Frequent cannabis use is linked to higher morning cortisol levels

New research published in the journal Cannabis indicates that adults who frequently use cannabis tend to have higher levels of the stress hormone cortisol immediately upon waking compared to non-users. The findings suggest that higher morning cortisol levels might act as a biological marker for problematic cannabis use, though the overall daily rhythm of cortisol release appears similar between users and non-users.

The human body manages stress through a network called the hypothalamic-pituitary-adrenal axis, or HPA axis. This neuroendocrine system coordinates a chain of chemical signals that result in the release of cortisol, a primary hormone that helps mobilize energy and respond to environmental demands. In a typical daily cycle, cortisol levels rise sharply within the first thirty minutes after waking up. This spike is known as the cortisol awakening response.

The cortisol awakening response acts as a physiological indicator of how well the body prepares for the day ahead. Repeated activation of the HPA axis from chronic stress or heavy substance use can cause physiological wear and tear, eventually disrupting this natural rhythm. Disruptions in daily cortisol patterns often accompany mental health challenges, such as anxiety and depression.

Research into other conditions, such as alcohol use disorder, indicates that chronic substance consumption can blunt this natural morning spike. Because cannabis is frequently used as a coping mechanism for daily stressors, scientists wanted to understand whether frequent marijuana consumption alters the body’s natural cortisol rhythms in a similar way.

“There had been limited research on whether frequent cannabis use is associated with changes in individuals’ diurnal stress activity, which can be measured by examining the cortisol awakening response,” said Anita Cservenka, an associate professor and director of the Substance Use & Neurocognition Lab in the School of Psychological Science at Oregon State University.

“However, some previous studies had shown that the typical rise of cortisol in the morning, which is thought to be a marker of our body’s preparation for managing the stressors of the day, may be blunted among individuals with alcohol use disorder,” Cservenka added. “A recent study by Glodosky et al., 2026, also suggested this may be the case among those with chronic cannabis use, so we attempted to replicate those findings.”

To conduct the study, the researchers recruited 82 adult participants. The sample included 39 frequent cannabis users who consumed the substance at least three days a week over the past year and reported past-month use. The remaining 43 participants were healthy controls who used cannabis no more than one day a month and had no past-month use.

To prevent outside variables from influencing the stress hormone readings, the authors excluded individuals with a lifetime diagnosis of any psychiatric disorder, severe medical conditions, and those taking psychotropic or steroid medications.

Participants visited a laboratory to provide a urine sample and complete a breathalyzer test to ensure they were not acutely intoxicated. They then completed several surveys assessing their sleep quality, depression, anxiety, and perceived stress over the previous month. The frequent cannabis use group also completed a questionnaire evaluating recent negative consequences related to their consumption, such as social or occupational problems.

After the lab visit, participants collected their own saliva samples at home on two consecutive weekdays. They were instructed to avoid eating, drinking, consuming caffeine, or brushing their teeth right before sampling. They took saliva samples at the exact time of awakening, thirty minutes after waking, and in the evening at 9:00 PM. Along with each sample, participants recorded their momentary subjective stress levels on a scale from zero to ten.

The frequent cannabis users reported higher rates of depression, anxiety, perceived stress, and poorer sleep quality compared to the healthy controls. However, both groups reported nearly identical average sleep durations of roughly seven and a half hours, alongside similar wake times. The majority of the frequent use group consumed marijuana flower, most commonly using a water pipe.

Laboratory analysis of the saliva samples showed no statistically significant group differences in the cortisol awakening response. Both groups experienced a similar relative increase in cortisol during the first thirty minutes after waking. The researchers also found no group differences in the evening cortisol levels.

“We were surprised that we were unable to replicate the findings by Glodosky et al., 2026 who found a blunted cortisol awakening response in individuals with chronic cannabis use relative to controls, as our study showed no group differences,” Cservenka said. “However, it is possible that differences in statistical approaches or other demographic differences could explain the lack of replication. Thus, these nuances may be very important and sensitive to assessing the cortisol awakening response.”

Despite having a similar thirty-minute morning spike, frequent cannabis users had higher absolute baseline levels of cortisol at the exact moment of awakening. Within the frequent cannabis use group, the elevated morning cortisol levels were positively associated with the severity of cannabis-related consequences. The self-reported number of cannabis use days in the past month did not predict morning cortisol. Instead, the specific score of negative life consequences related to cannabis use corresponded with the higher cortisol readings at waking.

“Although we did not find group differences in the cortisol awakening response (the difference in cortisol 30 minutes post-awakening and at the time of awakening) between individuals who engaged in frequent cannabis use relative to controls, we did find that cannabis use may be related to higher levels of cortisol at the time of awakening and this was significantly related to cannabis use consequences,” Cservenka said. “These findings could inform treatment efforts aimed at trying to reduce the negative consequences individuals may experience from their cannabis use that could also have potential beneficial effects on their physiological stress systems.”

When examining subjective stress, the researchers found that higher self-reported stress correlated with higher cortisol levels across all participants during the morning hours. This positive association between perceived stress and cortisol release tended to be stronger in the healthy control group than in the cannabis use group.

Exploratory analyses separating the participants by sex indicated that the positive link between subjective stress and morning cortisol was present in males. However, the statistical models for females did not show this association.

Observational studies of this nature cannot determine cause and effect. It is not possible to conclude whether frequent cannabis use directly increases basal morning cortisol levels, or if individuals with naturally higher baseline cortisol are more drawn to heavy cannabis consumption to cope with stress. The relationship between neurobiology and substance use often involves complex interactions.

“It remains to be seen whether these stress neuroaxis alterations are a predisposing factor for frequent cannabis use or if frequent cannabis use can lead to these changes, as there is very limited research in this area,” Cservenka said. “Future longitudinal studies that track individuals over time before and after engaging in cannabis use will be needed to answer the question related to the neuroendocrine changes that are preexisting or a result of chronic cannabis use.”

The frequent cannabis users in the sample were older on average, at roughly 25 years old, than the healthy controls, who averaged 21 years of age. Age differences can sometimes influence hormonal rhythms, though statistical models in this study did not find age to be a driving factor for cortisol levels. The sample size was also relatively small, with only 82 total participants.

When the researchers separated the data by sex for exploratory analyses, the statistical power dropped. This reduction makes it difficult to draw firm conclusions about how male and female stress systems might react differently to heavy cannabis use. Future research using larger sample sizes and comparing different methods of cannabis consumption is needed to build a more complete picture of hormonal stress responses.

The study, “Subjective Stress and Diurnal Salivary Cortisol in Adults with Frequent Cannabis Use,” was authored by Julia Donner, Alexia N. Obrochta, and Anita Cservenka.