A Semi-Naturalistic, Open-Label Trial Examining the Effect of Prescribed Medical Cannabis on Neurocognitive Performance.

IF 7.4 2区医学 Q1 CLINICAL NEUROLOGY

CNS drugs Pub Date : 2023-11-01 Epub Date: 2023-11-09 DOI:10.1007/s40263-023-01046-z

Thomas R Arkell, Brooke Manning, Luke A Downey, Amie C Hayley

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Abstract

Background and objectives: Medical cannabis use is increasing in Australia and other jurisdictions, yet little is known about the effects of medical cannabis on cognitive function. Findings from studies of non-medical ('recreational') cannabis may not be applicable to patients using prescribed medical cannabis to manage a health condition.

Methods: In this semi-naturalistic, open-label trial, patients with various health conditions attended a single laboratory session in which they self-administered a standard dose of prescribed medical cannabis as per instructions on the pharmacy label. We assessed cognitive performance using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and Druid application (app) prior to and following (CANTAB: + 3 h; Druid: + 3 and 5.5 h) medical cannabis self-administration. We also assessed subjective drug effects prior to and following (1, 2 and 4 h) medical cannabis self-administration using a range of 0-10 cm visual analogue scales ('stoned', 'sedated', 'relaxed', 'comfortable', 'anxious' and 'confident'). Data were analyzed using linear fixed-effect models.

Results: Participants (N = 40; 22 females) were prescribed a range of products including orally administered oils (n = 23) and flower for vaporization (n = 17). Participants had a mean (standard deviation [SD]) age of 41.38 (12.66) years and had been using medical cannabis for a mean (SD) of 10.18 (8.73) months. Chronic non-cancer pain was the most common indication for medical cannabis use (n = 20), followed by sleep disorder (n = 18) and anxiety (n = 11). The mean (SD) delta-9-tetrahydrocannabinol (THC)/cannabidiol (CBD) dose administered by participants was 9.61 (8.52) mg/9.15 (10.11) mg among those using an oil, and 37.00 (24.53) mg/0.38 (1.58) mg among those who vaporized flower, respectively. Participants' performance improved over time on the CANTAB Multitasking Test and Rapid Visual Information Processing test (both p-values <0.001). All other changes in cognitive performance measures over time were non-significant (p > 0.05). Vaporization of flower was associated with significantly stronger subjective feelings of 'stoned' and 'sedated' relative to oils (both p < 0.001).

Conclusions: These findings suggest that prescribed medical cannabis may have minimal acute impact on cognitive function among patients with chronic health conditions, although larger and controlled trials are needed.

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一项半自然、开放标签的试验，研究处方医用大麻对神经认知性能的影响。

背景和目标：医用大麻在澳大利亚和其他司法管辖区的使用正在增加，但人们对医用大麻对认知功能的影响知之甚少。非医用（“创造性”）大麻研究的结果可能不适用于使用处方医用大麻来控制健康状况的患者。方法：在这项半自然、开放标签的试验中，患有各种健康状况的患者参加了一次单独的实验室会议，他们根据药房标签上的说明自行服用标准剂量的处方医用大麻。我们使用剑桥神经心理测试自动电池（CANTAB）和Druid应用程序（app）评估了医用大麻自我给药前后（CANTAB:+3小时；Druid:+3和5.5小时）的认知表现。我们还使用0-10厘米的视觉模拟量表（“稳定”、“镇静”、“放松”、“舒适”、“焦虑”和“自信”）评估了医用大麻自我给药前后（1、2和4小时）的主观药物效果。使用线性固定效应模型对数据进行分析。结果：参与者（N=40；22名女性）被开了一系列产品，包括口服油（N=23）和汽化花（N=17）。参与者的平均（标准差[SD]）年龄为41.38（12.66）岁，使用医用大麻的平均（SD）为10.18（8.73）个月。慢性非癌症疼痛是医用大麻使用最常见的指征（n=20），其次是睡眠障碍（n=18）和焦虑（n=11）。参与者使用油的参与者服用的delta-9-四氢大麻酚（THC）/大麻二酚（CBD）的平均（SD）剂量分别为9.61（8.52）mg/9.15（10.11）mg和37.00（24.53）mg/0.38（1.58）mg。随着时间的推移，参与者在CANTAB多任务测试和快速视觉信息处理测试中的表现有所改善（均为0.05）。相对于油，花的蒸发与明显更强的主观感觉“石头味”和“镇静”有关（两个p结论：这些发现表明，处方医用大麻可能对慢性健康状况患者的认知功能产生最小的急性影响，尽管还需要更大规模的对照试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CNS drugs 医学-精神病学

CiteScore

12.00

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes: - Overviews of contentious or emerging issues. - Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses. - Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. - Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry. - Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.