Imogen Kretzschmar, a consultant psychiatrist at Mamedica, explains why psychiatry should pay closer attention to improvement from medical cannabis.
As a psychiatrist, I return often to the question of what meaningful improvement really looks like in mental health care. Rarely does it arrive in dramatic form, and almost never is it captured by a single number on a questionnaire. More often, it appears in quieter yet deeply significant shifts: a patient sleeping through the night, feeling less physically gripped by anxiety, thinking more clearly, or moving through the day with more steadiness. On paper, those changes may seem modest. In practice, they can alter the texture of a person’s life.
At a time when demand is placing extraordinary pressure on services, those quieter forms of progress deserve careful attention. In England, 2.24 million people were in contact with mental health services at the end of January this year, with 485,675 new referrals received in that month alone.
Clinicians are constantly weighing what is tolerable, what is proportionate, and what may help a patient regain some stability. As such, I think we should be cautious about dismissing treatments too quickly when emerging evidence, patient-reported outcomes, and clinical observation all suggest that some patients may be benefiting.
Significant improvements
Medical cannabis sits squarely within the debate, and the clinical signals already available make simple dismissal harder to defend. In a UK Medical Cannabis Registry analysis of patients treated for generalised anxiety disorder, researchers reported significant improvements in anxiety, sleep quality, and health-related quality of life. More recently, a two-year case series in patients with depression found clinically significant improvements in depression, anxiety, sleep, and quality of life, while also being clear that observational data cannot establish causality.
No serious clinic is claiming medical cannabis is right for every patient, and no responsible clinician would present it that way. Even so, for people who have tried multiple treatments without adequate relief, it deserves thoughtful consideration rather than reflex dismissal.
Prescribed medical cannabis is not interchangeable with recreational cannabis use, yet the two are still too often collapsed into the same conversation. A recent JAMA Internal Medicine review noted emerging low-certainty evidence that cannabidiol alone may reduce anxiety in people with anxiety disorders, while also warning that THC-predominant cannabis carries substantial risks for certain groups, particularly those with bipolar disorder, psychotic spectrum disorders, or a heightened vulnerability to harm.
Carefully selected
What follows from this is not a case for broad or indiscriminate use. Instead, it is a case for asking whether some carefully selected patients, assessed properly and monitored closely, may experience meaningful benefit.
Meanwhile, psychiatry itself has become more explicit about the importance of outcomes that reflect lived experience rather than abstract symptom scores alone. Better sleep, reduced physiological arousal, greater clarity of thought, improved confidence, and a renewed ability to participate in work, relationships, and daily life are not peripheral details. Very often, they are the point. The responsible question is not whether a treatment is culturally comfortable, but whether it can be assessed properly, prescribed appropriately and monitored safely. Medical cannabis belongs in that evidence-led, specialist-supervised conversation.
Medical cannabis is not a cure-all, not a first-line answer to every psychiatric difficulty, and not a treatment that should ever be prescribed casually. Careful screening, clear exclusion criteria, informed consent, and close follow-up remain essential. Even so, an equal risk exists on the other side of the debate. Once a treatment becomes culturally loaded, politically charged, or persistently misunderstood, clinicians can become more comfortable rejecting it than interrogating it.
For some patients, medical cannabis may be helping in ways that are clinically meaningful precisely because they are quiet. More restorative sleep. Less relentless anxiety. Better emotional regulation. Greater capacity to function. Those are not marginal gains. They are often the gains that allow a person to return to themselves. If psychiatry is serious about patient-centred care, it should also be serious about noticing improvement when it appears in forms that do not fit the neatest public narrative.
