Is there a role for cannabis in treating anorexia nervosa?

Anorexia nervosa (AN) has the highest mortality rate of any psychiatric disorder, and treatment options are limited. The ECS connection: CB1 receptors regulate appetite, body image perception, and reward processing — all disrupted in AN. Patients with AN show altered endocannabinoid levels and CB1 receptor expression. Dronabinol (synthetic THC) has been studied in AN: a 2014 RCT (Andries et al., n=24) found dronabinol (2.5mg twice daily) produced modest but significant weight gain vs. placebo over 4 weeks. A 2023 follow-up study found continued benefit at 1 year. Mechanism: THC may reduce the hypermetabolism and anxiety around eating in AN, in addition to direct appetite stimulation. Concerns: (1) AN patients have high rates of comorbid anxiety and depression — THC may worsen these. (2) Cannabis use disorder risk in a population with existing addictive tendencies. (3) The weight gain from dronabinol is modest and may not be clinically meaningful. (4) Body image distortion — a core AN feature — may be worsened by cannabis-induced perceptual changes. This remains an area of active investigation.