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

项目总结 暴露在创伤中与一系列负面后果有关，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，天、周、 和暴露后的几个月)代表着长期问题行为的关键风险时期，特别是 在新兴成年人(18-25岁)中，这构成了持续发展，同时伴随着 使用药物和增加创伤暴露的风险。作为关于大麻的地区性法律、文化和信仰 使用(CU)继续转变，人们担心创伤暴露可能会加剧使用(通过自我调节)和 导致更大的与大麻有关的问题，因为许多人报告说，使用大麻来缓解痛苦， 高度唤醒，以及其他创伤后症状。此外，虽然美国大多数拥有 医用大麻合法化包括压力和创伤的后果，如创伤后应激障碍 关于国家颁发的医用大麻许可证的条件，人们对大麻可能如何影响 创伤后早期课程。鉴于内源性大麻素系统在调节压力方面起着至关重要的作用 反应和获得性恐惧，CU在急性创伤后时期可能改变促进机制 恐惧神经回路的改变(例如，巩固/再巩固、提取、消失的改变)和 生理反应。然而，关于安慰剂的安全性和有效性的证据有限(和矛盾) 大麻排除了关于其潜在治疗作用的强有力的结论，并进行了一些前瞻性研究 证明慢性精神分裂症对创伤后应激障碍症状有害或没有长期影响。我们研究的总体目标是 研究创伤后应激症状与期间的大麻使用行为之间的相互作用 紧跟在创伤暴露之后。我们将招募并前瞻性地跟踪N=200名创伤暴露者 经常吸食大麻的人在接受医疗评估后被送往综合医院急诊科 创伤性损伤。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 创伤恢复早期的输出量(即心率)。参与者将返回完成临床面谈 和自我报告，以及描述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有关，(B)表征创伤后应激症状对大麻使用行为的影响， 以及(C)确定生理变化和创伤后应激症状的早期标记物是否 关于与大麻有关的长期不良后果的轨迹(即，使用障碍、问题、慢性/重度 使用)。

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).