Psychedelic Therapy vs. Medical Cannabis

A few years ago, cannabis became legal as a medical treatment in some states. Now, psychedelics are making the same moves. Because they’ve undergone similar journeys, it’s easy to group them. However, they have very different implications for clinicians and patients. Let’s compare psychedelic therapy vs. medical cannabis. 

Psychedelic Support believes in the power of plant medicine. However, there are important nuances in plant-derived therapy, and no substance will be helpful for every person every time. As clinicians, we need to be able to educate patients about the appropriate (legal) uses for these substances. 

Medical cannabis continues gaining legal ground in several states. We hope that psychedelic therapy will experience a similar rollout and public acceptance. Canada and Oregon are increasing access to psychedelics through progressive legislation. Other states will likely take notice and follow suit. On the federal level, we’re anticipating FDA approval for MDMA therapy within the next two years. 

For lay people, psychedelics like magic mushrooms and cannabis can seem similar. Both are plant-derived and have moved from a “fringe” substance into science. Both are still illegal in some states, decriminalized in others and fully legal in a few. Let’s start by comparing their subjecting effects. 

Comparing the Effects of Cannabis and Psychedelics

Medical Cannabis’s Acute and Long-Term Effects

The acute effects of cannabis last anywhere from two to ten hours, but these vary. The sensation of being “high” may come with a drop in anxiety and a feeling of relaxation. Others may experience paranoia, racing thoughts, and nausea. In this state, people may lose track of time or experience a loss in coordination. 

While some patients enjoy feeling “high,” others don’t. The good news is that most patients don’t have to have this sensation if they don’t want to. Depending on delivery and dosage, patients can experience symptom relief—without much change in their mental state. 

When it comes to consuming medical cannabis, there are many options. While smoking is most common, it’s also available in tinctures, food, topical lotions, and even suppositories. Patients who use topical cannabis for pain may not experience any mental changes. [1]

Some products only contain CBD, an extract from the cannabis plant, without containing THC. THC is the substance that gives you that “high” feeling. Using CBD products without the THC promotes relief without changing a person’s mental state.  

Cannabis has some physical effects, too. It may raise the heart rate for a few hours, especially if smoked. Some may experience headaches, dry mouth, and lightheadedness. While it’s often used to help with appetite and nausea, it can make some people very nauseous. It can also make people sleepy. It’s essential to advise patients not to drive or do risky activities while taking medical cannabis. [2]

Scientists are still not in consensus about the long-term effects of medical cannabis. We know that regular cannabis use can negatively affect mood, cognition, respiration, and other body systems. [3] However, cannabis use in the medical context is very different from recreational use. We’ll know more about the implications of long-term medical cannabis therapy with time. 

The Short and Long-Term Effects of Psychedelic Therapy

The short-term effects of psychedelic usage depend on the substance chosen for therapy. Patients who go through psilocybin-assisted therapy may have a very different experience from those treated with MDMA. Yet some common threads remain between psychedelic experiences.

Compared to medical cannabis, patients may experience more intense emotions under psychedelics. At therapeutic doses, psychedelics can bring up past memories. This allows patients to give new meaning to past experiences. 

One piece of the psychedelic therapy experience that contrasts with cannabis is the loss of ego that can come with psilocybin and LSD. Under this state of consciousness, patients may lose their place in time and space. They may forget who they are. This experience, sometimes called an “ego death,” can be terrifying and enlightening for patients undergoing psychedelic therapy. 

This contrasts with the “high” sensation of medical cannabis, which most patients can avoid if they want to. The psychedelic experience is wholly tethered to therapy outcomes. Patients’ emotions and perceptions during active psychedelic sessions are used as a tool in integration therapy.

People who microdose psychedelics may not experience these effects. Microdosing has only been studied anecdotally for possible therapeutic effects but could hold promise for people who want to avoid psychedelics’ “tripping” effects. [5]

Psychedelics have short-term physical effects as well, and these are substance-specific. LSD may cause a boost in heart rate and blood pressure. Mescaline can cause problems with movement or ataxia. Ayahuasca can cause nausea and vomiting, which are prohibitive side effects for many people. [5]

In the long term, psychedelic therapy can have very different effects on patients. Many of cannabis’s effects depend upon continuing use. However, after one or a few sessions with psychedelic therapy, patients may experience lasting personality changes. These may include spiritual changes, mindfulness, and improved depression and anxiety. [6]

Who Can Benefit From Medical Cannabis Compared to Psychedelic Therapy?

Psychedelic therapy and medical cannabis are prescribed for very different patient diagnoses. Cannabis is used off-label for patients suffering from a range of illnesses. It’s used to treat the symptoms of diseases like cancer and Parkinson’s.

Here are a few symptoms and diagnoses that patients may receive medical cannabis prescriptions for:

• Neuropathic pain
• Parkinson’s disease spasticity
• Nausea and vomiting from chemotherapy
• Anxiety disorder
• Depressive or mood disorders
• Sleep disorders
• Tourette’s syndrome
• Crohn’s disease
• Decreased appetite resulting from AIDS
• Anxiety from Post-Traumatic Stress Disorder
• Muscle spasms from spinal cord injuries and multiple sclerosis

Medical cannabis is often prescribed for the physical symptoms of a disease. It’s provided relief for millions of patients through ongoing prescription therapy. 

Psychedelic therapy is helpful for mental health diagnoses. Psychedelics have the potential to change personality and mood within just a few sittings radically.

Check out these psychedelics and the diagnoses that we’ve researched so far:

• Ketamine therapy is proven to help with anxiety, depression, and pain. [7]
• MDMA-assisted therapy has been shown to be “highly effective” for Post-Traumatic Stress Disorder. [8] It’s also being investigated for eating disorders. 
• Psilocybin-assisted therapy has been shown to be effective for Treatment-Resistant Depression. [9]
• Lysergic Acid Diethylamide (LSD) could treat Alcohol Use Disorder and mood disorders. [10]
• Ayahuasca could help treat depression. [11]
• Ibogaine is undergoing research to treat opioid withdrawal. [12]

More research is being conducted to figure out how clinicians like you can help their patients physically and mentally – with the help of psychedelics.  

How Is Psychedelic Therapy Delivered Compared With Medical Cannabis?

Psychedelic therapy typically isn’t meant to be ongoing. Patients may go through three to five active substance sessions, depending on the substance. These include therapeutic integration sessions before and after each. 

Regimens are substance-specific. For instance, it’s common to receive three ketamine therapy sessions spaced apart. Some patients may go through maintenance ketamine treatments after stabilizing. 

In psychedelic therapy, patients are closely supervised during their active sessions. A therapist, nurse, and/or facilitator may be present to ensure they’re comfortable and safe. It’s not recommended for patients to pursue psychedelic substances unsupervised. Patients should understand the potential risks associated with specific health conditions and medications.

Medical cannabis is often administered by the patient on an ongoing basis. Because its effects are less intense, patients are typically comfortable being by themselves or doing everyday activities after taking medical cannabis. Patients typically have an ongoing prescription for cannabis, accessing it through a local head shop.

Cannabis-assisted psychotherapy combines the medical and psychological benefits of cannabis with the therapeutic properties of psychedelic therapy. Though clinical trials using cannabis with therapy are still in the early days, research is promising. The assisted therapy model would mean that patients would consume cannabis under supervision and go through talk therapy with a licensed therapist. This model may look similar to psychedelic-assisted therapy. 

What to learn more about how psychedelics like cannabis help neurons grow? Check out our blog. 

What Are the Risks of Medical Cannabis and Psychedelic Therapy?

A significant benefit for both of these substances is their safety. Psychedelic therapy and medical cannabis are both considered safe, especially compared to other treatments. For example, patients with pain who take medical cannabis rather than opioids run far less risk of physical dependency. However, there are some safety concerns around medical cannabis and psychedelic therapy. 

We still don’t know how the long-term use of medical cannabis could change patient outcomes. One drawback that many patients worry about is Cannabis Use Disorder. This is when people become dependent on cannabis, with detrimental effects on mood and cognition. While cannabis isn’t physically addictive, THC does have addictive properties. [13]

Some experts believe that long-term cannabis use can change our brains, but how this happens and why is unclear. We know that cannabis affects our sense of self-awareness, evidenced by its effects on anxiety and memory impairment. In the same vein, it can affect motivation and personal experiences negatively. With time, we’ll understand these risks so that we can mitigate them for patients. [12]

Psychedelic therapy’s risks are more short-term. Often at the front of patients’ minds is the risk of having a “bad trip” or a negative experience. The therapist must educate themselves on harm reduction to respond to these situations when they happen. Other risks of psychedelics are mitigated by supervised therapy. Learn more about the risks of psychedelic experiences here. 

Psychedelic Therapy vs. Medical Cannabis: You Decide

Psychedelic therapy and medical cannabis have distinct effects, uses, and risks. There is no one-size-fits-all plant medicine. Some patients may find that trial-and-error (within the legal limits) is the best way to learn what treatment method works for them. We hope that with more research and education, we can help clinicians recommend the best substances for their patients. 

Want to learn more about comparing psychedelic therapy vs medical cannabis? Check out our Little Book of Psychedelic Substances. This free practical guide shows you eight popular psychedelic substances and their:  

• Effects
• Safety
• Dosage for medical and recreational settings 

Check out this guide on our Free Courses Page.

References

Comparing the Effects of Cannabis and Psychedelics

• 1. Mouhamed, Y., Vishnyakov, A., Qorri, B., Sambi, M., Frank, S. S., Nowierski, C., Lamba, A., Bhatti, U., & Szewczuk, M. R. (2018). Therapeutic Potential of Medicinal Cannabis: An Educational Primer for Health Care Professionals. Drug, Healthcare and Patient Safety, 10, 45–66. https://doi.org/10.2147/DHPS.S158592.
• 2. NIDA. 2019, December 24. Cannabis (cannabis) DrugFacts. Retrieved from https://nida.nih.gov/publications/drugfacts/cannabis-cannabis on 2022, May 18
• 3. Karila L, Roux P, Rolland B, Benyamina A, Reynaud M, Aubin HJ, Lançon C. Acute and long-term effects of cannabis use: a review. Curr Pharm Des. 2014;20(25):4112-8. doi: 10.2174/13816128113199990620. PMID: 24001294.
• 4. Kuypers K. (2020). The therapeutic potential of microdosing psychedelics in depression. Therapeutic advances in psychopharmacology, 10, 2045125320950567. https://doi.org/10.1177/2045125320950567
• 5. NIDA. 2020, June 2. How Do Hallucinogens (LSD, Psilocybin, Peyote, DMT, and Ayahuasca) Affect the Brain and Body?. Retrieved from https://nida.nih.gov/publications/research-reports/hallucinogens-dissociative-drugs/how-do-hallucinogens-lsd-psilocybin-peyote-dmt-ayahuasca-affect-brain-body 
• 6. Aday JS, Mitzkovitz CM, Bloesch EK, Davoli CC, Davis AK. Long-term effects of psychedelic drugs: A systematic review. Neurosci Biobehav Rev. 2020 Jun;113:179-189. doi: 10.1016/j.neubiorev.2020.03.017. Epub 2020 March 16. PMID: 32194129.

Who Can Benefit From Medical Cannabis Compared to Psychedelic Therapy?

• 7. Mandal, S., Sinha, V. K., & Goyal, N. (2019). Efficacy of ketamine therapy in the treatment of depression. Indian journal of psychiatry, 61(5), 480–485. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_484_18
• 8. Slomski, A. (2021). MDMA-Assisted Therapy Highly Effective for PTSD. JAMA, 326(4), 299. https://doi.org/10.1001/jama.2021.11748
• 9. Nichols, D. (2020). Faculty opinions recommendation of effects of psilocybin-assisted therapy on major depressive disorder: A randomized clinical trial. Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature. https://doi.org/10.3410/f.738980632.793580383
• 10. Fuentes, J. J., Fonseca, F., Elices, M., Farré, M., & Torrens, M. (2020). Therapeutic use of LSD in psychiatry: A systematic review of randomized-controlled clinical trials. Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.00943
• 11. Palhano-Fontes, F., Barreto, D., Onias, H., Andrade, K. C., Novaes, M. M., Pessoa, J. A., Mota-Rolim, S. A., Osório, F. L., Sanches, R., Dos Santos, R. G., Tófoli, L. F., de Oliveira Silveira, G., Yonamine, M., Riba, J., Santos, F. R., Silva-Junior, A. A., Alchieri, J. C., Galvão-Coelho, N. L., Lobão-Soares, B., Hallak, J., … Araújo, D. B. (2019). Rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression: a randomized placebo-controlled trial. Psychological medicine, 49(4), 655–663. https://doi.org/10.1017/S0033291718001356
• 12. A study of oral ibogaine in opioid withdrawal – full text view. Full Text View – ClinicalTrials.gov. (n.d.). Retrieved May 18, 2022, from https://clinicaltrials.gov/ct2/show/NCT05029401

What Are the Risks of Medical Cannabis and Psychedelic Therapy?

• 13. Patel J, Marwaha R. Cannabis Use Disorder. [Updated 2022 February 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538131/