In 2017, a study was published in the International Journal of Drug Policy indicating that approximately 63% of prescription drug users indicated that they had discontinued prescription drugs in favour of cannabis (Lucas & Walsh, 2017). This number was captured through a survey of 271 participants registered to a licensed cannabis dispensary. Interestingly, approximately 40 participants (16%) used cannabis specifically to replace benzodiazepine used to address mental health issues. This evidence is supported by a larger study published in the Journal of Pain Research which found similar results. After having recruited a total of 2,774 individuals, Corroon and colleagues (2017) found that almost 50% of their sample used cannabis in lieu of prescribed medication. More specifically, 13.6% of the 1,248 people using cannabis as a substitute did so to replace benzodiazepines.

These numbers sparked an interest. Although these studies did not report specifically on the exact implications of this phenomenon, they highlighted that a population of users of benzodiazepines opt for cannabis instead. The Canadian Centre on Substance Use and Addiction recently reported that 0.3% of the population (>1,000,000) of Canada used benzodiazepines without a prescription for the purpose of getting high (CCSA, 2017). Further, approximately 10% of Canadians (>3,500,000) reported using benzodiazepines at least once per year (Brands, Spraule, Marshman, 1998). Unfortunately, no recent statistics on these incidences are readily available. However, one study did look at benzodiazepine prescription trends in older Ontarian adults over the age 65 between 1998 and 2013 and found that indeed benzodiazepines are being less prescribed in this population. Although, the effect is very small, falling from ~11% of all prescriptions to 8% (Davies et al., 2018).

Currently, there is very little research into the matter. There is no available literature specifically investigating the effectiveness or underlying mechanism(s) of cannabis in deprescribing benzodiazepines or treating benzodiazepine addiction. In fact, most of these claims are anecdotal at this point. Nevertheless, we support further research into this matter and encourage the need for open-minded research on marijuana risks and benefits. In a broader context, there is an encouraging amount of opioid research emerging which suggests that cannabis indeed may be viable, low-risk substitute for opioid prescriptions, especially in individuals managing chronic pain (Vyas, LeBaron, Gilson, 2018). However, it should be cautioned that it is not reasonable to assume that cannabis is an appropriate substitute for benzodiazepines based on its effects in those who are addicted to opioids. Each drug interacts with the brain via very different underlying mechanisms. Having said that, more research into the matter of benzodiazepines should be strongly encouraged given its anecdotal evidence. This is how all investigatory scientific endeavours begin.

Until then, we commit to giving our residents a treatment plan that is carefully catered to their needs. This includes drafting a medical marijuana policy in order to accommodate our patients. These rules and regulations are still a work in progress and will be refined as new evidence becomes available. Right now, Searidge welcomes all patients with a valid medical marijuana prescription, and they will be subject to the following policy:

  1. Patients must carry a valid medical marijuana prescription from a licensed physician (MD)
  2. Prescribed marijuana in pill, or edible, or topical cream form is preferred.
  3. Marijuana which is smoked should be done with a vaporizer to minimize odour. We can provide a vaporizer to our residents for that purpose. The use of a vape pen can be accommodated if THC levels are not excessive or medically indicated.
  4. Prescribed marijuana can only be smoked in the nurse’s office in the designated area for smoking. This is a separate smoking area which as air vented through an ozoniser and activated charcoal air filters to eliminate marijuana smoke odours.
  5. Prescribed marijuana in any form must be delivered to our premise by mail from a licensed producer.
  6. As is the case for all medications, marijuana must be kept with the nurse.
  7. Low THC and high CBD marijuana medication is preferred
  8. Any high THC content such as Dabs, Snap, oil, Vape concentrate, etc. must be approved by the clinical director and the doctor as medically indicated.
  9. The use of medical marijuana by any patient who has had a psychotic episode in the last 6 months must be approved by the doctor or psychiatrist.

These policies reflect that we recognize that marijuana may be a viable replacement for certain prescription drugs, given that the risks associated with daily cannabis use may be lower than persistent benzodiazepine or opioid use (Boehnke, Litinas, Clauw, 2016). Further, it applies to those who require medical marijuana to manage pain and/or other comorbidities. If you are a current resident at Searidge and this applies to you, please do not hesitate to speak to your practitioner. Alternatively, we encourage all folks who are considering Searidge to reach out and learn more about our policy and how we can accommodate.

References

  1. Boehnke KF, Litinas E, Clauw DJ. Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain. J Pain. 2016 Jun;17(6):739-44. doi: 10.1016/j.jpain.2016.03.002. Epub 2016 Mar 19. PubMed PMID: 27001005.
  2. Brands, B., Sproule, B. and Marshman, J. (Eds) (1998). Drugs and Drug Abuse, Toronto, Addiction Research Foundation (ARF).
  3. Corroon JM Jr, Mischley LK, Sexton M. Cannabis as a substitute for prescription drugs – a cross-sectional study. J Pain Res. 2017 May 2;10:989-998. doi: 10.2147/JPR.S134330. eCollection 2017. PubMed PMID: 28496355; PubMed Central PMCID: PMC5422566.
  4. Lucas P, Walsh Z. Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients. Int J Drug Policy. 2017 Apr;42:30-35. doi: 10.1016/j.drugpo.2017.01.011. Epub 2017 Feb 9. PubMed PMID: 28189912.
  5. Vyas MB, LeBaron VT, Gilson AM. The use of cannabis in response to the opioid crisis: A review of the literature. Nurs Outlook. 2018 Jan – Feb;66(1):56-65. doi: 10.1016/j.outlook.2017.08.012. Epub 2017 Sep 21. Review. PubMed PMID: 28993073.