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Murray CH, Gannon BM, Winsauer PJ, Cooper ZD, Delatte MS. The Development of Cannabinoids as Therapeutic Agents in the United States. Pharmacol Rev 2024; 76:915-955. [PMID: 38849155 PMCID: PMC11331953 DOI: 10.1124/pharmrev.123.001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024] Open
Abstract
Cannabis is one of the oldest and widely used substances in the world. Cannabinoids within the cannabis plant, known as phytocannabinoids, mediate cannabis' effects through interactions with the body's endogenous cannabinoid system. This endogenous system, the endocannabinoid system, has important roles in physical and mental health. These roles point to the potential to develop cannabinoids as therapeutic agents while underscoring the risks related to interfering with the endogenous system during nonmedical use. This scoping narrative review synthesizes the current evidence for both the therapeutic and adverse effects of the major (i.e., Δ9-tetrahydrocannabinol and cannabidiol) and lesser studied minor phytocannabinoids, from nonclinical to clinical research. We pay particular attention to the areas where evidence is well established, including analgesic effects after acute exposures and neurocognitive risks after acute and chronic use. In addition, drug development considerations for cannabinoids as therapeutic agents within the United States are reviewed. The proposed clinical study design considerations encourage methodological standards for greater scientific rigor and reproducibility to ultimately extend our knowledge of the risks and benefits of cannabinoids for patients and providers. SIGNIFICANCE STATEMENT: This work provides a review of prior research related to phytocannabinoids, including therapeutic potential and known risks in the context of drug development within the United States. We also provide study design considerations for future cannabinoid drug development.
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Affiliation(s)
- Conor H Murray
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Departments of Psychiatry and Biobehavioral Sciences (C.H.M.) and Departments of Anesthesiology and Perioperative Medicine (Z.D.C.), David Geffen School of Medicine, University of California, Los Angeles, California; Department of Pharmacology and Toxicology, College of Medicine (B.M.G.) and Office of Research Regulatory Affairs, Division of Research and Innovation (B.M.G.), University of Arkansas for Medical Sciences, Little Rock, Arkansas; Departments of Pharmacology and Experimental Therapeutics and Biochemistry and Molecular Biology, School of Medicine (P.J.W.), and Alcohol and Drug Abuse Center of Excellence (P.J.W.) Louisiana State University Health Sciences Center, New Orleans, Louisiana; and Regulatory and Drug Development Consulting, Allucent, Carey, North Carolina (M.S.D.)
| | - Brenda M Gannon
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Departments of Psychiatry and Biobehavioral Sciences (C.H.M.) and Departments of Anesthesiology and Perioperative Medicine (Z.D.C.), David Geffen School of Medicine, University of California, Los Angeles, California; Department of Pharmacology and Toxicology, College of Medicine (B.M.G.) and Office of Research Regulatory Affairs, Division of Research and Innovation (B.M.G.), University of Arkansas for Medical Sciences, Little Rock, Arkansas; Departments of Pharmacology and Experimental Therapeutics and Biochemistry and Molecular Biology, School of Medicine (P.J.W.), and Alcohol and Drug Abuse Center of Excellence (P.J.W.) Louisiana State University Health Sciences Center, New Orleans, Louisiana; and Regulatory and Drug Development Consulting, Allucent, Carey, North Carolina (M.S.D.)
| | - Peter J Winsauer
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Departments of Psychiatry and Biobehavioral Sciences (C.H.M.) and Departments of Anesthesiology and Perioperative Medicine (Z.D.C.), David Geffen School of Medicine, University of California, Los Angeles, California; Department of Pharmacology and Toxicology, College of Medicine (B.M.G.) and Office of Research Regulatory Affairs, Division of Research and Innovation (B.M.G.), University of Arkansas for Medical Sciences, Little Rock, Arkansas; Departments of Pharmacology and Experimental Therapeutics and Biochemistry and Molecular Biology, School of Medicine (P.J.W.), and Alcohol and Drug Abuse Center of Excellence (P.J.W.) Louisiana State University Health Sciences Center, New Orleans, Louisiana; and Regulatory and Drug Development Consulting, Allucent, Carey, North Carolina (M.S.D.)
| | - Ziva D Cooper
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Departments of Psychiatry and Biobehavioral Sciences (C.H.M.) and Departments of Anesthesiology and Perioperative Medicine (Z.D.C.), David Geffen School of Medicine, University of California, Los Angeles, California; Department of Pharmacology and Toxicology, College of Medicine (B.M.G.) and Office of Research Regulatory Affairs, Division of Research and Innovation (B.M.G.), University of Arkansas for Medical Sciences, Little Rock, Arkansas; Departments of Pharmacology and Experimental Therapeutics and Biochemistry and Molecular Biology, School of Medicine (P.J.W.), and Alcohol and Drug Abuse Center of Excellence (P.J.W.) Louisiana State University Health Sciences Center, New Orleans, Louisiana; and Regulatory and Drug Development Consulting, Allucent, Carey, North Carolina (M.S.D.)
| | - Marcus S Delatte
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Departments of Psychiatry and Biobehavioral Sciences (C.H.M.) and Departments of Anesthesiology and Perioperative Medicine (Z.D.C.), David Geffen School of Medicine, University of California, Los Angeles, California; Department of Pharmacology and Toxicology, College of Medicine (B.M.G.) and Office of Research Regulatory Affairs, Division of Research and Innovation (B.M.G.), University of Arkansas for Medical Sciences, Little Rock, Arkansas; Departments of Pharmacology and Experimental Therapeutics and Biochemistry and Molecular Biology, School of Medicine (P.J.W.), and Alcohol and Drug Abuse Center of Excellence (P.J.W.) Louisiana State University Health Sciences Center, New Orleans, Louisiana; and Regulatory and Drug Development Consulting, Allucent, Carey, North Carolina (M.S.D.)
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Heal DJ, Gosden J, Smith SL. A critical assessment of the abuse, dependence and associated safety risks of naturally occurring and synthetic cannabinoids. Front Psychiatry 2024; 15:1322434. [PMID: 38915848 PMCID: PMC11194422 DOI: 10.3389/fpsyt.2024.1322434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 05/27/2024] [Indexed: 06/26/2024] Open
Abstract
Various countries and US States have legalized cannabis, and the use of the psychoactive1 and non-psychoactive cannabinoids is steadily increasing. In this review, we have collated evidence from published non-clinical and clinical sources to evaluate the abuse, dependence and associated safety risks of the individual cannabinoids present in cannabis. As context, we also evaluated various synthetic cannabinoids. The evidence shows that delta-9 tetrahydrocannabinol (Δ9-THC) and other psychoactive cannabinoids in cannabis have moderate reinforcing effects. Although they rapidly induce pharmacological tolerance, the withdrawal syndrome produced by the psychoactive cannabinoids in cannabis is of moderate severity and lasts from 2 to 6 days. The evidence overwhelmingly shows that non-psychoactive cannabinoids do not produce intoxicating, cognitive or rewarding properties in humans. There has been much speculation whether cannabidiol (CBD) influences the psychoactive and potentially harmful effects of Δ9-THC. Although most non-clinical and clinical investigations have shown that CBD does not attenuate the CNS effects of Δ9-THC or synthetic psychoactive cannabinoids, there is sufficient uncertainty to warrant further research. Based on the analysis, our assessment is cannabis has moderate levels of abuse and dependence risk. While the risks and harms are substantially lower than those posed by many illegal and legal substances of abuse, including tobacco and alcohol, they are far from negligible. In contrast, potent synthetic cannabinoid (CB1/CB2) receptor agonists are more reinforcing and highly intoxicating and pose a substantial risk for abuse and harm. 1 "Psychoactive" is defined as a substance that when taken or administered affects mental processes, e.g., perception, consciousness, cognition or mood and emotions.
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Affiliation(s)
- David J. Heal
- DevelRx Limited, Nottingham, United Kingdom
- Department of Life Sciences, University of Bath, Bath, United Kingdom
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3
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Spindle TR, Zamarripa CA, Russo E, Pollak L, Bigelow G, Ward AM, Tompson B, Sempio C, Shokati T, Klawitter J, Christians U, Vandrey R. Vaporized D-limonene selectively mitigates the acute anxiogenic effects of Δ9-tetrahydrocannabinol in healthy adults who intermittently use cannabis. Drug Alcohol Depend 2024; 257:111267. [PMID: 38498958 PMCID: PMC11031290 DOI: 10.1016/j.drugalcdep.2024.111267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/01/2024] [Accepted: 03/02/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Cannabis contains hundreds of chemical constituents beyond delta-9-tetrahydrocannabinol (THC), which is believed to drive most of its acute pharmacodynamic effects. The entourage effect theory asserts that non-THC constituents can impact acute cannabis effects, but few empirical studies have systematically evaluated this theory in humans. This study assessed whether the cannabis terpenoid d-limonene mitigates the acute anxiogenic effects of THC. METHODS Twenty healthy adults completed nine, double-blind outpatient sessions in which they inhaled vaporized THC alone (15mg or 30mg), d-limonene alone (1mg or 5mg), the same doses of THC and d-limonene together, or placebo; a subset of participants (n=12) completed a tenth session in which 30mg THC+15mg d-limonene was administered. Outcomes included subjective drug effects, cognitive/psychomotor performance, vital signs, and plasma THC and d-limonene concentrations. RESULTS When d-limonene was administered alone, pharmacodynamic outcomes did not differ from placebo. Administration of 15mg and 30mg THC alone produced subjective, cognitive, and physiological effects typical of acute cannabis exposure. Ratings of anxiety-like subjective effects qualitatively decreased as d-limonene dose increased and concurrent administration of 30mg THC+15mg d-limonene significantly reduced ratings of "anxious/nervous" and "paranoid" compared with 30mg THC alone. Other pharmacodynamic effects were unchanged by d-limonene. D-limonene plasma concentrations were dose orderly, and concurrent administration of d-limonene did not alter THC pharmacokinetics. CONCLUSIONS D-limonene selectively attenuated THC-induced anxiogenic effects, suggesting this terpenoid could increase the therapeutic index of THC. Future research should determine whether this effect extends to oral dose formulations and evaluate the interactions between other cannabis terpenoids or cannabinoids and THC.
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Affiliation(s)
- Tory R Spindle
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr, Baltimore, MD 21224, USA
| | - C Austin Zamarripa
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr, Baltimore, MD 21224, USA
| | - Ethan Russo
- CReDO Science, 20402 81st Avenue SW, Vashon, WA 98070, USA
| | - Lauren Pollak
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr, Baltimore, MD 21224, USA
| | - George Bigelow
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr, Baltimore, MD 21224, USA
| | - Alexandra M Ward
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Bridget Tompson
- iC42 Clinical Research and Development, Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Cristina Sempio
- iC42 Clinical Research and Development, Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Touraj Shokati
- iC42 Clinical Research and Development, Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jost Klawitter
- iC42 Clinical Research and Development, Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Uwe Christians
- iC42 Clinical Research and Development, Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr, Baltimore, MD 21224, USA.
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Kassim FM, Tod S, Rodger J, Hood SD, Lee JWY, Albrecht MA, Martin-Iverson MT. Nabilone Impairs Spatial and Verbal Working Memory in Healthy Volunteers. Cannabis Cannabinoid Res 2024; 9:199-211. [PMID: 36201240 DOI: 10.1089/can.2022.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Memory impairments and psychosis-like experiences can be adverse effects of cannabis use. However, reports on the cognitive impact of cannabis use are not consistent. There are also limited studies on the psychotomimetic effects of cannabinoid compounds to reveal the association between cannabis and psychosis. Therefore, we investigated the effect of acute cannabinoid intoxication on verbal working memory (VWM) and spatial working memory (SWM) following oral doses of the synthetic cannabinoid agonist, nabilone (1-2 mg, oral). We further investigated the effect of nabilone on psychosis-like experiences (schizotypy scores) and associations of schizotypy with VWM and SWM. Methods: Healthy participants (n=28) completed spatial and digit span tasks across different delay conditions (0, 6, 12, and 18 sec) after receiving nabilone (1-2 mg, PO) or placebo in a randomized, double-blind, counterbalanced, crossover manner. A subset of participants completed a short battery of schizotypy measures (n=25). Results: Nabilone impaired VWM (p=0.03, weak effect size η2=0.02) and SWM (p=0.00016, η2=0.08). Nabilone did not significantly change overall schizotypy scores. Schizotypy scores were negatively correlated with working memory (WM) averaged across all delays and both modalities, under placebo (ρ=-0.41, p=0.04). In addition, there were significant negative correlations between occasions of cannabis use and overall WM averaged scores across drug treatments (ρ=-0.49, p=0.007) and under placebo (ρ=-0.45, p=0.004). The results showed that the drug effect in the less frequent cannabis users was more pronounced on the SWM (p<0.01) and VWM (p<0.01), whereas there appeared to be little drug effect in the frequent cannabis users. Conclusion: Low doses of synthetic cannabinoid impaired SWM and VWM, indicating that exogenous activation of the cannabinoid system influences cognitive performance. Further, the results replicated previous findings that schizotypy is correlated with deficits in WM. Clinical Trial Registry Name: Nabilone and caffeine effects on the perceptions of visually, auditory, tactile and multimodal illusions in healthy volunteers. Clinical Trial Registration Number: CT-2018-CTN-02561 (Therapeutic Goods Administration Clinical Trial Registry) and ACTRN12618001292268 (The Australian New Zealand Clinical Trials Registry).
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Affiliation(s)
- Faiz M Kassim
- Psychopharmacology Research Unit, Discipline of Pharmacology, School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Sophie Tod
- Psychopharmacology Research Unit, Discipline of Pharmacology, School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Jennifer Rodger
- Experimental and Regenerative Neurosciences, School of Biological Sciences, University of Western Australia, Crawley, Western Australia, Australia
- Brain Plasticity Group, Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Sean D Hood
- Division of Psychiatry, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Joseph W Y Lee
- Division of Psychiatry, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Matthew A Albrecht
- Western Australian Centre for Road Safety Research, School of Psychological Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Mathew T Martin-Iverson
- Psychopharmacology Research Unit, Discipline of Pharmacology, School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
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5
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Motamedy S, Soltani B, Kameshki H, Kermani AA, Amleshi RS, Nazeri M, Shabani M. The Therapeutic Potential and Molecular Mechanisms Underlying the Neuroprotective Effects of Sativex ® - A Cannabis-derived Spray. Mini Rev Med Chem 2024; 24:1427-1448. [PMID: 38318827 DOI: 10.2174/0113895575285934240123110158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024]
Abstract
Sativex is a cannabis-based medicine that comes in the form of an oromucosal spray. It contains equal amounts of Δ9-tetrahydrocannabinol and cannabidiol, two compounds derived from cannabis plants. Sativex has been shown to have positive effects on symptoms of amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), and sleep disorders. It also has analgesic, antiinflammatory, antitumoral, and neuroprotective properties, which make it a potential treatment option for other neurological disorders. The article reviews the results of recent preclinical and clinical studies that support the therapeutic potential of Sativex and the molecular mechanisms behind its neuroprotective benefits in various neurological disorders. The article also discusses the possible advantages and disadvantages of using Sativex as a neurotherapeutic agent, such as its safety, efficacy, availability, and legal status.
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Affiliation(s)
- Sina Motamedy
- Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
| | - Bahareh Soltani
- Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Halimeh Kameshki
- Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Reza Saboori Amleshi
- Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
| | - Masoud Nazeri
- Department of Anesthesiology, Friedrich-Alexander-University Erlangen-Nuremberg, University Hospital Erlangen, Krankenhausstraße 12, 91054 Erlangen, Germany
| | - Mohammad Shabani
- Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
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Moore CF, Weerts EM, Kulpa J, Schwotzer D, Dye W, Jantzi J, McDonald JD, Lefever TW, Bonn-Miller MO. Pharmacokinetics of Oral Minor Cannabinoids in Blood and Brain. Cannabis Cannabinoid Res 2023; 8:S51-S61. [PMID: 37721988 DOI: 10.1089/can.2023.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Introduction: Minor cannabinoids are increasingly being consumed in oral formulations (i.e., edibles, tinctures) for medical and nonmedical purposes. This study examined the pharmacokinetics (PKs) of cannabinoids tetrahydrocannabivarin (THCV), cannabichromene (CBC), cannabinol (CBN), and delta-8-tetrahydrocannabinol (D8-THC) after the first and last oral dose during a 14-day administration period. Materials and Methods: Sprague-Dawley rats (N=6 animals/dose, 50% female) were given an assigned dose of one of four cannabinoids (THCV=3.2-100 mg/kg, CBC=3.2-100 mg/kg, CBN=1-100 mg/kg, or D8-THC=0.32-10 mg/kg) or vehicle (medium-chain triglyceride oil) through oral gavage once daily for 14 days. Blood was collected 45 min and 1.5, 3, and 24 h following the first dose (day 1) and the last dose (day 14) of repeated oral cannabinoid treatment for PK analysis. Outcomes of interest included time to maximum concentration (Tmax), maximum concentration (Cmax), and area under the concentration versus time curve (AUClast). Dose-normalized (DN) Cmax and DN AUClast were also calculated. Brain tissue was collected 24 h post-administration of the first (day 1) and the last (day 14) dose of each cannabinoid to determine concentrations in brain. Results: All cannabinoids tested were detectable in plasma after single and 14-day repeated dosing. DN Cmax and DN AUClast were highest for D8-THC, followed by CBC, CBN, and THCV. There was no sex difference observed in cannabinoid kinetics. Accumulation of D8-THC in plasma was observed after 14 days of administration. THCV levels in plasma were lower on day 14 compared to day 1, indicating potential adaptation of metabolic pathways and increased drug elimination. Cannabinoids were detected in brain tissue 24 h post-administration of the first and the last dose of 17-100 mg/kg THCV, 3.2-100 mg/kg CBC, 10-100 mg/kg CBN, and 10 mg/kg D8-THC. Conclusions: THCV, CBC, CBN, and D8-THC produced detectable levels in plasma and translocated to brain tissue after the first dose (day 1) and the last dose (day 14) of repeated oral dosing. Examination of PKs of these minor cannabinoids in blood and brain provides a critical step for informing target dose ranges and dosing schedules in future studies that evaluate the potential effects of these compounds.
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Affiliation(s)
- Catherine F Moore
- Division of Behavioral Biology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elise M Weerts
- Division of Behavioral Biology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Justyna Kulpa
- Canopy Growth Corporation, Smiths Falls, Ontario, Canada
| | | | - Wendy Dye
- Lovelace Biomedical, Albuquerque, New Mexico, USA
| | - Jacob Jantzi
- Lovelace Biomedical, Albuquerque, New Mexico, USA
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7
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Gräfe EL, Reid HMO, Shkolnikov I, Conway K, Kit A, Acosta C, Christie BR. Women are Taking the Hit: Examining the Unique Consequences of Cannabis Use Across the Female Lifespan. Front Neuroendocrinol 2023; 70:101076. [PMID: 37217080 DOI: 10.1016/j.yfrne.2023.101076] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/28/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023]
Abstract
Cannabis use has risen dramatically in recent years due to global decriminalization and a resurgence in the interest of potential therapeutic benefits. While emerging research is shaping our understanding of the benefits and harms of cannabis, there remains a paucity of data specifically focused on how cannabis affects the female population. The female experience of cannabis use is unique, both in the societal context and because of the biological ramifications. This is increasingly important given the rise in cannabis potency, as well as the implications this has for the prevalence of Cannabis Use Disorder (CUD). Therefore, this scoping review aims to discuss the prevalence of cannabis use and CUD in women throughout their lifespan and provide a balanced prospective on the positive and negative consequences of cannabis use. In doing so, this review will highlight the necessity for continued research that goes beyond sex differences.
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Affiliation(s)
- E L Gräfe
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - H M O Reid
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - I Shkolnikov
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - K Conway
- Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada
| | - A Kit
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - C Acosta
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - B R Christie
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada; Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada.
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Narayan AJ, Downey LA, Manning B, Hayley AC. Cannabinoid treatments for anxiety: A systematic review and consideration of the impact of sleep disturbance. Neurosci Biobehav Rev 2022. [DOI: https:/doi.org.ezproxy.mnsu.edu/10.1016/j.neubiorev.2022.104941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
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Syed SA, Schnakenberg Martin AM, Cortes-Briones JA, Skosnik PD. The Relationship Between Cannabinoids and Neural Oscillations: How Cannabis Disrupts Sensation, Perception, and Cognition. Clin EEG Neurosci 2022:15500594221138280. [PMID: 36426543 DOI: 10.1177/15500594221138280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Disruptions in neural oscillations are believed to be one critical mechanism by which cannabinoids, such as delta-9-tetrahyrdrocannabinol (THC; the primary psychoactive constituent of cannabis), perturbs brain function. Here we briefly review the role of synchronized neural activity, particularly in the gamma (30-80 Hz) and theta (4-7 Hz) frequency range, in sensation, perception, and cognition. This is followed by a review of clinical studies utilizing electroencephalography (EEG) which have demonstrated that both chronic and acute cannabinoid exposure disrupts neural oscillations in humans. We also offer a hypothetical framework through which endocannabinoids modulate neural synchrony at the network level. This also includes speculation on how both chronic and acute cannabinoids disrupt functionally relevant neural oscillations by altering the fine tuning of oscillations and the inhibitory/excitatory balance of neural circuits. Finally, we highlight important clinical implications of such oscillatory disruptions, such as the potential relationship between cannabis use, altered neural synchrony, and disruptions in sensation, perception, and cognition, which are perturbed in disorders such as schizophrenia.
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Affiliation(s)
- Shariful A Syed
- Department of Psychiatry, 12228Yale University School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ashley M Schnakenberg Martin
- Department of Psychiatry, 12228Yale University School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Jose A Cortes-Briones
- Department of Psychiatry, 12228Yale University School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Patrick D Skosnik
- Department of Psychiatry, 12228Yale University School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
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10
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Narayan A, Downey LA, Manning B, Hayley AC. Cannabinoid Treatments for Anxiety: A Systematic Review and Consideration of the Impact of Sleep Disturbance. Neurosci Biobehav Rev 2022; 143:104941. [DOI: 10.1016/j.neubiorev.2022.104941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 10/13/2022] [Accepted: 10/30/2022] [Indexed: 11/11/2022]
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11
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Murray CH, Huang Z, Lee R, de Wit H. Adolescents are more sensitive than adults to acute behavioral and cognitive effects of THC. Neuropsychopharmacology 2022; 47:1331-1338. [PMID: 35110688 PMCID: PMC9117219 DOI: 10.1038/s41386-022-01281-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 11/09/2022]
Abstract
Increased cannabis availability has contributed to increased use with concomitant incidence of adverse effects. One risk factor for adverse drug reactions may be age. There is preclinical evidence that acute effects of delta-9-tetrahydrocannabinol (THC), the primary active constituent of cannabis, are greater during adolescence, but this has not been fully studied in humans. The present study sought to determine whether adolescent men and women are more sensitive than adults to acute THC. Adolescents aged 18-20 (N = 12) and adults aged 30-40 (N = 12), with less than 20 total lifetime uses of THC-containing products, received capsules of THC (7.5, 15 mg) and placebo across three study sessions in randomized order under double blind conditions. During each session, subjective, cardiovascular, behavioral, and EEG measures were obtained. Behavioral measures included Simple Reaction Time, Stop Task, Time Production and N-back and EEG measures included P300 amplitudes during an auditory oddball task and eyes-closed resting state. THC affected subjective state and heart rate similarly in both age groups. However, adolescents were more sensitive to performance impairing effects, exhibiting dose-dependent impairments on reaction time, response accuracy, and time perception. On EEG measures, THC dose-dependently decreased P300 amplitude in adolescents but not adults. Adolescents were more sensitive to behavioral and cognitive effects of THC, but not to cardiovascular effects or subjective measures. Thus, at doses that produce comparable ratings of intoxication, adolescents may exhibit greater cognitive impairment and alterations in brain function.
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Affiliation(s)
- Conor H. Murray
- grid.170205.10000 0004 1936 7822Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637 USA
| | - Zhengyi Huang
- grid.170205.10000 0004 1936 7822Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637 USA
| | - Royce Lee
- grid.170205.10000 0004 1936 7822Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637 USA
| | - Harriet de Wit
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
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12
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Barbieri M, Tirri M, Bilel S, Arfè R, Corli G, Marchetti B, Caruso L, Soukupova M, Cristofori V, Serpelloni G, Marti M. Synthetic cannabinoid JWH-073 alters both acute behavior and in vivo/vitro electrophysiological responses in mice. Front Psychiatry 2022; 13:953909. [PMID: 36339851 PMCID: PMC9634257 DOI: 10.3389/fpsyt.2022.953909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/04/2022] [Indexed: 11/30/2022] Open
Abstract
JWH-073 is a synthetic cannabinoid (SCB) that is illegally marketed within an "herbal blend", causing psychoactive effects more intense than those produced by Cannabis. Users report that JWH-073 causes less harmful effects than other SCBs, misrepresenting it as a "safe JWH-018 alternative", which in turn prompts its recreational use. The present study is aimed to investigate the in vivo pharmacological activity on physiological and neurobehavioral parameters in male CD-1 mice after acute 1 mg/kg JWH-073 administration. To this aim we investigate its effect on sensorimotor (visual, acoustic, and tactile), motor (spontaneous motor activity and catalepsy), and memory functions (novel object recognition; NOR) in mice coupling behavioral and EEG data. Moreover, to clarify how memory function is affected by JWH-073, we performed in vitro electrophysiological studies in hippocampal preparations using a Long-Term Potentiation (LTP) stimulation paradigm. We demonstrated that acute administration of JWH-073 transiently decreased motor activity for up to 25 min and visual sensorimotor responses for up to 105 min, with the highest effects at 25 min (~48 and ~38%, respectively), while the memory function was altered up to 24 h (~33%) in treated-mice as compared to the vehicle. EEG in the somatosensory cortex showed a maximal decrease of α (~23%) and γ (~26%) bands at 15 min, β (~26%) band at 25 min, a maximal increase of θ (~14%) band at 25 min and δ (~35%) band at 2 h, and a significant decrease of θ (~18%), α (~26%), and β (~10%) bands during 24 h. On the other hand, EEG in the hippocampus showed a significant decrease of all bands from 10 min to 2 h, with the maximal effect at 30 min for θ (~34%) and γ (~26%) bands and 2 h for α (~36%), β (~29%), and δ (~15%) bands. Notably, the δ band significant increase both at 5 min (~12%) and 24 h (~19%). Moreover, in vitro results support cognitive function impairment (~60% of decrease) by interfering with hippocampal synaptic transmission and LTP generation. Our results suggest that JWH-073 deeply alters brain electrical responsiveness with minor behavioral symptoms. Thus, it poses a subtle threat to consumers who mistakenly consider it safer than other SCBs.
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Affiliation(s)
- Mario Barbieri
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Micaela Tirri
- Department of Translational Medicine, Section of Legal Medicine and Laboratory for Technologies of Advanced Therapies (LTTA) Centre, University of Ferrara, Ferrara, Italy
| | - Sabrine Bilel
- Department of Translational Medicine, Section of Legal Medicine and Laboratory for Technologies of Advanced Therapies (LTTA) Centre, University of Ferrara, Ferrara, Italy
| | - Raffaella Arfè
- Department of Translational Medicine, Section of Legal Medicine and Laboratory for Technologies of Advanced Therapies (LTTA) Centre, University of Ferrara, Ferrara, Italy
| | - Giorgia Corli
- Department of Translational Medicine, Section of Legal Medicine and Laboratory for Technologies of Advanced Therapies (LTTA) Centre, University of Ferrara, Ferrara, Italy
| | - Beatrice Marchetti
- Department of Translational Medicine, Section of Legal Medicine and Laboratory for Technologies of Advanced Therapies (LTTA) Centre, University of Ferrara, Ferrara, Italy
| | - Lorenzo Caruso
- Department of Environment and Prevention Sciences, University of Ferrara, Ferrara, Italy
| | - Marie Soukupova
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Virginia Cristofori
- Department of Chemistry and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Serpelloni
- Neuroscience Clinical Center and Transcranial Magnetic Stimulation (TMS) Unit, Verona, Italy
| | - Matteo Marti
- Department of Translational Medicine, Section of Legal Medicine and Laboratory for Technologies of Advanced Therapies (LTTA) Centre, University of Ferrara, Ferrara, Italy.,Department for Anti-Drug Policies, Collaborative Center of the National Early Warning System, Presidency of the Council of Ministers, Rome, Italy
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13
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Francis AM, Bissonnette JN, MacNeil SE, Crocker CE, Tibbo PG, Fisher DJ. Interaction of sex and cannabis in adult in vivo brain imaging studies: A systematic review. Brain Neurosci Adv 2022; 6:23982128211073431. [PMID: 35097219 PMCID: PMC8793398 DOI: 10.1177/23982128211073431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 12/22/2021] [Indexed: 12/21/2022] Open
Abstract
Cannabis has been shown to cause structural and functional neurocognitive changes in heavy users. Cannabis use initiation aligns with brain development trajectories; therefore, it is imperative that the potential neurological implications of cannabis use are understood. Males and females reach neurodevelopmental milestones at different rates making it necessary to consider biological sex in all cannabis and brain-based research. Through use of a systamatic review in accordance with PRISMA guidelines, we aimed to understand the interaction between biological sex and cannabis use on brain-based markers. In total, 18 articles containing a sex-based analysis of cannabis users were identified. While the majority of studies (n = 11) reported no sex by cannabis use interactions on brain-based markers, those that reported findings (n = 8) suggest females may be more susceptible to cannabis' neurotoxic effects. Unfortunately, a large portion of the literature was excluded due to no sex-based analysis. In addition, studies that reported no sex differences often contained a reduced number of females which may result in some studies being underpowered for sex-based analyses, making it difficult to draw firm conclusions. Suggestions to improve cannabis and sex-based reseach are proposed.
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Affiliation(s)
- Ashley M. Francis
- Department of Psychology, Saint Mary’s University, Halifax, NS, Canada
| | - Jenna N. Bissonnette
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Psychology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Sarah E. MacNeil
- Department of Psychology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Candice E. Crocker
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Philip G. Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Derek J. Fisher
- Department of Psychology, Saint Mary’s University, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Psychology, Mount Saint Vincent University, Halifax, NS, Canada
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14
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Binkowska AA, Jakubowska N, Krystecka K, Galant N, Piotrowska-Cyplik A, Brzezicka A. Theta and Alpha Oscillatory Activity During Working Memory Maintenance in Long-Term Cannabis Users: The Importance of the Polydrug Use Context. Front Hum Neurosci 2021; 15:740277. [PMID: 34733146 PMCID: PMC8558244 DOI: 10.3389/fnhum.2021.740277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Impairments in various subdomains of memory have been associated with chronic cannabis use, but less is known about their neural underpinnings, especially in the domain of the brain's oscillatory activity. Aims: To investigate neural oscillatory activity supporting working memory (WM) in regular cannabis users and non-using controls. We focused our analyses on frontal midline theta and posterior alpha asymmetry as oscillatory fingerprints for the WM's maintenance process. Methods: 30 non-using controls (CG) and 57 regular cannabis users-27 exclusive cannabis users (CU) and 30 polydrug cannabis users (PU) completed a Sternberg modified WM task with a concurrent electroencephalography recording. Theta, alpha and beta frequency bands were examined during WM maintenance. Results: When compared to non-using controls, the PU group displayed increased frontal midline theta (FMT) power during WM maintenance, which was positively correlated with RT. The posterior alpha asymmetry during the maintenance phase, on the other hand, was negatively correlated with RT in the CU group. WM performance did not differ between groups. Conclusions: Both groups of cannabis users (CU and PU), when compared to the control group, displayed differences in oscillatory activity during WM maintenance, unique for each group (in CU posterior alpha and in PU FMT correlated with performance). We interpret those differences as a reflection of compensatory strategies, as there were no differences between groups in task performance. Understanding the psychophysiological processes in regular cannabis users may provide insight on how chronic use may affect neural networks underlying cognitive processes, however, a polydrug use context (i.e., combining cannabis with other illegal substances) seems to be an important factor.
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Affiliation(s)
| | - Natalia Jakubowska
- SWPS University of Social Sciences and Humanities, Warsaw, Poland.,Polish-Japanese Academy of Information Technology, Warsaw, Poland
| | | | | | | | - Aneta Brzezicka
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
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15
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Petrie GN, Nastase AS, Aukema RJ, Hill MN. Endocannabinoids, cannabinoids and the regulation of anxiety. Neuropharmacology 2021; 195:108626. [PMID: 34116110 DOI: 10.1016/j.neuropharm.2021.108626] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/11/2021] [Accepted: 05/24/2021] [Indexed: 12/16/2022]
Abstract
Cannabis has been used for hundreds of years, with its ability to dampen feelings of anxiety often reported as a primary reason for use. Only recently has the specific role cannabinoids play in anxiety been thoroughly investigated. Here we discuss the body of evidence describing how endocannabinoids and exogenous cannabinoids are capable of regulating the generation and termination of anxiety states. Disruption of the endogenous cannabinoid (eCB) system following genetic manipulation, pharmacological intervention or stress exposure reliably leads to the generation of an anxiety state. On the other hand, upregulation of eCB signaling is capable of alleviating anxiety-like behaviors in multiple paradigms. When considering exogenous cannabinoid administration, cannabinoid receptor 1 (CB1) agonists have a biphasic, dose-dependent effect on anxiety such that low doses are anxiolytic while high doses are anxiogenic, a phenomenon that is evident in both rodent models and humans. Translational studies investigating a loss of function mutation in the gene for fatty acid amide hydrolase, the enzyme responsible for metabolizing AEA, have also shown that AEA signaling regulates anxiety in humans. Taken together, evidence reviewed here has outlined a convincing argument for cannabinoids being powerful regulators of both the manifestation and amelioration of anxiety symptoms, and highlights the therapeutic potential of targeting the eCB system for the development of novel classes of anxiolytics. This article is part of the special issue on 'Cannabinoids'.
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Affiliation(s)
- Gavin N Petrie
- Hotchkiss Brain Institute and the Mathison Centre for Mental Health Education and Research, Departments of Cell Biology and Anatomy & Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Andrei S Nastase
- Hotchkiss Brain Institute and the Mathison Centre for Mental Health Education and Research, Departments of Cell Biology and Anatomy & Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Robert J Aukema
- Hotchkiss Brain Institute and the Mathison Centre for Mental Health Education and Research, Departments of Cell Biology and Anatomy & Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Matthew N Hill
- Hotchkiss Brain Institute and the Mathison Centre for Mental Health Education and Research, Departments of Cell Biology and Anatomy & Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada.
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16
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Zhornitsky S, Pelletier J, Assaf R, Giroux S, Li CSR, Potvin S. Acute effects of partial CB 1 receptor agonists on cognition - A meta-analysis of human studies. Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110063. [PMID: 32791166 DOI: 10.1016/j.pnpbp.2020.110063] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/05/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Impairment in cognition is frequently associated with acute cannabis consumption. However, some questions remain unanswered as to which deficits are most prominent and which demographic groups are most vulnerable. METHODS A literature search yielded 52 experimental studies of acute administration of partial CB1 receptor agonists (i.e. cannabis, THC, and nabilone) that assessed cognitive dysfunction in 1580 healthy volunteers. Effect size estimates were calculated using the Comprehensive Meta-Analysis for the following six cognitive domains: attention, executive functions, impulsivity, speed of processing, verbal learning/memory, and working memory. RESULTS There were small-to-moderate impairments across all cognitive domains. Deficits in verbal learning/memory and working memory were more prominent, whereas attention and impulsivity were the least affected. Meta-regression analysis revealed that the greater the male ratio is in a sample, the greater the negative effect of cannabinoids on speed of processing and impulsivity. Analysis of route of administration showed that the deficits in speed of processing were smaller in the oral, relative to smoking, vaping, and intravenous administration studies. A publication bias was observed. DISCUSSION Verbal learning/memory and working memory are most prominently affected by acute administration of partial CB1 receptor agonists. The results are consistent with the residual cognitive effects that have been documented among chronic cannabis users.
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Affiliation(s)
- Simon Zhornitsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, United States of America
| | - Julie Pelletier
- Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Roxane Assaf
- Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada; Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | - Sarah Giroux
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, United States of America; Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06520, United States of America; Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT 06520, United States of America
| | - Stephane Potvin
- Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada; Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.
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17
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Nenert R, Allendorfer JB, Bebin EM, Gaston TE, Grayson LE, Houston JT, Szaflarski JP. Cannabidiol normalizes resting-state functional connectivity in treatment-resistant epilepsy. Epilepsy Behav 2020; 112:107297. [PMID: 32745959 DOI: 10.1016/j.yebeh.2020.107297] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/20/2020] [Accepted: 06/28/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Resting-state (rs) network dysfunction is a contributing factor to treatment resistance in epilepsy. In treatment-resistant epilepsy (TRE), pharmacological and nonpharmacological therapies have been shown to improve such dysfunction. In this study, our goal was to prospectively evaluate the effect of highly purified plant-derived cannabidiol (CBD; Epidiolex®) on rs functional magnetic resonance imaging (fMRI) functional connectivity (rs-FC). We hypothesized that CBD would change and potentially normalize the rs-FC in TRE. METHODS Twenty-two of 27 participants with TRE completed all study procedures including longitudinal pre-/on-CBD rs-fMRI (8M/14F, mean age = 36.2 ± 15.9 years, TRE duration = 18.3 ± 12.6 years); there were no differences in age (p = 0.99) or sex (p = 0.15) between groups. Assessments collected included seizure frequency (SF), Chalfont Seizure Severity Scale (CSSS), Columbia Suicide Severity Rating Scale (C-SSRS), Adverse Events Profile (AEP), and Profile of Mood States (POMS). Twenty-three healthy controls (HCs) received rs-fMRI and POMS once. RESULTS Participants with TRE showed average decrease of 71.7% in SF (p < 0.0001) and improved CSSS, AEP, and POMS confusion, depression, and fatigue subscores (all p < 0.05) on-CBD with POMS scores becoming similar to those of HCs. Paired t-tests showed significant pre-/on-CBD changes in rs-FC in cerebellum, frontal areas, temporal areas, hippocampus, and amygdala with some of them correlating with improvement in behavioral measures. Significant differences in rs-FC between pre-CBD and HCs were found in cerebellum, frontal, and occipital regions. After controlling for changes in SF with CBD, these differences were no longer present when comparing on-CBD to HCs. SIGNIFICANCE This study indicates that highly purified CBD modulates and potentially normalizes rs-FC in the epileptic brain. This effect may underlie its efficacy. This study provides Class III evidence for CBD's normalizing effect on rs-FC in TRE.
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Affiliation(s)
- Rodolphe Nenert
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Jane B Allendorfer
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - E Martina Bebin
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tyler E Gaston
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veteran's Administration Medical Center, Birmingham, AL, USA
| | - Leslie E Grayson
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veteran's Administration Medical Center, Birmingham, AL, USA
| | - James T Houston
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
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18
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Effects of ∆ 9-tetrahydrocannabinol on aversive memories and anxiety: a review from human studies. BMC Psychiatry 2020; 20:420. [PMID: 32842985 PMCID: PMC7448997 DOI: 10.1186/s12888-020-02813-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/05/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) may stem from the formation of aberrant and enduring aversive memories. Some PTSD patients have recreationally used Cannabis, probably aiming at relieving their symptomatology. However, it is still largely unknown whether and how Cannabis or its psychotomimetic compound Δ9-tetrahydrocannabinol (THC) attenuates the aversive/traumatic memory outcomes. Here, we seek to review and discuss the effects of THC on aversive memory extinction and anxiety in healthy humans and PTSD patients. METHODS Medline, PubMed, Cochrane Library, and Central Register for Controlled Trials databases were searched to identify peer-reviewed published studies and randomized controlled trials in humans published in English between 1974 and July 2020, including those using only THC and THC combined with cannabidiol (CBD). The effect size of the experimental intervention under investigation was calculated. RESULTS At low doses, THC can enhance the extinction rate and reduce anxiety responses. Both effects involve the activation of cannabinoid type-1 receptors in discrete components of the corticolimbic circuitry, which could couterbalance the low "endocannabinoid tonus" reported in PTSD patients. The advantage of associating CBD with THC to attenuate anxiety while minimizing the potential psychotic or anxiogenic effect produced by high doses of THC has been reported. The effects of THC either alone or combined with CBD on aversive memory reconsolidation, however, are still unknown. CONCLUSIONS Current evidence from healthy humans and PTSD patients supports the THC value to suppress anxiety and aversive memory expression without producing significant adverse effects if used in low doses or when associated with CBD. Future studies are guaranteed to address open questions related to their dose ratios, administration routes, pharmacokinetic interactions, sex-dependent differences, and prolonged efficacy.
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19
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Receptors and Channels Possibly Mediating the Effects of Phytocannabinoids on Seizures and Epilepsy. Pharmaceuticals (Basel) 2020; 13:ph13080174. [PMID: 32751761 PMCID: PMC7463541 DOI: 10.3390/ph13080174] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/17/2020] [Accepted: 07/29/2020] [Indexed: 12/19/2022] Open
Abstract
Epilepsy contributes to approximately 1% of the global disease burden. By affecting especially young children as well as older persons of all social and racial variety, epilepsy is a present disorder worldwide. Currently, only 65% of epileptic patients can be successfully treated with antiepileptic drugs. For this reason, alternative medicine receives more attention. Cannabis has been cultivated for over 6000 years to treat pain and insomnia and used since the 19th century to suppress epileptic seizures. The two best described phytocannabinoids, (−)-trans-Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are claimed to have positive effects on different neurological as well as neurodegenerative diseases, including epilepsy. There are different cannabinoids which act through different types of receptors and channels, including the cannabinoid receptor 1 and 2 (CB1, CB2), G protein-coupled receptor 55 (GPR55) and 18 (GPR18), opioid receptor µ and δ, transient receptor potential vanilloid type 1 (TRPV1) and 2 (TRPV2), type A γ-aminobutyric acid receptor (GABAAR) and voltage-gated sodium channels (VGSC). The mechanisms and importance of the interaction between phytocannabinoids and their different sites of action regarding epileptic seizures and their clinical value are described in this review.
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20
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Abstract
The use of Cannabis-based preparations for medicinal use has waxed and waned in the multi-millennial history of human co-existence with the plant and its cultivation. Recorded use of preparations from Cannabis is effectively as old as recorded history with examples from China, India and Ancient Egypt. Prohibition and restriction of availability allowed a number of alternatives to take the place of Cannabis preparations. However, there has been a worldwide resurgence in medicinal Cannabis advocacy from the public. Media interest has been piqued by particular evocative cases. Altogether, therefore, there is pressure on healthcare professionals to prescribe and dispense Cannabis-based preparations. This review enunciates some of the barriers which are slowing the wider adoption of medicinal Cannabis.
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Affiliation(s)
- Stephen Ph Alexander
- School of Life Sciences, University of Nottingham Medical School, Nottingham, UK
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21
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Woelfl T, Rohleder C, Mueller JK, Lange B, Reuter A, Schmidt AM, Koethe D, Hellmich M, Leweke FM. Effects of Cannabidiol and Delta-9-Tetrahydrocannabinol on Emotion, Cognition, and Attention: A Double-Blind, Placebo-Controlled, Randomized Experimental Trial in Healthy Volunteers. Front Psychiatry 2020; 11:576877. [PMID: 33304282 PMCID: PMC7693539 DOI: 10.3389/fpsyt.2020.576877] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/15/2020] [Indexed: 01/31/2023] Open
Abstract
The two main phytocannabinoids-delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD)-have been extensively studied, and it has been shown that THC can induce transient psychosis. At the same time, CBD appears to have no psychotomimetic potential. On the contrary, emerging evidence for CBD's antipsychotic properties suggests that it may attenuate effects induced by THC. Thus, we investigated and compared the effects of THC and CBD administration on emotion, cognition, and attention as well as the impact of CBD pre-treatment on THC effects in healthy volunteers. We performed a placebo-controlled, double-blind, experimental trial (GEI-TCP II; ClinicalTrials.gov identifier: NCT02487381) with 60 healthy volunteers randomly allocated to four parallel intervention groups, receiving either placebo, 800 mg CBD, 20 mg THC, or both cannabinoids. Subjects underwent neuropsychological tests assessing working memory (Letter Number Sequencing test), cognitive processing speed (Digit Symbol Coding task), attention (d2 Test of Attention), and emotional state (adjective mood rating scale [EWL]). Administration of CBD alone did not influence the emotional state, cognitive performance, and attention. At the same time, THC affected two of six emotional categories-more precisely, the performance-related activity and extraversion-, reduced the cognitive processing speed and impaired the performance on the d2 Test of Attention. Interestingly, pre-treatment with CBD did not attenuate the effects induced by THC. These findings show that the acute intake of CBD itself has no effect per se in healthy volunteers and that a single dose of CBD prior to THC administration was insufficient to mitigate the detrimental impact of THC in the given setting. This is in support of a complex interaction between CBD and THC whose effects are not counterbalanced by CBD under all circumstances.
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Affiliation(s)
- Timo Woelfl
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Cathrin Rohleder
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Youth Mental Health Team, Brain and Mind Centre, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Juliane K Mueller
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Bettina Lange
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anne Reuter
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anna Maria Schmidt
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dagmar Koethe
- Youth Mental Health Team, Brain and Mind Centre, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Psychosomatics Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - F Markus Leweke
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Youth Mental Health Team, Brain and Mind Centre, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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22
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Spindle TR, Bonn-Miller MO, Vandrey R. Changing landscape of cannabis: novel products, formulations, and methods of administration. Curr Opin Psychol 2019; 30:98-102. [PMID: 31071592 PMCID: PMC7041884 DOI: 10.1016/j.copsyc.2019.04.002] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 04/03/2019] [Indexed: 11/26/2022]
Abstract
Laws regulating cannabis have changed radically in the U.S. and abroad. Historically, users smoked dried cannabis flowers that contained Δ9-tetrahydrocannabinol (THC), the primary psychoactive component of cannabis, as the principal product constituent. Coincident with cannabis legalization and increased interest in medicinal use of the plant, there is now an expansive retail cannabis marketplace with novel cannabis products, formulations, and methods of administration. In this review, we describe emergent cannabis product chemotypes (e.g. THC-dominant, CBD-dominant, balanced or 'hybrid' with high concentrations of THC and CBD), product formulations (e.g. edibles, concentrates), and methods of administration (e.g. smoked, vaporized, orally ingested). Psychologists can play a pivotal role in studying the health impact of cannabis legalization and conducting research to inform product regulation.
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Affiliation(s)
- Tory R Spindle
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Marcel O Bonn-Miller
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States
| | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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23
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Udoh M, Santiago M, Devenish S, McGregor IS, Connor M. Cannabichromene is a cannabinoid CB 2 receptor agonist. Br J Pharmacol 2019; 176:4537-4547. [PMID: 31368508 DOI: 10.1111/bph.14815] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 06/11/2019] [Accepted: 07/22/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Cannabichromene (CBC) is one of the most abundant phytocannabinoids in Cannabis spp. It has modest antinociceptive and anti-inflammatory effects and potentiates some effects of Δ9 -tetrahydrocannabinol in vivo. How CBC exerts these effects is poorly defined and there is little information about its efficacy at cannabinoid receptors. We sought to determine the functional activity of CBC at cannabinoid CB1 and CB2 receptors. EXPERIMENTAL APPROACH AtT20 cells stably expressing haemagglutinin-tagged human CB1 and CB2 receptors were used. Assays of cellular membrane potential and loss of cell surface receptors were performed. KEY RESULTS CBC activated CB2 but not CB1 receptors to produce hyperpolarization of AtT20 cells. This activation was inhibited by a CB2 receptor antagonist AM630, and sensitive to Pertussis toxin. Application of CBC reduced activation of CB2 , but not CB1 , receptors by subsequent co-application of CP55,940, an efficacious CB1 and CB2 receptor agonist. Continuous CBC application induced loss of cell surface CB2 receptors and desensitization of the CB2 receptor-induced hyperpolarization. CONCLUSIONS AND IMPLICATIONS CBC is a selective CB2 receptor agonist displaying higher efficacy than tetrahydrocannabinol in hyperpolarizing AtT20 cells. CBC can also recruit CB2 receptor regulatory mechanisms. CBC may contribute to the potential therapeutic effectiveness of some cannabis preparations, potentially through CB2 receptor-mediated modulation of inflammation.
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Affiliation(s)
- Michael Udoh
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Marina Santiago
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Steven Devenish
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Iain S McGregor
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Mark Connor
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
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24
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Bonn-Miller MO, Pollack CV, Casarett D, Dart R, ElSohly M, Good L, Guzmán M, Hanuš L, Hill KP, Huestis MA, Marsh E, Sisley S, Skinner N, Spahr J, Vandrey R, Viscusi E, Ware MA, Abrams D. Priority Considerations for Medicinal Cannabis-Related Research. Cannabis Cannabinoid Res 2019; 4:139-157. [PMID: 31579832 DOI: 10.1089/can.2019.0045] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Marcel O Bonn-Miller
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charles V Pollack
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - David Casarett
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Richard Dart
- Rocky Mountain Drug and Poison Control Center, Denver, Colorado
| | - Mahmoud ElSohly
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, Oxford, Mississippi
| | - Larry Good
- Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Manuel Guzmán
- Department of Biochemistry and Molecular Biology, Complutense University of Madrid, Madrid, Spain
| | - Lumír Hanuš
- Department of Medicinal and Natural Products, Institute for Drug Research, The Hadassah Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kevin P Hill
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Eric Marsh
- Departments of Neurology and Pediatrics, Division of Child Neurology, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan Sisley
- Colorado State University-Pueblo, Pueblo, Colorado
| | | | | | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eugene Viscusi
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark A Ware
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Donald Abrams
- UCSF Osher Center for Integrative Medicine, University of California-San Francisco, San Francisco, California
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25
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Santiago M, Sachdev S, Arnold JC, McGregor IS, Connor M. Absence of Entourage: Terpenoids Commonly Found in Cannabis sativa Do Not Modulate the Functional Activity of Δ 9-THC at Human CB 1 and CB 2 Receptors. Cannabis Cannabinoid Res 2019; 4:165-176. [PMID: 31559333 PMCID: PMC6757242 DOI: 10.1089/can.2019.0016] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Introduction: Compounds present in Cannabis sativa such as phytocannabinoids and terpenoids may act in concert to elicit therapeutic effects. Cannabinoids such as Δ9-tetrahydrocannabinol (Δ9-THC) directly activate cannabinoid receptor 1 (CB1) and cannabinoid receptor 2 (CB2); however, it is not known if terpenoids present in Cannabis also affect cannabinoid receptor signaling. Therefore, we examined six common terpenoids alone, and in combination with cannabinoid receptor agonists, on CB1 and CB2 signaling in vitro. Materials and Methods: Potassium channel activity in AtT20 FlpIn cells transfected with human CB1 or CB2 receptors was measured in real time using FLIPR® membrane potential dye in a FlexStation 3 plate reader. Terpenoids were tested individually and in combination for periods up to 30 min. Endogenous somatostatin receptors served as a control for direct effects of drugs on potassium channels. Results: α-Pinene, β-pinene, β-caryophyllene, linalool, limonene, and β-myrcene (up to 30-100 μM) did not change membrane potential in AtT20 cells expressing CB1 or CB2, or affect the response to a maximally effective concentration of the synthetic cannabinoid CP55,940. The presence of individual or a combination of terpenoids did not affect the hyperpolarization produced by Δ9-THC (10 μM): (CB1: control, 59%±7%; with terpenoids (10 μM each) 55%±4%; CB2: Δ9-THC 16%±5%, with terpenoids (10 μM each) 17%±4%). To investigate possible effect on desensitization of CB1 responses, all six terpenoids were added together with Δ9-THC and signaling measured continuously over 30 min. Terpenoids did not affect desensitization, after 30 min the control hyperpolarization recovered by 63%±6% in the presence of the terpenoids recovery was 61%±5%. Discussion: None of the six of the most common terpenoids in Cannabis directly activated CB1 or CB2, or modulated the signaling of the phytocannabinoid agonist Δ9-THC. These results suggest that if a phytocannabinoid-terpenoid entourage effect exists, it is not at the CB1 or CB2 receptor level. It remains possible that terpenoids activate CB1 and CB2 signaling pathways that do not involve potassium channels; however, it seems more likely that they may act at different molecular target(s) in the neuronal circuits important for the behavioral effect of Cannabis.
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Affiliation(s)
- Marina Santiago
- Department of Biomedical Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Shivani Sachdev
- Department of Biomedical Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jonathon C. Arnold
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- Discipline of Pharmacology, The University of Sydney, Sydney, New South Wales, Australia
| | - Iain S. McGregor
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Connor
- Department of Biomedical Sciences, Macquarie University, Sydney, New South Wales, Australia
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26
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Brumbach S, Goodman SS, Baiduc RR. Behavioral Hearing Thresholds and Distortion Product Otoacoustic Emissions in Cannabis Smokers. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3500-3515. [PMID: 31525116 DOI: 10.1044/2019_jslhr-h-18-0361] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Cannabis is a widely used drug both medically and recreationally. The aim of this study was to determine if cannabis smoking is associated with changes in auditory function, as measured by behavioral hearing thresholds and/or distortion product otoacoustic emissions (DPOAEs). Method We investigated hearing thresholds and 2f1-f2 DPOAEs in 20 cannabis smokers and 20 nonsmokers between 18 and 28 years old. Behavioral thresholds were obtained from 0.25 to 16 kHz. DPOAEs were measured using discrete tones between f2 of 0.5 and 19.03 kHz using an f2/f1 ratio of 1.22 and L1/L2 = 65/55 dB SPL. Thresholds and DPOAE amplitudes were compared between groups using linear mixed-effects models with sex and frequency as predictors. Results Behavioral thresholds in smokers did not differ significantly between smokers and nonsmokers (all ps > .05). Although not significant, long-term smokers exhibited poorer thresholds than short-term smokers and nonsmokers. Smokers generally exhibited lower DPOAE amplitudes than nonsmokers, although the differences were not significant. Male smokers had significantly poorer DPOAE amplitudes than male nonsmokers in the low frequencies (f2 ≤ 2 kHz; p = .0245). Conclusion Results indicate that smoking cannabis may negatively alter the function of outer hair cells in young men. This subtle cochleopathology is evident in the absence of measurable differences in behavioral hearing thresholds between cannabis smokers and nonsmokers.
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Affiliation(s)
- Samantha Brumbach
- Department of Speech, Language, and Hearing Sciences, University of Colorado Boulder
| | - Shawn S Goodman
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Rachael R Baiduc
- Department of Speech, Language, and Hearing Sciences, University of Colorado Boulder
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Ryan JE, Noeder M, Burke C, Stubblefield SC, Sulieman S, Miller EG. Denying renal transplantation to an adolescent medical cannabis user: An ethical case study. Pediatr Transplant 2019; 23:e13467. [PMID: 31124250 PMCID: PMC6671627 DOI: 10.1111/petr.13467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/26/2018] [Accepted: 03/30/2019] [Indexed: 11/28/2022]
Abstract
Medical cannabis is now legal in over half of the United States. As more patients adopt this unconventional therapy, it is inevitable that potential transplant recipients will disclose their cannabis use during transplant evaluation. Transplant teams are tasked with the decision to utilize a pressure resource, often with little guidance from international and national professional organizations. Many healthcare providers remain uniformed or misinformed about the risks of cannabis use and organ transplantation. In order to illustrate the multifaceted and complex evaluation of transplant patients using medical cannabis, this article presents the case of a 20-year-old woman recommended for renal transplant who was originally denied active listing due to her medical cannabis use. A review of the literature explores the perceived and actual risks of cannabis use in the immunocompromised patient. Furthermore, a discussion of the ethics of medical cannabis use and organ transplantation is included with recommendations for multidisciplinary transplant teams.
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Affiliation(s)
- Jennie E. Ryan
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan,Nemours/AI duPont Hospital for Children, Wilmington, Delaware
| | - Maia Noeder
- Nemours/AI duPont Hospital for Children, Wilmington, Delaware
| | - Christine Burke
- Nemours/AI duPont Hospital for Children, Wilmington, Delaware
| | - Samuel C. Stubblefield
- Nemours/AI duPont Hospital for Children, Wilmington, Delaware,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Salwa Sulieman
- Nemours/AI duPont Hospital for Children, Wilmington, Delaware,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elissa G. Miller
- Nemours/AI duPont Hospital for Children, Wilmington, Delaware,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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28
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Cannabidiol (CBD) content in vaporized cannabis does not prevent tetrahydrocannabinol (THC)-induced impairment of driving and cognition. Psychopharmacology (Berl) 2019; 236:2713-2724. [PMID: 31044290 PMCID: PMC6695367 DOI: 10.1007/s00213-019-05246-8] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/09/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND The main psychoactive component of cannabis, delta-9-tetrahydrocannabinol (THC), can impair driving performance. Cannabidiol (CBD), a non-intoxicating cannabis component, is thought to mitigate certain adverse effects of THC. It is possible then that cannabis containing equivalent CBD and THC will differentially affect driving and cognition relative to THC-dominant cannabis. AIMS The present study investigated and compared the effects of THC-dominant and THC/CBD equivalent cannabis on simulated driving and cognitive performance. METHODS In a randomized, double-blind, within-subjects crossover design, healthy volunteers (n = 14) with a history of light cannabis use attended three outpatient experimental test sessions in which simulated driving and cognitive performance were assessed at two timepoints (20-60 min and 200-240 min) following vaporization of 125 mg THC-dominant (11% THC; < 1% CBD), THC/CBD equivalent (11% THC, 11% CBD), or placebo (< 1% THC/CBD) cannabis. RESULTS/OUTCOMES Both active cannabis types increased lane weaving during a car-following task but had little effect on other driving performance measures. Active cannabis types impaired performance on the Digit Symbol Substitution Task (DSST), Divided Attention Task (DAT) and Paced Auditory Serial Addition Task (PASAT) with impairment on the latter two tasks worse with THC/CBD equivalent cannabis. Subjective drug effects (e.g., "stoned") and confidence in driving ability did not vary with CBD content. Peak plasma THC concentrations were higher following THC/CBD equivalent cannabis relative to THC-dominant cannabis, suggesting a possible pharmacokinetic interaction. CONCLUSIONS/INTERPRETATION Cannabis containing equivalent concentrations of CBD and THC appears no less impairing than THC-dominant cannabis, and in some circumstances, CBD may actually exacerbate THC-induced impairment.
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29
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Sagar KA, Gruber SA. Interactions between recreational cannabis use and cognitive function: lessons from functional magnetic resonance imaging. Ann N Y Acad Sci 2018; 1451:42-70. [PMID: 30426517 DOI: 10.1111/nyas.13990] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 10/13/2018] [Accepted: 10/19/2018] [Indexed: 12/28/2022]
Abstract
Cannabis use is becoming increasingly popular as a growing number of states pass legislation to legalize cannabis and cannabis-derived products for recreational and/or medical purposes. Given the widespread use of cannabis, it is critical to understand the neural consequences related to cannabis use. In this review, we focus on evidence from functional magnetic resonance imaging studies that document acute and residual alterations in brain function during tasks spanning a variety of cognitive domains: executive function, attention and working memory, memory, motor skills, error monitoring, and reward and affective processing. Although it is clear that cannabis affects brain function, the findings are somewhat inconsistent; variables that potentially affect study outcomes are outlined, including a discussion of the impact of chronological age and age of cannabis onset as well as length of abstinence at the time of assessment, which are important considerations when measuring cannabis use patterns. Inherent differences between recreational/adult cannabis use versus use for medical purposes are also discussed, given their importance to public policy decisions.
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Affiliation(s)
- Kelly A Sagar
- Cognitive and Clinical Neuroimaging Core, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Staci A Gruber
- Cognitive and Clinical Neuroimaging Core, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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30
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Greene NZ, Wiley JL, Yu Z, Clowers BH, Craft RM. Cannabidiol modulation of antinociceptive tolerance to Δ 9-tetrahydrocannabinol. Psychopharmacology (Berl) 2018; 235:3289-3302. [PMID: 30238130 PMCID: PMC6454895 DOI: 10.1007/s00213-018-5036-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/07/2018] [Indexed: 01/02/2023]
Abstract
RATIONALE Humans typically self-administer cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) together repeatedly (as in cannabis, cannabis extract, or Sativex®) to relieve pain. It has been suggested that one benefit of the drug combination may be decreased tolerance development. OBJECTIVE The present study compared the development of tolerance to the antinociceptive effects of THC given alone versus combined with CBD, in rats. METHODS THC dose-effect curves on tail withdrawal and paw pressure tests were obtained before and after twice-daily treatment with vehicle or CBD (10 mg/kg), plus vehicle or THC (3.6 mg/kg females; 9.3 mg/kg males) for 4 days. RESULTS On the first day, THC was more potent in females than males on both nociceptive tests. From pre- to post-chronic (day 1 to day 6), THC potency on the tail withdrawal test decreased more in females than males, and rats that had been treated with CBD + THC repeatedly showed greater rightward/downward shifts of the THC dose-effect curve than rats that had been treated with THC alone. Analysis of blood samples taken after day 6 testing showed that serum THC levels were higher in CBD + THC-treated females than in vehicle + THC-treated females, and THC's active metabolite 11-OH-THC and its inactive metabolite THC-COOH were lower in CBD + THC-treated rats than in vehicle + THC-treated rats of both sexes. CBD also increased serum levels of the active metabolite cannabinol in both sexes. CONCLUSION The decrease in THC's antinociceptive effects after repeated CBD exposure may be due to CBD-induced inhibition of THC metabolism, and/or antagonism of THC effects that emerges with repeated CBD treatment.
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Affiliation(s)
| | | | - Zhihao Yu
- Department of Chemistry, Washington State University, Pullman, WA
| | - Brian H. Clowers
- Department of Chemistry, Washington State University, Pullman, WA
| | - Rebecca M. Craft
- Department of Psychology, Washington State University, Pullman, WA
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31
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Bloomfield MAP, Hindocha C, Green SF, Wall MB, Lees R, Petrilli K, Costello H, Ogunbiyi MO, Bossong MG, Freeman TP. The neuropsychopharmacology of cannabis: A review of human imaging studies. Pharmacol Ther 2018; 195:132-161. [PMID: 30347211 PMCID: PMC6416743 DOI: 10.1016/j.pharmthera.2018.10.006] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The laws governing cannabis are evolving worldwide and associated with changing patterns of use. The main psychoactive drug in cannabis is Δ9-tetrahydrocannabinol (THC), a partial agonist at the endocannabinoid CB1 receptor. Acutely, cannabis and THC produce a range of effects on several neurocognitive and pharmacological systems. These include effects on executive, emotional, reward and memory processing via direct interactions with the endocannabinoid system and indirect effects on the glutamatergic, GABAergic and dopaminergic systems. Cannabidiol, a non-intoxicating cannabinoid found in some forms of cannabis, may offset some of these acute effects. Heavy repeated cannabis use, particularly during adolescence, has been associated with adverse effects on these systems, which increase the risk of mental illnesses including addiction and psychosis. Here, we provide a comprehensive state of the art review on the acute and chronic neuropsychopharmacology of cannabis by synthesizing the available neuroimaging research in humans. We describe the effects of drug exposure during development, implications for understanding psychosis and cannabis use disorder, and methodological considerations. Greater understanding of the precise mechanisms underlying the effects of cannabis may also give rise to new treatment targets.
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Affiliation(s)
- Michael A P Bloomfield
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, United Kingdom; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, United Kingdom.
| | - Chandni Hindocha
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, United Kingdom
| | - Sebastian F Green
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom
| | - Matthew B Wall
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine, Imperial College London, United Kingdom; Invicro UK, Hammersmith Hospital, London, United Kingdom
| | - Rachel Lees
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, United Kingdom
| | - Katherine Petrilli
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, United Kingdom
| | - Harry Costello
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom
| | - M Olabisi Ogunbiyi
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom
| | - Matthijs G Bossong
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Tom P Freeman
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Department of Psychology, University of Bath, United Kingdom; National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
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Hall KE, Monte AA, Chang T, Fox J, Brevik C, Vigil DI, Van Dyke M, James KA. Mental Health-related Emergency Department Visits Associated With Cannabis in Colorado. Acad Emerg Med 2018; 25:526-537. [PMID: 29476688 DOI: 10.1111/acem.13393] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 01/05/2018] [Accepted: 02/17/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cannabis legalization in Colorado resulted in increased cannabis-associated health care utilization. Our objective was to examine cooccurrence of cannabis and mental health diagnostic coding in Colorado emergency department (ED) discharges and replicate the study in a subpopulation of ED visits where cannabis involvement and psychiatric diagnosis were confirmed through medical review. METHODS We collected statewide ED International Classification of Diseases, 9th Revision, Clinical Modification diagnoses from the Colorado Hospital Association and a subpopulation of ED visits from a large, academic hospital from 2012 to 2014. Diagnosis codes identified visits associated with mental health and cannabis. Codes for mental health conditions and cannabis were confirmed by manual records review in the academic hospital subpopulation. Prevalence ratios (PRs) of mental health ED discharges were calculated to compare cannabis-associated visits to those without cannabis. Rates of mental health and cannabis-associated ED discharges were examined over time. RESULTS Statewide data demonstrated a fivefold higher prevalence of mental health diagnoses in cannabis-associated ED visits (PR = 5.35, 95% confidence interval [CI], 5.27-5.43) compared to visits without cannabis. The hospital subpopulation supported this finding with a fourfold higher prevalence of psychiatric complaints in cannabis attributable ED visits (PR = 4.87, 95% CI = 4.36-5.44) compared to visits not attributable to cannabis. Statewide rates of ED visits associated with both cannabis and mental health significantly increased from 2012 to 2014 from 224.5 to 268.4 per 100,000 (p < 0.0001). CONCLUSIONS In Colorado, the prevalence of mental health conditions in ED visits with cannabis-associated diagnostic codes is higher than in those without cannabis. There is a need for further research determining if these findings are truly attributed to cannabis or merely coincident with concurrent increased use and availability.
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Affiliation(s)
- Katelyn E. Hall
- Department of Environmental Epidemiology Occupational Health, and Toxicology Colorado Department of Public Health and Environment Denver CO
| | - Andrew A. Monte
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
- Rocky Mountain Poison & Drug Center Denver Health and Hospital Authority Denver CO
| | - Tae Chang
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Jacob Fox
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Cody Brevik
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Daniel I. Vigil
- Department of Environmental Epidemiology Occupational Health, and Toxicology Colorado Department of Public Health and Environment Denver CO
| | - Mike Van Dyke
- Department of Environmental Epidemiology Occupational Health, and Toxicology Colorado Department of Public Health and Environment Denver CO
| | - Katherine A. James
- Department of Family Medicine University of Colorado School of Medicine Aurora CO
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Moustafa AA, Salama M, Peak R, Tindle R, Salem A, Keri S, Misiak B, Frydecka D, Mohamed W. Interactions between cannabis and schizophrenia in humans and rodents. Rev Neurosci 2018; 28:811-823. [PMID: 28498796 DOI: 10.1515/revneuro-2016-0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/18/2017] [Indexed: 12/12/2022]
Abstract
In this review, we provide an overview of the relationship between cannabis use and the development of schizophrenia, using both animal and human studies. We further discuss the potential neural mechanism that may mediate the relationship between cannabis use and schizophrenia symptoms. We finally provide clinical implications and future studies that can further elucidate the relationship between cannabis and schizophrenia.
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Sherif MA, Cortes-Briones JA, Ranganathan M, Skosnik PD. Cannabinoid-glutamate interactions and neural oscillations: implications for psychosis. Eur J Neurosci 2018; 48:2890-2902. [PMID: 29247465 DOI: 10.1111/ejn.13800] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/06/2017] [Accepted: 12/07/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Mohamed A. Sherif
- Department of Psychiatry; Yale University School of Medicine; VA Connecticut Healthcare System Building 5, Suite C-214 950 Campbell Avenue West Haven CT 06516 USA
| | - Jose A. Cortes-Briones
- Department of Psychiatry; Yale University School of Medicine; VA Connecticut Healthcare System Building 5, Suite C-214 950 Campbell Avenue West Haven CT 06516 USA
| | - Mohini Ranganathan
- Department of Psychiatry; Yale University School of Medicine; VA Connecticut Healthcare System Building 5, Suite C-214 950 Campbell Avenue West Haven CT 06516 USA
| | - Patrick D. Skosnik
- Department of Psychiatry; Yale University School of Medicine; VA Connecticut Healthcare System Building 5, Suite C-214 950 Campbell Avenue West Haven CT 06516 USA
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Ranganathan M, Radhakrishnan R, Addy PH, Schnakenberg-Martin AM, Williams AH, Carbuto M, Elander J, Pittman B, Andrew Sewell R, Skosnik PD, D'Souza DC. Tetrahydrocannabinol (THC) impairs encoding but not retrieval of verbal information. Prog Neuropsychopharmacol Biol Psychiatry 2017. [PMID: 28642081 DOI: 10.1016/j.pnpbp.2017.06.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Cannabis and agonists of the brain cannabinoid receptor (CB1R) produce acute memory impairments in humans. However, the extent to which cannabinoids impair the component processes of encoding and retrieval has not been established in humans. The objective of this analysis was to determine whether the administration of Δ9-Tetrahydrocannabinol (THC), the principal psychoactive constituent of cannabis, impairs encoding and/or retrieval of verbal information. MATERIALS AND METHODS Healthy subjects were recruited from the community. Subjects were administered the Rey-Auditory Verbal Learning Test (RAVLT) either before administration of THC (experiment #1) (n=38) or while under the influence of THC (experiment #2) (n=57). Immediate and delayed recall on the RAVLT was compared. Subjects received intravenous THC, in a placebo-controlled, double-blind, randomized manner at doses known to produce behavioral and subjective effects consistent with cannabis intoxication. RESULTS Total immediate recall, short delayed recall, and long delayed recall were reduced in a statistically significant manner only when the RAVLT was administered to subjects while they were under the influence of THC (experiment #2) and not when the RAVLT was administered prior. CONCLUSIONS THC acutely interferes with encoding of verbal memory without interfering with retrieval. These data suggest that learning information prior to the use of cannabis or cannabinoids is not likely to disrupt recall of that information. Future studies will be necessary to determine whether THC impairs encoding of non-verbal information, to what extent THC impairs memory consolidation, and the role of other cannabinoids in the memory-impairing effects of cannabis. CLINICAL TRIAL INFORMATION Cannabinoids, Neural Synchrony, and Information Processing (THC-Gamma) http://clinicaltrials.gov/ct2/show/study/NCT00708994 NCT00708994 Pharmacogenetics of Cannabinoid Response http://clinicaltrials.gov/ct2/show/NCT00678730 NCT00678730.
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Affiliation(s)
- Mohini Ranganathan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA.
| | - Rajiv Radhakrishnan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Peter H Addy
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Medical Informatics, VA Connecticut Healthcare System, West Haven, CT, USA; Substance Abuse Treatment Unit, Connecticut Mental Health Center, New Haven, CT, USA
| | - Ashley M Schnakenberg-Martin
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Ashley H Williams
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Michelle Carbuto
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Jacqueline Elander
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Brian Pittman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - R Andrew Sewell
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Patrick D Skosnik
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Deepak Cyril D'Souza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
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Nasir B, Fatima H, Ahmed M, Phull AR, Ihsan-ul-Haq. Cannabis: A Prehistoric Remedy for the Deficits of Existing and Emerging Anticancer Therapies. JOURNAL OF EXPLORATORY RESEARCH IN PHARMACOLOGY 2017; 2:82-93. [DOI: 10.14218/jerp.2017.00012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Murray RM, Englund A, Abi-Dargham A, Lewis DA, Di Forti M, Davies C, Sherif M, McGuire P, D'Souza DC. Cannabis-associated psychosis: Neural substrate and clinical impact. Neuropharmacology 2017. [PMID: 28634109 DOI: 10.1016/j.neuropharm.2017.06.018] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Prospective epidemiological studies have consistently demonstrated that cannabis use is associated with an increased subsequent risk of both psychotic symptoms and schizophrenia-like psychoses. Early onset of use, daily use of high-potency cannabis, and synthetic cannabinoids carry the greatest risk. The risk-increasing effects are not explained by shared genetic predisposition between schizophrenia and cannabis use. Experimental studies in healthy humans show that cannabis and its active ingredient, delta-9-tetrahydrocannabinol (THC), can produce transient, dose-dependent, psychotic symptoms, as well as an array of psychosis-relevant behavioral, cognitive and psychophysiological effects; the psychotogenic effects can be ameliorated by cannabidiol (CBD). Findings from structural imaging studies in cannabis users have been inconsistent but functional MRI studies have linked the psychotomimetic and cognitive effects of THC to activation in brain regions implicated in psychosis. Human PET studies have shown that acute administration of THC weakly releases dopamine in the striatum but that chronic users are characterised by low striatal dopamine. We are beginning to understand how cannabis use impacts on the endocannabinoid system but there is much still to learn about the biological mechanisms underlying how cannabis increases risk of psychosis. This article is part of the Special Issue entitled "A New Dawn in Cannabinoid Neurobiology".
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Affiliation(s)
- R M Murray
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.
| | - A Englund
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - A Abi-Dargham
- Department of Psychiatry, School of Medicine, Stony Brook University, New York, USA
| | - D A Lewis
- Department of Psychiatry, University of Pittsburg, PA, USA
| | - M Di Forti
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - C Davies
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - M Sherif
- Department of Psychiatry, Yale University School of Medicine, CT, USA
| | - P McGuire
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - D C D'Souza
- Department of Psychiatry, Yale University School of Medicine, CT, USA
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Richards JR. Cannabinoid hyperemesis syndrome: A disorder of the HPA axis and sympathetic nervous system? Med Hypotheses 2017; 103:90-95. [DOI: 10.1016/j.mehy.2017.04.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/22/2017] [Indexed: 12/26/2022]
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Allendorfer JB, Szaflarski JP. Neuroimaging studies towards understanding the central effects of pharmacological cannabis products on patients with epilepsy. Epilepsy Behav 2017; 70:349-354. [PMID: 28109780 DOI: 10.1016/j.yebeh.2016.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 11/11/2016] [Accepted: 11/14/2016] [Indexed: 02/04/2023]
Abstract
Recent interest for the use of cannabis-derived products as therapeutic agents in the treatment of epilepsies has necessitated a reevaluation of their effects on brain and behavior. Overall, prolonged cannabis use is thought to result in functional and structural brain alterations. These effects may be dependent on a number of factors: e.g., which phytocannabinoid is used (e.g., cannabidiol (CBD) vs. tetrahyrocannabinol (THC)), the frequency of use (occasional vs. heavy), and at what age (prenatal, childhood, adulthood) the use began. However, due to the fact that there are over seven hundred constituents that make up the Cannabis sativa plant, it is difficult to determine which compound or combination of compounds is responsible for specific effects when studying recreational users. Therefore, this review focuses only on the functional MRI studies investigating the effects of specific pharmacological preparations of cannabis compounds, specifically THC, tetrahydrocannabivarin (THCV), and CBD, on brain function in healthy individuals and persons with epilepsy with references to non-epilepsy studies only to underline the gaps in research that need to be filled before cannabis-derived products are considered for a wide use in the treatment of epilepsy. This article is part of a Special Issue entitled "Cannabinoids and Epilepsy".
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Affiliation(s)
- Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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Weiss SRB, Howlett KD, Baler RD. Building smart cannabis policy from the science up. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 42:39-49. [PMID: 28189459 PMCID: PMC5404989 DOI: 10.1016/j.drugpo.2017.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 12/21/2016] [Accepted: 01/09/2017] [Indexed: 12/12/2022]
Abstract
Social attitudes and cultural norms around the issue of substance abuse are shifting rapidly around the world, leading to complex and unpredictable consequences. On the positive side, efforts to more intensely disseminate the scientific evidence for the many connections between chronic substance use and the emergence of measurable and discrete brain dysfunctions, has ushered in an evolving climate of acceptance and a new era of improved access to more effective interventions, at least in the United States. On the negative side, there has been a steady erosion in the public perception of the harms associated with the use of popular drugs, especially cannabis. This worrisome trend has sprouted at the convergence of several forces that have combined, more or less fortuitously, to effectively change long-standing policies away from prohibition and toward decriminalization or legalization. These forces include the outsized popularity of the cannabis plant among recreational users, the unflagging campaign by corporate lobbyists and patient advocates to mainstream its medicinal use, and the honest realization in some quarters of the deleterious impact of the drug war and its draconian cannabis laws, in particular, on society's most vulnerable populations. Updating drug policies is a desirable goal, and significant changes may indeed be warranted. However, there is a real concern when policy changes are hurriedly implemented without the required input from the medical, scientific, or policy research communities. Regardless of how well intentioned, such initiatives are bound to magnify the potential for unintended adverse consequences in the form of far ranging health and social costs. To minimize this risk, science must be front and center in this important policy debate. Here, we review the state of the science on cannabis and cannabinoid health effects, both adverse and therapeutic. We focus on the prevalence of use in different populations, the mechanisms by which cannabis exerts its effects (i.e., via the endocannabinoid system), and the double-edged potential of this system to inspire new medications, on one hand, and to cause short and long term harmful effects on the other. By providing knowledge of cannabis' broad ranging effects, we hope to enable better decision making regarding cannabis legislation and policy implementation.
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Affiliation(s)
- Susan R B Weiss
- National Institute on Drug Abuse, National Institutes of Health, United States.
| | - Katia D Howlett
- National Institute on Drug Abuse, National Institutes of Health, United States
| | - Ruben D Baler
- National Institute on Drug Abuse, National Institutes of Health, United States
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Walsh Z, Gonzalez R, Crosby K, S. Thiessen M, Carroll C, Bonn-Miller MO. Medical cannabis and mental health: A guided systematic review. Clin Psychol Rev 2017; 51:15-29. [DOI: 10.1016/j.cpr.2016.10.002] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 10/06/2016] [Accepted: 10/10/2016] [Indexed: 12/28/2022]
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A systematic review of the effect of cannabidiol on cognitive function: Relevance to schizophrenia. Neurosci Biobehav Rev 2017; 72:310-324. [DOI: 10.1016/j.neubiorev.2016.11.012] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 10/25/2016] [Accepted: 11/17/2016] [Indexed: 11/18/2022]
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Abstract
Prevalence of psychiatric disorders continues to rise globally, yet remission rates and patient outcome remain less than ideal. As a result, novel treatment approaches for these disorders are necessary to decrease societal economic burden, as well as increase individual functioning. The recent discovery of the endocannabinoid system has provided an outlet for further research into its role in psychiatric disorders, because efficacy of targeted treatments have been demonstrated in medical illnesses, including cancers, neuropathic pain, and multiple sclerosis. The present review will investigate the role of the endocannabinoid system in psychiatric disorders, specifically schizophrenia, depressive, anxiety, and posttraumatic stress disorders, as well as attention-deficit hyperactivity disorder. Controversy remains in prescribing medicinal cannabinoid treatments due to the fear of adverse effects. However, one must consider all potential limitations when determining the safety and tolerability of cannabinoid products, specifically cannabinoid content (ie, Δ-tetrahydrocannabinol vs cannabidiol) as well as study design. The potential efficacy of cannabinoid treatments in the psychiatric population is an emerging topic of interest that provides potential value going forward in medicine.
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Boggs DL, Peckham A, Boggs AA, Ranganathan M. Delta-9-tetrahydrocannabinol and cannabidiol: Separating the chemicals from the "weed," a pharmacodynamic discussion. Ment Health Clin 2016; 6:277-284. [PMID: 29955482 PMCID: PMC6007535 DOI: 10.9740/mhc.2016.11.277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cannabis is being increasingly used as a medical treatment for a variety of illnesses. However, the cannabis plant has more than 70 different phytocannabinoids with potential pharmacologic activity. Two of the most researched phytocannabinoids are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Evidence suggests CBD can decrease some of the psychomimetic effects of THC. This has led to the development of a new drug, Nabiximols, for the treatment of moderate to severe spasticity due to multiple sclerosis. A discussion of evidence supporting proposed pharmacodynamic interplay between CBD and THC is presented.
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Affiliation(s)
- Douglas Lee Boggs
- Clinical Pharmacy Specialist-Outpatient Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut; Associate Research Scientist, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut,
| | - Alyssa Peckham
- PGY-2 Psychiatry Pharmacy Resident, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Angela A Boggs
- Clinical Pharmacy Specialist-Outpatient Psychiatry, VA Connecticut Healthcare System, Newington, Connecticut
| | - Mohini Ranganathan
- Attending Psychiatrist, VA Connecticut Healthcare System, West Haven, Connecticut; Abraham Ribicoff Research Facilities, and Assisstant Professor, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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Spronk DB, De Bruijn ERA, van Wel JHP, Ramaekers JG, Verkes RJ. Acute effects of cocaine and cannabis on response inhibition in humans: an ERP investigation. Addict Biol 2016; 21:1186-1198. [PMID: 26037156 DOI: 10.1111/adb.12274] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Substance abuse has often been associated with alterations in response inhibition in humans. Not much research has examined how the acute effects of drugs modify the neurophysiological correlates of response inhibition, or how these effects interact with individual variation in trait levels of impulsivity and novelty seeking. This study investigated the effects of cocaine and cannabis on behavioural and event-related potential (ERP) correlates of response inhibition in 38 healthy drug using volunteers. A double-blind placebo-controlled randomized three-way crossover design was used. All subjects completed a standard Go/NoGo task after administration of the drugs. Compared with a placebo, cocaine yielded improved accuracy, quicker reaction times and an increased prefrontal NoGo-P3 ERP. Cannabis produced opposing results; slower reaction times, impaired accuracy and a reduction in the amplitude of the prefrontal NoGo-P3. Cannabis in addition decreased the amplitude of the parietally recorded P3, while cocaine did not affect this. Neither drugs specifically affected the N2 component, suggesting that pre-motor response inhibitory processes remain unaffected. Neither trait impulsivity nor novelty seeking interacted with drug-induced effects on measures of response inhibition. We conclude that acute drug effects on response inhibition seem to be specific to the later, evaluative stages of response inhibition. The acute effects of cannabis appeared less specific to response inhibition than those of cocaine. Together, the results show that the behavioural effects on response inhibition are reflected in electrophysiological correlates. This study did not support a substantial role of vulnerability personality traits in the acute intoxication stage.
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Affiliation(s)
- Desirée B. Spronk
- Department of Psychiatry; Radboud University Medical Centre; Nijmegen The Netherlands
- Donders Institute for Brain, Cognition and Behaviour; Radboud University Nijmegen; Nijmegen The Netherlands
| | - Ellen R. A. De Bruijn
- Department of Clinical Psychology, Leiden Institute for Brain and Cognition; Leiden University; Leiden The Netherlands
| | - Janelle H. P. van Wel
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience; Maastricht University; Maastricht The Netherlands
| | - Johannes G. Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience; Maastricht University; Maastricht The Netherlands
| | - Robbert J. Verkes
- Department of Psychiatry; Radboud University Medical Centre; Nijmegen The Netherlands
- Donders Institute for Brain, Cognition and Behaviour; Radboud University Nijmegen; Nijmegen The Netherlands
- Pompestichting for Forensic Psychiatry; Nijmegen The Netherlands
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Murray RM, Quigley H, Quattrone D, Englund A, Di Forti M. Traditional marijuana, high-potency cannabis and synthetic cannabinoids: increasing risk for psychosis. World Psychiatry 2016; 15:195-204. [PMID: 27717258 PMCID: PMC5032490 DOI: 10.1002/wps.20341] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Epidemiological evidence demonstrates that cannabis use is associated with an increased risk of psychotic outcomes, and confirms a dose-response relationship between the level of use and the risk of later psychosis. High-potency cannabis and synthetic cannabinoids carry the greatest risk. Experimental administration of tetrahydrocannabinol, the active ingredient of cannabis, induces transient psychosis in normal subjects, but this effect can be ameliorated by co-administration of cannabidiol. This latter is a constituent of traditional hashish, but is largely absent from modern high-potency forms of cannabis. Argument continues over the extent to which genetic predisposition is correlated to, or interacts with, cannabis use, and what proportion of psychosis could be prevented by minimizing heavy use. As yet, there is not convincing evidence that cannabis use increases risk of other psychiatric disorders, but there are no such doubts concerning its detrimental effect on cognitive function. All of the negative aspects are magnified if use starts in early adolescence. Irrespective of whether use of cannabis is decriminalized or legalized, the evidence that it is a component cause of psychosis is now sufficient for public health messages outlining the risk, especially of regular use of high-potency cannabis and synthetic cannabinoids.
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Affiliation(s)
- Robin M. Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's CollegeDe Crespigny ParkLondonSE5 8AFUK
| | - Harriet Quigley
- Institute of Psychiatry, Psychology and Neuroscience, King's CollegeDe Crespigny ParkLondonSE5 8AFUK
| | - Diego Quattrone
- Institute of Psychiatry, Psychology and Neuroscience, King's CollegeDe Crespigny ParkLondonSE5 8AFUK
| | - Amir Englund
- Institute of Psychiatry, Psychology and Neuroscience, King's CollegeDe Crespigny ParkLondonSE5 8AFUK
| | - Marta Di Forti
- Institute of Psychiatry, Psychology and Neuroscience, King's CollegeDe Crespigny ParkLondonSE5 8AFUK
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Russo EB. Current Therapeutic Cannabis Controversies and Clinical Trial Design Issues. Front Pharmacol 2016; 7:309. [PMID: 27683558 PMCID: PMC5022003 DOI: 10.3389/fphar.2016.00309] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/30/2016] [Indexed: 12/12/2022] Open
Abstract
This overview covers a wide range of cannabis topics, initially examining issues in dispensaries and self-administration, plus regulatory requirements for production of cannabis-based medicines, particularly the Food and Drug Administration "Botanical Guidance." The remainder pertains to various cannabis controversies that certainly require closer examination if the scientific, consumer, and governmental stakeholders are ever to reach consensus on safety issues, specifically: whether botanical cannabis displays herbal synergy of its components, pharmacokinetics of cannabis and dose titration, whether cannabis medicines produce cyclo-oxygenase inhibition, cannabis-drug interactions, and cytochrome P450 issues, whether cannabis randomized clinical trials are properly blinded, combatting the placebo effect in those trials via new approaches, the drug abuse liability (DAL) of cannabis-based medicines and their regulatory scheduling, their effects on cognitive function and psychiatric sequelae, immunological effects, cannabis and driving safety, youth usage, issues related to cannabis smoking and vaporization, cannabis concentrates and vape-pens, and laboratory analysis for contamination with bacteria and heavy metals. Finally, the issue of pesticide usage on cannabis crops is addressed. New and disturbing data on pesticide residues in legal cannabis products in Washington State are presented with the observation of an 84.6% contamination rate including potentially neurotoxic and carcinogenic agents. With ongoing developments in legalization of cannabis in medical and recreational settings, numerous scientific, safety, and public health issues remain.
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Wilsey B, Marcotte TD, Deutsch R, Zhao H, Prasad H, Phan A. An Exploratory Human Laboratory Experiment Evaluating Vaporized Cannabis in the Treatment of Neuropathic Pain From Spinal Cord Injury and Disease. THE JOURNAL OF PAIN 2016; 17:982-1000. [PMID: 27286745 PMCID: PMC5007175 DOI: 10.1016/j.jpain.2016.05.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/18/2016] [Accepted: 05/20/2016] [Indexed: 12/14/2022]
Abstract
UNLABELLED Using 8-hour human laboratory experiments, we evaluated the analgesic efficacy of vaporized cannabis in patients with neuropathic pain related to injury or disease of the spinal cord, most of whom were experiencing pain despite traditional treatment. After obtaining baseline data, 42 participants underwent a standardized procedure for inhaling 4 puffs of vaporized cannabis containing either placebo, 2.9%, or 6.7% delta 9-THC on 3 separate occasions. A second dosing occurred 3 hours later; participants chose to inhale 4 to 8 puffs. This flexible dosing was used to attempt to reduce the placebo effect. Using an 11-point numerical pain intensity rating scale as the primary outcome, a mixed effects linear regression model showed a significant analgesic response for vaporized cannabis. When subjective and psychoactive side effects (eg, good drug effect, feeling high, etc) were added as covariates to the model, the reduction in pain intensity remained significant above and beyond any effect of these measures (all P < .0004). Psychoactive and subjective effects were dose-dependent. Measurement of neuropsychological performance proved challenging because of various disabilities in the population studied. Because the 2 active doses did not significantly differ from each other in terms of analgesic potency, the lower dose appears to offer the best risk-benefit ratio in patients with neuropathic pain associated with injury or disease of the spinal cord. PERSPECTIVE A crossover, randomized, placebo-controlled human laboratory experiment involving administration of vaporized cannabis was performed in patients with neuropathic pain related to spinal cord injury and disease. This study supports consideration of future research that would include longer duration studies over weeks to months to evaluate the efficacy of medicinal cannabis in patients with central neuropathic pain.
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Affiliation(s)
- Barth Wilsey
- VA Northern California Health Care System Sacramento VA Medical Center, 10535 Hospital Way, Mather, CA 95655 USA, 916-843-7000 | 800-382-8387
- Department of Physical Medicine and Rehabilitation, University of California, Davis Medical Center, Lawrence J. Ellison Ambulatory Care Center, 4860 Y Street, Sacramento, CA 95817 USA
| | - Thomas D. Marcotte
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Street, Suite B, MC8231, San Diego, CA 92103-8231 USA
| | - Reena Deutsch
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Street, Suite B, MC8231, San Diego, CA 92103-8231 USA
| | - Holly Zhao
- VA Northern California Health Care System Sacramento VA Medical Center, 10535 Hospital Way, Mather, CA 95655 USA, 916-843-7000 | 800-382-8387
- Department of Physical Medicine and Rehabilitation, University of California, Davis Medical Center, Lawrence J. Ellison Ambulatory Care Center, 4860 Y Street, Sacramento, CA 95817 USA
| | - Hannah Prasad
- VA Northern California Health Care System Sacramento VA Medical Center, 10535 Hospital Way, Mather, CA 95655 USA, 916-843-7000 | 800-382-8387
- Department of Physical Medicine and Rehabilitation, University of California, Davis Medical Center, Lawrence J. Ellison Ambulatory Care Center, 4860 Y Street, Sacramento, CA 95817 USA
| | - Amy Phan
- VA Northern California Health Care System Sacramento VA Medical Center, 10535 Hospital Way, Mather, CA 95655 USA, 916-843-7000 | 800-382-8387
- Department of Physical Medicine and Rehabilitation, University of California, Davis Medical Center, Lawrence J. Ellison Ambulatory Care Center, 4860 Y Street, Sacramento, CA 95817 USA
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Rentzsch J, Stadtmann A, Montag C, Kunte H, Plöckl D, Hellweg R, Gallinat J, Kronenberg G, Jockers-Scherübl MC. Attentional dysfunction in abstinent long-term cannabis users with and without schizophrenia. Eur Arch Psychiatry Clin Neurosci 2016; 266:409-21. [PMID: 26182894 DOI: 10.1007/s00406-015-0616-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 07/07/2015] [Indexed: 01/24/2023]
Abstract
Long-term cannabis use may confer cognitive deficits and increased risk of psychosis. However, the relationship between cannabis use and schizophrenia is complex. In particular, little is known about the effects of chronic cannabis use on the attention-related electric brain response in schizophrenia. We investigated auditory novelty and oddball P300 evoked potentials in a mixed sample of first-episode and chronic schizophrenic patients and healthy controls with (SZCA, n = 20; COCA, n = 20, abstinence ≥28 days) or without (SZ, n = 20; CO, n = 20) chronic cannabis use. Duration of regular cannabis use was 8.3 ± 5.6 (SZCA) and 9.1 ± 7.1 (COCA) years. In general, schizophrenic patients showed reduced P300 amplitudes. Cannabis use was associated with both a reduced early and late left-hemispheric novelty P300. There was a significant 'diagnosis × cannabis' interaction for the left-hemispheric late novelty P300 in that cannabis use was associated with a reduced amplitude in the otherwise healthy but not in the schizophrenic group compared with their relative control groups (corrected p < 0.02; p > 0.9, respectively). The left-hemispheric late novelty P300 in the otherwise healthy cannabis group correlated inversely with amount and duration of cannabis use (r = -0.50, p = 0.024; r = -0.57, p = 0.009, respectively). Our study confirms attentional deficits with chronic cannabis use. However, cannabis use may lead to different cognitive sequelae in patients with schizophrenia and in healthy controls, possibly reflecting preexisting alterations in the endocannabinoid system in schizophrenia.
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Affiliation(s)
- Johannes Rentzsch
- Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
| | - Ada Stadtmann
- Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050, Berlin, Germany
| | - Christiane Montag
- Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.,Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Große Hamburger Straße 5-11, 10115, Berlin, Germany
| | - Hagen Kunte
- Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Doris Plöckl
- Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Rainer Hellweg
- Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Jürgen Gallinat
- Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Golo Kronenberg
- Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
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