A study has found that many patients stop using benzodiazepines after receiving medicinal cannabis. The findings have been published in the journal .
“I was interested in this project because it presented an opportunity to address the use of benzodiazepines and cannabis, which are becoming increasingly socially relevant. “Benzodiazepines can be effective in treating many medical conditions, but unlike opioids, there appears to be little public awareness of the risks associated with these commonly used prescription medications,” said study author Chad Purcell, a medical student at Dalhousie University.
Benzodiazepines are a class of medications used to treat conditions such as anxiety and insomnia. They are the most commonly used psychotropics and include Alprazolam (Xanax, Niravam), diazepam (Valium), clonazepam (Klonopin), lorazepam (Ativan) and others.
Regarding the cognitive effects of benzodiazepine consumption, one study suggests that long-term users were significantly impaired, compared to controls, in all areas evaluated. However, this study had several limitations, one of which is having a relatively small number of investigations. The observation that long-term benzodiazepine use has widespread effects on cognition presents numerous implications for the informed and responsible prescribing of these drugs. .
Benzodiazepines constitute a group of drugs that are widely prescribed in clinical practice. Their pharmacological effects are shared but their pharmacokinetic profile modifies their usefulness in different clinical scenarios. Its irrational prescription is a global public health problem, with chronic use and the risks associated with it being a clear example of this pattern of inappropriate use. They are subject to frequent drug interactions and there are populations more vulnerable to their adverse effects, such as the elderly. Some of its most notable adverse effects are falls and the appearance of dependence and tolerance associated with chronic incorrect use, with the appearance of discontinuation syndromes if it is abruptly interrupted. There are rational use guidelines that should be known when prescribing. .
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Others have noted that although benzodiazepines are invaluable in the treatment of anxiety disorders, they have some potential for abuse and can cause dependence or addiction. Drug dependence, a predictable and natural adaptation of a body system long accustomed to the presence of a drug, can occur in patients taking therapeutic doses of benzodiazepines. However, this dependence, which generally manifests itself in withdrawal symptoms after abrupt discontinuation of medication, can be controlled and ended by gradually reducing the dose, changing medication and/or increasing the medication. Due to the chronic nature of anxiety, long-term low-dose benzodiazepine treatment may be necessary for some patients; This continuation of treatment should not be considered abuse or addiction .
Purcell says that in his previous experience as a pharmacist he was able to see firsthand how benzodiazepines affected the lives of his patients. “I became familiar with the adverse effects of these medications which include dependence, falls, and increased sedation, especially when used in combination with other medications.”
Canada has legalized cannabis, and this positions its researchers in a unique position regarding the possibility of contributing to the development of research on this drug. Purcell comments on his desire to take “this opportunity to help better understand the potential uses and harms of cannabis,” and how it might mitigate the effects of benzodiazepine use.
Cannabis use and discontinuation of benzodiazepines
The researchers observed significant benzodiazepine discontinuation rates in 146 medical cannabis patients, who were regularly using benzodiazepines at the start of the study. Approximately 45% of patients had stopped taking benzodiazepine medication within six months of starting medical cannabis use.
Many patients also reported decreased daily distress due to medical conditions after being prescribed cannabis. “We hope that future research will explain this observation and provide recommendations for patients using benzodiazepines and/or cannabis,” Purcell said.
However, the author cautions that “the study design precludes our ability to reliably state that benzodiazepine discontinuation was caused by initiating medical cannabis. We can simply state that this association was observed. “Nor can we suggest a possible physiological mechanism to explain this association.”
Regarding the characteristics of the administered cannabis, Purcell highlighted that they did not have “access to information about cannabis varieties, growth and producers,” also warning that for this reason it is not possible to “generalize these results to products that are currently commercially available in Canada.” Finally, it should be noted that the research team does not suggest that cannabis can or should be used as a substitute or complement to medically indicated and prescribed benzodiazepines. Further studies are necessary to better understand the possible existing relationship and its effects.
References:
Barker, M.J., Greenwood, K.M., Jackson, M., & Crowe, S.F. (2004). Cognitive effects of long-term benzodiazepine use: a meta-analysis. CNS Drugs, 18(1), 37-48. https://doi.org/
Domínguez, V., Collares, M., Ormaechea, G., & Tamosiunas, G. (2016). Rational use of benzodiazepines: towards better prescription. Uruguayan Journal of Internal Medicine, 1(3), 14-24. Recovered from
O’brien, C. P. (2005). Benzodiazepine use, abuse, and dependence. The Journal of Clinical Psychiatry, 66 Suppl 2, 28-33. Recovered from
Purcell, C., Davis, A., Moolman, N., & Taylor, S. M. (2019). Reduction of Benzodiazepine Use in Patients Prescribed Medical Cannabis. Cannabis and Cannabinoid Research. https://doi.org/
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