Doctors frequently prescribe benzodiazepines for anxiety, insomnia, and seizures. However, their negative side effects often outweigh their usefulness. A new study published in the journal Cannabis and Cannabinoid Research explores the promising possibility of using medical cannabis as a way to reduce benzodiazepine use.
Overview of Benzodiazepines
Benzodiazepines, commonly referred to as benzos, are a class of drug compounds.
Commonly prescribed benzos include:
- alprazolam (Xanax)
- clonazepam (Klonopin)
- diazepam (Valium)
- chlordiazepoxide (Librium)
- triazolam (Halcion)
- lorazepam (Ativan)
- temazepam (Restoril)
So how do they work? Benzos enhance the effect of gamma-aminobutyric acid (GABA) neurotransmitters and receptors found in the brain. GABA receptors decrease the excitability of your neurons.
When a dose of benzos supercharges your GABA receptors, they will talk to each other less, thereby creating a calming effect on many functions in the brain.
As a result, benzos have a number of medically useful properties including sedative, anti-anxiety, sleep-inducing, anticonvulsant, and muscle relaxant effects.
They are most commonly prescribed for anxiety and insomnia disorders, but can also be used to treat alcohol, seizure, and spasticity disorders. Physicians generally consider benzos to be safer than outdated sedatives like barbiturates. Between 5-10% of people use benzos in the United States and Canada.
Despite their utility, common side effects associated with benzos can be significant.
They can cause a lack of coordination, muscle fatigue, and dizziness, all of which can lead to falls and injuries—particularly in elderly patients—and even traffic accidents.
Decreased libido and erectile problems also occur frequently in benzo users.
Patients prescribed higher doses experience even more severe side effects. Behavioral disinhibition can occur, causing impulsivity, irritability, violence, aggression, and even suicidal behavior.
Long term use can bring about paradoxical effects where the use of benzos seems to worsen the symptoms they were supposed to be treating.
With long term use of benzos, users are likely to develop tolerance. This occurs when the therapeutic effect of the drug becomes weaker after taking the same dose over an extended period of time.
There is good evidence that tolerance develops for the sedative, sleep-inducing, anticonvulsant, and muscle relaxant effects of benzos. Tolerance to the anti-anxiety effects of benzos can also occur but develops more slowly.
Moreover, while tolerance can occur in as quickly as two to four weeks, negative side effects may continue to persist. For this reason, most recommendations call for limiting benzo use to two to four weeks. Unfortunately, many doctors still prescribe these medications for months or even years.
If a patient stops using benzos without tapering off their dose, withdrawal symptoms can also be severe. Typical symptoms include muscle spasms, tremors, insomnia, agitation, and gastric problems.
This represents a major disadvantage of benzos, making them unsuitable for long term use.
But is there an alternative?
Cannabis as a Potential Alternative to Benzos
One potential alternative therapeutic is cannabis and cannabis-derived compounds like cannabidiol (CBD). Researchers have shown that cannabis can be used to treat several of the ailments for which benzos are commonly prescribed. This includes anxiety, insomnia, and even seizures.
Researchers in Canada wanted to explore whether medical cannabis could help patients reduce their benzo use. They used data collected on medical cannabis patients from Canabo Medical Clinic. Canabo runs 22 referral-only medical cannabis clinics across Canada and curates a growing a database of information from its patients.
First, the researchers identified patients who were using benzos prior to their first Canabo clinic visit. Canabo physicians gave these patients two-month medical cannabis prescriptions. At the end of their first visit, patients completed a self-reported survey.
The patients attended three follow up appointments to renew their medical cannabis prescriptions and complete an additional self-reported survey. In total, 146 patients completed all three follow-up visits and made up the sample for the study.
Results of the Cannabis/Benzo Study
The Main Points
Of the participants, 47.9% reported using benzos for pain, 31.9% reported using benzos for psychiatric conditions, and 7.5% reported using benzos for neurological conditions.
At the first follow up visit, 44 patients (30.1%) had completely stopped using benzos. By the third and final follow up visit, 66 patients (45.2%) had stopped using benzos.
Even better, the patients reported an increase in their quality of life. At the initial visit, 74% of patients reported that their life is constantly impacted by their medical condition. But on the final visit, 45.0% of the patients still using benzos and only 30.3% of the patients who stopped using benzos felt this way.
Like any study that relies on self-reported survey data, it’s important to recognize its limitations.
As a caveat of the observational nature of this study, researchers cannot conclude that cannabis directly caused patients to stop using benzos.
While the results are certainly promising, doctors cannot yet recommend cannabis as a replacement for benzo use.
Benzodiazepines represent a class of drugs in which the downsides often outweigh any therapeutic usefulness, especially over the long term.
Of course, more research is needed. But this new study demonstrates that medical cannabis can help people reduce their use of benzos.