Exploring the Utility of a Functional Magnetic Resonance Imaging Cannabis Cue-Reactivity Paradigm in Treatment-Seeking Adults With Cannabis Use Disorder.

Background: Functional magnetic resonance imaging studies examining cue reactivity in cannabis use disorder (CUD) either have had small sample sizes or have involved non-treatment-seeking participants. As a secondary analysis, we administered a functional magnetic resonance imaging cue-reactivity task to participants with CUD enrolled in 2 separate clinical trials (varenicline or repetitive transcranial magnetic stimulation) to determine the task activation patterns for treatment-seeking participants with CUD. We aimed to determine the activation patterns for the total sample and behavioral correlates. We additionally compared studies to determine if patterns were consistent.

Methods: Treatment-seeking participants with moderate or severe CUD had behavioral craving measured at baseline using the Marijuana Craving Questionnaire-Short Form and completed a visual cannabis cue-reactivity task during functional magnetic resonance imaging (measuring the blood oxygen level-dependent response) following 24 hours of cannabis abstinence.

Results: The sample included 65 participants (n = 37: varenicline trial; n = 28: repetitive transcranial magnetic stimulation trial; 32% female; mean age = 30.4 ± 9.9 years). When comparing cannabis images versus matched neutral images, participants showed greater blood oxygen level-dependent response in bilateral ventromedial-prefrontal, dorsolateral-prefrontal, anterior cingulate, and visual cortices as well as the striatum. There was stronger task-based functional connectivity between the medial prefrontal cortex and both the amygdala and the visual cortex. Craving negatively correlated with blood oxygen level-dependent response in the left ventral striatum (R² = -0.32; p = .01) in the full sample. There were no significant differences in either activation or task-based functional connectivity between studies.

Conclusions: In 2 separate treatment-seeking groups with CUD, there was increased cannabis cue reactivity and task-based functional connectivity in regions related to executive function and reward processing. Cannabis craving was negatively associated with cue reactivity in the left ventral striatum.