below. 

• The Samaritans – available 24 hours a day, 7 days a week. You can free phone them on 116 123, (Welsh language line: 0808 164 0123), visit a Samaritans branch, or email on jo@samaritans.org 

• CALM: Campaign Against Living Miserably – available from 5pm-midnight, 7 days a week. Access their webchat here, or call 0800 58 58 58 

• SANEline - available from 4.30pm - 10.30pm 7 days a week, call 0300 304 7000

• SHOUT – available 24 hours a day, 7 days a week as a text line support for mental health. To access, text ‘SHOUT’ to 85258