Systematic review of structural and functional neuroimaging studies of cannabis use in adolescence and emerging adulthood: evidence from 90 studies and 9441 participants.
Sarah D Lichenstein, Nick Manco, Lora M Cope, Leslie Egbo, Kathleen A Garrison, Jillian Hardee, Ansel T Hillmer, Kristen Reeder, Elisa F Stern, Patrick D. Worhunsky, Sarah W Yip
Neuropsychopharmacology April 2022 DOI: 10.1038/s41386-021-01226-9 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Peer reviewed |
|---|---|
| Sample size | 9,441 |
| Population | Adolescents and emerging adults, including 3,924 cannabis users and 5,517 non-users |
| Topics | Cannabis |
| Key findings | The review reports preliminary evidence that adolescent cannabis use is associated with functional and structural alterations in frontoparietal, frontolimbic, frontostriatal, and cerebellar regions. The authors conclude that larger, more rigorous studies are needed to reconcile divergent results, separate risk factors from consequences of exposure, and clarify whether effects are reversible with abstinence. |
Abstract
Cannabis use peaks in adolescence, and adolescents may be more vulnerable to the neural effects of cannabis and cannabis-related harms due to ongoing brain development during this period. In light of ongoing cannabis policy changes, increased availability, reduced perceptions of harm, heightened interest in medicinal applications of cannabis, and drastic increases in cannabis potency, it is essential to establish an understanding of cannabis effects on the developing adolescent brain. This systematic review aims to: (1) synthesize extant literature on functional and structural neural alterations associated with cannabis use during adolescence and emerging adulthood; (2) identify gaps in the literature that critically impede our ability to accurately assess the effect of cannabis on adolescent brain function and development; and (3) provide recommendations for future research to bridge these gaps and elucidate the mechanisms underlying cannabis-related harms in adolescence and emerging adulthood, with the long-term goal of facilitating the development of improved prevention, early intervention, and treatment approaches targeting adolescent cannabis users (CU). Based on a systematic search of Medline and PsycInfo and other non-systematic sources, we identified 90 studies including 9441 adolescents and emerging adults (n = 3924 CU, n = 5517 non-CU), which provide preliminary evidence for functional and structural alterations in frontoparietal, frontolimbic, frontostriatal, and cerebellar regions among adolescent cannabis users. Larger, more rigorous studies are essential to reconcile divergent results, assess potential moderators of cannabis effects on the developing brain, disentangle risk factors for use from consequences of exposure, and elucidate the extent to which cannabis effects are reversible with abstinence. Guidelines for conducting this work are provided.
Comparable studies
Other systematic reviews and meta-analyses on cannabis, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Effects of cannabis use on outcomes of psychotic disorders: systematic review People with psychotic disorders, as examined in 13 longitudinal studies | 2008 | Systematic review | |
| The Impact of Cannabis Use on Cognitive Functioning in Patients With Schizophrenia: A Meta-analysis of Existing Findings and New Data in a First-Episode Sample Patients with established schizophrenia (meta-analysis: 572) and patients with... | 2010 | Meta-analysis and cross-sectional observational study | n = 700 |
| Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review | 2020 | Systematic review | |
| Neuroimaging in cannabis use: a systematic review of the literature Cannabis users and controls in neuroimaging studies | 2009 | Systematic review | |
| Human Laboratory Studies on Cannabinoids and Psychosis. Healthy human subjects and individuals with schizophrenia | 2016 | Systematic review |
Citations in the library
Cited by 9
- Associations between regular cannabis use and brain resting-state functional connectivity in adolescents and adults Journal of Psychopharmacology July 29, 2023
- Exploring the Impact of Recreational Drugs on Suicidal Behavior: A Narrative Review Psychoactives July 3, 2024
- The Relationship Between Cannabis Use and Schizophrenia As a Risk Factor or For Its Therapeutic Potential: A Systematic Review of Evidence Cureus September 20, 2025
- Associations Between Youth Marijuana and Alcohol Use, Neurocognitive Performance, and Triple-Network Resting-State Connectivity. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging August 2026
- Altered reward-related resting-state network properties in adolescent cannabis use and depression. Progress in Neuro-Psychopharmacology and Biological Psychiatry July 13, 2026
and 4 more in the library
Cites 28
- The neuropsychopharmacology of cannabis: A review of human imaging studies Pharmacology & Therapeutics October 20, 2018
- Age-related differences in the impact of cannabis use on the brain and cognition: a systematic review European Archives of Psychiatry and Clinical Neuroscience January 24, 2019
- Grey Matter Volume Differences Associated with Extremely Low Levels of Cannabis Use in Adolescence Journal of Neuroscience January 14, 2019
- Attenuated frontal and sensory inputs to the basal ganglia in cannabis users Addiction Biology March 3, 2016
- Impact of cannabis use on thalamic volume in people at familial high risk of schizophrenia The British Journal of Psychiatry September 9, 2011
and 23 more in the library