Impact of cannabis use on health outcomes and prescription benzodiazepine use

Objective: With the rising misuse of benzodiazepine (BZD) and associated overdose deaths, cannabis has been touted as a potential substitute with proposed benefit of better health outcomes. This two-year retrospective analysis examined whether cannabis use among BZD users was associated with changes in outcomes of (1) all-cause mortality, (2) hospitalizations, (3) emergency department (ED) visits, and (4) whether it demonstrated BZD-sparing effects on prescription quantity over time. Methods: Using data from Yale New Haven Health System, we conducted a retrospective, longitudinal cohort study among BZD users. Cannabis use was the primary exposure, with BZD users without cannabis exposure as controls. Using inverse probability of treatment weighting and propensity score matching techniques, cohorts were balanced at baseline adjusting for medical comorbidities, socioeconomic status and other clinical factors. Kaplan-Meier curves and Cox proportional hazard models were examined with four outcomes of interest. Results: The sample included 1,026 patients with 60.3% females and mean age was 54.2. There was no significant effect of cannabis use on BZD quantity. Cannabis use was not significantly associated with all-cause mortality, hospitalization, or ED visits. In exploratory analysis, medical cannabis users had a lower risk of all-cause mortality but greater risk for hospitalizations among those aged < 50 years. Conclusion: In this longitudinal cohort study, cannabis use was not significantly associated with all-cause mortality, hospitalization and ED visits, or benzodiazepine dose reduction. Our results do not support a benzodiazepine-sparing effect for cannabis use.