Recently, there’s been more talk about how cannabis could be an alternative to opioids for pain relief. But for those battling anxiety, how feasible would it be to replace benzodiazepines with medical marijuana?
Also called "benzos," benzodiazepines entered the market in the 1970s and since the 1980s have been a go-to pharmaceutical for everything from general anxiety and obsessive-compulsive disorder (OCD) to post-traumatic stress disorder (PTSD).
Fortunately for people looking for benzo alternatives, studies have shown that cannabis can successfully treat anxiety disorders without the harmful side effects of these pharmaceuticals.
Anxiety Comes in Different Forms
Anxiety encompasses several different disorders resulting in feelings of excessive worry, panic and agitation. Anxiety is a natural and healthy reaction to actual danger—considered a warning system that prompts our fight or flight response. But when anxiety arises chronically, seemingly in response to nothing imminent, and results in debilitating fear, it may be considered pathological.
In Canada, anxiety disorders are on the list of conditions that qualify for medicinal cannabis. But not all doctors are comfortable prescribing it, so many cases of anxiety disorders continue to be treated with conventional benzodiazepine drugs.
These are four of the most common anxiety disorders currently being treated by doctors:
- Generalised anxiety disorder (GAD): a chronic type of anxiety that can launch a long-term and irrational state of worrying revolving around everyday life and events. Catalyzed by some kind of trigger, GAD can turn into a sudden onset of immense terror—a panic attack—resulting in confusion, dizziness and nausea.
- Social anxiety disorder (SAD): a social phobia characterized by an intense fear of judgment, scrutiny, embarrassment and possible shameful circumstances resulting from social interactions. Symptoms manifest psychologically as well as physically, with elevated heart rate, dizziness, muscle spasms, lightheadedness and nausea.
- Obsessive-compulsive disorder (OCD): almost always brought on by one or a series of traumatic events resulting in distressing, repetitive thoughts, leading to urgent actions—compulsions to perform specific acts or rituals repeatedly.
- Post-traumatic stress disorder (PTSD): results from a traumatic experience. Some of the most likely causes of PTSD are military combat, natural disaster, sexual or physical assault, a severe accident, being held against one's will or repeated abuse. In the affected individual, the disorder can manifest as hypervigilance, flashbacks, situational avoidance, anger, fear and/or depression.
What Are Benzodiazepines?
Benzodiazepines are a class of psychoactive drugs that occupy GABA-A receptors within the brain and sedate the central nervous system. The drug results in negatively charged neurons that become resistant to excitation; the patient's anxious thoughts and actions become obstructed.
There are several different formulations of benzodiazepines that differ in potency and duration. The ones commonly prescribed to treat anxiety disorders include:
Notoriously habit-forming, these drugs are considered by some doctors to be overprescribed. Unfortunately, those who become dependent on the drugs can easily purchase them on the black market.
Cannabis vs. Prescription Benzos for Anxiety Disorders
Medical marijuana has been much harder to get a doctor's recommendation for than obtaining prescriptions for benzos. This confounding contrast makes it seem as if benzos are safer than cannabis when in actuality the opposite is more likely the truth.
Evidence suggests that benzodiazepines are useful only up to a few weeks or months when used regularly. As the patient's tolerance to benzos rises, withdrawal effects begin to appear, and the dosage must be increased for the medication to continue to work effectively.
High doses of benzodiazepines can cause:
- Blurred vision
- Slurred speech
- Lack of coordination
- Difficulty breathing
- Addiction to the drug
Chronic benzos misuse can lead to:
- Muscle deterioration
- Worsened anxiety
Patients have even experienced benzodiazepine-induced comas as well as lethal overdose-related deaths.
And there's an opioid link, too. Researchers found benzos involved in at least 30% of all fatal opioid overdoses in the United States.
This heightened risk means that a patient trying to treat both chronic pain and anxiety related to a traumatic accident can’t use both types of conventional medications without risk of death.
Cannabis, on the other hand, has no lethal overdoses linked to its use—medicinal or recreational. Marijuana can reduce the symptoms of anxiety by making social interactions easier, sedating physical manifestations and inducing deep, natural sleep.
All three of these attributes can be achieved independently throughout the day by using specific cannabis varieties or products made from medicinal marijuana. This point is particularly important in the case of anxiety where a patient may medicate throughout the day to keep symptoms at bay while remaining productive and sociable.
Advice for Getting Off Benzos Safely & Switching to Cannabis
The hardest part about switching from pharmaceutical tranquilizers to marijuana is knowing how to get off benzos safely.
The Ashton Manual, seen as the unofficial encyclopedia on benzodiazepines, suggests first having the support of your doctor and a clinical psychologist to help in the transition off of benzos. It emphasizes patience, being confident in the process and using your intuitive sense to choose the withdrawal method that works best for you. Patients can either taper off of the benzo slowly or switch to a long-acting benzo formulation to safely withdraw.
During this time, you should focus on coming off of the medication before transitioning to cannabis as the two substances may cause unwanted interactions and side effects such as over-sedation.
Once off of benzodiazepines, you can start to try cannabis—different strains, cannabinoids and products—to see what works for you. It’s not as simple as getting a prescription for a single, set dose of benzos, but it’s a healthier, more sustainable choice in the long run.
Be sure to talk to your doctor before you attempt any medication change.
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