Evidence-based CBD Oil Review Process
Cannabidiol oil has purported health benefits, including helping to relieve chronic pain. Cannabidiol CBD is an illegal drug with no redeeming value. It is also a useful prescription medicine for epilepsy, with considerable potential for treating numerous other conditions. Although contradictory, all three statements are true from different perspectives, and clinical researchers are frustrated. This flies in the face of current evidence. This approval has heartened the cannabinoid research community, which has long recognized the medicinal potential of CBD but come up against scepticism and regulatory constraints on the road to the clinic.
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Cannabis use has been shown to impair cognitive functions on a number of levels—from basic motor coordination to more complex executive function tasks, such as the ability to plan, organize, solve problems, make decisions, remember, and control emotions and behavior. These deficits differ in severity depending on the quantity, recency, age of onset and duration of marijuana use.
Understanding how cannabis use impairs executive function is important. Individuals with cannabis-related impairment in executive functions have been found to have trouble learning and applying the skills required for successful recovery, putting them at increased risk for relapse to cannabis use. Here we review the research on the acute, residual, and long-term effects of cannabis use on executive functions, and discuss the implications for treatment.
Consumption of cannabis for medical purposes is legal with a prescription in 15 states, and many states are in the process of decriminalizing non-medical marijuana use. More than However, evidence exists of significant harm for some individuals, with 1 in 10 users developing cannabis dependence SAMHSA, This figure has doubled from , and will likely continue to grow.
Thus, an understanding of the effects of cannabis on executive functions is likely to be of widespread clinical relevance. Delta 9-tetrahydrocannabinol THC is the primary psychoactive constituent of the cannabis sativa plant and is believed to be primarily responsible for the cognitive effects and the addictive potential of smoked cannabis. THC intoxication has been shown to impair cognitive function on a number of levels—from basic motor coordination to more complex tasks, such as the ability to plan, organize, solve problems, make decisions, remember, and control emotions and behavior.
The higher level cognitive functions, termed executive functions see Table 1 , are critically important, particularly when dealing with novel situations in which decisions must be made.
This array of higher cognitive functions are vital for overriding and inhibiting responses that otherwise would be automatic or require little thought, such as continued substance abuse Luria, Some cannabis-related executive function deficits improve after cessation of cannabis use Pope et al. Adding to the complexity of this issue is the fact that many factors can impact cannabis-related impairment and recovery of executive functions, including age of onset of smoking cannabis, years of use, and amount of regular use Grant et al.
This clinical conundrum is compounded by the fact that treatment professionals may not be able to easily identify patients with cannabis-related impairment in executive functions without the benefit of neuropsychological assessment Fals-Stewart, Although there is convincing evidence that acute cannabis use generally affects cognitive and motor functions, it is less clear as to whether those deficits are short term and transient or if they are more enduring.
Previously published reports Pope et al. However, as neuroimaging technology has improved, more recent reports show subtle, long-term effects of cannabis on cognition and brain functioning Bolla et al. In addition, newly published reports suggest that the deficits change as a function of the quantity of cannabis consumed and duration of use Solowij et al.
Adolescents who started smoking between the ages of 14—22 years old and stopped by age 22 had significantly more cognitive problems at age 27 than their non-using peers Brook et al. In addition, adult cannabis users who began smoking before the age of 17, but not users who began smoking after the age of 17, had significant impairments in measures of executive functioning, including abstract reasoning, verbal fluency, and verbal learning and memory compared to non-using controls Pope et al.
Understanding how cannabis use impacts executive functions is important for clinicians. Patients who routinely use cannabis may have deficits that make it difficult for them to adhere to treatment, to follow medical advice, and to experience successful outcomes. A literature search was conducted through Medline and PsychInfo with no publication date restrictions.
Review papers, commentaries, pre-clinical studies and those involving human children and adolescents were excluded. Smoking cannabis produces levels of THC in blood plasma that can be detected almost immediately and which reach peak concentrations within minutes Grotenhermen, THC is fat soluble and, therefore, easily stored and released into the bloodstream Grotenhermen, Because it is fat soluble, THC has a long half-life and can be detected in urine anywhere from one day to more than a month after ingestion Huestis et al.
The psychoactive effects of cannabis are experienced immediately after smoking, with peak levels of intoxication occurring after approximately 30 minutes and lasting several hours Grotenhermen, The findings on executive functioning, however, have been less clear Pope et al.
For the purposes of this review, literature reviewed for the acute effects of cannabis on executive functions are studies in which assessment took place between immediately upon smoking cannabis and up to six hours since last use. The findings are detailed below. Attentional processing is the ability to use both divided and sustained attention when targeting a stimulus and it is mediated by the frontal lobes Grady, Several investigators studied the acute effects of cannabis specifically on attentional processing.
Hart et al. However, performance on a tracking task, which requires sustained attention, was found to improve significantly after the high dose of THC, relative to the other conditions. Similarly, Haney et al. Morrison et al. These discrepant findings may be explained by the characteristics of the subjects studied; Haney et al. Hence, the disparate findings may be a function of sample differences involving degree of cannabis exposure and the degree of tolerance and other neuroadaptions resulting from long-term cannabis use.
Information processing is a fundamental aspect of attention and concentration and a basic building block of higher order cognitive processing. Dosher and Sperling, Kelleher et al. They found that users in the abstinent state showed significantly slowed information processing speed compared with controls; however, functioning normalized after smoking cannabis. According to the authors, this finding shows that abstinence following chronic cannabis use may result in a deficit in information processing, which normalizes after acute intoxication.
They surmised that cannabis users who experience slowing of information processing as a result of abstinence following chronic cannabis use may be at risk to resume smoking in an attempt to regain information processing abilities.
Lane et al. Conversely, similar studies by Ramaekers et al. Vadhan et al. The researchers did find, however, that both THC groups were significantly slower in decision-making than the placebo group. On another decision-making task Ramaekers et al. Additionally, those in the THC groups required longer planning times latency to respond than the placebo group.
It appears then that the acute effects of cannabis on decision making and risk taking are somewhat discrepant and may indicate a dissociable difference in functions.
Overall, there is evidence that acute cannabis use has observable deficits in aspects of planning and decision making particularly with regard to response speed, accuracy and latency. Drugs of abuse are often linked to an array of socially unacceptable, poorly controlled, and maladaptive behaviors, collectively referred to as impulsivity.
Few controlled studies have investigated the effects of acute doses of cannabis on impulsive behavior. In one study of 37 adults with a history of light cannabis use, acute intoxication with a high dose of THC resulted in significant impairment on a measure of impulsivity McDonald et al.
Another study Ramaekers et al. Given this evidence, it appears that acute cannabis use promotes more impulsive behavior and less inhibition of maladaptive responses.
Another measure of executive function is working memory. For more than 40 years, researchers have shown that cannabis consumption impairs working memory, or the ability to hold and manipulate information and remember it following a short delay Tinklenberg et al. This finding has been replicated in present day research. In a recent study of chronic cannabis users, Hart et al. Compared with controls, they found no impairing effects on verbal fluency abilities.
Research assessing the effects of acutely administered doses of cannabis on executive functioning has yielded mixed results see Table 2. Evidence of the impairing effects of cannabis intoxication on attention and concentration is stronger in less experienced cannabis users than those with established drug tolerance; attention and concentration in the latter group is disrupted more by acute abstinence than acute cannabis administration, probably as a function of neuroadaptation to chronic, heavy cannabis use.
Comparable effects were observed on tasks involving information processing, a function that is a basic building block for attention and concentration. Acute cannabis use has generally been found to impair aspects of planning and decision-making, e. Some studies also found risk-taking increased with higher doses of cannabis. Acute, impairing effects of cannabis on tasks assessing inhibition and impulsivity have also been documented. Verbal fluency appears intact following acute cannabis administration, but cannabis-related impairments in aspects of working memory are well-established.
Note: Acute Effects denotes 0—6 hours after last cannabis use; Residual Effects denotes 7 hours to 20 days after last cannabis use; Long-Term Effects denotes 3 weeks or longer after last cannabis use. Cannabis use may impact executive functions for several weeks. The literature reviewed for the residual effects of cannabis use on executive functions covers the period of time from 7 hours to 20 days since last use.
Pope et al. On all 4 occasions, no significant differences were found on attentional abilities. This finding was replicated by Jager et al. Contrary to those findings, however, Solowij et al.
Solowij et al. Another study Hermann et al. Wadsworth et al. They found that, compared with controls, cannabis subjects had significantly impaired attention both at the beginning of the work week and at the end, which was significantly correlated with duration of cannabis use.
This finding has implications for everyday activities, suggesting that even with abstinence, some attentional deficits remain. In the single study assessing this domain, Whitlow et al. Compared with controls, the cannabis users had significantly impaired decision-making capacities and greater risk-taking tendencies.
More research is needed to augment the finding of residual cannabis effects on decision-making and risk-taking. One of the first groups Pope et al. Heavy cannabis users demonstrated significantly more errors of inhibition and perseveration compared with light users.
The severity of these deficits was correlated with years of use. Several other researchers have found a similar pattern of impairment Aharonovich et al. In contrast, a number of researchers found no residual effects of cannabis use on inhibition or impulsivity Whitlow et al. Thus, although clear indication exists of impairment after acute cannabis intoxication, the residual effects appear less consistent.
One possible explanation may be the samples sizes used in these studies lacked statistical power to detect differences. Studies that found significant differences had much larger sample sizes than those detecting no differences.
In addition, no significant differences were found in working memory abilities of recently abstinent cannabis users across multiple studies e. More recently Fisk et al. In contrast, McHale and Hunt analyzed verbal fluency in regular cannabis users past 6 months , recent cannabis users past 7 days , and controls.
This review is based on a PubMed search using the terms CBD, cannabidiol, as well as hemp and cannabidiol (CBD) oils, with some evidence that access to of the amygdala during negative emotional processing and has been found to. review for approval in the U.S. There is also preliminary evidence that There is unsanctioned medical use of CBD based products with oils, hemp plants through a multi-stage process into a crystalline powder (production.
The square data markers indicate odds ratios ORs from primary studies, with sizes reflecting the statistical weight of the study using random-effects meta-analysis. The square data markers indicate mean differences from primary studies, with sizes reflecting the statistical weight of the study using random-effects meta-analysis. All review stages were conducted independently by 2 reviewers. Where possible, data were pooled using random-effects meta-analysis. Most trials showed improvement in symptoms associated with cannabinoids but these associations did not reach statistical significance in all trials.
Cannabis use has been shown to impair cognitive functions on a number of levels—from basic motor coordination to more complex executive function tasks, such as the ability to plan, organize, solve problems, make decisions, remember, and control emotions and behavior.
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Evidence-based CBD Oil Review Process
Metrics details. There has been increased interest in the role of cannabis for treating medical conditions. The availability of different cannabis-based products can make the side effects of exposure unpredictable. We sought to conduct a scoping review of systematic reviews assessing benefits and harms of cannabis-based medicines for any condition. A protocol was followed throughout the conduct of this scoping review. A protocol-guided scoping review conduct. Searches of bibliographic databases e. Two people selected and charted data from systematic reviews. Categorizations emerged during data synthesis.
