Co-exposure of cannabinoids with amphetamines and biological, behavioural and health outcomes: a scoping review of animal and human studies

Abstract

Rationale The growing prevalence of psychostimulant (including amphetamine) use and associated health harms, with limited treatment options, present a global challenge. There is an increasing availability and medical applications of cannabinoids, and growing interest in their therapeutic potential for addictive disorders. Objectives The objective of this study is to review available data regarding cannabis/cannabinoid co-use or exposure on amphetamine-related outcomes. Methods Towards the present scoping review, we systematically searched four databases (Medline, Web-of-Science, CINAHL Plus and PsycInfo) using cannabis/cannabinoid and amphetamine text-terms identifying peer-reviewed, English-language studies published in 2000–2020 involving multiple methods approaches among both human and animal study samples, assessing the association of co-use/administration of cannabis/cannabinoids products with non-medical amphetamines on biological, behavioural or health outcomes. Results Twenty-five articles were included. Pre-clinical studies (n = 15) found mostly protective effects of single or repeated cannabinoids administration on rodents in amphetamine addiction models, amphetamine-induced models of human mental disorders (e.g. schizophrenia) and amphetamine-induced neurotoxicity. Human studies (n = 10) were more heterogeneously designed (e.g. cross-sectional, case–control, longitudinal) and assessed natural ongoing cannabis and methamphetamine use or dependence, showing mostly enhanced harms in a diversity of outcomes (e.g. mental health, methamphetamine use, cognition). Conclusions While human studies suggest cannabis use as an adverse risk factor among non-medical amphetamine users, pre-clinical studies suggest therapeutic potential of cannabinoids, especially cannabidiol, to alleviate amphetamine addiction and harms, including treatment outcomes. Given increasing psychostimulant harms but lack of care options, rigorous, high-quality design studies should aim to translate and investigate pre-clinical study results for potential therapeutic benefits of cannabinoids for amphetamine use/abuse in human subjects.

Cannabis use may attenuate neurocognitive performance deficits resulting from methamphetamine use disorder

“…Existing evidence suggests that worse neurocognitive performance and higher rates of impairment can result from methamphetamine use (Daldegan-Bueno et al, 2021;Naveed et al, 2022;Reback et al, 2018;Saloner et al, 2020;Scheffler et al, 2022;Watson et al, 2020), and our present results are consistent with these findings. Lifetime methamphetamine use disorder was associated with worse neurocognitive performance and higher rates of NCI, relative to lifetime cannabis use disorder or neither substance use disorder.…”

“…The connection between methamphetamine use and neurocognitive deficits has been well documented, with prominent deficits observed in episodic memory, executive functioning, information processing speed, and visuospatial abilities (Daldegan-Bueno et al, 2021; Naveed et al, 2022; Reback et al, 2018; Saloner et al, 2020; Scheffler et al, 2022; Watson et al, 2020). Research on cannabis use and neurocognitive outcomes is less conclusive than for methamphetamine use.…”

“…Human participants research has primarily focused on subpopulations in which the use of methamphetamine and cannabis is relatively more prevalent than in the general populations (e.g., people with schizophrenia, people living with HIV). Evidence from these clinical populations follows much the same pattern: methamphetamine use confers risk for lower neurocognitive performance, but the effects of cannabis use are variable, and may be beneficial, detrimental, or unrelated to neurocognitive performance (Daldegan-Bueno et al, 2021; Naveed et al, 2022; Reback et al, 2018; Saloner et al, 2020; Scheffler et al, 2022; Watson et al, 2020).…”

Cannabis use, risk behaviours and harms in Brazil: A comprehensive review of available data indicators

“…In addition, some qualitative-based studies identified reports of cannabis being used as self-medication to alleviate crackcocaine detriments or cravings by populations with socioeconomic vulnerabilities. Related, there is a growing interest in cannabinoids as therapeutic agents for addiction treatment [150,151]; however, available data for psychostimulants (i.e., cocaine and amphetamines) are mostly preliminary and still inconclusive [152,153]. Overall, these reports call attention to the potential of cannabinoid product use to reduce the risk for harm from crack-cocaine use, especially in the Brazilian context of common crack-cocaine and/or amphetamine use by socio-economically marginalised groups [93,154].…”

The Combined Effects of Cannabis, Methamphetamine, and HIV on Neurocognition

“…The evidence linking methamphetamine use to neurocognitive deficits is robust, with lower relative performance and greater rates of impairment being observed in memory, executive functioning, information-processing speed, and visuospatial abilities [ 29 , 30 , 31 , 32 , 33 ].…”