Marihuana effects on learning, attention and time estimation

Cannabis and Driving

As more states in the U.S legalize recreational and medicinal cannabis, rates of driving under the influence of this drug are increasing significantly. Aspects of this emerging public health issue potentially pit science against public policy. The authors believe that the legal cart is currently significantly ahead of the scientific horse. Issues such as detection procedures for cannabis-impaired drivers, and use of blood THC levels to gauge impairment, should rely heavily on current scientific knowledge. However, there are many, often unacknowledged research gaps in these and related areas, that need to be addressed in order provide a more coherent basis for public policies. This review focuses especially on those areas. In this article we review in a focused manner, current information linking cannabis to motor vehicle accidents and examine patterns of cannabis-impairment of driving related behaviors, their time courses, relationship to cannabis dose and THC blood levels, and compare cannabis and alcohol-impaired driving patterns directly. This review also delves into questions of alcohol-cannabis combinations and addresses the basis for of per-se limits in cannabis driving convictions. Finally, we distinguish between areas where research has provided clear answers to the above questions, areas that remain unclear, and make recommendations to fill gaps in current knowledge.

Cannabis and Its Different Strains

Previous studies show how time perception can be altered by cannabis consumption, but it is not clear yet whether cannabis produces temporal underproductions or overproductions after acute cannabis intoxication. The present study aimed to analyze a sample of 50 regular cannabis users controlling for cannabis strain (sativa, indica, and hybrid) and to compare their scores in a temporal production task before and after consuming cannabis with a control group of 49 nonusers. Results showed that cannabis intake leads to overproductions, suggesting that regular users' internal tempo slows down after acute intoxication. However, the analyses of main effects showed that indica users, both at baseline levels and after consuming, reported significant underproductions compared to controls, sativa, and hybrid users, and the cannabis-induced effects had a higher magnitude after smoking in the indica-strain group. Results highlight the relevance of including the type of strain consumed in cannabis studies, and they are discussed in terms of short- and long-term alterations in temporal perception under the light of the self-medication theory and the therapeutic uses of cannabis.

Marijuana: respiratory tract effects

Marijuana is the most commonly used drug of abuse in the USA. It is commonly abused through inhalation and therefore has effects on the lung that are similar to tobacco smoke, including increased cough, sputum production, hyperinflation, and upper lobe emphysematous changes. However, at this time, it does not appear that marijuana smoke contributes to the development of chronic obstructive pulmonary disease. Marijuana can have multiple physiologic effects such as tachycardia, peripheral vasodilatation, behavioral and emotional changes, and possible prolonged cognitive impairment. The carcinogenic effects of marijuana are unclear at this time. Studies are mixed on the ability of marijuana smoke to increase the risk for head and neck squamous cell carcinoma, lung cancer, prostate cancer, and cervical cancer. Some studies show that marijuana is protective for development of malignancy. Marijuana smoke has been shown to have an inhibitory effect on the immune system. Components of cannabis are under investigation as treatment for autoimmune diseases and malignancy. As marijuana becomes legalized in many states for medical and recreational use, other forms of tetrahydrocannabinol (THC) have been developed, such as food products and beverages. As most research on marijuana at this time has been on whole marijuana smoke, rather than THC, it is difficult to determine if the currently available data is applicable to these newer products.

Role of the endocannabinoid system in brain functions relevant for schizophrenia: an overview of human challenge studies with cannabis or ∆9-tetrahydrocannabinol (THC)

Accumulating evidence suggests involvement of the endocannabinoid system in the pathophysiology of schizophrenia, which signifies a potential application for this system in the treatment of this disorder. However, before new research can focus on potential treatments that work by manipulating the endocannabinoid system, it needs to be elucidated how this system is involved in symptoms of schizophrenia. Here we review human studies that investigated acute effects of cannabis or ∆9-tetrahydrocannabinol (THC) on brain functions that are implicated in schizophrenia. Results suggest that the impact of THC administration depends on the difficulty of the task performed. Impaired performance of cognitive paradigms is reported on more challenging tasks, which is associated with both activity deficits in temporal and prefrontal areas and a failure to deactivate regions of the default mode network. Comparable reductions in prefrontal activity and impairments in deactivation of the default mode network are seen in patients during performance of cognitive paradigms. Normal performance levels after THC administration demonstrated for less demanding tasks are shown to be related to either increased neural effort in task-specific regions ('neurophysiological inefficiency'), or recruitment of alternative brain areas, which suggests a change in strategy to meet cognitive demands. Particularly a pattern of performance and brain activity corresponding with an inefficient working memory system is consistently demonstrated in patients. These similarities in brain function between intoxicated healthy volunteers and schizophrenia patients provide an argument for a role of the endocannabinoid system in symptoms of schizophrenia, and further emphasize this system as a potential novel target for treatment of these symptoms.

Cannabis smoking and respiratory health: consideration of the literature

The respiratory health effects from tobacco smoking are well described. Cannabis smoke contains a similar profile of carcinogenic chemicals as tobacco smoke but is inhaled more deeply. Although cannabis smoke is known to contain similar harmful and carcinogenic substances to tobacco smoke, relatively little is understood regarding the respiratory health effects from cannabis smoking. There is a need to integrate research on cannabis and respiratory health effects so that gaps in the literature can be identified and the more consistent findings can be consolidated with the purpose of educating smokers and health service providers. This review focuses on several aspects of respiratory health and cannabis use (as well as concurrent cannabis and tobacco use) and provides an update to (i) the pathophysiology; (ii) general respiratory health including symptoms of chronic bronchitis; and (iii) lung cancer.

Acute effects of THC on time perception in frequent and infrequent cannabis users

RATIONALE

Cannabinoids have been shown to alter time perception, but existing literature has several limitations. Few studies have included both time estimation and production tasks, few control for subvocal counting, most had small sample sizes, some did not record subjects' cannabis use, many tested only one dose, and used either oral or inhaled administration of Δ⁹-tetrahydrocannabinol (THC), leading to variable pharmacokinetics, and some used whole-plant cannabis containing cannabinoids other than THC. Our study attempted to address these limitations.

OBJECTIVES

This study aims to characterize the acute effects of THC and frequent cannabis use on seconds-range time perception. THC was hypothesized to produce transient, dose-related time overestimation and underproduction. Frequent cannabis smokers were hypothesized to show blunted responses to these alterations.

METHODS

IV THC was administered at doses from 0.015 to 0.05 mg/kg to 44 subjects who participated in several double-blind, randomized, counterbalanced, crossover, placebo-controlled studies. Visual time estimation and production tasks in the seconds range were presented to subjects three times on each test day.

RESULTS

All doses induced time overestimation and underproduction. Chronic cannabis use had no effect on baseline time perception. While infrequent/nonsmokers showed temporal overestimation at medium and high doses and temporal underproduction at all doses, frequent cannabis users showed no differences. THC effects on time perception were not dose related.

CONCLUSIONS

A psychoactive dose of THC increases internal clock speed as indicated by time overestimation and underproduction. This effect is not dose related and is blunted in chronic cannabis smokers who did not otherwise have altered baseline time perception.

Biomarkers for the effects of cannabis and THC in healthy volunteers

An increasing number of novel therapeutic agents are targeted at cannabinoid receptors. Drug development programmes of new cannabinoid drugs may be facilitated by the identification of useful biomarkers. This systemic literature review aims to assess the usefulness of direct biomarkers for the effects of cannabis and tetrahydrocannabinol (THC) in healthy volunteers. One hundred and sixty-five useful articles were found that investigated the acute effects of cannabis or THC on the central nervous system (CNS) and heart rate in healthy volunteers. Three hundred and eighteen tests (or test variants) were grouped in test clusters and functional domains, to allow their evaluation as a useful biomarker and to study their dose-response effects. Cannabis/THC affected a wide range of CNS domains. In addition to heart rate, subjective effects were the most reliable biomarkers, showing significant responses to cannabis in almost all studies. Some CNS domains showed indications of depression at lower and stimulation at higher doses. Subjective effects and heart rate are currently the most reliable biomarkers to study the effect of cannabis. Cannabis affects most CNS domains, but too many different CNS tests are used to quantify the drug-response relationships reliably. Test standardization, particularly in motor and memory domains, may reveal additional biomarkers.

Effect of intrapulmonary tetrahydrocannabinol administration in humans

This randomised, double-blind, placebo-controlled, cross-over study was designed to identify which pharmacodynamic parameters most accurately quantify the effects of delta-9-Tetrahydrocannabinol (THC), the predominantly psychoactive component of cannabis. In addition, we investigated the acceptability and usefulness of a novel mode of intrapulmonary THC administration using a Volcano vaporizer and pure THC instead of cannabis. Rising doses of THC (2, 4, 6 and 8 mg) or vehicle were administered with 90 minutes intervals to twelve healthy males using a Volcano vaporizer. Very low between-subject variability was observed in THC plasma concentrations, characterising the Volcano vaporizer as a suitable method for the administration of THC. Heart rate showed a sharp increase and rapid decline after each THC administration (8 mg: 19.4 bpm: 95% CI 13.2, 25.5). By contrast, dose dependent effects of body sway (8 mg: 108.5%: 95% CI 72.2%, 152.4%) and different subjective parameters did not return to baseline between doses (Visual Analogue Scales of 'alertness' (8 mg: -33.6 mm: 95% CI -41.6, -25.7), 'feeling high' (8 mg: 1.09 U: 95% CI 0.85, 1.33), 'external perception' (8 mg: 0.62 U: 95% CI 0.37, 0.86)). PK/PD-modeling of heart rate displayed a relatively short equilibration half-life of 7.68 min. CNS parameters showed equilibration half-lives ranging between 39.4 - 84.2 min. Some EEG-frequency bands, and pupil size showed small changes following the highest dose of THC. No changes were seen in saccadic eye movements, smooth pursuit and adaptive tracking performance. These results may be applicable in the development of novel cannabinoid agonists and antagonists, and in studies of the pharmacology and physiology of cannabinoid systems in humans.

Effects of marijuana smoking on pulmonary function and respiratory complications: a systematic review

BACKGROUND

The relationship between marijuana smoking and pulmonary function or respiratory complications is poorly understood; therefore, we conducted a systematic review of the impact of marijuana smoking on pulmonary function and respiratory complications.

METHODS

Studies that evaluated the effect of marijuana smoking on pulmonary function and respiratory complications were selected from the MEDLINE, PsychINFO, and EMBASE databases according to predefined criteria from January 1, 1966, to October 28, 2005. Two independent reviewers extracted data and evaluated study quality based on established criteria. Study results were critically appraised for clinical applicability and research methods.

RESULTS

Thirty-four publications met selection criteria. Reports were classified as challenge studies if they examined the association between short-term marijuana use and airway response; other reports were classified as studies of long-term marijuana smoking and pulmonary function or respiratory complications. Eleven of 12 challenge studies found an association between short-term marijuana administration and bronchodilation (eg, increases of 0.15-0.25 L in forced expiratory volume in 1 second). No consistent association was found between long-term marijuana smoking and airflow obstruction measures. All 14 studies that assessed long-term marijuana smoking and respiratory complications noted an association with increased respiratory symptoms, including cough, phlegm, and wheeze (eg, odds ratio, 2.00; 95% confidence interval, 1.32-3.01, for the association between marijuana smoking and cough). Studies were variable in their overall quality (eg, controlling for confounders, including tobacco smoking).

CONCLUSIONS

Short-term exposure to marijuana is associated with bronchodilation. Physiologic data were inconclusive regarding an association between long-term marijuana smoking and airflow obstruction measures. Long-term marijuana smoking is associated with increased respiratory symptoms suggestive of obstructive lung disease.

The acute effects of cannabinoids on memory in humans: a review

RATIONALE

Cannabis is one of the most frequently used substances. Cannabis and its constituent cannabinoids are known to impair several aspects of cognitive function, with the most robust effects on short-term episodic and working memory in humans. A large body of the work in this area occurred in the 1970s before the discovery of cannabinoid receptors. Recent advances in the knowledge of cannabinoid receptors' function have rekindled interest in examining effects of exogenous cannabinoids on memory and in understanding the mechanism of these effects.

OBJECTIVE

The literature about the acute effects of cannabinoids on memory tasks in humans is reviewed. The limitations of the human literature including issues of dose, route of administration, small sample sizes, sample selection, effects of other drug use, tolerance and dependence to cannabinoids, and the timing and sensitivity of psychological tests are discussed. Finally, the human literature is discussed against the backdrop of preclinical findings.

RESULTS

Acute administration of Delta-9-THC transiently impairs immediate and delayed free recall of information presented after, but not before, drug administration in a dose- and delay-dependent manner. In particular, cannabinoids increase intrusion errors. These effects are more robust with the inhaled and intravenous route and correspond to peak drug levels.

CONCLUSIONS

This profile of effects suggests that cannabinoids impair all stages of memory including encoding, consolidation, and retrieval. Several mechanisms, including effects on long-term potentiation and long-term depression and the inhibition of neurotransmitter (GABA, glutamate, acetyl choline, dopamine) release, have been implicated in the amnestic effects of cannabinoids. Future research in humans is necessary to characterize the neuroanatomical and neurochemical basis of the memory impairing effects of cannabinoids, to dissect out their effects on the various stages of memory and to bridge the expanding gap between the humans and preclinical literature.

Effects of marijuana on temporal discriminations in humans

Marijuana has been reported to alter the discrimination of time. The present study used a psychophysical approach to examine the effects of marijuana on temporal discrimination in humans. Research participants were required to push one of two buttons depending on the duration of a conditional stimulus (a blue square on a computer monitor). Correct choices ('C' button after a 2-s stimulus; 'A' button after a 4-s stimulus) resulted in an increase in session earnings of 0.12 dollars. Intermediate durations (probe stimuli between 2 and 4 s) were also presented. Psychophysical functions relating the probability of judging a duration as 'long' (4 s) as a function of actual stimulus durations were characterized by a logistic function fitted to the data. Administration of both low (1/2 placebo and 1/2 2.2% Delta (9)-tetrahydrocannabinol cigarette) and high (3.89% Delta(9)-tetrahydrocannabinol) potency marijuana cigarettes produced a bias of judging intervals as long, consistent with an interpretation that subjective time passes more quickly when an individual is intoxicated by marijuana. Deliberation time, operationally defined as response latency, peaked on trials with sample durations that corresponded to the measure of central tendency, and shifted in a similar manner after marijuana administration. The data are consistent with other studies on the effects of marijuana on time estimation.

Cannabinoid modulation of sensitivity to time

The present studies used a psychophysical approach to examine the effect of cannabinoids on temporal processing. Rats trained to discriminate 2- and 8-s (Experiment 1, n=72) and 4- and 16-s (Experiment 2, n=60) intervals were tested with intermediate durations. Psychophysical functions for time, relating the probability of judging a duration as "long" as a function of the actual stimulus durations, were characterized by measures of central tendency (point of subjective equality, PSE) and variability (Weber fraction, WF). The potent cannabinoid agonist, WIN55,212-2 (1-3 mg/kg), produced a dose-related decrease in sensitivity to time (i.e. increase in WF) without systematically affecting PSE (Experiments 1 and 2). The central cannabinoid CB1 antagonist, SR141716A (1-3 mg/kg), did not alter either the WF or PSE (Experiments 1 and 2). Coadministration of SR141716A with WIN55,212-2 blocked the effect of the agonist on WF (Experiment 2), suggesting that the WF effect is mediated by actions at cannabinoid CB1 receptors. Computational modeling with an information processing theory of timing suggests that the reduction in sensitivity to time can be attributed to a disorder of attention.

Marijuana and Job Performance: Comparing the Major Streams of Research

Though some estimate that marijuana use has cost U.S. companies billions of dollars in lost productivity, the relationship between use of marijuana and job performance is far from clear. In this paper, I review studies on this topic from four different methodological perspectives and discuss models to account for their apparently contradictory findings. This discussion suggests hypotheses for future research addressing possible reasons for inconsistencies in past findings.

Cerebellar activity and disturbed time sense after THC

Because marijuana continues to be the most commonly used illicit drug, its effects on the brain function are of major interest. We utilized positron emission tomography (PET) and magnetic resonance imaging (MRI) to study the effects of delta-9-tetrahydrocannabinol (THC) infusion on brain blood flow and its behavioral correlates in 46 volunteers. Consistent with previous reports, there was a significant increase in cortical and cerebellar blood flow following THC, but not all subjects showed this effect. Those who showed a decrease in cerebellar CBF also had a significant alteration in time sense. The relationship between decreased cerebellar flow and impaired time sense is of interest because the cerebellum has been linked to an internal timing system.

Acute effects of marijuana smoke on complex operant behavior in rhesus monkeys

The acute behavioral effects of marijuana smoke were assessed in rhesus monkeys using a battery of food-reinforced complex operant tasks that included incremental repeated acquisition (IRA, n = 9), conditioned position responding (CPR, n = 8), progressive ratio (PR, n = 8), delayed matching to sample (DMTS, n = 6), and temporal response differentiation responding (TRD, n = 3). Marijuana or placebo smoke was delivered by a specialized face mask 15-min before sessions at exposure levels of 1, 5, 10, and 15 puffs (35cc/puff) or one cigarette smoked to a butt length of approximately 10 mm (approximately 20 puffs). Marijuana smoke caused significant disruptions of performance in all tests except PR after exposure to 10 or more puffs. Generally, response rates decreased or latencies to respond increased. Performance in the PR test was not consistently affected by marijuana exposure. Accuracy of responding was not altered by marijuana smoke at doses lower than those that decreased response rates in the IRA or CPR tests. In the three animals performing under all five schedules, the relative sensitivities for detecting marijuana behavioral effects were DMTS = TRD greater than IRA = CPR greater than PR. These results suggest that performance under operant schedules that are thought to represent some aspect of time perception, short-term memory, learning, motivation, and position discrimination show differential sensitivity to disruption by marijuana smoke, a finding similar to that noted previously for iv THC administration.

Marijuana's effects on human cognitive functions, psychomotor functions, and personality

Marijuana is complex chemically and not yet fully understood, but it is not a narcotic. Like alcohol, marijuana acts as both stimulant and depressant, but it lingers in body organs longer than alcohol. Smoking marijuana can injure mucosal tissue and may have more carcinogenic potential than tobacco. Research has indicated that marijuana intoxication definitely hinders attention, long-term memory storage, and psychomotor skills involved in driving a car or flying a plane. Expectations and past experience with marijuana have often influenced results more than pharmacological aspects have. Marijuana has triggered psychotic episodes in those more vulnerable. Psychological and some instances of physiological dependence on marijuana have been demonstrated. As a psychoactive drug, marijuana surely alters mental functioning. Although it is possible that chronic use of marijuana produces irreversible damage to mind or brain areas, this has not been determined by research.

Propranolol effects on acute marihuana intoxication in man

To investigate the possible interaction of a beta adrenergic blocking agent and marihuana, six healthy experienced marihuana smokers received the two drugs separately and in combination. Propranolol (120 mg per os) reduced resting HR and BP; there were no changes in performance on tasks designed to test psychomotor speed, attention, memory and learning. Marihuana (10 mg delta9-THC), administered in smoke, induced the typical subjective state ("high") with marked increases in HR, BP and conjunctival injection; it impaired performance on a learning test without significantly affecting attention. Pre-treatment with propranolol blocked effectively the cardiovascular effects of marihuana; it prevented the learning impairment and, to a lesser degree, the characteristic subjective experience.

Effects of marihuana on reaction time and short-term memory in human volunteers

Twenty-seven adult male marihuana smokers volunteered to participate in a hospital research ward study for a 31-day period. Following five days of baseline acclimatization, subjects could purchase and smoke marihuana cigarettes on a free choice basis for a period of 21 consecutive days. The marihuana smoking period was followed by a concluding five-day baseline. Measurements of simple reaction time, choice reaction time and short-term memory were carried out during the entire study. Analysis of variance revealed no statistically significant differences between control and marihuana performance; however, a correlational analysis showed that individual subject performances on all three tasks were significantly correlated from test session to test session during control conditions but not during marihuana smoking conditions. Findings are discussed in relation to attentional and motivational factors associated with performance on the three tasks.

Marijuana and ethanol: differential effects on time perception, heart rate, and subjective response

Performance on a time production task, heart rate, and subjective responses were studied in twelve male sujects given oral doses of marijuana (0.7 mg of delta-9-tetrahydrocannabinol/kg), ethanol (1.0 ml/kg), and placebo, on three testing days which were each separated by 1 week. Orders were balanced across subjects and testing conditions were double-blind. Compared to ethanol and placebo, marijuana induced a significant under-production of time intervals, suggesting an acceleration of the internal rate of time perception. The onset of this acceleration of time sense in which geophysical time seemed to pass slowly corresponded with the characteristic increase in heart rate and the onset of the subjective feelings of drug effects. Initial phases of alcohol intoxication were associated with the opposite effects on the time production task. These findings replicate previous work and indicate that an easily administered time production task provides a consistent, non-motor measure of acute marijuana intoxication and also reflects ethanol intoxication.

Effects of practice on marijuana-induced changes in reaction time

The effect of smoked marijuana on performance of complex reaction time (RT) tasks was studied in two groups receiving different amounts of practice. Group M-P had no undrugged practice on the task before performing during marijuana intoxication for four consecutive daily sessions. On the fifth test day they performed while non-intoxicated. Group P-M performed the task on four consecutive test days while non-intoxicated, then smoked marijuana on session 5. Significant RT slowing was found on session 1 for group M-P (performing during marijuana intoxication without prior practice). Performance of this group improved rapidly and by the end of session 2 was not different from undrugged performance. Group P-M (receiving four sessions of undrugged practice before marijuana intoxication) showed no RT slowing while intoxicated. Reaction time performance may involve two phases: an early, attention-demanding phase which is sensitive to drug effects and a later, "automatic", phase which results from practice and is more resistant to drug effects. Pulse rate, salivary flow and subjective responses were recorded before and after smoking. These physiological and subjective measures showed only slight reduction in the acute effects of the drug over the four days of repeated usage.