Pharmacology & Therapeutics
October 20, 2018
Michael Bloomfield, Chandni Hindocha, Sebastian F Green et al.
236 citations
Cannabis and its primary psychoactive component, THC, acutely alter executive, emotional, reward, and memory processing by directly interacting with the endocannabinoid system and indirectly affecting glutamatergic, GABAergic, and dopaminergic systems. Cannabidiol, a non-intoxicating cannabinoid, may offset some of these acute effects. Heavy repeated cannabis use, especially during adolescence, is associated with adverse effects that increase the risk of mental illnesses such as addiction and psychosis. This review synthesizes human neuroimaging research on the acute and chronic neuropsychopharmacology of cannabis, covering effects during development, implications for psychosis and cannabis use disorder, and methodological considerations.
Psychopharmacology
September 2, 2016
Will Lawn, Tom P. Freeman, Rebecca Pope et al.
177 citations
Cannabis containing only THC reduced the likelihood of choosing high-effort rewards compared to placebo, indicating a transient amotivational state, while adding CBD altered the effect of THC on expected value. Cannabis-dependent individuals showed preserved motivation but impaired reward learning compared to non-dependent controls, though depression may have influenced results.
Psychological Medicine
March 18, 2020
Diego Quattrone, Laura Ferraro, Giada Tripoli et al.
89 citations
Daily use of high-potency cannabis is associated with more positive symptoms and fewer negative symptoms in first-episode psychosis patients. Among 901 patients and 1,235 controls across six European countries, those who used high-potency cannabis daily had the highest scores on positive symptoms, while negative symptoms were more common in patients who never used cannabis. Psychotic experiences in controls were linked to current cannabis use but not to lifetime use. Depressive symptoms showed no differences related to cannabis use in either group.
Journal of Psychopharmacology
April 23, 2019
Matthew B. Wall, Rebecca Pope, Tom P. Freeman et al.
89 citations
Two strains of cannabis—one containing only THC (8 mg) and another containing THC plus CBD (8 mg THC + 10 mg CBD)—were compared with placebo in seventeen healthy, experienced but non-regular cannabis users. Using resting-state fMRI, both strains reduced functional connectivity in the default mode and salience networks relative to placebo, but with distinct spatial patterns. The THC-only strain specifically disrupted the posterior cingulate cortex within the default mode network, and this disruption correlated with subjective feelings of being 'stoned' and 'high'. The THC-plus-CBD strain produced less disruption of the salience network, suggesting CBD may buffer THC's effects on salience processing, which could underlie its potential therapeutic role in disorders like psychosis and addiction.
The International Journal of Neuropsychopharmacology
August 30, 2017
Tom P. Freeman, Rebecca Pope, Matthew B. Wall et al.
67 citations
Cannabis dampens the brain's response to music in regions involved in reward and emotion, including the auditory cortex, hippocampus, amygdala, and ventral striatum. However, when cannabis also contains cannabidiol, these dampening effects are offset, and brain activity does not differ from placebo. Despite reduced neural responses, both types of cannabis increased participants' self-reported desire to listen to music and enhanced sound perception. The findings suggest that cannabidiol may mitigate some of cannabis's effects on brain reward systems.
Consciousness and Cognition
January 10, 2012
Gráinne Schäfer, Amanda Feilding, Celia J. A. Morgan et al.
60 citations
Cannabis acutely increases schizotypy and chronic use is linked to higher rates of psychosis. Creative individuals tend to have higher schizotypy, but the connection between cannabis, schizotypy, and creativity had not been studied. In 160 cannabis users tested sober and intoxicated, cannabis increased verbal fluency in low-creative individuals to the same level as high-creative individuals. Cannabis also increased state psychosis-like symptoms in both groups. High-creativity participants had significantly higher trait schizotypy, but this was not linked to the verbal fluency change. Acute cannabis use enhances divergent thinking, measured by verbal fluency, specifically in those with low trait creativity.
Psychological Medicine
March 3, 2016
Ravi Das, Amanda J. F. Tamman, Viktoriya L. Nikolova et al.
48 citations
Inhaling nitrous oxide shortly after a traumatic event speeds the decline of intrusive memories, reducing them by the next day compared to four days later with medical air. The gas appears to disrupt memory consolidation, but it increases intrusive memories in people who were highly dissociated at the time of the trauma. Sleep quality did not differ between groups. The findings suggest nitrous oxide may help prevent PTSD symptoms in some individuals, but caution is warranted for those with dissociation.
Journal of Psychopharmacology
May 18, 2015
Sunjeev K. Kamboj, Emma J. Kilford, Stephanie Minchin et al.
43 citations
MDMA (ecstasy) and compassionate imagery both increase self-compassion and reduce self-criticism in recreational users. In a non-blind experiment, participants who consumed ecstasy showed similar pro-social effects to those produced by a contemplative compassion exercise, particularly in those with higher attachment-related avoidance. The findings suggest MDMA may enhance psychotherapy by fostering compassionate attitudes toward oneself. However, because the study was not blinded and drug purity was unknown, controlled trials with pharmaceutical-grade MDMA are needed to confirm these effects.
Addiction
February 8, 2023
Will Lawn, Katie Trinci, Claire Mokrysz et al.
36 citations
Adolescent cannabis users are neither more resilient nor more vulnerable than adult cannabis users to the acute psychotomimetic, verbal memory-impairing, or subjective effects of cannabis. In a randomized, double-blind, placebo-controlled crossover experiment with 24 adolescents (16-17 years old) and 24 adults (26-29 years old) who used cannabis 0.5-3 days per week, vaporized THC (8 mg for a 75 kg person) and THC plus CBD (24 mg) both significantly increased subjective drug effect, impaired verbal episodic memory, and increased psychotomimetic effects compared to placebo. There was no evidence that adolescents differed from adults in their responses, and CBD did not modulate the acute effects of THC.
Mindfulness
November 4, 2017
Sunjeev K. Kamboj, Ylva Walldén, Caroline J. Falconer et al.
27 citations
In a naturalistic setting, recreational users who consumed chemically verified MDMA performed a self-focused compassionate imagery exercise on two separate occasions: once after taking MDMA and once without. The exercise and MDMA each independently increased emotional empathy toward critical facial expressions and self-compassion, and their effects on self-compassion appeared to add together. The findings suggest that combining MDMA with compassionate imagery may enhance self-directed affiliative feelings, though controlled studies are needed to confirm the combined utility for therapeutic contexts.
Psychological Medicine
April 28, 2020
Claire Mokrysz, Natacha D. C. Shaban, Tom P. Freeman et al.
24 citations
Inhaling cannabis reliably increases psychotic-like symptoms in healthy cannabis users and may raise the incidence of speech illusion—hearing words in meaningless white noise. Cannabidiol (CBD) did not blunt these effects. In one study, adults had stronger psychotic-like symptom responses than adolescents, suggesting adolescents may be less vulnerable to the acute psychotic-like effects of cannabis. The odds of experiencing speech illusion were 3.1 times higher after inhaling cannabis with THC and negligible CBD compared to placebo.
Journal of Psychopharmacology
August 5, 2020
Will Lawn, J. P. Hill, Chandni Hindocha et al.
23 citations
A single 600 mg oral dose of cannabidiol did not alter brain activity related to anticipating or receiving rewards in healthy adults. Using functional magnetic resonance imaging during a monetary incentive delay task, the expected reward-related brain regions—including the insula, caudate, nucleus accumbens, anterior cingulate, and orbitofrontal cortex—were activated, but no difference was observed between cannabidiol and placebo. Bayesian analyses confirmed that activity in these regions was similar under both conditions, and behavioral measures of motivation for reward also showed no significant difference. The findings suggest that acute cannabidiol does not affect the neural correlates of reward anticipation or feedback in healthy individuals.
International Journal of Environmental Research and Public Health
January 19, 2023
Koen Ponnet, Bert Hauspie, Nicky Dirkx et al.
21 citations
Attendees of electronic dance music events are a high-risk group for substance use. A survey of 1345 Belgian attendees found that ecstasy/MDMA/Molly (52.28%), other synthetic hallucinogens (53.68%), ketamine (42.13%), amphetamines (40.45%), and alkyl nitrites (32.76%) were most used at festivals, outdoor parties, and raves. Cocaine was prevalent in nightclubs (32.29%), while cannabis (68.88%) and magic mushrooms (66.44%) were most used at private events. Overall enjoyment was the key motive for attendance, followed by music and socialization. Users rated many motives (dance, exploration, escapism, excitement, alcohol, drugs) as more important than non-users. Substance use prevalence depended on the event setting, and a three-dimensional classification of attendance motives was supported.
Journal of Psychopharmacology
May 20, 2022
Matthew B. Wall, Tom P. Freeman, Chandni Hindocha et al.
21 citations
THC strongly disrupts connectivity between the striatum and cortex, but co-administering CBD mitigates this effect in the limbic striatum network. In one study, inhaled cannabis with 8 mg THC or 8 mg THC plus 10 mg CBD disrupted associative and sensorimotor networks, while THC alone also disrupted the limbic striatum network. In a second study, oral 600 mg CBD increased connectivity in the associative network and caused minor disruptions in limbic and sensorimotor networks. The insula emerges as a key region affected by cannabinoid-induced changes in functional connectivity, with implications for understanding cannabis-related disorders and developing cannabinoid therapeutics.
Cannabis and Cannabinoid Research
December 9, 2022
Lucy Chester, Amir Englund, Edward Chesney et al.
20 citations
Inhaling vaporized cannabis containing 10 mg of THC acutely increased blood levels of the endocannabinoid anandamide by 18% and several related noncannabinoid lipids, but adding 10, 20, or 30 mg of CBD did not alter these effects. Over four sessions spaced about two weeks apart, pre-inhalation levels of anandamide and one related compound progressively declined, possibly due to repeated THC exposure or reduced anxiety. The findings suggest that CBD, at the doses tested, does not modulate THC's acute influence on endocannabinoid concentrations, though higher or chronic CBD doses might have an effect.
Neuropsychopharmacology
May 28, 2024
Natalie Ertl, Tom P. Freeman, Claire Mokrysz et al.
19 citations
Cannabis use disrupts resting-state functional connectivity in key brain networks—default mode, executive control, salience, hippocampal, and limbic striatal—similarly in adolescents (16–17 years) and young adults (26–29 years). Cannabidiol (CBD) did not counteract the effects of delta-9-tetrahydrocannabinol (THC) and, in some cases, further reduced connectivity both within networks and across the whole brain. These findings challenge the assumption that CBD makes cannabis safer and indicate that the adolescent brain is not more vulnerable to cannabis-induced connectivity disruptions than the adult brain.
Psychopharmacology
May 1, 2022
Sam Craft, Jason Ferris, Monica J Barratt et al.
19 citations
People who frequently use synthetic cannabinoid receptor agonists (SCRAs) experience a distinct withdrawal syndrome, with sleep problems, irritability, and low mood being the most common symptoms. Among 284 frequent users who had tried to quit, an average of 4.4 withdrawal symptoms occurred after just one day without use. Greater frequency and quantity of SCRA use were linked to more withdrawal symptoms. Compared to high-potency herbal cannabis, SCRAs were rated as having a faster onset, shorter duration of effects, faster tolerance development, and more severe withdrawal. The findings suggest that SCRAs carry a greater risk of problematic use and a more severe withdrawal syndrome than natural cannabis.
Journal of Psychopharmacology
July 29, 2023
Natalie Ertl, Will Lawn, Claire Mokrysz et al.
17 citations
Regular cannabis use is associated with localized increases in connectivity of the executive control network (ECN), which may reflect adaptive or compensatory changes in response to regular intoxication. Adolescents generally showed weaker connectivity than adults across multiple brain networks, consistent with normal developmental effects. However, there were no significant interactions between age group and cannabis user group, meaning the connectivity changes linked to cannabis use did not differ between adolescents and adults. No associations were found between cannabis use frequency and any connectivity measures.
Journal of Psychopharmacology
January 9, 2021
Abigail M. Freeman, Claire Mokrysz, Chandni Hindocha et al.
6 citations
Tolerance to some acute effects of delta-9-tetrahydrocannabinol (THC) develops in a domain-specific way, with more frequent cannabis use linked to reduced intensity of subjective effects like feeling stoned and reduced psychosis-like effects. Tolerance to alertness reduction occurred more readily than tolerance to psychotomimetic effects, while tolerance to memory impairment was weak. Trait schizotypy did not moderate the acute psychosis-like effects of THC. These findings come from a mega-analysis of 128 cannabis users across four double-blind, placebo-controlled studies.
Psychopharmacology
February 28, 2024
Daniel L. Hall, Will Lawn, Shelan Ofori et al.
5 citations
Acute intoxication with vaporized THC eliminated attentional bias away from cannabis-related cues in both adolescents and adults who used cannabis 0.5–3 days per week. In a randomized, double-blind, placebo-controlled crossover study with 48 participants (24 adolescents aged 16–17 and 24 adults aged 26–29), a weight-adjusted dose of 8 mg THC eliminated the bias, while adding 24 mg CBD did not alter this effect. There was no significant difference in response between age groups. The findings suggest that acute THC intoxication shifts attentional processing of cannabis cues, but CBD does not moderate this effect.
Psychological Medicine
August 8, 2025
Giulia Trotta, Edoardo Spinazzola, Hannah Degen et al.
4 citations
Childhood trauma, especially emotional and physical abuse, is strongly linked to paranoia, and cannabis use amplifies that effect. In a survey of 4,736 adults, those who experienced childhood trauma reported higher paranoia, and weekly cannabis use—measured in standard THC units—also predicted greater paranoia. Cannabis use partially mediated the link between trauma and paranoia, though trauma itself had a much larger direct effect. The findings suggest that assessing both trauma history and cannabis exposure in standard THC units could improve risk detection and guide interventions for people with childhood trauma.
bioRxiv (Cold Spring Harbor Laboratory)
November 21, 2020
Matthew B. Wall, Tom P. Freeman, Chandni Hindocha et al.
4 citations
preprint
Cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) are two major cannabis constituents with contrasting actions: THC is psychoactive and addiction-promoting, while CBD may have opposite effects. In two placebo-controlled, double-blind studies, inhaled THC (8 mg) strongly disrupted functional connectivity in associative and sensorimotor striatal networks, and this disruption was selectively alleviated in the limbic striatum when co-administered with CBD (10 mg). Oral CBD (600 mg) alone increased connectivity in the associative network but caused minor decreases in limbic and sensorimotor networks. The insula emerged as a key region affected by cannabinoid-induced connectivity changes, with implications for cannabis-related disorders and cannabinoid therapeutics.
European Addiction Research
January 1, 2024
Ruben Johannes Jacob Van Beek, Matthijs Blankers, Marloes Kleinjan et al.
3 citations
Young adults who use ecstasy in the United Kingdom and the Netherlands show three similar patterns of polydrug use: traditional polydrug use (UK 28%, NL 40%), stimulant and ketamine use (UK 48%, NL 52%), and extensive polydrug use involving stimulants, depressants, and psychedelics (UK 24%, NL 8%). UK users more often consume MDMA as powder/crystalline at higher doses, while Dutch users prefer tablets. Most respondents in both countries intend to reduce but not quit their use. The patterns are structurally similar across countries, though individual substance frequencies and preferred MDMA form differ.
Drug and Alcohol Dependence
August 11, 2023
Teuntje A. D. Pelgrim, Johannes G. Ramaekers, Matthew B. Wall et al.
3 citations
THC, the main psychoactive component of cannabis, reduces functional connectivity in the salience network—a brain system involved in processing awareness and salient information—specifically weakening connections from the right insula to the left insula and anterior cingulate cortex. A trend toward decreased connectivity was also observed in the hippocampus-midbrain-striatum network, which may relate to acute psychotic-like effects. The COMT Val158Met genotype modulated subjective responses: individuals with the Met/Met genotype experienced the strongest dysphoric reactions and showed reduced connectivity in the hippocampus-midbrain-striatum network after THC. These findings suggest that prefrontal dopamine levels influence the acute effects of cannabis.
Drug and Alcohol Dependence
September 12, 2025
Matthijs Blankers, Ruben Van Beek, Desirée Spronk et al.
1 citation
In the three days after using ecstasy/MDMA, young adults who regularly use the drug report a small but significant drop in mental well-being, even after accounting for other substance use, sleep, and baseline depression or anxiety. Cocaine co-use and poor sleep further worsened the effect. No similar drop was seen after use of other common substances. The findings suggest the post-acute mood decline is specifically linked to ecstasy/MDMA, not just party or lifestyle factors.