Cannabis use following trauma exposure: An observational study of the impact of acute stress and fear response on cannabis outcomes

创伤暴露后使用大麻：急性压力和恐惧反应对大麻结果影响的观察性研究

• 批准号: 10444156
• 负责人: Leslie Ann Daline Brick
• 金额: $ 73.19万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10444156
• 关键词: Accident and Emergency department; Acute; Adolescent; Arousal; Automobile Driving; Behavior; Belief; Biological Process; Cannabinoids; Cannabis; Cannabis-Related Disorder; Chronic; Clinical; Coupled; Coupling; Data; Development; Diagnosis; Disease; Distress; Drug usage; Early-life trauma; Ecological momentary assessment; Evaluation; Exhibits; Exposure to; Extinction (Psychology); Fright; Galvanic Skin Response; General Hospitals; Geographic state; Goals; Heart Rate; Hospitals; Impairment; Individual; Informal Social Control; Interview; Investigation; Laboratory Procedures; Laws; Lead; Learning; Legal; Licensing; Link; Long-Term Effects; Measures; Medical; Medical Marijuana; Memory; Modeling; Negative Reinforcements; Neurobiology; Observational Study; Outcome; Output; Participant; Patient Self-Report; Phase; Physiological; Physiology; Play; Post-Traumatic Stress Disorders; Problem behavior; Prospective Studies; Psychotropic Drugs; Public Health; Qualifying; Recreational Drugs; Reporting; Research; Retrieval; Risk; Role; Safety; Self Medication; Severities; Stress; Substance Use Disorder; Symptoms; System; Therapeutic; Time; Trauma; Trauma recovery; Traumatic injury; United States; Work; acute stress; acute symptom; aged; biological adaptation to stress; craving; critical period; emerging adult; endocannabinoid signaling; endogenous cannabinoid system; fear memory; follow-up; high risk; high risk population; in vivo; indexing; insight; marijuana legalization; marijuana use; marijuana use disorder; marijuana user; neural circuit; neurophysiology; physical assault; post-trauma; post-traumatic symptoms; pre-clinical research; prospective; recruit; response; smart watch; substance use; trauma exposure; traumatic event; vehicular accident; wearable sensor technology; young adult

PROJECT SUMMARY Exposure to trauma is associated with a range of negative outcomes such as posttraumatic stress disorder (PTSD) and substance use disorder, particularly cannabis. The early posttrauma period (i.e., the days, weeks, and months following exposure) represents a critical period of risk for long term problem behaviors, especially among emerging adults (aged 18-25), which constitutes continued development accompanied by a peak in substance use and increased risk for trauma exposure. As regional laws, cultures, and beliefs about cannabis use (CU) continue to shift, there is concern that trauma exposure may exacerbate use (via self-regulation) and lead to greater cannabis-related problems, as many individuals report using cannabis to relieve distress, hyperarousal, and other posttrauma symptoms. Furthermore, while the majority of US states that have legalized cannabis for medical use include outcomes of stress and trauma, such as PTSD, as qualifying conditions for a state-issued medical marijuana license, little is known about how cannabis may impact the early post-trauma course. Given that the endocannabinoid system plays an essential role in regulating stress response and learned fear, CU in the acute post-trauma period may alter mechanisms contributing to alterations in fear neurocircuitry (e.g., alterations in consolidation/ reconsolidation, retrieval, extinction) and physiological reactivity. Limited (and contradicting) evidence, however, regarding safety and efficacy of cannabis preclude strong conclusions about its potential therapeutic role, with some prospective studies demonstrating detrimental or no long-term effects of CU on PTSD symptoms. The overall goal of our study is to examine the interplay between posttraumatic stress symptoms and cannabis use behavior during the period immediately following trauma exposure. We will recruit and prospectively follow N=200 trauma-exposed regular cannabis users admitted to the general hospital emergency department after medical evaluation for traumatic injury. Upon discharge, participants will complete ecological momentary assessment (EMA) paired with wearable biosensors (smartwatch) to record CU behavior, symptom development, and physiological output (i.e., heart rate) during early trauma recovery. Participants will return for completion of clinical interview and self-report, as well as laboratory procedures to characterize fear extinction and physiological reactivity. The main goals of this research are to: (a) assess alterations in fear response and physiological reactivity associated with CU, (b) characterize the impact of posttraumatic stress symptoms on cannabis use behaviors, and (c) determine whether early markers of altered physiology and posttraumatic stress symptoms are makers for trajectories of long-term adverse cannabis-related outcomes (i.e., use disorder, problems, chronic/heavy use).

项目概要 遭受创伤与一系列负面结果有关，例如创伤后应激障碍 （创伤后应激障碍）和物质使用障碍，特别是大麻。创伤后早期（即几天、几周、 以及暴露后的几个月）代表了长期问题行为的关键风险期，尤其是 新兴成年人（18-25 岁）中，这构成了持续发展并伴随着高峰 物质使用和外伤暴露风险增加。随着有关大麻的地区法律、文化和信仰 使用（CU）继续发生变化，人们担心创伤暴露可能会加剧使用（通过自我调节）和 导致更大的与大麻相关的问题，因为许多人报告使用大麻来缓解痛苦， 过度警觉和其他创伤后症状。此外，虽然美国大多数州已经 医用大麻合法化包括压力和创伤的后果，例如创伤后应激障碍（PTSD），作为合格的 尽管国家颁发的医用大麻许可证的条件，但人们对大麻可能如何影响知之甚少。 早期创伤后课程。鉴于内源性大麻素系统在调节压力方面发挥着重要作用 反应和习得性恐惧，急性创伤后时期的 CU 可能会改变导致 恐惧神经回路的改变（例如，巩固/再巩固、检索、消退的改变）和 生理反应。然而，关于安全性和有效性的证据有限（且相互矛盾） 大麻排除了关于其潜在治疗作用的强有力的结论，一些前瞻性研究 证明 CU 对 PTSD 症状有有害或没有长期影响。我们研究的总体目标是 检查在此期间创伤后应激症状与大麻使用行为之间的相互作用 创伤暴露后立即。我们将招募并前瞻性跟踪 N=200 名遭受过创伤的人 经常吸食大麻的人在经过医疗评估后被送往综合医院急诊科 外伤。出院后，参与者将完成配对的生态瞬时评估（EMA） 使用可穿戴生物传感器（智能手表）记录 CU 行为、症状发展和生理情况 早期创伤恢复期间的输出（即心率）。参与者将返回完成临床访谈 自我报告，以及表征恐惧消退和生理反应的实验室程序。 这项研究的主要目标是：（a）评估恐惧反应和生理反应的变化 与 CU 相关，(b) 描述创伤后应激症状对大麻使用行为的影响， (c) 确定生理改变和创伤后应激症状的早期标志是否是制造者 与大麻相关的长期不良后果的轨迹（即使用障碍、问题、慢性/重度 使用）。