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The 7 most important cannabis research studies of 2023

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2023 saw tons of new research come out related to cannabis. Below is a selection of some of the studies that caught my attention, with brief summaries of each. The first two studies are in the realm of public health. After that, three studies on commercial cannabis followed by two basic research studies on the endocannabinoid system.

This year, we saw a nice review of the public health research done over the past few years, finding little evidence that legalization promotes marijuana consumption among teens, together with evidence that does promote lower teen alcohol consumption. There was also interesting research done on the Cannabis plant itself, including non-terpene volatiles that drive its aroma and its susceptibility to Hop Latent Viroid, a devastating infection that’s spreading across North America. There was also interesting basic research, shedding new light on how the endocannabinoid system works.

Here’s a brief summary of a selection of studies from 2023.

Hippie Hill 2022. Several thousand are expected this year. (David Downs/Leafly)
The galactic epicenter of 420: Hippie Hill, San Francisco Golden Gate Park. (David Downs/Leafly)

As of the publication of this paper, 36 states had legalized medical marijuana and 18 had legalized recreational adult-use cannabis. This review paper summarizes studies that have come out to do with public health consequences of legalization. The major outcomes they reviewed the literature on included: youth marijuana use, alcohol consumption, the abuse of prescription opioids, traffic fatalities, and crime.

“Little credible evidence to suggest that legalization promotes marijuana use among teenagers.”

Topics with a strong level of agreement across studies included:

  • “Little credible evidence to suggest that legalization promotes marijuana use among teenagers.”
  • “Convincing evidence that young adults consume less alcohol when medical marijuana is legalized.”

For other topics, the authors found a lower level of agreement across studies preventing firm conclusions from being drawn. Those included:

  • “For other public health outcomes such as mortality involving prescription opioids, the effect of legalizing medical marijuana has proven more difficult to gauge and, as a consequence, we are less comfortable drawing firm conclusions.”

For more detail on the literature they reviewed, check out the paper itself.

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The question this study sought to address was whether state cannabis legalization was associated with increased rates of psychosis-related health care claims. This cohort study looked at claims data from over 63 million beneficiaries between 2003-2017. They found no statistically significant differences in the rates of psychosis-related diagnoses or prescribed antipsychotics in states with legal medical or adult-use cannabis compared to those without legal cannabis.

Terps are not the whole story. (Courtesy Abstrax)
Terps are not the whole story. (Courtesy Abstrax)

Following up on previous work showing that the “skunky” aroma of some strains comes not from terpenes, but from a class of compounds called, “volatile sulfur compounds,” a team from Abstrax dug deeper into the chemistry of cannabis aroma. They found that a variety of nonterpene volatile compounds are the main drivers of many of the “exotic” aromas that give strains various sweet or savory scents. 

To learn more about this particular study, check out this Leafly article and listen to the video lecture by Abstrax chemist Dr. Iain Oswald.

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This bud is showing nitrogen issues, as well as thin crinkle-cut leaf, and the airy, larfy bud development. All signs of a hop latent viroid infection. (David Downs/Leafly)
This bud is showing nitrogen issues, as well as thin crinkle-cut leaf, and the airy, larfy bud development. All signs of a hop latent viroid infection. (David Downs/Leafly)

Hop latent viroid is a virus-like infection that’s been devastating cannabis crops throughout North America. We have previously written about what HLV is and how it affects marijuana growers. This was a key study from 2023 showing what HLV does to Cannabis plants and how prevalent it already is in some locations. Given the enormous impact HLV is already having, expect to hear more about this bug in 2024.

Raw Garden harvest photo essay by David Downs at Leafly
(David Downs/Leafly)

Some cannabis is grown indoors, some outdoors. Many consumers have strong opinions on which is better. In this 2023 study, researchers did a head-to-head comparison of two genetically identical cultivars grown indoors vs. outdoors, looking at their cannabinoid and terpene content. Main findings included:

  • Significantly higher levels of oxidized and degraded cannabinoids in indoor-grown samples.
  • Significantly more “unusual cannabinoids” such as C4- and C6-THCA in outdoor-grown samples.
  • Significant differences in terpene profiles for outdoor- vs. indoor-grown samples, with outdoor-grown samples generally showing higher levels of sesquiterpenes like caryophyllene, humulene, etc.

The endocannabinoid system regulates many different systems in the brain and body. As we covered in this article, endocannabinoids play an important role in regulating pain perception, fear, and anxiety. At any given moment, there is a certain level of “endocannabinoid tone” in your brain. As this rodent study showed, endocannabinoid tone “gates” the stress response generated in the hypothalamus of the brain. In general, endocannabinoids restrict activation of the hypothalamic-pituitary-adrenal (HPA) axis, which is the key brain system regulating stress levels. Higher endocannabinoid tone had the effect of lessening stress levels in rodents. 

Endocannabinoid receptors are one of the most abundant proteins in the brain, found in many different brain regions and types of neurons. This is one reason why the effects of THC can be so diverse. Depending on the dose of THC consumed, different neurons and brain regions can be affected to different degrees, generating different effects. In this rodent study, neuroscientists studied the effects of a specific subset of dopamine neurons in the brain which express CB1 receptors. They found that this particular subset of neurons has some of the negative side effects that cannabinoids like THC can induce (especially at high doses), including anxiety. This highlights how specific subsets of neurons in the brain can control specific effects that cannabinoids generate.



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Study: Early cannabis use in pregnancy doesn’t predict autism

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Cannabis use during pregnancy has been increasing in the US, and many people may be wondering what impacts this trend could have on children. Some previous research has pointed towards the possibility that prenatal cannabis exposure could increase the likelihood of having autistic children. But a recent study—one of the largest ever conducted on cannabis and autism—found that cannabis exposure in early pregnancy did not lead to higher odds of an autism diagnosis.

What is autism?

Autism is classified as a developmental disorder. It impacts how individuals interact with others, communicate, learn, and experience life. One in 36 Americans are diagnosed with autism; symptoms usually appear during the first two years of a person’s life. Autism is also a spectrum condition—it encompasses a wide variety of different symptoms that an individual might experience, and different levels of health care support may be needed.

Some of the challenges that autistic people might face include having a style of communication that non-autistic people have trouble understanding, having sensory issues because of heightened or reduced sensory perception, and having more repetitive or restricted patterns of behavior than non-autistic peers.

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While medical literature classifies autism as a disorder, many autistic advocates point out that many of the “symptoms” of autism are not inherently problematic or disordered; they simply clash with non-autistic expectations, leaving autistic people marginalized. 

Previous research on cannabis exposure and autism

The recent study, conducted by researchers from Kaiser Permanente and UC San Francisco, evaluated whether cannabis use in early pregnancy could increase the likelihood of a woman giving birth to an autistic child. Autism has been linked to a variety of potential environmental causes, but most research points towards genetics as the primary cause.  

One study, published in 2020, did find an association between prenatal cannabis use and autism, leading to questions about whether cannabis use could cause autism. However, otherstudies found no associations. Unfortunately, those studies utilized self-reporting methods, which may have skewed the results due to a potential underreporting of cannabis use. 

Researchers in the recent Kaiser / UCSF used more rigorous methods to determine whether prenatal cannabis use caused higher rates of autism in children.

Studying prenatal cannabis and autism

This recent study was one of the largest ever done on the topic (it included 178,948 pregnancies), but it also utilized a more robust data set for cannabis use and autism.

This recent study was one of the largest ever done on the topic (it included 178,948 pregnancies), but it also utilized a more robust data set for cannabis use and autism. The study incorporated information from Kaiser Permanente Northern California’s integrated health-care system, which universally screens pregnant individuals for cannabis use—via both self-reporting and a urine toxicology test. Kaiser also routinely screens and assesses children for autism.

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The researchers also included related factors in their analysis like sociodemographic data, the additional medications and substances that a mother consumes, and general health conditions.

Prenatal cannabis use not associated with autism

While an initial analysis appeared to indicate an association between autism and prenatal cannabis use, the association disappeared after adjusting for factors like sociodemographic characteristics and the medical conditions of the mother.

This lack of association suggests that mothers who use cannabis during pregnancy are more likely to have autistic children—not because of the cannabis itself, but because of other factors that also increase likelihood of cannabis use. 

While the researchers don’t identify those specific factors, these results shouldn’t be that surprising: For one, Autism has high hereditary rates. Furthermore, cannabis is sometimes used as an effective treatment for symptoms of autism. Separate studies have noted that autistic individuals tend to have lower levels of endocannabinoids in their bodies, which could suggest an impairment of the endocannabinoid system. 

Mothers with autism—or other conditions tied to the same genes as autism—are more likely to both use cannabis and have autistic children; this correlation may help explain the initial results of the study. Still, only more research will offer conclusive answers to these questions. 

Limitations and future research

This study used a strong methodology, with a large and diverse data set. Still, it was limited by the fact that cannabis use was only measured in early pregnancy. Future studies should measure cannabis use throughout pregnancy, and ideally include information like the methods and dosing of the cannabis itself.

While this study suggests prenatal cannabis use is not associated with autism, the authors nonetheless caution that there is evidence that cannabis can impact development in other ways and should be avoided during pregnancy. 



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AMA

Study: Cannabis Shows No Long-Term Impact on Brain Function

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In recent years, the debate surrounding cannabis effect on brain function has intensified, especially as more states and countries move toward legalizing the drug for both medical and recreational use. Historically, marijuana has been associated with cognitive impairments, particularly in areas such as memory, attention, and executive function. However, a new study published by the American Medical Association (AMA) challenges this long-standing view, suggesting that moderate cannabis use does not significantly impair certain cognitive processes such as working memory, reward processing, and inhibitory control. This groundbreaking research shifts the conversation about cannabis, particularly in its medical applications, and prompts a re-evaluation of prior assumptions.

Background: Changing Perceptions of Cannabis

For decades, cannabis was largely viewed as a recreational substance that carried risks of addiction, cognitive decline, and other negative health outcomes, particularly in adolescents and heavy users. Early studies indicated that cannabis use, especially when initiated during adolescence, could impair brain development and lead to long-term cognitive deficits. This perspective influenced policy and public opinion, leading to its classification as a Schedule I substance in the United States, alongside drugs like heroin and LSD.

However, as cannabis legalization has gained momentum, the need for a more nuanced understanding of its effects has become increasingly important. Medical cannabis, in particular, is used to manage conditions such as chronic pain, anxiety, and depression. These evolving applications prompted researchers to take a closer look at how cannabis affects brain function, especially in moderate, controlled doses for medical use.

The AMA Study: Key Findings

The AMA-funded study, published in JAMA Network Open, investigated the long-term effects of marijuana use on cognitive functions. The research focused on adults who were using medical cannabis to manage symptoms like chronic pain, anxiety, and depression. Researchers utilized functional magnetic resonance imaging (fMRI) to assess brain activity related to working memory, reward processing, and inhibitory control tasks at baseline and after one year of moderate cannabis use.

The results were surprising. Contrary to previous assumptions, the study found no significant differences in brain activation between the two time points, even after a year of consistent marijuana use. Specifically, the researchers reported that “working memory, reward, and inhibitory control tasks did not differ statistically from baseline to one year and were not associated with changes in cannabis use frequency.” This suggests that moderate cannabis use for medical purposes does not impair these key areas of cognitive function.

Furthermore, the study noted that prior research on marijuana’s cognitive impacts often focused on adolescents or heavy, recreational users, which could explain the previously observed deficits. The current study’s focus on adults using cannabis for medical purposes, and typically in moderate amounts, paints a different picture, indicating that the cognitive risks associated with cannabis may not apply equally to all users.

Implications for Medical Marijuana Patients

The AMA study offers promising news for medical marijuana patients. Many individuals who use cannabis to manage chronic health conditions often worry about the potential cognitive side effects of long-term use. This research provides some reassurance that moderate use, particularly in adults, may not carry the same risks as previously thought.

For patients dealing with chronic pain, anxiety, or depression, medical marijuana has often been viewed as a trade-off: potential relief from debilitating symptoms in exchange for possible cognitive decline. The findings of this study suggest that for those using cannabis in controlled, moderate amounts, the cognitive risks may be minimal. This is especially important for patients who rely on cannabis to manage their symptoms without the use of more addictive medications, such as opioids.

The Importance of Context: Adolescents vs. Adults

One key takeaway from the AMA study is the distinction between the effects of cannabis on adolescents and adults. Prior studies have shown that cannabis use, particularly when started in adolescence, can lead to long-term cognitive impairments. The adolescent brain is still in a critical stage of development, and cannabis use during this period has been linked to changes in brain structure and function.

However, the AMA study focused on adult users, who have fully developed brains, and the results suggest that moderate cannabis use in this population does not have the same deleterious effects. This highlights the importance of considering age and developmental stage when discussing the risks associated with marijuana use. While cannabis may still pose risks for younger users, adults who use it for medical purposes may experience fewer cognitive side effects than previously believed.

Study Cannabis Shows No Long-Term Impact on Brain Function
Study Cannabis Shows No Long-Term Impact on Brain Function

Long-Term Cognitive Effects: What We Still Don’t Know

While the AMA study provides valuable insights, it also underscores the need for further research. The study focused on light to moderate cannabis use for medical purposes, and it’s unclear whether the findings would hold true for heavier use or for recreational users. Additionally, the study’s participants were adults with chronic health conditions, a group that may respond differently to cannabis than the general population.

Further studies are needed to explore the effects of higher doses of cannabis, different consumption methods (such as smoking vs. edibles), and the long-term cognitive effects across a broader range of populations. As more states legalize cannabis, the number of users is likely to increase, making it even more important to understand the full scope of marijuana’s impact on brain function.

Potential Policy Implications

The AMA’s findings could have significant implications for cannabis policy. As more evidence emerges suggesting that moderate cannabis use does not impair cognitive function, there may be increased pressure to reclassify cannabis under federal law. Currently, its Schedule I classification denotes that it has “no accepted medical use and a high potential for abuse,” a categorization that is increasingly at odds with scientific research and public opinion.

If further research continues to support the AMA’s findings, policymakers may be more inclined to reconsider cannabis’s legal status. Additionally, this research could influence the guidelines and recommendations for medical marijuana use, helping to establish safe, evidence-based dosing protocols for patients.

Conclusion

The AMA study offers new insights into the effects of marijuana on brain function, challenging long-held assumptions about its cognitive risks. For adults using cannabis moderately to manage medical symptoms, the findings are reassuring, suggesting that key cognitive processes like working memory and reward processing are not significantly impacted by long-term use. However, more research is needed to fully understand the broader implications of these findings, particularly in younger populations and heavier users. As the legal landscape around cannabis continues to evolve, studies like this one will be critical in shaping our understanding of marijuana’s role in both medical and recreational contexts.

AMA research is here.



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CBD vs. THC for Anxiety Relief: New Study Finds the Answer

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A groundbreaking study conducted by the University of Colorado Boulder reveals that strains of cannabis high in cannabidiol (CBD) and low in tetrahydrocannabinol (THC) are most effective at alleviating anxiety. This research, the first to examine the acute and extended effects of legal market cannabis products on anxiety symptoms, underscores the therapeutic potential of CBD, offering a safer alternative to THC-dominant strains and prescription medications for anxiety relief.

Cannabis has long been a subject of debate due to its varied effects on different individuals, with some experiencing relaxation and others facing heightened paranoia and anxiety. This study provides scientific backing to the anecdotal evidence, pinpointing CBD as the key compound for anxiety relief without the adverse effects associated with THC.

The research team embarked on a first-of-its-kind experiment involving 300 participants with anxiety, assessing their responses to different strains of cannabis with varying levels of THC and CBD. The study categorized the cannabis strains into three groups: THC-dominant, equal parts THC and CBD, and CBD-dominant, alongside a control group with no cannabis use.

Over the course of four weeks, participants reported their experiences, with those using CBD-dominant strains experiencing significant reductions in tension and anxiety without the impairment or paranoia linked to higher THC levels. Notably, even the THC-containing strains did not exacerbate anxiety over the long term, suggesting that THC’s anti-anxiety effects might still be beneficial compared to abstaining from cannabis use altogether.

This research, published in Cannabis and Cannabinoid Research, offers compelling evidence of CBD’s role in anxiety management, potentially guiding legal prescriptions and product development in countries that have embraced medical cannabis.

Why It Matters: The findings highlight the importance of understanding cannabis’s chemical composition for therapeutic use, particularly for anxiety treatment. By distinguishing the effects of CBD from THC, this study paves the way for safer, more effective anxiety treatments that harness the benefits of cannabis without the risk of exacerbating anxiety symptoms.

Potential Implications: This study could significantly impact the medical cannabis industry, influencing the development of CBD-dominant products for anxiety relief. It may also inform regulatory policies and consumer choices, encouraging a shift towards strains and products that provide the therapeutic benefits of cannabis without the negative side effects associated with high THC levels.

Source: ScienceAlert



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