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.
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.
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.
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.
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.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.
Opioid prescriptions for chronic pain and subsequent opioid-related complications have risen dramatically in the US. Recent data suggest that medical marijuana laws have been associated with lower state-level opioid overdose mortality. In a national survey, we examined the prevalence of substitution of marijuana for opioids among US adults taking opioids for pain.Using GfK’s KnowledgePanel, we conducted an Internet-based survey of a nationally representative sample of 16,280 adults in 2017 about individual perceptions and use of marijuana.
We developed questions designed to assess the extent and reasons for substitution of marijuana for opioids. We examined opioid substitution among respondents with a history of ever using marijuana who used opioids in the past 12 months. There were 9,003 respondents, corresponding to a 55.3% response rate.
The mean age was 48 years. Among the 5% (n = 486) who reported ever using marijuana and using opioids in the past year, 43% used opioids daily, and 23% reported current (past 30 day) marijuana use. Forty-one percent reported a decrease or cessation of opioid use due to marijuana use; 46% reported no change in opioid use; and 8% reported an increase in opioid use. We found that a substantial number of US adults reported that they substituted marijuana for opioids.
Chronic pain affects approximately one-third of the U.S. population, and opioid prescriptions have substantially increased over the last 20 years . In parallel, there has been an increase in opioid-related complications, with opioid overdose deaths quadrupling between 1999 and 2015 . Growing concerns about the risks of opioids, including overdose-related deaths and opioid use disorder, have prompted greater focus on the more judicious use of these agents for managing pain and the need to identify other agents to treat pain .
The data on the efficacy of cannabinoids in the management of pain is evolving. In a systematic review, there was low-strength evidence that cannabis is effective for treating neuropathic pain and insufficient evidence of its effectiveness for other types of pain . The American Academy of Neurology has endorsed use of cannabinoids for the pain and spasticity associated with multiple sclerosis but cautions that the safety profile of cannabinoids has not been compared to other approved drugs . Despite the lack of robust evidence for efficacy of cannabinoids in pain management, marijuana has been approved by legislatures or ballot initiative for the management of pain in over 30 states .
Recent data suggest that medical marijuana laws have been associated with lower state-level opioid overdose mortality, hospitalizations related to opioid complications, detection of opioids among fatally injured drivers, and prescription of analgesics . These ecologic studies, while hypothesis generating, do not inform our understanding of the individual effects of marijuana use or combined marijuana and opioid use. Prospective cohort studies and clinical trials are needed to improve our understanding of the effects of cannabis on pain management.
Nonetheless, these studies have spurred discussion about the potential for marijuana to serve as a substitute for opioids, particularly in contexts where marijuana is increasingly available through legalization. Small surveys of convenience samples of American and Canadian marijuana users have reported that substitution of marijuana for opioids is common, ranging from approximately 30% to 97% [8, 9]. To our knowledge, there are no nationally representative surveys examining substitution and reasons for substitution among the general US adult population. We examined the prevalence and reasons for substitution of marijuana for opioids among US adults taking opioids for pain, as well as the factors associated with substitution.
Many Americans rely on opioids at varying dosages to help ameliorate their suffering. However, empirical evidence is mounting that opioids are ineffective at controlling non-cancer related chronic pain, and many argue the strategies meant to relieve patient suffering are contributing to the growing opioid epidemic. Concurrently, several states now allow the use of medical cannabis to treat a variety of medical conditions, including chronic pain. Needing more exploration is the impact of cannabis laws on general opioid reliance and whether chronic pain sufferers are opting to use cannabis medicinally instead of opioids.
This study investigates the effect of Medical Marijuana Laws (MML)s on opioid use and misuse controlling for a number of relevant factors using data from several years of the National Survey on Drug Use and Health and multivariate logistic regression and longitudinal analysis strategies.
Results provide evidence that MMLs may be effective at reducing opioid reliance as survey respondents living in states with medical cannabis legislation are much less apt to report using opioid analgesics than people living in states without such laws, net other factors. Results further indicate that the presence of medicinal cannabis legislation appears to have no influence over opioid misuse.
MMLs may ultimately serve to attenuate the consequences of opioid overreliance.
Context: Chronic pain is highly prevalent in most of the industrialized nations around the world. Despite the documented adverse effects, opioids are widely used for pain management. Cannabinoids, and specifically Cannabidiol, is proposed as an opioid alternative, having comparable efficacy with better safety profile.
Objectives: We aim to investigate the impact of full hemp extract cannabidiol (CBD) on opioid use and quality of life indicators among chronic pain patients.
Methods: An initial sample of 131 patients was recruited from a private pain management center’s investigative population. Ninety-seven patients completed the 8-week study. The primary inclusion criteria included patients between 30 and 65 years old with chronic pain who have been on opioids for at least 1 year. Data were collected at three different time points: baseline, 4, and 8 weeks. Opioid and other medication use were evaluated via the medication and psychiatric treatment receipt. Improvement was evaluated using four indices: Pain Disability Index (PDI-4); Pittsburgh Sleep Quality Index (PSQI), Pain Intensity and Interference (PEG); and Patient Health Questionnaire (PHQ-4).
Results: Over half of chronic pain patients (53%) reduced or eliminated their opioids within 8 weeks after adding CBD-rich hemp extract to their regimens. Almost all CBD users (94%) reported quality of life improvements. The results indicated a significant relationship between CBD and PSQI (p = 0.003), and PEG (p = 0.006). There was a trend toward improvement but no significant relationship between CBD use and PHQ and PDI.
Conclusion: CBD could significantly reduce opioid use and improve chronic pain and sleep quality among patients who are currently using opioids for pain management.
Key Message: This is a prospective, single-arm cohort study for the potential role of cannabinoids as an alternative for opioids. The results indicate that using the CBD-rich extract enabled our patients to reduce or eliminate opioids with significant improvement in their quality of life indices.
Matched pilot study examining cannabis-based dronabinol for acute pain following traumatic injury.
Background, to determine whether adjunctive dronabinol, a licensed form of delta-9-tetrahydrocannabinol, reduces opioid consumption when used off-label for managing acute pain following traumatic injury.
Methods, this matched cohort study included patients who were admitted with a traumatic injury between 1 March 2017 and 30 October 2017. The hospital pharmacy database was used to identify patients who received dronabinol (cases), and they were matched 1:1 to patients who did not receive dronabinol (controls) using age, cause of injury and hospital length of stay. The primary outcome, change in opioid consumption, was calculated using morphine milligram equivalents (MME). The change in MME was calculated for cases as total MME over 48 hours with adjunctive dronabinol minus 48 hours prior to dronabinol, and for controls as total MME 48–96 hours from admission minus 0–48 hours from admission. Data are presented as mean and SE or median and IQR. Statistical analysis was performed using paired t-tests and McNemar’s tests.
Results, there were 66 patients included: 33 cases and 33 matched controls. Dronabinol was initiated 55 (28–107) hours from admission. Cases and controls were well matched. Cases had a significant reduction in opioid consumption with adjunctive dronabinol (−79 (20) MME, p<0.001), while opioid consumption was unchanged for controls (−9 (20) MME, p=0.63). This resulted in a ninefold greater reduction in opioid consumption for cases versus controls that was statistically different between pairs (p=0.02). Nineteen (58%) cases reported using marijuana; in this subset, opioid consumption was reduced with adjunctive dronabinol (−97 (24) MME, p<0.001) versus a non-significant increase in opioid consumption in matched controls (11 (29) MME, p=0.70); difference between groups, p=0.01.
Conclusions, the results of this study suggest adjunctive dronabinol reduces opioid consumption following traumatic injury. The opioid-sparing effect of dronabinol may be greater in patients who are marijuana users.
Camas-Washougal Post Record Article, February 27th, 2020
Political action committee, launched by New Vansterdam owners, hopes to get issue on November ballot.
Camas Washougal Post Article
When the issue of legalizing cannabis came before Washington voters in 2012, nearly half of Camas voters — 47 percent overall and more than 50 percent in the city’s Ward 1 — supported decriminalizing the drug. But when the issue of opening the one cannabis retail shop allowed in Camas under the state ordinance came before city council members in 2015, the council voted 5-2 to ban marijuana shops within city limits. Now, the owners of a popular Vancouver cannabis shop hope to reverse that decision.
Rachel and James Bean own the New Vansterdam cannabis retail shop located off Mill Plain Boulevard and hold the the lone cannabis retailer license available in Camas. Although the Beans would love to see Camas officials lift the 2015 retailer ban, they are prepared to take the issue to the city’s voters through a local ballot measure process.
“We would hope this could be resolved with the city council. I believe it would just take a little more education and more discussion,” said Rachel Bean. “But we will be moving forward with the (voter) initiative either way.”
Bean and her physician husband have formed the Camas for Cannabis Access political action committee (PAC) to gather the 2,377 Camas voter signatures needed to place the issue on the November general election ballot.
“We’ve been kind of sitting back a little, waiting and trying to work with the city council,” Bean said. “We have three other stores (in Vancouver, Tacoma and Wenatchee), so we were pretty busy and (the Camas license) wasn’t a high priority for us. But this year, with the big election, it seemed like the year to jump on this.”
A Camas native who now lives in Vancouver, Pitchford became involved in cannabis-legalization activism in 2008, after surviving a violent home invasion linked to the illicit marijuana trade. Home invaders mistook the home Pitchford, then a 19-year-old Clark College student, shared with roommates as being the site of an illegal stash of marijuana.
“Masked gang members held me hostage,” Pitchford said of the incident that led her into cannabis activism. “Afterward, I started thinking about the reasons why cannabis was illegal and about the people involved in violent crimes connected to the illicit cannabis market.”
Pitchford participated in early efforts to legalize cannabis in Washington state, and said she has seen a shift in people’s perception of marijuana since Washington voters approved Initiative 502, a measure that decriminalized recreational marijuana, in November 2012.
“People have been able to see what it looks like to go into a cannabis store, to see that these shops are a functional part of the community,” Pitchford said. “There is less stigma.”
Rachel Bean agreed.
“People have become much more open to the idea of retail cannabis,” she said. “I think things have changed drastically since 2012, when legalization was passed, and even more since stores started opening in 2014.”
Bean said people’s attitudes toward cannabis also is shifting as health providers start to understand the medicinal benefits of the herb, and as more research is conducted on cannabis’ ability to help with pain management, cancer treatments and opioid addiction.
“Time and time again, I see people coming into the shop for the first time, including a lot of the elderly population, and they’re looking to try new things to help whatever ailment they might have. They have doctors telling them to try these new things,” Bean said. “(Cannabis) has become less taboo and more of an actual medicine that is helping people.”
Pitchford said the Camas for Cannabis Access PAC is training workers to collect signatures and help educate Camas voters about the legal cannabis industry and the benefits of having a cannabis retail shop within the city limits.
“This is really about access,” Pitchford said. “We know the support exists in Camas.”
Armed with statistics and research showing that legalizing marijuana has helped reduce marijuana use among teens, led to a reduction in violent crimes, provided living-wage jobs — New Vansterdam, Bean said, pays more than a living wage and provides a full range of benefits to its 20 employees — and helped bring millions of dollars in tax revenue to cities and counties that allow cannabis retailers, the Camas for Cannabis Access PAC is gearing up to attend local events and collect signatures to get the issue onto the November ballot.
“We want to be very respectful and help educate people,” Pitchford said. “A lot of the (signature collectors) have worked in the industry and are knowledgeable about cannabis and cannabis retail, so they will be able to answer questions people might have.”
The Beans, who live in Vancouver, said they hope Camas voters and officials will see them for who they are — professionals who run successful cannabis businesses in other Washington cities.
“I’d like people to know that we are a part of the community and that we respect the people and businesses around us,” Rachel Bean said. “We don’t want people to be concerned about who is holding this license.”
Already, the Beans have made a concession that they didn’t have to make — agreeing to not site the cannabis store in historic, downtown Camas if voters approve the initiative or if city council members decide to overturn their 2015 cannabis retail ban.
“That wasn’t something we had to do, but we had heard from council members that (not having a cannabis retailer) in the historic district was important to their constituents, so that was something we were more than happy to respect,” Rachel Bean said.
Pitchford said she hopes to get more information out to the Camas community about cannabis that will help dispel some of the fears and myths surrounding the drug. For instance, she said, although many people have said they worry that having a legal cannabis shop in Camas will lead to greater marijuana usage by children, the facts show otherwise.
“I’m the mother of two young children, so I understand why they would be concerned,” Pitchford said. “But when you look at the studies, including the Healthy Youth Survey that is done in Clark County, there is a decrease (in marijuana use among teens and children) and that is a direct result of legalizing cannabis. They just can’t get it anymore. The shops are very strict about that. Some of them even have scanners to make sure the IDs (for those over the age of 21) are real.”
During the 2015 hearing that led to the city’s ban on cannabis retailers, only two Camas officials — current Councilwoman Melissa Smith and former Camas Mayor Shannon Turk — voted against the ban.
“It will be a novelty at first for some, but as more people are aware of it I think it will de-stigmatize it,” Smith said in 2015, adding that she had researched cannabis several years prior, after receiving a doctor’s prescription for marijuana to treat pain.
Other council members who still serve as elected officials, including Councilman Don Chaney, spoke in favor of the ban in 2015.
“It’s not about the use or possession of marijuana, at least as far as I’m concerned,” Chaney said in 2015. “And it’s not about the personal qualities or business opportunities of the proponents. That’s not an issue here for me. The issue is, what’s it going to do to our community, and how does the fact that we do or do not (allow retail marijuana businesses) reflect the culture of our community?”
Washougal city officials also have banned cannabis retail operations, and both Camas and Washougal have bans in place on the growing and processing of retail marijuana within city limits. To learn more about the Camas for Cannabis Access group and its efforts, visit xray.fm/broadcasts/33110 and listen to XRAY FM’s interview with Rachel Bean and Pitchford. The group plans to launch a website soon and will have social media sites up and running within the next few weeks.
Marijuana legalization Support Soars, Two-thirds of Americans support marijuana legalization, according to two recent polls.
The overwhelming majority of Americans support marijuana legalization, according to two recent surveys from major polling organizations.
The newest poll, from the Pew Research Center, found that 67 percent of Americans now back marijuana legalization, up from 62 percent in 2018. Opposition to legalization also dropped to 32 percent, down from 34 percent last year.
Pew also asked respondents about what kind of legalization they back. About 59 percent said they want medical and recreational legalization, while 32 percent said they only want medical legalization. Only 8 percent said neither.
Pew found that even a majority — 55 percent — of Republicans support legalizing pot. About 78 percent of Democrats do as well.
At the same time, another recent poll by Gallup found 66 percent of Americans support marijuana legalization, the same as Gallup found last year. Gallup also found that a majority of both Republicans and Democrats support legalization.
Marijuana legalization has had some big victories in the past few years. The first two states — Colorado and Washington — legalized in 2012. In the seven years since, nine more states and Washington, DC, have legalized, with Illinois’ legislature most recently becoming the first legislature to legalize commercial sales of marijuana for recreational uses.
Meanwhile, Democratic presidential candidates have increasingly thrown their support behind legalization. With the exception of Joe Biden, the higher-polling Democrats back it.
Supporters of legalization argue that it eliminates the harms of marijuana prohibition: the hundreds of thousands of arrests around the US, the racial disparities behind those arrests, and the billions of dollars that flow from the black market for illicit marijuana to drug cartels that then use the money for violent operations around the world. All of this, legalization advocates say, will outweigh any of the potential downsides — such as increased cannabis use — that might come with legalization.
Opponents, however, claim that legalization will enable a huge marijuana industry that will market the drug irresponsibly. They point to America’s experiences with the alcohol and tobacco industries in particular, which have built their financial empires in large part on some of the heaviest consumers of their products. This could result in more people using pot, even if it leads to negative health consequences.