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

项目摘要 暴露于创伤与一系列负面结果有关，如创伤后应激障碍 （PTSD）和物质使用障碍，特别是大麻。创伤后早期（即，那些日子，那些星期， 和暴露后的几个月）代表了长期问题行为的关键风险期，特别是 在新兴成年人（18 - 25岁）中，这是一个持续的发展，伴随着一个高峰， 物质使用和创伤暴露风险增加。作为区域法律，文化，和信仰有关大麻 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）， 导致更大的大麻相关问题，因为许多人报告使用大麻来缓解痛苦， 以及其他创伤后症状此外，虽然美国大多数州 合法的医用大麻包括压力和创伤的结果，如创伤后应激障碍， 由于国家颁发医用大麻许可证的条件，人们对大麻可能如何影响知之甚少 创伤后早期治疗鉴于内源性大麻素系统在调节压力方面起着重要作用， 反应和学习恐惧，CU在急性创伤后时期可能会改变机制， 恐惧神经回路的改变（例如，合并/再合并、恢复、消失中的变化）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 表明CU对PTSD症状的有害影响或没有长期影响。我们研究的总体目标是 研究创伤后应激症状和大麻使用行为之间的相互作用， 就在创伤暴露后我们将招募并前瞻性随访N = 200名创伤暴露者， 常规大麻使用者在接受医疗评估后进入综合医院急诊科， 外伤出院后，参与者将完成生态瞬时评估（EMA）， 可穿戴生物传感器（智能手表）记录CU行为，症状发展和生理 输出（即，心率）。参与者将返回完成临床访谈 和自我报告，以及表征恐惧消退和生理反应的实验室程序。 本研究的主要目的是：（a）评估恐惧反应和生理反应的变化 与CU相关，（B）表征创伤后应激症状对大麻使用行为的影响， 以及（c）确定生理改变和创伤后应激症状的早期标志物是否是 对于长期不利的大麻相关结果的轨迹（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).