(215) Concurrent Use of Prescription Benzodiazepines and Cannabis in Prevalent Medical Cannabis Users with Mental Health Conditions: A Cross-Sectional Survey

Background: Medical cannabis programs are proliferating as regulatory pathways for cannabis access evolve. There are safety concerns for cannabis use in certain mental health conditions, particularly for anxiety and psychosis. Though substitution of benzodiazepines with cannabis has been observed in single-site cohort studies, there is limited data regarding concurrent cannabis and prescription benzodiazepine use changes in the wake of recent widespread medical cannabis access changes.

Objectives: We aim to identify the proportion of medical cannabis users that report concurrent prescription benzodiazepine use and to examine whether there are changes in benzodiazepine use following medical cannabis initiation in a large medical cannabis program.

Methods: We recruited adult cannabis users from Florida clinics, where one of the largest state medical cannabis programs is regulated, using convenience sampling for a cross-sectional survey conducted from May 2022 to May 2023. The survey included items from validated instruments to assess health status and cannabis use behaviors, along with questions about medical history and medication use. We report proportions of concurrent cannabis and benzodiazepine users, and lifetime diagnoses of depression, anxiety, and PTSD. Changes in benzodiazepine use were assessed with questions about attempts to change use since starting medical cannabis, and whether benzodiazepines were increased, decreased, unchanged, or stopped completely.

Results: There were 632 respondents with a mean age at first cannabis use of 19.8 years (SD=12.1) and a mean current age of 45.3 years (SD=18.4). The majority (86.6%) reported using cannabis "4 or more times per week," while only 1.6% indicated "monthly or less" use, suggesting an over-representation of heavy cannabis users. Lifetime diagnoses for mental health conditions were prevalent: 71.6% for anxiety, 62.0% for depression, and 42.7% for PTSD. More than a quarter of respondents (26.7%, n=169) reported concurrent benzodiazepine and cannabis use. Of concurrent users, few increased (0.6%) or reported no change (14.8%) in benzodiazepine use since initiating medical cannabis. However, a significant proportion reported a decrease (44.4%) or cessation (36.7%) in benzodiazepines following medical cannabis initiation.

Conclusions: Mental health conditions and concurrent benzodiazepine use were prevalent among this convenience sample of heavy cannabis users and benzodiazepine use declined following medical cannabis initiation; however, these findings may not be generalizable. Nonetheless, they indicate the importance of discussing cannabis use in patient-provider risk communications prior to treatment initiation with benzodiazepines.