Disturbances of postural sway components in cannabis users

Bolbecker, Amanda R.; Apthorp, Deborah; Martin, Ashley M. Schnakenberg; Tahayori, Behdad; Moravec, Leah; Gomez, Karen L.; O’Donnell, Brian F.; Newman, Sharlene D.; Hetrick, William P.

doi:10.1016/j.drugalcdep.2018.05.012

Cited by 20 publications

(13 citation statements)

References 78 publications

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“…In chronic users of cannabis, the cerebellum presents neuroanatomical alterations that impair its ability to execute postural adjustments, resulting in trembling . Results from a study published in 2017 suggest that cannabis users show subtle changes in gait, primarily in open‐chain components of walking gait, but not in balance …”

Section: Discussionmentioning

confidence: 99%

Adverse events following cannabis for medical use in Tuscany: An analysis of the Italian Phytovigilance database

Crescioli

Lombardi

Bettiol

et al. 2020

Brit J Clinical Pharma

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Aims: Despite a significant increase in using cannabis for medical purposes, current evidence on its safety in real-world clinical practice is still poorly characterised. By a case-by-case analysis of spontaneous reports of suspected adverse events (AEs) collected in Tuscany within the Italian Phytovigilance database, the aim of the present study was to describe AEs occurred in patients exposed to medical cannabis. Methods: We evaluated all reports of cannabis-related suspected AEs collected within the Phytovigilance database up to December 2018. Information regarding cannabis therapy, patient's demographic and clinical characteristics, concomitant medications, AE description according to the Medical Dictionary for Regulatory Activities (MedDRA) classification, AE seriousness and AE outcome, were collected. The causality assessment was performed following World Health Organisation-Uppsala Monitoring Centre criteria.Results: Fifty-three cannabis-related AE reports were analysed. The majority of patients were females (77.3%), with a mean age of 61.9 years. Thirty-nine (73.6%) cases were defined as nonserious and the majority of them (86.9%) showed a complete resolution or improvement. Forty-six (86.8%) cases were judged as probably related to cannabis consumption. The most frequently reported system organ class was psychiatric and nervous system disorders, and a potential drug-drug interaction was present in 16 cases. Conclusion:Cannabis was generally well tolerated and the majority of AEs were mild and transient. Our analysis highlighted important safety issues for clinical practice, in particular the need for an accurate prescription monitoring during the titration phase, particularly in the presence of concomitant medications. K E Y W O R D Sadverse drug reactions, clinical pharmacology, drug safety, general practice, medical cannabis Giada Crescioli and Niccolò Lombardi are co-first authors.

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Section: Discussionmentioning

confidence: 99%

Adverse events following cannabis for medical use in Tuscany: An analysis of the Italian Phytovigilance database

Crescioli

Lombardi

Bettiol

et al. 2020

Brit J Clinical Pharma

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“…9,10 Some decrements in psychomotor performance, particularly divided attention and postural sway (horizontal movement around a person's center of gravity), persist even when cannabis users are not acutely intoxicated. 11,12 Other studies show that frequent users have persisting negative effects on impulsivity 13,14 and executive function. 15 Human neuroimaging research confirms that cannabis users experience deficits in brain activation in motor control regions that persist beyond acute intoxication.…”

Section: Introductionmentioning

confidence: 99%

Effects of High-Potency Cannabis on Psychomotor Performance in Frequent Cannabis Users

Karoly

Milburn²,

Brooks‐Russell

et al. 2022

Cannabis and Cannabinoid Research

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Background: Recently increased access to cannabis products in the United States has been associated with increased rates of driving after cannabis use. Although numerous studies indicate that cannabis impairs psychomotor and neurocognitive functions that can affect driving ability, the determination of cannabis-impaired driving risk is complicated by the extent to which frequent cannabis users develop tolerance to THC's subjective, cognitive, and psychomotor effects, and by the fact that there is no validated behavioral or biological marker of recent cannabis use or cannabis-related impairment. This study examined the psychomotor impairment-related effects experienced by frequent cannabis users in Colorado after naturalistic consumption of smoked cannabis, both immediately and 1 h postuse. Results were then validated in a smaller replication sample from Washington state. Methods: In the primary Colorado study, participants (n = 70) used the DRUID Ò mobile app, a brief measure of psychomotor and cognitive domains that are sensitive to the effects of cannabis. First, participants used DRUID to establish a sober baseline impairment score. During a second appointment, they used DRUID at three time points: preuse, immediately after acutely using cannabis, and 1 h postuse. In the Washington replication sample, participants (n = 39) used DRUID before acute cannabis consumption and then every half hour for 2.5 h. Results: In both studies, peak DRUID impairment effects were seen immediately after cannabis use, with recovery of performance at 1 h postuse. Specifically, significant quadratic effects of time emerged for both studies (Colorado study: (b = À0.935, SE = 0.204, p < 0.001); Washington study: b = 3.0299, SE = 1.3085, p < 0.01). Domain-specific effects were tested in the larger Colorado study and were observed for reaction time within a complex divided attention task and a postural-stability balance task. Conclusions: These findings demonstrate that psychomotor impairment emerges immediately after acute cannabis use even in regular users, but decreases significantly 1 h postuse. These results underscore the potential utility of the DRUID app for assessing acute cannabis-related psychomotor impairment. Further research is needed to explore whether the DRUID app and/or the specific psychomotor functions it assesses might serve as a tool for measuring cannabis-related driving impairment. Clinical trials registration number for the Colorado Study: NCT03522103.

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“…One potential mechanism for this is adverse effects on the cerebellum and basal ganglia, both of which express high levels of CB1 receptors. Prior research (Bolbecker et al, 2018) found that chronic cannabis use in HIV− individuals was associated with increased postural sway in individuals who were not acutely intoxicated. Our results are similar to those of Bidwell et al (2020) who found that balance function was impaired after immediate cannabis use and different from those of Pearson-Dennett et al (2017) who found that the effect of long-term cannabis use was associated with long-lasting changes in open-chain elements of walking gait, but the magnitude of change was not clinically detectable.…”

Section: Discussionmentioning

confidence: 99%

Cannabis use is not associated with increased balance disturbances in HIV-infected individuals

et al. 2021

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Background The association between long-term cannabis use and balance disturbances has not been investigated in people living with HIV (PWH). We hypothesized that long-term cannabis use in PWH might be associated with more deleterious effects on balance than in HIV seronegative individuals due to potential neurotoxic interactions between HIV and cannabis. Methods Three thousand six-hundred and forty-eight participants with and without HIV completed an interviewer-administered timeline follow-back assessment to assess lifetime days and quantity of cannabis use and other cannabis use characteristics. A structured clinical interview was used to collect any history of balance disturbance. Comparisons between HIV+ vs the HIV− groups and moderate-severe vs. no or minimal imbalance in participant characteristics (demographics, cannabis use, medication currently used, and neurological disease) were performed using Student t tests for continuous variables and Fisher’s exact test for binary and categorical variables. Multivariate logistic regression was applied to determine the interaction effect of total quantity of cannabis use with HIV status on balance disturbance. Age, gender, cDSPN symptoms, gait ataxia, opioid medications, and sedatives were included as covariates in the adjusted model after variable selection. The effect sizes are presented as Cohen’s d or odds ratios. Results On average, participants were 45.4 years old (SD = 11 years), primarily male (77.7%), and non-Hispanic white (48.1%). A majority of participants were HIV+ (79.1%). Four hundred thirty (11.9%) of the participants reported balance disturbances within the past 10 years. PWH were more likely to have balance disturbances than demographically matched HIV-uninfected participants (odds ratio [OR] 2.66, 95% CI 1.91–3.7). Participants with moderate-severe balance disturbances did not differ from those with no or minimal imbalance in the proportion who had ever used cannabis (73.8% vs. 74.4%; p = 0.8) (OR 1.03, 95% CI 0.80–1.32) neither did they have a higher total amount of cannabis use (4871 vs. 4648; p = 0.3) (Cohen’s d 0.11, 95% CI 0.01–0.14). In the HIV− population, those with balance disturbances reported more total amount of cannabis use as compared to those with normal balance (11316 vs 4154; p = 0.007). In the HIV+ population on the other hand, there was no significant association (4379 vs 4773; p = 0.6). Conclusions We found unexpectedly that while long-term cannabis use in HIV− individuals was associated with more severe balance disturbances, there were no associations in HIV+ individuals. This suggests that cannabis use in HIV is safe with respect to balance disturbances. Given that HIV is related to persistent inflammation despite virologic suppression on antiretroviral therapy, future mechanistic studies are needed to determine whether HIV-associated inflammation contributes to the higher prevalence of balance disturbance in HIV+ individuals and whether cannabinoids have anti-inflammatory effects that mitigate HIV-associated balance disturbance.

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Disturbances of postural sway components in cannabis users

Abstract: Regular cannabis use is associated with increased postural sway, and this appears to be predominantly due to the trembling component, which is believed to reflect the peripheral nervous system's contribution to the sway signal.

Cited by 20 publications

References 78 publications

Adverse events following cannabis for medical use in Tuscany: An analysis of the Italian Phytovigilance database

Adverse events following cannabis for medical use in Tuscany: An analysis of the Italian Phytovigilance database

Effects of High-Potency Cannabis on Psychomotor Performance in Frequent Cannabis Users

Cannabis use is not associated with increased balance disturbances in HIV-infected individuals

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