Reduction of Benzodiazepine Use in Patients Prescribed Medical Cannabis
Chad Purcell, Andrew Davis, Nico Moolman, and S. Mark Taylor
Cannabis and Cannabinoid Research, 2019, Volume 4, Number 3,
Doi : 10.1089/can.2018.0020
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.
Keywords : benzodiazepines; deprescribing; discontinuation; medical cannabis
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 gammaaminobutyric 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.8 While benzodiazepines remain an essential class of medication, there is certainly need for caution regarding its side effect profile.
This study seeks to investigate benzodiazepine discontinuation rates in a population of patients referred for medical cannabis therapy.