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Factors Associated with Concurrent Use of Prescription Benzodiazepines and Cannabis in Anxiety: A Cross-Sectional Survey

Vanessa Quinn
University of Florida

Co-Authors: Amie Goodin, Jungjun Bae
University of Florida

Background: Cannabis has been proposed as a potential therapeutic or as therapeutic adjuvant for a variety of physical and mental health conditions, including anxiety. However, there are inconclusive findings regarding safety and effectiveness of cannabis as a treatment for anxiety disorders or symptoms of anxiety. Substitution of prescription benzodiazepines with cannabis to relieve anxiety has been reported in small cohort studies; however, there is limited data regarding factors associated with concurrent cannabis and prescription benzodiazepine use.

Objectives: Our objective is to examine factors associated with concurrent medical cannabis and prescription benzodiazepine use in people with anxiety.

Methods: Recruitment strategies for this cross-sectional survey were convenience sampling from May 2022 through May 2023 of adult medical cannabis users from Florida clinics. The survey included items from validated instruments to assess mental and physical health status and cannabis use behaviors, along with questions about medication use. We examine sociodemographic factors and cannabis use behaviors in respondents that reported diagnoses of anxiety. Factors include: age, race/ethnicity, sex at birth, veteran status, health insurance status, age at first cannabis use, and cannabis use frequency. A logistic regression model estimated the relationship between sociodemographic factors and cannabis use behaviors associated with concurrent prescription benzodiazepine use relative to no benzodiazepine use. Results were calculated with robust standard errors and reported with 95% Confidence Intervals.

Results: There were 632 total respondents and 451 respondents had anxiety diagnoses (71% of all respondents). Among those with anxiety, mean age at first cannabis use was 20 years (SD=10) and mean current age was 44 years (SD=13). The majority (88%) reported using cannabis “4 or more times per week.” Concurrent prescription benzodiazepines were reported by 151 (33%) of those with anxiety. Current age was the only sociodemographic factor significantly associated with concurrent benzodiazepine use (OR=1.02; 95% CI 1.00-1.03), where each additional year of age suggested a 2% increase in likelihood of concurrent prescription benzodiazepine use. No other sociodemographic factors nor cannabis use behaviors (e.g., age at first use and frequency of use) were significantly associated with concurrent prescription benzodiazepine use; however, few respondents indicated infrequent cannabis use.

Conclusions: Prescription benzodiazepine use was prevalent among this convenience sample of cannabis users with anxiety. Older adults were more likely to have concurrent prescription benzodiazepine and cannabis use than younger adults with anxiety, indicating that safety communications could be tailored to this population. Findings may not be generalizable due to the sampling strategy.