Medical Cannabis Greatly Reduces Use of Benzodiazepine in Patients
A new peer-reviewed study from the Canadian medicinal cannabis company Aleafia Health, believed to be the first of its kind, has been published in the journal Cannabis and Cannabinoid Research. Carried out by researchers from Dalhousie University and Acadia University, the retrospective study looked at data from a group of 146 medical cannabis patients who regularly used benzodiazepine. The study found a significant reduction in benzodiazepine use among patients on beginning medical cannabis treatment. Two months after beginning to take medical cannabis, 30.1% of patients in the study who had previously been regularly using benzodiazepines had stopped taking the drug — this number rising to 45.2% of patients six months after beginning medical cannabis treatment.
What are benzodiazepines?
Benzodiazepines, sometimes more informally referred to as “benzos”, are commonly prescribed for treating anxiety, or to help with insomnia. The calming, sedative effects of benzodiazepines also make them suitable for treating seizures, muscle spasm, and even to assist in treating severe alcohol withdrawal. Common examples of benzodiazepines include alprazolam (Xanax), diazepam (Valium) and lorazepam (Ativan).
Short-term use of benzodiazepines is relatively safe, with the most common side effects being drowsiness or dizziness. Some users describe a “hangover effect”, medically referred to as next day drowsiness, as an additional side effect of the medication. As a result, people taking a form of benzodiazepine medication are often advised not to drive, operate machinery, or perform other potentially hazardous activities while taking the drug.
However, there are complications associated with the long-term use of this type of drug. These complications range from a lack of or problems with concentration, to various levels of dependence, tolerance, addiction, and in some cases, overdose. For people who rely on benzodiazepines to treat the symptoms of longstanding health conditions, such as muscle spasms caused by multiple sclerosis, caution must be taken to ensure that patients are not suffering from any of these side effects associated with long term use.
This study was a retrospective analysis performed on a group of patients who were prescribed medicinal cannabis therapy. The patient data, all anonymized, originated from the database of Canabo Medical Clinic, who operate 10 physician referral-only clinics and are owned by Aleafia Health. Canabo clinics specialize in the controlled prescribing of medical cannabis to treat a variety of conditions.
All the data came from self-reported patient information that was recorded by the treating physician at the Canabo clinic. As physicians typically write prescriptions to last for 2-month periods, by looking at data from the initial prescription appointment through three follow-up appointments, it was possible for the researchers to examine variation in benzodiazepine usage in the first six months following medical cannabis use.
Initially, 884 patients were identified who self-reported using benzodiazepines at their initial visit to the clinic. After ruling out patients who did not complete three follow-up visits, or about whom sufficient data could not be collected during the timeframe of the study, researchers were left with 146 sets of usable patient data. The average age of these patients was 47.7 years and 61% of the group identified as female. Fifty-four percent reported using cannabis prior to the initiation of treatment, but 97.6% reported that they were not currently engaged in any recreational drug use. No significant demographic discrepancies were identified between patients who discontinued benzodiazepine use over the course of the study period and those who did not.
Statistical testing using binomial t-tests were used to assess population mean differences in benzodiazepine use following each visit to the clinic, as the small sample size meant that regression models would be unsuitable. The researchers also monitored the potential relevance of several other factors on benzodiazepine usage, such as the tetrahydrocannabinol (THC) and cannabidiol (CBD) content of the medical cannabis prescribed, and any self-reported changes in the effect the patient’s medical condition was having on their life.
Significant benzodiazepine discontinuation rates observed
In the paper, researchers note that “Benzodiazepine management and discontinuation was not a specific goal of any Canabo physician, and benzodiazepine cessation may have been initiated by a physician or patients.” Treatment from the Canabo clinic physicians was carried out with the sole intention of treating the underlying medical condition to the best of their ability.
Additionally, patients were not tested to verify they had stopped taking benzodiazepines — all reports of cessation of use in the patient data were based on patients self-reporting during clinic visits.
Still, from the patient data it was observed that after the first visit, 44 patients (30.1%) had discontinued their use of benzodiazepines. By the second visit, 21 more patients reported the same, bringing the total figure to 65 patients (44.5%). After the third visit, around the six-month mark, one more patient reported ceasing benzodiazepine use, making the final total 66 patients (45.2%). All of these reductions were deemed statistically significant at the p<0.001 level.
At the point of the initial visit, 74% of patients identified with the statement “life is affected/impacted by [my] medical condition … all the time” when asked about their current quality of life. After three clinic visits, the number of patients reporting this high impact on quality of life had fallen to 45% in the group of patients who had continued taking benzodiazepines, and just 30.3% of patients who reported discontinuing their use. The other options for the effect on the quality of life question were “most of the time” and “occasionally/rarely”.
At the first visit, only 3.4% of patients identified their condition as only “occasionally/rarely” affecting their life. By the third visit, 16.3% of medical cannabis patients who continued benzodiazepine use and 25.8% of those who did not continue agreed with this statement.
The study authors found no significant difference in the CBD or THC content of the medical cannabis consumed between either the continuing or discontinuing use groups.
Limitations of the study
In the discussion section of the paper, the researchers stress that “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.” The small sample size of the study is responsible for this in part, but also the suitability of medical cannabis to replace benzodiazepine treatment can only be established through randomized clinical trials, and the development of dependable safety data.
Additionally, the researchers note that the patient data did not include several other potentially valuable parameters that would merit further study, such as the potential effect of specific cannabis strains, benzodiazepine dosage, duration of benzodiazepine use, and the reason given for discontinuation.
Still, the study does undeniably show some association between medical cannabis therapy and a reduction in benzodiazepine use. This result merits further study, whether that be through randomized clinical trials or further retrospective studies that are able to evaluate a wider number of parameters.