Purpose of Review <p>Anxiety disorders and cannabis use are highly comorbid, yet their relationship remains controversial, with evidence suggesting that cannabis may have both anxiolytic and anxiogenic effects. Disentangling this complex relationship is crucial for developing clear clinical guidelines that can directly inform treatment approaches and public health recommendations. By conducting a systematic search of English-language studies published between 2004 and 2024 that examined cannabis use and anxiety, we aimed to: 1) examine the impact of cannabis on pre-existing anxiety, 2) investigate the acute effects of cannabis on anxiety, 3) explore the longitudinal relationship between chronic cannabis use and the subsequent development of anxiety, and; 4) assess whether cannabis cessation influences anxiety outcomes.</p> Recent findings <p>The initial search yielded 22,951 studies, of which 62 met inclusion criteria. Our findings revealed promising potential for cannabis in the clinical treatment of anxiety. However, substantial evidence also linked cannabis consumption to acute anxiety episodes, as well as reduced anxiety levels following cessation in regular users. Chronic use demonstrated greater variability in anxiety outcomes, influenced by factors including dose, cannabinoid composition, and individual characteristics.</p> Summary <p>Our findings suggest a multifaceted relationship between cannabis and anxiety, highlighting both anxiolytic and anxiogenic effects. Future research should clarify the factors underlying these heterogeneous outcomes.</p>