Adverse Effects of Cannabis Use on Neurocognitive Functioning: A Systematic Review of Meta- Analytic Studies

Light Cannabis Use and the Adolescent Brain: An 8-years Longitudinal Assessment of Mental Health, Cognition, and Reward Processing

RATIONALE

For decades, cannabis has been the most widely used illicit substance in the world, particularly among youth. Research suggests that mental health problems associated with cannabis use may result from its effect on reward brain circuit, emotional processes, and cognition. However, findings are mostly derived from correlational studies and inconsistent, particularly in adolescents.

OBJECTIVES AND METHODS

Using data from the IMAGEN study, participants (non-users, persistent users, abstinent users) were classified according to their cannabis use at 19 and 22 years-old. All participants were cannabis-naïve at baseline (14 years-old). Psychopathological symptoms, cognitive performance, and brain activity while performing a Monetary Incentive Delay task were used as predictors of substance use and to analyze group differences over time.

RESULTS

Higher scores on conduct problems and lower on peer problems at 14 years-old (n = 318) predicted a greater likelihood of transitioning to cannabis use within 5 years. At 19 years of age, individuals who consistently engaged in low-frequency (i.e., light) cannabis use (n = 57) exhibited greater conduct problems and hyperactivity/inattention symptoms compared to non-users (n = 52) but did not differ in emotional symptoms, cognitive functioning, or brain activity during the MID task. At 22 years, those who used cannabis at both 19 and 22 years-old n = 17), but not individuals that had been abstinent for ≥ 1 month (n = 19), reported higher conduct problems than non-users (n = 17).

CONCLUSIONS

Impairments in reward-related brain activity and cognitive functioning do not appear to precede or succeed cannabis use (i.e., weekly, or monthly use). Cannabis-naïve adolescents with conduct problems and more socially engaged with their peers may be at a greater risk for lighter yet persistent cannabis use in the future.

Comparing Cannabis Use Motivations and Dependence Across Regular Cannabis Users Who Have or Have Not Recently Used Psilocybin

Introduction: In Colorado, both cannabis and psilocybin are legal and becoming more commonly used. However, there is almost no research detailing the public health concerns regarding negative outcomes (e.g., dependence) of cannabis and psilocybin co-use and motives that may perpetuate these negative outcomes (e.g., coping, boredom). Methods: Using data from a larger observational study on cannabis and metabolic processes, regular cannabis users (use ≥7 times/month; n = 97, 35.1% female, 89.7% WHITE) who used psilocybin in the past 3 months (n = 34) were compared with those who had not used psilocybin in the past 3 months (n = 63) on cannabis dependence as measured by the Marijuana Dependence Scale and endorsement of 12 cannabis motives from the Comprehensive Marijuana Motives Questionnaire. Correlations between motives and dependence were also examined and compared across groups. Results: Findings revealed that individuals who had recently used psilocybin had greater cannabis dependence scores than those who had not used recently [F (1, 95) = 5.53, p = 0.02], and more strongly endorsed that their cannabis use was motivated by enjoyment [F (1, 91) = 4.31, p = 0.04], boredom [F (1, 91) = 9.10, p < 0.01], and availability [F (1, 91) = 9.46, p < 0.01]. Correlations between dependence scores and coping and boredom motives were also significantly positive for both groups (all p values <0.05) whereas positive correlations with experimentation, celebration, and availability motives were only significant for recent psilocybin users (all p values <0.05). Discussion: These results suggest there are motivational differences for cannabis use among those who co-use cannabis and psilocybin, and there may be a greater risk for harm for these individuals.

Cannabis advertising impacts on youth cannabis use intentions following recreational legalization in Canada: An Ecological Momentary Assessment (EMA) study

OBJECTIVE

In 2018, Canada's Cannabis Act legalized adult recreational cannabis use and limited cannabis product advertising to adults. Cannabis product advertising to youth remains illegal. The extent to which adult-targeted, or illicit youth-targeted cannabis advertisements is reaching and impacting Canadian youth is unknown. We used Ecological Momentary Assessment (EMA) to describe how often and how much exposures to cannabis advertising influence Canadian youths' real-world, real-time intentions to use cannabis.

METHODS

120 Ontario, Canada youths ages 14-18, took photos of cannabis advertising that they encountered in their natural environments over a period of nine consecutive days. Following each exposure and twice daily device-issued random prompts, they also rated their intentions to use cannabis.

RESULTS

Many participating youth (n = 85; 70.83 %) reported at least one cannabis advertising exposure during the study (range 1-30, M = 4.02). Exposures occurred through a range of advertising channels (e.g., internet ads, billboards). Multilevel modeling showed that youth advertising exposure increased cannabis use intentions in vivo (β = 0.06,SE = 0.03;t = 1.98;p =.04;n = 1,348).

CONCLUSION

Data from this study shows that cannabis advertisements are regularly reaching Canadian youth and increasing their intentions to use cannabis. This suggests that current Canadian prohibitions on cannabis advertising to youth are ineffective and/or ineffectively enforced, and that the Canadian government needs additional or enhanced prohibitions on cannabis promotion to protect youth from harms associated with increased advertisement exposure, such as increased cannabis use.

Neurocognitive Impact of Exposure to Cannabis Concentrates and Cannabinoids Including Vaping in Children and Adolescents: A Systematic Review

During adolescence, significant changes unfold in the brain's maturation process. The density of white matter increases, accompanied by the pruning back of gray matter. This critical and vulnerable period becomes especially noteworthy in the context of drug use, as adolescents are extensively exposed to substances such as tobacco, alcohol, and cannabis. The concern is heightened now that cannabis has been legalized for recreational use in many places, leading to increased exposure levels. Additionally, knowledge about the impact of cannabis on neurocognitive development during this stage is limited. This knowledge gap compounds the issue, making it even more concerning. Therefore, a systematic review was carried out based on the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using medical databases such as PubMed, PubMed Central (PMC), Medline, Cochrane Library, Internet Archive Scholar, and Embase-Elsevier for relevant medical literature. The identified articles were reviewed, eligibility criteria were applied, and 19 research articles were identified. The final papers explored the correlation between children's and adolescents' exposure to cannabis-containing compounds and subsequent changes in the central nervous system (CNS). Findings revealed a considerable impact, ranging from transient alterations in mood to permanent cognitive function and sensory processing changes, affecting the deterioration of the quality of life of these individuals in adulthood. Presently, most studies were conducted on animals, and the few studies on humans have considerable limitations, such as the type of study, age of the population, and small samples, among others. For this reason, it is essential for the scientific community and public health organizations, in general, to conduct more studies that demonstrate the true neurobiological impact of this drug and its accessibility to young people and, based on the results, consider its legalization or propose regulations for its use and commercialization.

Regular cannabis use alters the neural dynamics serving complex motor control

Cannabis is the most widely used recreational drug in the United States and regular use has been linked to deficits in attention and memory. However, the effects of regular use on motor control are less understood, with some studies showing deficits and others indicating normal performance. Eighteen users and 23 nonusers performed a motor sequencing task during high-density magnetoencephalography (MEG). The MEG data was transformed into the time-frequency domain and beta responses (16-24 Hz) during motor planning and execution phases were imaged separately using a beamformer approach. Whole-brain maps were examined for group (cannabis user/nonuser) and time window (planning/execution) effects. As expected, there were no group differences in task performance (e.g., reaction time, accuracy, etc.). Regular cannabis users exhibited stronger beta oscillations in the contralateral primary motor cortex compared to nonusers during the execution phase of the motor sequences, but not during the motor planning phase. Similar group-by-time window interactions were observed in the left superior parietal, right inferior frontal cortices, right posterior insular cortex, and the bilateral motor cortex. We observed differences in the neural dynamics serving motor control in regular cannabis users compared to nonusers, suggesting regular users may employ compensatory processing in both primary motor and higher-order motor cortices to maintain adequate task performance. Future studies will need to examine more complex motor control tasks to ascertain whether this putative compensatory activity eventually becomes exhausted and behavioral differences emerge.

Cannabis and Alcohol Use by U.S. Young Adults, 2008-2019: Changes in Prevalence After Recreational Cannabis Legalization

INTRODUCTION

Young adults' cannabis and alcohol use patterns have changed after state recreational cannabis legalization according to studies based on college samples but not nationally representative samples. Associations between recreational cannabis legalization and changes in cannabis and alcohol use outcomes among young adults were examined, including differences by college enrollment and minor status (ages 18-20 vs 21-23 years).

METHODS

Repeated cross-sectional data (2008-2019) were collected from college-eligible participants aged 18-23 years in the National Survey on Drug Use and Health. Self-reported past-month cannabis use and frequent use (≥20 days) and a proxy for past-year DSM-5 cannabis use disorder were primary outcomes; past-month frequent alcohol use and binge drinking were secondary outcomes. Multilevel logistic regression models quantified changes in outcome prevalence from the study years before to after recreational cannabis legalization, adjusting for secular trends. Analyses were conducted on March 22, 2022.

RESULTS

Prevalence increased from before to after recreational cannabis legalization for past-month cannabis use (from 21% to 25%) and past-year proxy cannabis use disorder (from 11% to 13%); the increases were statistically significant [adjusted odds ratio (95% CI) = 1.20 (1.08-1.32) and 1.14 (1.003-1.30), respectively]. Increases were detected for young adults who were not in college and who were aged 21-23 years. Recreational cannabis legalization impacts were not detected for secondary outcomes.

CONCLUSIONS

Some young adults appear sensitive to state recreational cannabis legalization, including in terms of cannabis use disorder risk. Additional prevention efforts should be directed to young adults who are not in college and timed to occur before age 21 years.

UK Medical Cannabis Registry: An analysis of clinical outcomes of medicinal cannabis therapy for attention-deficit/hyperactivity disorder

AIM

This study aims to analyze the health-related quality of life (HRQoL) and safety outcomes in attention-deficit/hyperactivity disorder (ADHD) patients treated with cannabis-based medicinal products (CBMPs).

METHODS

Patients were identified from the UK Medical Cannabis Registry. Primary outcomes were changes in the following patient-reported outcome measures (PROMs) at 1, 3, 6, and 12 months from baseline: EQ-5D-5L index value, generalized anxiety disorder-7 (GAD-7) questionnaire, and the single-item sleep quality score (SQS). Secondary outcomes assessed the incidence of adverse events. Statistical significance was defined as p < 0.050.

RESULTS

Sixty-eight patients met the inclusion criteria. Significant improvements were identified in general HRQoL assessed by EQ-5D-5L index value at 1, 3, and 6 months (p < 0.050). Improvements were also identified in GAD-7 and SQS scores at 1, 3, 6, and 12 months (p < 0.010). 61 (89.71%) adverse events were recorded by 11 (16.18%) participants, of which most were moderate (n = 26, 38.24%).

CONCLUSION

An association between CBMP treatment and improvements in anxiety, sleep quality, and general HRQoL was observed in patients with ADHD. Treatment was well tolerated at 12 months. Results must be interpreted with caution as a causative effect cannot be proven. These results, however, do provide additional support for future evaluation within randomized controlled trials.

Risk-thresholds for the association between frequency of cannabis use and the development of psychosis: a systematic review and meta-analysis

BACKGROUND

Epidemiological studies show a dose-response association between cannabis use and the risk of psychosis. This review aimed to determine whether there are identifiable risk-thresholds between the frequency of cannabis use and psychosis development.

METHODS

Systematic search of Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science for relevant studies (1 January 2010-26 April 2021). Case-control or cohort studies that investigated the relationship between cannabis use and the risk of psychosis development that reported effect estimates [odds ratios (OR), hazard ratios (HR), risk ratios (RR)] or the raw data to calculate them, with information on the frequency of cannabis consumption were included. Effect estimates were extracted from individual studies and converted to RR. Two-stage dose-response multivariable meta-analytic models were utilized and sensitivity analyses conducted. The Newcastle Ottawa Scale was used to assess the risk of bias of included studies.

RESULTS

Ten original (three cohorts, seven case-control) studies were included, including 7390 participants with an age range of 12-65 years. Random-effect model meta-analyses showed a significant log-linear dose-response association between cannabis use frequency and psychosis development. A restricted cubic-splines model provided the best fit for the data, with the risk of psychosis significantly increasing for weekly or more frequent cannabis use [RR = 1.01, 95% confidence interval (CI) 0.93-1.11 yearly; RR = 1.10, 95% CI 0.97-1.25 monthly; RR = 1.35, 95% CI 1.19-1.52 weekly; RR = 1.76, 95% CI 1.47-2.12 daily].

CONCLUSION

Individuals using cannabis frequently are at increased risk of psychosis, with no significant risk associated with less frequent use. Public health prevention messages should convey these risk-thresholds, which should be refined through further work.

Understanding the Mechanisms of Action and Effects of Drugs of Abuse

AIM

Drug abuse and addiction are major public health concerns, with millions of people worldwide affected by the negative consequences of drug use. To better understand this complex issue, a review was conducted to examine the mechanisms of action and effects of drugs of abuse, including their acute and chronic effects, the symptoms of abstinence syndrome, as well as their cardiovascular impacts.

METHODS

The analyzed data were obtained after surveying an electronic database, namely PubMed, with no time limit, grey literature sources, and reference lists of relevant articles.

RESULTS

The review highlights the different categories of drugs of abuse, such as opioids, stimulants, depressants, hallucinogens, and cannabis, and discusses the specific ways that each drug affects the brain and body. Additionally, the review explores the short-term and long-term effects of drug abuse on the body and mind, including changes in brain structure and function, physical health problems, and mental health issues, such as depression and anxiety. In addition, the review explores the effects of drug abuse on cardiovascular health, focusing on electrocardiogram changes. Moreover, the analysis of relevant literature also highlighted possible genetic susceptibility in various addictions. Furthermore, the review delves into the withdrawal symptoms that occur when someone stops using drugs of abuse after a period of chronic use.

CONCLUSION

Overall, this review provides a comprehensive overview of the current state of knowledge on drug abuse and addiction. The findings of this review can inform the development of evidence-based prevention and intervention strategies to address this critical public health issue.

Ratings of executive function as a risk factor for adolescents' frequent cannabis use: A prospective longitudinal study

OBJECTIVE

We examined the extent to which behavioral ratings of children's executive function (EF) in early adolescence predicted adolescents' cannabis use, and whether associations were independent of parents' cannabis and alcohol use and adolescents' alcohol use.

METHOD

Participants were 198 offspring (44% boys) of 127 mothers and 106 fathers. Parents and teachers completed the Behavior Rating Inventory of Executive Function (BRIEF) at ages 11-14 years. Youth were interviewed repeatedly from ages 14 to 20 years regarding frequency of cannabis and alcohol use. Two-level models regressed dichotomous cannabis outcomes (annual, weekly, or daily use) on age at the within-person level and the random intercept of cannabis use on EF, parent substance use, and covariates (age 7 IQ indicators, child gender, parent education, and mean of ages assessed) at the between-person level.

RESULTS

Poorer child EF predicted significantly (p < .05) higher likelihood of weekly (b[SE] = .64[.24]) and daily (b[SE] = .65[.25]), but not annual (b[SE] = .38[.22]), cannabis use. Parent cannabis use (b[SE] = .53[.25] to .81[.39], p < .05) independently predicted all three outcomes, and effects were distinct from those explained by parent alcohol use (b[SE] = .66[.29] to .81[.35], p < .05). EF remained a significant predictor of weekly and daily cannabis use after adjusting for parental alcohol and cannabis use, and adolescents' alcohol use.

CONCLUSIONS

Children exhibiting poorer EF were more likely to use cannabis weekly and daily in later adolescence. Whereas literature suggests poorer EF may be a consequence of cannabis use, these findings suggest EF should be considered prior to cannabis use initiation. EF during childhood may be a fruitful prevention target. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cannabinoids and Multiple Sclerosis: A Critical Analysis of Therapeutic Potentials and Safety Concerns

Multiple sclerosis (MS) is a complicated condition in which the immune system attacks myelinated axons in the central nervous system (CNS), destroying both myelin and axons to varying degrees. Several environmental, genetic, and epigenetic factors influence the risk of developing the disease and how well it responds to treatment. Cannabinoids have recently sparked renewed interest in their therapeutic applications, with growing evidence for their role in symptom control in MS. Cannabinoids exert their roles through the endogenous cannabinoid (ECB) system, with some reports shedding light on the molecular biology of this system and lending credence to some anecdotal medical claims. The double nature of cannabinoids, which cause both positive and negative effects, comes from their actions on the same receptor. Several mechanisms have been adopted to evade this effect. However, there are still numerous limitations to using cannabinoids to treat MS patients. In this review, we will explore and discuss the molecular effect of cannabinoids on the ECB system, the various factors that affect the response to cannabinoids in the body, including the role of gene polymorphism and its relation to dosage, assessing the positive over the adverse effects of cannabinoids in MS, and finally, exploring the possible functional mechanism of cannabinoids in MS and the current and future progress of cannabinoid therapeutics.

The associations of cannabis and methamphetamine use with cognitive performance over the first 2 years of treatment in schizophrenia spectrum disorders

AIM

Cognitive deficits are a core feature of schizophrenia, and comorbid substance use may be a contributory factor. Methamphetamine use has been associated with cognitive impairment in schizophrenia, while associations with cannabis use are less clear-cut. This study aimed to investigate the associations of cannabis and methamphetamine use with cognitive performance in first-episode schizophrenia spectrum disorders over the first 2 years of treatment.

METHODS

This was a longitudinal cohort study in 81 patients treated with flupenthixol decanoate according to a standardized protocol over 24 months. Cognitive performance was assessed with the Measurement and Treatment Research to Improve Cognition in Schizophrenia Cognitive Consensus Battery at four time points, and urine testing for cannabis and methamphetamine was conducted at six time points. We used linear mixed-effect models for repeated measures to assess visit-wise changes in composite cognitive scores in patients (n = 91) compared to matched controls without psychiatric or medical disorders (n = 100). Linear regression models were constructed to examine pre-treatment and end-point effects in patients.

RESULTS

Compared to controls, patients exhibited greater cognitive impairments at baseline, which improved with treatment, but remained significantly lower throughout. The number of positive methamphetamine, but not cannabis, tests predicted less cognitive improvement in patients.

CONCLUSIONS

Our findings suggest a negative association between methamphetamine and cognition, but not cannabis.

Assessment of Withdrawal, Mood, and Sleep Inventories After Monitored 3-Week Abstinence in Cannabis-Using Adolescents and Young Adults

Introduction: Among adolescents and young adults, cannabis use is prevalent. Prior studies characterizing withdrawal effects in this age range have primarily included treatment seeking or comorbid psychiatric samples; these studies have identified several affected domains, especially sleep, mood, and anxiety. The present study compared a community (i.e., nontreatment seeking) sample of cannabis-using and control participants on mood, anxiety, sleep, and withdrawal inventories during the course of a monitored 3-week cannabis abstinence period. Materials and Methods: Seventy-nine adolescent and young adult participants (cannabis-using group=37 and control group=42) were recruited from the community to undergo 3 weeks of confirmed abstinence (i.e., urine and sweat patch toxicology) and completion of Cannabis Withdrawal Symptom Criteria, State-Trait Anxiety Inventory, Beck's Depression Inventory, and Pittsburgh Sleep Quality Index across the study period. Repeated measures and cross-sectional regressions were used to examine main effects of group and interactions with time (where appropriate), while accounting for recent alcohol use and cotinine levels. Results: Cannabis-using participants reported higher mood (p=0.006), overall withdrawal (p=0.009), and sleep-related withdrawal (p<0.001) symptoms across abstinence compared to controls. Overall withdrawal severity (p=0.04) and sleep-related withdrawal symptoms (p=0.02) demonstrated a quadratic trajectory across the monitored abstinence periods, with an increase from baseline and subsequent decreases in symptom severity. No differences of anxiety scores (p=0.07) or trajectories (p=0.18) were observed. By study completion, groups did not differ among sleep quality components (all p's>.05). Conclusions: These findings revealed that nontreatment-seeking cannabis-using adolescents and young adults reported heightened total withdrawal symptoms during a 3-week sustained abstinence period relative to controls. Cannabis-using participants demonstrated an increase in withdrawal symptom trajectory during the first week followed by decreased symptoms from weeks 2 to 3, which contrasts with prior linear decreases observed in cannabis-using adolescent and young adults. More mood symptoms were observed in the cannabis-using group even while excluding for comorbid psychopathologies-along with significantly more sleep problems during the abstinence period. Implications include the necessity to provide psychoeducation for recreational, nontreatment-seeking cannabis-using individuals about cannabis withdrawal, mood symptoms, and sleep quality difficulties when cannabis cessation is attempted, to improve likelihood of long-term sustained abstinence.

A functional neuroimaging study of self-other processing alterations in atypical developmental trajectories of psychotic-like experiences

Self-disturbances constitute a hallmark of psychosis, but it remains unclear whether these alterations are present in at-risk populations, and therefore their role in the development of psychosis has yet to be confirmed. The present study addressed this question by measuring neural correlates of self-other processing in youth belonging to three developmental trajectories of psychotic experiences. Eighty-six youths were recruited from a longitudinal cohort of over 3800 adolescents based on their trajectories of Psychotic-Like Experiences from 12 to 16 years of age. Participants underwent neuroimaging at 17 years of age (mean). A functional neuroimaging task evaluating self- and other-related trait judgments was used to measure whole-brain activation and connectivity. Youth who showed an increasing trajectory displayed hypoactivation of the dorsomedial prefrontal cortex and hypoconnectivity with the cerebellum. By contrast, youth who showed a decreasing trajectory displayed decreased activation of the superior temporal gyrus, the inferior frontal gyrus, and the middle occipital gyrus. These findings suggest that the increasing trajectory is associated with alterations that might erode distinctions between self and other, influencing the emergence of symptoms such as hallucinations. The decreasing trajectory, in comparison, was associated with hypoactivations in areas influencing attention and basic information processing more generally. These alterations might affect the trajectories’ susceptibilities to positive vs. negative symptoms, respectively.

Swear Word Fluency, Verbal Fluency, Vocabulary, Personality, and Drug Involvement

Abstract. Swearing is stereotypically associated with socially undesirable traits and behaviors, including limited verbal ability, disagreeable personality, and alcohol use. We sought to demonstrate that, contrary to such stereotypes, swear word fluency (i.e., ability to generate swear words) does not arise from a lack of verbal skills. We also explored whether swear word fluency might serve as an index of personality traits related to drug use. Accordingly, we conducted a preregistered study in which 266 undergraduates at a US university ( Mage = 19.36; 66.9% self-identified as women and 49.6% as White) completed measures of swear word fluency, verbal fluency (i.e., overall ability to generate words), vocabulary, Big Five traits, sensation seeking, and drug use. We observed positive associations between swear word fluency and verbal fluency, vocabulary, Openness, and Extraversion, and a negative association with Agreeableness. Moreover, swear word fluency accounted for unique variance in self-reported drug use over and above that accounted for by personality and general verbal ability. Swear word fluency might serve as one of few tasks where higher scores predict more drug involvement, justifying further work linking this measure with other aspects of personality and drug use.

How do cannabis users mentally travel in time? Evidence from an fMRI study of episodic future thinking

RATIONALE

Episodic future thinking (EFT) is a cognitive function that allows individuals to imagine novel experiences that may happen in the future. Prior studies show that EFT is impaired in different groups of substance users. However, there is no evidence regarding the neurobiological mechanisms of EFT in cannabis users.

OBJECTIVES

We aimed to compare brain activations of regular cannabis users and non-using controls during an EFT fMRI task. Exploratory analyses were also conducted to investigate the association between EFT and cannabis use variables (e.g., duration of use, age onset, frequency of use).

METHODS

Twenty current cannabis users and 22 drug-naïve controls underwent an fMRI scanning session while completing a task involving envisioning future-related events and retrieval of past memories as a control condition. The EFT fMRI task was adapted from the autobiographical interview and composed of 20 auditory cue sentences (10 cues for past and 10 cues for future events). Participants were asked to recall a past or generate a future event, in response to the cues, and then rate their vividness after each response.

RESULTS

We found that cannabis users compared to non-user controls had lower activation within the cerebellum, medial and superior temporal gyrus, lateral occipital cortex, and occipital fusiform gyrus while envisioning future events. Cannabis users rated the vividness of past events significantly lower than non-users (P < 0.005). There were marginal group differences for rating the vividness of future events (P = 0.052). Significant correlations were also found between the medial and superior temporal gyrus activities and behavioral measures of EFT and episodic memory.

CONCLUSIONS

Cannabis users, compared to drug-naïve controls, have lower brain activation in EFT relevant regions. Thus, any attempts to improve aberrant EFT performance in cannabis users may benefit from EFT training.

Medical Cannabis Use Reduces Opioid Prescriptions in Patients With Chronic Back Pain

Background

This study investigates whether the use of medical cannabis (MC) in patients with chronic back pain is associated with a decreased opioid prescription.

Methods

The study included 186 patients with chronic back pain who were certified for MC use. The average morphine milligram equivalent (MME)/day of opioid prescriptions filled within the six months prior to MC certification was compared to that of six months after. Pain and disability questionnaires were distributed at three, six, and nine months post-certification.

Results

Patients who started at less than 15 MME/day and patients who started at greater than 15 MME/day decreased from 15.1 to 11.0 (n = 186, p < 0.01), 3.5 to 2­­­.1 (n = 134, p < 0.01), and 44.9 to 33.9 (n = 52, p < 0.01), respectively. Pain and disability scores were improved at follow-up as well.

Conclusion

MC use reduces opioid prescription for patients with chronic back pain and improves pain and disability scores.

Simultaneous Alcohol and Marijuana Use Among Young Adults: A Scoping Review of Prevalence, Patterns, Psychosocial Correlates, and Consequences

BACKGROUND

Alcohol and marijuana are commonly used by young adults, and use of both substances, particularly at the same time, is prevalent among this population. Understanding the prevalence, patterns, correlates, and consequences of simultaneous alcohol and marijuana (SAM) use is important to inform interventions. However, this literature is complicated by myriad terms used to describe SAM use, including use with overlapping effects and same-day co-use.

OBJECTIVES

This scoping review identifies and describes the peer-reviewed literature focused on SAM use by young adults and distinguishes simultaneous use from same-day co-use of alcohol and marijuana. This review also provides a narrative summary of the prevalence of SAM use, patterns of SAM and other substance use, psychosocial correlates, and consequences of SAM use.

ELIGIBILITY CRITERIA

This review is limited to papers written in English and published in peer-reviewed journals between January 2000 and August 2021. It includes papers assessing simultaneous use or same-day co-use of alcohol and marijuana among young adults ages 18 to 30. Review papers, qualitative interviews, experimental lab studies, policy work, toxicology or medical reports, and papers focused on neurological outcomes are excluded.

SOURCES OF EVIDENCE

PubMed, PsycINFO, and Web of Science databases were searched. Databases were selected and the search strategy developed in consultation with an information specialist.

CHARTING METHODS

A data charting form was utilized to specify which information would be extracted from included papers. Eight categories of data were extracted: (1) research questions and hypotheses; (2) sample characteristics; (3) study procedures; (4) definition of SAM use; (5) prevalence of SAM use; (6) patterns of SAM and other substance use; (7) psychosocial correlates of SAM use; and (8) consequences of SAM use.

RESULTS

A total of 1,282 papers were identified through initial search terms. Through double-blind title/abstract screening and full-text review, the review was narrowed to 74 papers that met review inclusion criteria. Review of these papers demonstrated that SAM use was prevalent among young adults, particularly among those who reported heavier quantities and more frequent use of alcohol and marijuana. Enhancement-related motives for use were consistently positively associated with SAM use. SAM use was associated with greater perceived positive and negative consequences of alcohol and/or marijuana use. Inconsistencies in prevalence, patterns, correlates, and consequences were found between studies, which may be due to large variations in measurement of SAM use, populations studied, methodological design (e.g., cross-sectional vs. intensive longitudinal), and the covariates included in models.

CONCLUSIONS

The literature on simultaneous use and same-day co-use of alcohol and marijuana has expanded rapidly. Of the 74 included papers (61 on SAM use; 13 on same-day co-use), 60 papers (47 on SAM use; 13 on same-day co-use) were published within the last 5 years. Future research focusing on the ways in which SAM use confers acute risk, above and beyond the risks associated with separate consumption of alcohol and marijuana, is needed for understanding potential targets for intervention.

Adolescent exposure to cannabis marketing following recreational cannabis legalization in Canada: A pilot study using ecological momentary assessment

Objective

The goal of this pilot study was to assess the feasibility of a 9-day, smartphone-based ecological momentary assessment (EMA) protocol for tracking the frequency of Canadian adolescents' exposures to cannabis marketing, their reactions to such exposures, and the context in which exposures occur in the real-world and in real-time.

Method

Participants were n = 18 adolescents between the ages of 14 and 18 years of age. They used an EMA application to capture and describe cannabis marketing exposures through photographs and brief questionnaires assessing marketing channel and context. Participants also rated their reactions to each exposure in real-time.

Results

Results showed that participants were generally compliant with the protocol. Participants recorded 40 total exposures to cannabis marketing, representing an average of 2.2 (SD 2.3) exposures per participant during the 9-day study. Exposures tended to occur in the afternoon (45.0%) or evening (37.5%), and while participants were at home (70%) and alone (52.5%). Most exposures occurred through promotion by public figures (27.5%) or explicitly marked internet ads (27.5%).

Conclusion

This is the first study to demonstrate the feasibility and utility of EMA to capture adolescent exposures to cannabis marketing as it occurs in participants' natural environments. Our research offers an early look at the predictable wave of cannabis advertising targeting youth and a promising approach for studying its impacts in a post-legalization context, as well as a strategy for assessing policies, such as advertising restrictions, intending to mitigate the harms of early cannabis use among youth.

Initiation of Moderately Frequent Cannabis use in Adolescence and Young Adulthood is Associated with Declines in Verbal Learning and Memory: A Longitudinal Comparison of Pre- versus Post-Initiation Cognitive Performance

OBJECTIVE

Cannabis use is associated with relative cognitive weaknesses as observed by cross-sectional as well as longitudinal research. Longitudinal studies, controlling for relevant confounds, are necessary to differentiate premorbid from post-initiation contributions to these effects.

METHODS

We followed a sample of adolescents and young adults across ten years. Participants provided neurocognitive data and substance use information at two-year intervals. Participants who initiated cannabis and/or alcohol use were identified (n = 86) and split into alcohol-only initiators (n = 39) and infrequent (n = 29) and moderately frequent (n = 18) cannabis initiators. Participants completed the Rey Auditory Verbal Learning Task (RAVLT) and the Iowa Gambling Task (IGT). Group differences before and after substance use initiation and the extent to which alcohol, nicotine, and cannabis use frequencies contributed to cognitive functions over time were examined.

RESULTS

After controlling for parental education, RAVLT new learning was worse in moderately frequent cannabis users prior to use initiation. RAVLT total learning and delayed recall showed significant declines from pre- to post-initiation in moderately frequent cannabis users. Regression analyses confirmed that frequencies of cannabis, but not alcohol, use contributed to post-initiation variations. Nicotine use showed an independent negative association with delayed memory. Findings for the IGT were not significant.

CONCLUSIONS

Verbal learning and memory may be disrupted following the initiation of moderately frequent cannabis use while decreased new learning may represent a premorbid liability. Our use of a control group of alcohol-only users adds interpretive clarity to the findings and suggests that future studies should carefully control for comorbid substance use.

Cannabis and driving ability

The aim of this review is to discuss recent evidence on cannabis and driving ability. In particular, the review examines experimental research on the acute effects of tetrahydrocannabinol (THC) on driving-related neurobehavioral skills and driving performance based on simulator and road course studies. The evidence indicates that certain driving abilities are significantly, albeit modestly, impaired in individuals experiencing the acute effects of THC. Treatment effects are moderated by dose, delivery method, recency of use, and tolerance development, with inconclusive evidence concerning the moderating influence of cannabidiol. Emerging research priorities include linking neurobehavioral deficits to specific decrements in driving performance, estimating the real-world implications of experimental impaired driving research, understanding how tolerance differentially affects driving impairment across subgroups, and developing more evidence on cannabidiol's potential role in mitigating THC-induced impairment.

Investigating the Residual Effects of Chronic Cannabis Use and Abstinence on Verbal and Visuospatial Learning

Rationale: Regular cannabis users have been shown to differ from non-using controls in learning performance. It is unclear if these differences are specific to distinct domains of learning (verbal, visuospatial), exacerbate with extent of cannabis exposure and dissipate with sustained abstinence. Objective: This study examines different domains of learning (verbal, visuospatial) in current and abstaining cannabis users, and the role of chronicity of use. Methods: In a cross-sectional design, we examined 127 psychiatrically healthy participants (65 female) with mean aged of 34 years. Of these, 69 individuals were current regular cannabis users (mean 15 years use), 12 were former cannabis users abstinent for ~2.5 yrs (after a mean of 16 years use), and 46 were non-cannabis using controls. Groups were compared on verbal learning performance assessed via the California Verbal Learning Test (CVLT-II) and for visuospatial learning measured with the Brown Location Test (BLT). We explored the association between CVLT/BLT performance and cannabis use levels in current and former users. Results: Current cannabis use compared to non-use was associated with worse performance on select aspects of verbal learning (Long Delay Cued Recall) and of visuospatial learning (Retroactive Interference and LD Rotated Recall). Prolonged abstinence was associated with altered verbal learning but intact visuospatial learning. There were non-significant correlations between distinct cannabis use measures, age and learning in both current and former users. Conclusions: Our findings suggest cannabis use status (current use, former use) affects different domains of learning (verbal and visuospatial) in a distinct fashion. These findings might be accounted for in the design of cognitive interventions aimed to support abstinence in cannabis users.

Risks versus consequences of adolescent and young adult substance use: A focus on executive control

PURPOSE OF REVIEW

This review examines the role of executive control processes in the liability for substance misuse and whether substance use, once initiated, leads to subsequent decrements as proposed by neurotoxicity models of substance use disorder (SUD).

RECENT FINDINGS

As indicated by a number of recent meta-analyses, executive control processes, which include working memory, cognitive flexibility and numerous aspects of attentional, behavioral and emotional control, are impaired in the context of active SUD. Longitudinal studies of behaviorally disinhibited children, individuals with familial risks for SUD, and twins within whom genetic versus environmental influences on behavior can be modeled robustly indicate that relatively poor control is a vulnerability factor for early substance use initiation, binge patterns of use, and subsequent SUD. Evidence of further declines in executive control, once substance use is initiated, is mixed, although a growing number of neuroimaging studies indicate that frontostriatal, frontolimbic, and frontocerebellar systems are altered as a consequence of use.

SUMMARY

Together these patterns suggest strategies for identifying children and adolescents at high risk for SUD, avenues through which substance-related neurotoxicities can be more reliably detected, and the need to structure prevention efforts in a manner that is developmentally appropriate and perhaps personalized to individual vulnerabilities.

Vaping and e-cigarette use. Mysterious lung manifestations and an epidemic

Electronic (e)-cigarette use and the practice of vaping has rapidly expanded both in adult smokers and previously nicotine naïve youths. Research has focused on harm reduction in adults using e-cigarettes to stop or reduce traditional cigarette use, but the short and long-term safety of these products has not been established. Vaping has more recently been associated with a growing list of pulmonary complications with the most urgent being the e-cigarette or vaping product use-associated lung injury (EVALI) epidemic. This review details the inhalant toxicology of vaping products, the described lung diseases associated with vaping with a focus on EVALI, and the predicted long-term consequences of e-cigarette use, including increased asthma severity.

Facing the option for the legalisation of cannabis use and supply in New Zealand: An overview of relevant evidence, concepts and considerations

ISSUES

Non-medical cannabis policies are changing, including towards legalisation-with-regulation frameworks. New Zealand will hold a public referendum on cannabis legalisation in 2020. We reviewed data on cannabis use and health/social harms; policy reform options; experiences with and outcomes of reforms elsewhere; and other relevant considerations towards informing policy choices in the upcoming referendum.

APPROACH

Relevant epidemiological, health, social, criminal justice and policy studies and data were identified and comprehensively reviewed.

KEY FINDINGS

Cannabis use is common (including in New Zealand) and associated with risks for health and social harms, mainly concentrated in young users; key harms are attributable to criminalisation. 'Decriminalisation' reforms have produced ambivalent results. Existing cannabis legalisation frameworks vary considerably in main parameters. Legalisation offers some distinct advantages, for example regulated use, products and user education, yet outcomes depend on essential regulation parameters, including commercialisation, and policy ecologies. While major changes in use are not observed, legalisation experiences are inconclusive to date, including mixed health and social outcomes, with select harms increasing and resilient illegal markets. It is unclear whether legalisation reduces cannabis exposure or social harms (e.g. from enforcement) for youth.

IMPLICATIONS/CONCLUSIONS

No conclusive overall evidence on the outcomes of legalisation elsewhere exists, nor is evidence easily transferable to other settings. Legalisation offers direct social justice benefits for adults, yet overall public health impacts are uncertain. Legalisation may not categorically improve health or social outcomes for youth. Legalisation remains a well-intended, while experimental policy option towards more measured and sensible cannabis control and overall greater policy coherence, requiring close monitoring and possible adjustments depending on setting-specific outcomes.