Reduction of Benzodiazepine Use in Patients Prescribed Medical Cannabis

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

doi:10.1089/can.2018.0020

Cited by 38 publications

(31 citation statements)

References 19 publications

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“…The positive bi-directional association between benzodiazepines and analgesics is supported by many previous studies ( 37 – 39 ). However, others have found a negative association between the use of cannabis and benzodiazepines ( 40 , 41 ), and have identified a substitutional role between them ( 42 ). These findings could explain the negative bi-directional relationship found in the present study.…”

Section: Discussionmentioning

confidence: 99%

Substance Use in Mild-COVID-19 Patients: A Retrospective Study

Ismael

Zaramella

Battagin

et al. 2021

Front. Public Health

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Background: There is a need for prospective studies investigating substance use variations in mild COVID-19 patients. These individuals represent the majority of patients affected by the disease and are routinely treated at home, facing periods of quarantine.Methods: This was a retrospective cohort study. All people who tested positive for COVID-19 and classified as mild cases (i.e., no alarm sign/symptom, no need for in-person consultation) during the treatment in the public health system of a Brazilian city with around 160,000 inhabitants were monitored by phone for all the COVID-19 symptoms listed by the Centers for Disease Control and Prevention (CDC) during the active phase of the disease (i.e., no longer experiencing symptoms, up to 14 days in mild cases). After this phase (median = 108 days after intake, IQR = 76–137), we asked these patients who were classified as experiencing mild COVID-19 (n = 993) about last-month substance use in three time-points: pre-COVID, just after COVID-19 acute phase (post-COVID acute phase) and in the period before survey (post-COVID follow-up phase).Results: The number of COVID-19 symptoms was not associated with pre- or post-infection substance use. Pre-COVID alcohol and non-medical benzodiazepine use were associated with specific COVID-19 symptoms. However, sensitivity analyses showed that such associations could be explained by previous psychiatric and medical profiles. Alcohol and tobacco use decreased and non-medical analgesics increased in the post-COVID acute phase. However, just alcohol use remained lower in the post-COVID follow-up period. Higher pre-COVID levels of tobacco and alcohol were associated with post-COVID follow-up cannabis and non-medical analgesic use, respectively. Non-medical benzodiazepine use had positive and negative bi-directional associations with cannabis and non-medical analgesic use, respectively.Conclusion: We were not able to find specific associations between substance use and COVID-19 symptomatology in the present study. Patients with mild COVID-19 should be monitored for substance use in the post-COVID-19 period, and preventive interventions for non-medical analgesic use should be implemented. Focused preventive interventions increasing the perceived risks of cannabis and non-medical benzodiazepine and analgesic use among people experiencing mild COVID-19 that reported previous substance use could be useful.

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Section: Discussionmentioning

confidence: 99%

Substance Use in Mild-COVID-19 Patients: A Retrospective Study

Ismael

Zaramella

Battagin

et al. 2021

Front. Public Health

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“…Further, Rogers et al (2019)(2) stated that potential polysubstance use of other illegal substances taken for the treatment of pain -was a signi cant limitation for fully understanding the cannabis-opioid relationship. Likewise, there are a limited number of Canadian-speci c epidemiological studies (6,52,53) that study medical cannabis -and even smaller numbers that study its association with opioid use (6,29). The majority of these studies have very small cohort numbers and are highly reliant on self-reported outcomes.…”

Section: Discussionmentioning

confidence: 99%

Opioid Use in Medical Cannabis Authorization Adult Patients from 2013-2018: Alberta, Canada

Lee

Lin

Martins

et al. 2021

Preprint

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Background: The opioid overdose epidemic in Canada and the United States has become a public health crisis - with exponential increases in opioid-related morbidity and mortality. Recently, there has been an increasing body of evidence focusing on the opioid-sparing effects of medical cannabis use (reduction of opioid use and reliance), and medical cannabis as a potential alternative treatment for chronic pain. The objective of this study is to assess the effect of medical cannabis authorization on opioid use (oral morphine equivalent; OME) between 2013-2018 in Alberta, Canada.Methods: All adult patients defined as chronic opioid users who received medical cannabis authorization in the province of Alberta from 2013-2018 were propensity score matched to non-authorized chronic opioid using controls. 5373 medical cannabis patients were matched to controls, who were all chronic opioid users. The change in the weekly average OME of opioid drugs for medical cannabis patients relative to controls was measured. Interrupted time series (ITS) analyses was used to assess the trend change in OME during the 26 weeks (6 months) before and 52 weeks (1 year) after the authorization of medical cannabis among adult chronic opioid users.Results: Average age was 52 years and 54% were female. Patients on low dose opioids (<50 OME) had a slightly increase in their weekly OME per week (absolute increase of 112.1 OME, 95% CI: 104.1 to 120.3); whereas higher dose users (OME >100), showed a significant decrease over 6 months (-435.5, 95% CI: -596.8 to -274.2) compared to controls. Conclusions: This short-term study found that medical cannabis authorization showed intermediate effects on opioid utilization, which was dependent on initial opioid use. Greater observations of changes in OME appear to be in those patients who were on a high dosage of opioids (OME>100); however, continued surveillance of patients utilizing both opioids and medical cannabis – is warranted by clinicians to understand the long-term potential benefits and any harms of ongoing use.

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“…There is also evidence that prescribing cannabinoid-based medicines may reduce the use of benzodiazepines and non-steroidal anti-inflammatory drugs. 52 , 64 , 126 …”

Section: Potential As Adjunctive Therapymentioning

confidence: 99%

<p>Safety Considerations in Cannabinoid-Based Medicine</p>

Gottschling¹,

Ayonrinde²,

Bhaskar³

et al. 2020

IJGM

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Cannabinoids are a diverse class of chemical compounds that are increasingly recognized as potential therapeutic options for a range of conditions. While many studies and reviews of cannabinoids focus on efficacy, safety is much less well reported. Overall assessment of the safety of cannabinoid-based medicines is confounded by confusion with recreational cannabis use as well as different study designs, indications, dosing, and administration methods. However, clinical studies in registered products are increasingly available, and this article aims to discuss and clarify what is known regarding the safety profiles of cannabinoid-based medicines, focusing on the medical and clinical safety evidence and identifying areas for future research. The two most well-studied cannabinoids are Δ 9tetrahydrocannabinol (THC), or its synthetic variants (dronabinol, nabilone), and cannabidiol (CBD). Across diverse indications, dizziness and fatigue are generally the most common adverse events experienced by patients receiving THC or combined THC and CBD. Patients receiving THC may experience adverse cognitive effects and impairment in psychomotor skills, with implications for driving and some occupations, while CBD may help to lower the psychotropic effects of THC when used in combination. Studies on dependency and addiction in a medical context are limited, but have shown inconsistent findings regarding misuse potential. Generally, the recommended route of administration is oral ingestion, as smoking medicinal cannabinoid products potentially releases mutagenic and carcinogenic byproducts. There are several potential drug-drug interactions and contraindications for cannabinoid-based medicines, which physicians should account for when making prescribing decisions. The available evidence shows that, as with any other class of pharmaceuticals, cannabinoid-based medicines are associated with safety risks which should be assessed in the context of potential therapeutic benefits. Each patient should be assessed on an individual basis and physicians must rely on informed, evidence-based decision-making when determining whether a cannabinoid-based medicine could be an appropriate treatment option.

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Reduction of Benzodiazepine Use in Patients Prescribed Medical Cannabis

Cited by 38 publications

References 19 publications

Substance Use in Mild-COVID-19 Patients: A Retrospective Study

Substance Use in Mild-COVID-19 Patients: A Retrospective Study

Opioid Use in Medical Cannabis Authorization Adult Patients from 2013-2018: Alberta, Canada

<p>Safety Considerations in Cannabinoid-Based Medicine</p>

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