Assessing anxiety longitudinally among medical cannabis patients in Pennsylvania

<i>Background:</i> Anxiety is a common reason for cannabis use, yet how symptoms evolve among medical cannabis patients over time remains underexplored. Characterizing anxiety trajectories in this population may inform clinical care and guide patient support.<i>Objectives:</i> To assess anxiety longitudinally among medical cannabis patients alongside concurrent changes in health and cannabis use.<i>Methods:</i> Between 2021-2023, 526 Pennsylvania-based medical cannabis patients (59% female) completed at least two quarterly GAD-7 anxiety assessments over 12 months. Latent class growth analysis identified longitudinal anxiety profiles and their predictors. Parallel changes in health and cannabis use were examined across profiles.<i>Results:</i> Three longitudinal anxiety profiles emerged: Minimal (43%), Moderate (36%), and Severe (21%), with minimal-decreasing, moderate-decreasing, and severe-stable GAD-7 scores, respectively. In Minimal and Moderate groups, anxiety declined but reductions were not clinically meaningful. Younger age and female sex predicted Moderate and Severe profiles, while lifetime PTSD and anxiety disorders as a primary qualifying condition predicted the Severe group only (<i>p</i> < .05). Depression, interference from anxiety and depression, and health-related quality of life aligned with anxiety profiles and significantly differed across them (<i>p</i> < .001). The Severe group had higher baseline levels of benzodiazepine prescriptions and cannabidiol use than the Minimal group (<i>p</i> < .05). Across profiles, prescription rates for anxiety medications remained stable, and cannabis use was near-daily.<i>Conclusion:</i> Anxiety trajectories varied, aligning with other mental health indicators. Only less severe profiles showed anxiety reductions, so patients with severe anxiety may require support. Potential co-use of cannabis and anxiety medications warrants clinical attention.