Medical Marijuana, Neurocognition, and Subsequent Substance Use

医用大麻(MM)政策正在迅速变化，使用MM对那些 寻求访问它的人是未知的。在提交本文件时，25个州以及哥伦比亚特区 已经使MM合法化，在这一政策变化之后，可能没有使用过MM的个人 过去使用大麻，或偶尔将大麻用于娱乐目的的人，将开始使用 第一次将大麻用于药用。一旦这些人收到MM卡，他们将增加 由于被认为有医疗益处，因此获得大麻以及社会许可。更多地访问 大麻可能导致使用的升级和可能的与大麻有关的危害；作为娱乐用大麻 与不良健康后果有关，如大麻使用障碍(CUD)、神经认知 对于多发性骨髓瘤患者是否会经历类似的影响，研究损害和基于大脑的变化是至关重要的。 为了解决这些及时和临床上重要的问题，我们建议进行随机的、纵向的 MM的研究将：(1)表征MM对成瘾指标的影响，如CUD、行为升级 停止使用的人的使用、耐受性和戒断；(2)通过给药日记评估MM的效果 其他药物的使用模式，以及对潜在疾病症状的认知，(3) 描述MM对神经认知表现的影响，包括执行功能、记忆、注意力、 和决策以及(4)检验MM对大脑结构和功能影响的证据。我们建议 招募200名目前没有吸食大麻或大量吸食大麻(例如，每周或更少使用大麻)的成年人，他们表示 有兴趣获得MM卡使用MM治疗疼痛、失眠、焦虑和/或抑郁的人最多 使用MM的常见条件。参与者将被随机分配到活动的MM ARM(n =100)，其中他们可以不延迟地获得MM卡，或者到达等待列表控制臂(WLC)(n=100)，其中 他们被要求等待3个月才能拿到卡。参与者将在基线时进行评估，定期 3个月，以及6个月和1年的MM使用行为、CUD的发展、对 疾病症状和神经认知能力。参与者将被激励保持详细的 通过智能手机应用程序，记录每天使用MM的量，使用的其他药物， 每天对疼痛、睡眠质量和情绪进行评级。每次就诊时收集的尿液将被评估为 大麻代谢物的定量分析。在MM组，MRI扫描将在基线和1点收集 年，纵向调查与MM使用相关的可能的大脑变化。拟议中的项目将填补 我们在知识上的一个关键差距，在大麻被合法化用于医疗用途的重要时刻，几乎没有 已知MM对疾病症状、成瘾、神经认知或脑功能的影响。我们期待着 这项研究的结果数据将使临床医生、科学家和政策制定者了解潜在的 增加获得新兴市场机会的政策变化的不利影响

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.