Marijuana Investigations for Neuroscientific Discovery (MIND)

UntitledMore than 22.2 million Americans engage in past month marijuana (MJ) use. Over the last several decades, although MJ users in the US have historically sought out MJ for recreational purposes, a growing number are exploring MJ for medicinal reasons. In fact, there are over 1 million registered medical MJ (MMJ) consumers in the US, and this number continues to grow as the public becomes increasingly aware of and open to the potential therapeutic effects of MJ. Legal marijuana (MJ) is considered the fastest growing market in the United States, with a current estimated value of $2.7 billion dollars. To date, twenty-three states and the District of Columbia have legalized medical marijuana (MMJ), with an additional 15 states providing limited MMJ access. Further, four states and the District of Columbia have also approved recreational MJ use, with legislation planned or pending in several other states. Despite these rapid changes in the law, many policy makers, consumers, physicians, and the general public remain misinformed about MJ. While there is a growing body of evidence demonstrating alterations in brain structure and function secondary to recreational MJ use, particularly during vulnerable developmental periods such as adolescence, critical questions regarding the effects of MMJ remain unanswered. For example, how do recreational and medical MJ use differ? Recreational MJ and MMJ, although derived from the same plant species, are often not entirely the same; strains tend to vary in constituent composition, including THC, the main psychoactive component in MJ to cannabidiol (CBD), a non-psychoactive component. What is the impact of MMJ on adults with regard to both short and longer term use? The MIND (Marijuana Investigations for Neuroscientific Discovery) program is designed to begin to address some of these questions as thus far, little data is available regarding the impact of MMJ on measures of cognition, sleep, clinical state, quality of life, and brain related measures.

The first phase of this study is a non-invasive investigation of participants who currently hold a certification for medical marijuana for various medical and/or psychological conditions. Subjects are assessed at baseline, prior to beginning their medical marijuana treatment regimen and complete clinical and diagnostic scales/interviews, cognitive testing, measures related to quality of life, sleep, general activities, and where appropriate, a neuroimaging session which assess brain structure, function, chemistry and white matter integrity. Following their visit, subjects track their use of MMJ products daily (type, mode of use, amount, frequency) using a log system, and are in touch with researchers biweekly. Follow up visits occur at 3 months, 6 months, 12 months, 15 months, 18 months, and 24 months post MMJ treatment initiation in order to better assess the potential impact of MMJ on cognitive function and related brain and quality of life measures

The second phase of the MIND project is an FDA-approved clinical trial of a high-CBD sublingual tincture for the treatment of anxiety. Subjects are assessed at baseline and weekly for four weeks of treatment. The primary outcome measures of the study are clinical state measures related to anxiety. Additionally, subjects will complete measures related to quality of life, sleep, and activity levels, cognitive testing, and for those who are eligible, neuroimaging to assess brain structure, function, and neurochemistry. Please visit https://clinicaltrials.gov/show/NCT02548559 for more information.

The third phase is a study that examines clinical state and cognition in veterans who are using cannabinoids to treat a variety of conditions, including post-traumatic stress disorder (PTSD), insomnia, and pain. Veterans are assessed monthly throughout six months of cannabinoid use, and complete measures of clinical state, quality of life, sleep, and pain, and also complete cognitive testing. A subset of veterans will also participate in MR imaging to examine brain structure, function, and chemistry during six months of cannabinoid use.

In the future, the MIND program will be exploring additional projects related to the potential effects of cannabinoid use on general health, psychiatric conditions, and conditions that disproportionally affect women.

At this point, policy has vastly outpaced science, with little empirical data available regarding the impact of medical marijuana on cognitive function, despite the legal status of the product in a growing number of states. Findings from this investigation will ultimately foster a greater understanding of the impact of medical marijuana on cognitive function and may in turn facilitate the examination of the efficacy of marijuana for different disorders for which it is recommended. Given the considerable difficulty with cognitive function and disrupted mood experienced by patients with severe medical disorders, the addition of marijuana, which has shown promise in alleviating a range of symptoms, could potentially improve cognitive performance. Equally critical, data showing a loss or impairment of cognitive function following the use of medical marijuana could inform alternative courses of treatment, staggered dosing, and ultimately prevent unjustified exposure to harm. As the number of states who have passed medical marijuana laws continues to grow, the ‘need to know’ has never been more important, relevant or timely, and has significant implications for public health policy.