Medical Marijuana, Neurocognition, and Subsequent Substance Use

医用大麻（MM）政策正在迅速变化，MM使用的后果对于那些 寻求访问它是未知的。在提交本报告时，25个州以及哥伦比亚特区 已经合法化MM，并且随着这一政策的变化，很可能那些没有使用过MM的人， 大麻在过去，或谁曾使用大麻偶尔为娱乐目的，将开始使用 第一次将大麻作为药用。一旦这些人收到MM卡，他们将增加 获得大麻以及社会许可，因为认为医疗效益。更多机会获得 大麻可能导致使用的升级和可能的大麻相关危害;作为娱乐性大麻使用 与不良健康结果有关，如大麻使用障碍（CUD），神经认知障碍， 损伤和大脑变化，研究MM患者是否会经历类似的影响至关重要。 为了解决这些及时和临床上重要的问题，我们建议进行一项随机，纵向 MM的研究将：（1）表征MM对成瘾指数的影响，如CUD， 使用，耐受性，和停止使用者中的退出，（2）通过给药日记评估MM的作用 使用其他药物的使用模式，以及对基础疾病的认知，（3） 表征MM对神经认知性能的影响，包括执行功能、记忆力、注意力， 和决策和（4）检查MM对大脑结构和功能影响的证据。我们提出 招募200名目前没有CUD或大量使用大麻的成年人（例如每周或更少），他们表示 有兴趣获得MM卡使用MM治疗疼痛，失眠，焦虑和/或抑郁症，最 使用MM的常见条件。受试者将被随机分配至活性MM组（n = 100），其中他们可以获得MM卡没有延迟，或等待列表控制臂（WLC）（n = 100），其中 申请人须等候三个月才可获发身份证。将在基线时对参与者进行评估， 3个月，以及6个月和1年随访时的MM使用行为、CUD发展、 疾病行为学和神经认知表现。参与者将被激励保持详细 通过智能手机应用程序记录每天使用多少MM，使用的其他药物， 以及疼痛、睡眠质量和情绪的每日评分。每次访视时采集的尿液将使用以下指标进行评估： 大麻代谢物的定量分析。在MM组中，将在基线和第1天收集MRI扫描结果。 年，纵向研究与MM使用相关的可能的大脑变化。该项目将填补 在我们的知识中存在一个关键的差距，在大麻被合法化用于“医疗”用途的重要时刻， 已知MM对疾病症状、成瘾、神经认知或脑功能的影响。我们预计 这项研究的结果数据将告知临床医生，科学家和政策制定者关于潜在的 政策变化的不利影响，增加了对MM的访问。

Medical marijuana (MM) policies are changing rapidly, and the consequences of MM use for individuals who seek access to it are unknown. At the time of this submission, 25 states as well as the District of Columbia have legalized MM, and following this policy change, it is likely that individuals who either have not used marijuana in the past, or who have used marijuana occasionally for recreational purposes, will start to use marijuana medicinally for the first time. Once these individuals receive MM cards, they will have increased access to marijuana as well as societal permission because of perceived medical benefit. Increased access to marijuana may lead to escalation of use and possible marijuana-related harms; as recreational marijuana use has been associated with adverse heath outcomes such as cannabis use disorders (CUD), neurocognitive impairments, and brain-based changes, it is critical to study whether MM patients will experience similar effects. To address these timely and clinically important questions, we propose to conduct a randomized, longitudinal study of MM that will: (1) characterize the impact of MM on indices of addiction, such as CUD, escalation of use, tolerance, and withdrawal among those who stop using, (2) assess, via dosing diaries, the effect of MM use patterns on use of other medications, and perception of underlying disease symptomatology, (3) characterize the impact of MM on neurocognitive performance, including executive function, memory, attention, and decision-making and (4) examine evidence for impact of MM on brain structure and function. We propose to enroll 200 adults with no current CUD or heavy marijuana use (e.g. weekly or less frequent), who express interest in obtaining MM cards to use MM to treat pain, insomnia, anxiety, and/or depression, the most common conditions for which MM is used. Participants will be randomly assigned to either an active MM arm (n = 100) in which they can obtain MM cards without delay, or to a waitlist control arm (WLC) (n = 100), in which they are asked to wait 3 months before obtaining a card. Participants will be assessed at baseline, regularly for 3 months, and at a 6-month and 1-year follow-up for MM use behaviors, development of CUD, perception of disease symptomatology, and neurocognitive performance. Participants will be incentivized to keep detailed dosing diaries, via smartphone apps, to record how much MM was used each day, other medications used, and daily ratings of pain, sleep quality, and mood. Urine collected at each visit will be assessed with quantitative assays for cannabis metabolites. In the MM group, MRI scans will be collected at baseline and at 1 year, to longitudinally investigate possible brain changes associated with MM use. The proposed project will fill a critical gap in our knowledge, at a significant time when cannabis is being legalized for ‘medical’ use with little known about effects of MM on disease symptoms, addictions, neurocognition or brain function. We anticipate that the resulting data from this study will inform clinicians, scientists, and policy-makers about potential adverse effects of policy changes that increase access to MM.