Canadian Researchers Prove Cannabis Reduces Benzodiazepine Use

Earlier this year a group of professionals in Canada produced groundbreaking research that proved how cannabinoid medicine reduces Benzodiazepine use and cravings. This class of drugs is well known for it's addictive traits and a very long term withdrawal that often leads to the necessity for other pharmaceuticals to be prescribed for depression and anxiety. Prior research indicates that the vast majority of Benzodiazepine cessation attempts in medical patients do not end well even with the assistance of their prescription. Some studies have indicated that over 50% of those that quit the use of them will at some point return to use. A very powerful class of drugs with more than a potential for dependence – generally within 2 weeks of use an individual becomes dependent, or in other words addicted. Many that attempt to quit the medication without the help of cannabinoid medicine intervention will experience seizures and other serious issues during a withdrawal and then need direct medical assistance. Many have turned to medicinal cannabis and it's extracts to replace the pharmaceuticals that have caused such issues with success, this research goes in depth with how patients were able to reduce consumption of various Benzodiazepines.

Reduction of Benzodiazepine Use in Patients Prescribed Medical Cannabis:

Chad Purcell
, Andrew Davis
, Nico Moolman
, and S. Mark Taylor

Published Online:23 Jan 2019

Abstract

Background: Benzodiazepines are a class of medication with sedative properties, commonly used for anxiety and other neurological conditions. These medications are associated with several well-known adverse effects. This observational study aims to investigate the reduction of benzodiazepine use in patients using prescribed medical cannabis.

Methods: A retrospective analysis was performed on a cohort of 146 medical cannabis patients (average age 47 years, 61% female, 54% reporting prior use of cannabis) who reported benzodiazepine use at initiation of cannabis therapy. These data are a part of a database gathered by a medical cannabis clinic (Canabo Medical). Descriptive statistics were used to quantify associations of the proportion of benzodiazepine use with time on medical cannabis therapy.

Results: After completing an average 2-month prescription course of medical cannabis, 30.1% of patients had discontinued benzodiazepines. At a follow-up after two prescriptions, 65 total patients (44.5%) had discontinued benzodiazepines. At the final follow-up period after three medical cannabis prescription courses, 66 total patients (45.2%) had discontinued benzodiazepine use, showing a stable cessation rate over an average of 6 months.

Conclusion: Within a cohort of 146 patients initiated on medical cannabis therapy, 45.2% patients successfully discontinued their pre-existing benzodiazepine therapy. This observation merits further investigation into the risks and benefits of the therapeutic use of medical cannabis and its role relating to benzodiazepine use.

Introduction

Benzodiazepines are a class of medications commonly used to treat a variety of neurological conditions.1 Hypnotic and anxiolytic properties make benzodiazepines a mainstay in the treatment of insomnia and anxiety disorders, as well as alcohol, seizure, and spasticity disorders. These effects are exerted by amplification of inhibitory neural signaling, primarily via gamma-aminobutyric acid receptors.2 A comprehensive review of the pharmacologic properties of benzodiazepines is outside the scope of this study, but can be found elsewhere.3

Annual incidence rates of benzodiazepine use vary across North American populations and regions, with estimates upward of 10%.4,5 Likewise, Canadian survey data suggest benzodiazepine use has consistently been within the range of 5% in 2003 to 10% in 2012.6 Benzodiazepines are considered to have a relatively good safety profile in comparison with older sedative hypnotics, such as barbiturates. However, common side effects include ataxia, dizziness, drowsiness, fatigue, slowed reaction, and muscle weakness.1 Complications of long-term use include lack of concentration, dependence, tolerance, overdose, and addiction.2 A recent meta-analysis found increased mortality in benzodiazepine users compared with nonusers, with a hazard ratio (HR) of 1.6 (p≤0.05).7 This has similarly been shown in a systematic review demonstrating an increase in overall mortality in regular benzodiazepine users, with a HR ranging from 1.2 to 1.7 in the studies reviewed.8While benzodiazepines remain an essential class of medication, there is certainly need for caution regarding its side effect profile.

We're going to skip to the Discussion/Conclusion, but you can read the entire study here: https://doi.org/10.1089/can.2018.0020

Discussion

Patients initiated on medical cannabis therapy showed significant benzodiazepine discontinuation rates after their first follow-up visit to their medical cannabis prescriber, and continued to show significant discontinuation rates thereafter. Discontinuation was not associated with any measured demographic characteristic. Patients also reported decreased daily distress due to their medical condition(s) following prescription cannabinoids. The CBD and THC content of cannabis used did not differ among patients who continued and those who discontinued benzodiazepines.

The observed association between medical cannabis use and benzodiazepine discontinuation should not be misinterpreted as causative, and these results do not support inferences about substitution of medical cannabis for benzodiazepine therapy. Substitution of cannabis for opioids is supported by a growing body of evidence, although many challenges and unknowns limit widespread adoption of cannabis use for this indication.9,10 Extrapolation of self-reported data suggests that there are potentially as many Canadians using cannabis for its sedative and anxiolytic properties as there are patients taking sedatives such as benzodiazepines.11,12 The substitution effect of medical cannabis has also been seen with medications for pain, anxiety, migraine, depression, chronic pain, and headache.10,13,14

This study found no significant difference in the proportions of CBD and THC in the cannabis used by patients who continued and those who discontinued benzodiazepines. This study did not intend to address the relationship between cannabis and anxiety, or the physiological mechanisms of THC and CBD. However, review of the literature on this topic is warranted, as the effects of cannabis on anxiety are not fully understood.15 Animal studies have reported anxiolytic effects of whole cannabis administration.16 Experimental animal evidence cannot be easily generalized to human consumption because the use of dried cannabis flower may exhibit varying effects. These effects may be dependent on factors such as proportions and interactions among cannabinoids, amount used, and method of use. The potency of cannabis has been increasing over the past two decades. THC content has been increasing and CBD content decreasing, resulting in an increase in THC:CBD ratios from 14:1 in 1995 to 80:1 in 2014.17 Previous studies have reported associations of high THC/low CBD content with increased risk of anxiety.18 CBD and THC have proposed conflicting effects on anxiety. CBD has been associated with anxiolytic effects regardless of dose, while THC reliably produces subjective effects of anxiety, but appears to be anxiolytic at lower doses and anxiogenic at higher doses.15,19 Pre-clinical studies of CBD have demonstrated promise in treating anxiety disorders.20 Animal models support a reduction of anxiety symptoms in relation to generalized anxiety disorder and post-traumatic stress disorder through CBD treatment.21,22 Human and animal studies suggest that CBD may have role in attenuating the effects of THC, including anxiety.15 The observed association of benzodiazepine discontinuation with use of medical cannabis highlights the importance of further characterization of the anxiolytic properties of cannabis in the future.

Medical cannabis use has increased dramatically in recent years. The total number of Canadians registered for medical cannabis as of September 30th increased from 12,409 in 2014, to 30,537 in 2015 and 98,460 in 2016.23 Canabo clinics experienced similar growth from 2014 through 2015 with patient volumes expanding by more than double each year. Canabo data accessed in October 2016 consisted primarily of new patients from the same calendar year. Of the 207 patients who initiated medical cannabis with Canabo by January 31, 2016, 61 patients did not complete three visits before study end date. The designation of a 9-month window to receive three follow-up visits may contribute to these lost 61 patients. These patients may have received prescriptions for >3 months, or used their medical cannabis less frequently than discussed with their physician. Patient reasons for discontinuing clinic treatment are unknown and may include the typical reasons for loss to follow-up from any medical clinic.

There are several limitations to the current study. This study is not designed to, nor should be used to hypothesize physiological mechanisms to explain this observed association between benzodiazepines and cannabis. The retrospective observational methodology and sample size preclude an inference of a causal relationship between cannabis and benzodiazepine use trends. Sample size limitations also preclude our ability to make inference from the smaller proportion of benzodiazepine discontinuers than continuers who reported that their medical condition affected their life all the time after three clinic visits. Without dependable safety data and evidence from randomized trials for this cohort, cannabis cannot be recommended as an alternative to benzodiazepine therapy. Retrospective analysis of pre-existing Canabo data from ongoing clinic standard operating procedures precludes examination of many potentially valuable parameters for study, such as benzodiazepine dosing, indication and duration of use, and information about patients' intentions with discontinuation. No objective measure of benzodiazepine discontinuation was used to confirm self-reported data. Future studies could make use of biomarkers to more closely characterize benzodiazepine discontinuation. Although relative proportions of THC and CBD were reported, data did not include the strain of cannabis, or method of use. Consistent use of cannabis was approximated by patients returning to clinic three times after initial visit. Consistent use was thereby inferred from patients consistently returning to clinic. The present study demonstrates an association between medical cannabis therapy and reductions in benzodiazepine use. There is a fundamental paucity of research on the effectiveness of cannabis as a medical therapy, as well as the risks and benefits of its use.24 Future studies should aim to expand on the current understanding of cannabis and its potential medical applications.

Conclusion

Medical cannabis remains a controversial but potentially effective treatment for patients suffering from a variety of medical conditions. Within a cohort of patients initiated on medical cannabis therapy, a large proportion successfully discontinued their pre-existing benzodiazepine therapy. This study therefore supports the continued research of medical cannabis and urges further exploration into its therapeutic value.

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