Download PDF
Semin Neurol 2024; 44(04): 430-440
DOI: 10.1055/s-0044-1787570
Review Article

Neurological Complications of Cannabinoids

Mariyam Humayun
1   Department of Neurology, University of Illinois, Chicago, Illinois
,
Jose I. Suarez
2   Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Vishank A. Shah
2   Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Cannabinoid use, particularly for recreational purposes, is increasing exponentially across all age groups, especially in younger populations, due to its perceived low risk and legalization. While cannabinoids may be largely considered as safe, there is mounting evidence of increased risk of systemic and neurological complications through their interaction with the poorly understood endocannabinoid receptor network within the central nervous system and other organ systems. Acute cannabinoid exposure can cause neuropsychiatric symptoms in addition to altering cerebral blood flow, leading to cerebrovascular complications such as ischemic stroke, subarachnoid hemorrhage, and reversible cerebral vasoconstriction syndrome (RCVS). Chronic use, particularly among adolescents, may be associated with increased risk of long-term cognitive deficits, schizophrenia, and other neuropsychiatric effects. Synthetic cannabinoids have increased potency, with reports of causing profound neurological complications including coma, seizures, posterior reversible encephalopathy syndrome, and RCVS. Despite increasing evidence, the quality of literature describing neurologic complications with cannabinoids remains limited to case series and retrospective cohort studies, with significant confounding factors such as concomitant use of other illicit drugs, limiting interpretation. In this review, we summarize the effect of cannabinoids on the neurologic system and associated neurological complications.

Keywords

cannabis - THC - cannabinoids - neurological complications - substance abuse


Publication History

Article published online:
24 June 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Crime UNOOD&. World Drug Report 2021. CrimRxiv. Accessed June 6, 2024 at: https://www.crimrxiv.com/pub/gnxezvag/release/1
    PubMed
  • 2 For Behavioral Health Statistics C, Quality. Results from the 2019 National Survey on Drug Use and Health: Detailed tables. Accessed June 6, 2024 at: https://www.unodc.org/unodc/data-and-analysis/wdr2021.html
    PubMed
  • 3 United Nations publication SNoE 21. XI 8. World Drug Report 2021. https://www.unodc.org/unodc/data-and-analysis/wdr2021.html
    PubMed
  • 4 Archie SR, Cucullo L. Harmful effects of smoking cannabis: a cerebrovascular and neurological perspective. Front Pharmacol 2019; 10: 1481
    CrossrefPubMedGoogle Scholar
  • 5 Curran HV, Freeman TP, Mokrysz C, Lewis DA, Morgan CJA, Parsons LH. Keep off the grass? Cannabis, cognition and addiction. Nat Rev Neurosci 2016; 17 (05) 293-306
    CrossrefPubMedGoogle Scholar
  • 6 Lu HC, Mackie K. An introduction to the endogenous cannabinoid system. Biol Psychiatry 2016; 79 (07) 516-525
    CrossrefPubMedGoogle Scholar
  • 7 Govindarajan RK, Mishra AK, Cho KH, Kim KH, Yoon KM, Baek KH. Biosynthesis of phytocannabinoids and structural insights: a review. Metabolites 2023; 13 (03) 442
    CrossrefPubMedGoogle Scholar
  • 8 Cristino L, Bisogno T, Di Marzo V. Cannabinoids and the expanded endocannabinoid system in neurological disorders. Nat Rev Neurol 2020; 16 (01) 9-29
    CrossrefPubMedGoogle Scholar
  • 9 Schlicker E, Kathmann M. Modulation of transmitter release via presynaptic cannabinoid receptors. Trends Pharmacol Sci 2001; 22 (11) 565-572
    CrossrefPubMedGoogle Scholar
  • 10 Kendall DA, Yudowski GA. Cannabinoid receptors in the central nervous system: Their signaling and roles in disease. Front Cell Neurosci 2017; 10: 294
    CrossrefPubMedGoogle Scholar
  • 11 Cooper ZD, Haney M. Actions of delta-9-tetrahydrocannabinol in cannabis: relation to use, abuse, dependence. Int Rev Psychiatry 2009; 21 (02) 104-112
    CrossrefPubMedGoogle Scholar
  • 12 Iversen L. Cannabis and the brain. Brain 2003; 126 (Pt 6): 1252-1270
    CrossrefPubMedGoogle Scholar
  • 13 Cohen K, Weinstein AM. Synthetic and non-synthetic cannabinoid drugs and their adverse effects-a review from public health prospective. Front Public Health 2018; 6: 162
    CrossrefPubMedGoogle Scholar
  • 14 Smith LA, Azariah F, Lavender VT, Stoner NS, Bettiol S. Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane Database Syst Rev 2015; 2015 (11) CD009464
    PubMedGoogle Scholar
  • 15 Whiting PF, Wolff RF, Deshpande S. et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA 2015; 313 (24) 2456-2473
    CrossrefPubMedGoogle Scholar
  • 16 Parker LA, Rock EM, Limebeer CL. Regulation of nausea and vomiting by cannabinoids. Br J Pharmacol 2011; 163 (07) 1411-1422
    CrossrefPubMedGoogle Scholar
  • 17 Miller I, Scheffer IE, Gunning B. et al; GWPCARE2 Study Group. Dose-ranging effect of adjunctive oral cannabidiol vs placebo on convulsive seizure frequency in dravet syndrome: a randomized clinical trial. JAMA Neurol 2020; 77 (05) 613-621
    CrossrefPubMedGoogle Scholar
  • 18 Thiele EA, Marsh ED, French JA. et al; GWPCARE4 Study Group. Cannabidiol in patients with seizures associated with Lennox-Gastaut syndrome (GWPCARE4): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 2018; 391 (10125): 1085-1096
    CrossrefPubMedGoogle Scholar
  • 19 Raucci U, Pietrafusa N, Paolino MC. et al. Cannabidiol treatment for refractory epilepsies in pediatrics. Front Pharmacol 2020; 11: 586110
    CrossrefPubMedGoogle Scholar
  • 20 Leweke FM, Piomelli D, Pahlisch F. et al. Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Transl Psychiatry 2012; 2 (03) e94
    CrossrefPubMedGoogle Scholar
  • 21 Bergamaschi MM, Queiroz RHC, Chagas MHN. et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. Neuropsychopharmacology 2011; 36 (06) 1219-1226
    CrossrefPubMedGoogle Scholar
  • 22 Mangoo S, Erridge S, Holvey C. et al. Assessment of clinical outcomes of medicinal cannabis therapy for depression: analysis from the UK Medical Cannabis Registry. Expert Rev Neurother 2022; 22 (11–12): 995-1008
    CrossrefPubMedGoogle Scholar
  • 23 Rehman Y, Saini A, Huang S, Sood E, Gill R, Yanikomeroglu S. Cannabis in the management of PTSD: a systematic review. AIMS Neurosci 2021; 8 (03) 414-434
    CrossrefPubMedGoogle Scholar
  • 24 Tetrault JM, Crothers K, Moore BA, Mehra R, Concato J, Fiellin DA. Effects of marijuana smoking on pulmonary function and respiratory complications: a systematic review. Arch Intern Med 2007; 167 (03) 221-228
    CrossrefPubMedGoogle Scholar
  • 25 National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: National Academies Press (US); January 12, 2017
    PubMed
  • 26 Müller-Vahl KR, Schneider U, Koblenz A. et al. Treatment of Tourette's syndrome with Δ 9-tetrahydrocannabinol (THC): a randomized crossover trial. Pharmacopsychiatry 2002; 35 (02) 57-61
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Carter GT, Rosen BS. Marijuana in the management of amyotrophic lateral sclerosis. Am J Hosp Palliat Care 2001; 18 (04) 264-270
    CrossrefPubMedGoogle Scholar
  • 28 Urbi B, Corbett J, Hughes I. et al. Effects of cannabis in Parkinson's disease: a systematic review and meta-analysis. J Parkinsons Dis 2022; 12 (02) 495-508
    CrossrefPubMedGoogle Scholar
  • 29 Karila L, Roux P, Rolland B. et al. Acute and long-term effects of cannabis use: a review. Curr Pharm Des 2014; 20 (25) 4112-4118
    CrossrefPubMedGoogle Scholar
  • 30 Thomas G, Kloner RA, Rezkalla S. Adverse cardiovascular, cerebrovascular, and peripheral vascular effects of marijuana inhalation: what cardiologists need to know. Am J Cardiol 2014; 113 (01) 187-190
    CrossrefPubMedGoogle Scholar
  • 31 Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation 2001; 103 (23) 2805-2809
    CrossrefPubMedGoogle Scholar
  • 32 Kaplan AG. Cannabis and lung health: does the bad outweigh the good?. Pulm Ther 2021; 7 (02) 395-408
    CrossrefPubMedGoogle Scholar
  • 33 Shah J, Fermo O. Review of systemic and syndromic complications of cannabis use: a review. Medicine (Baltimore) 2022; 101 (49) e32111
    CrossrefPubMedGoogle Scholar
  • 34 Tashkin DP, Simmons MS, Tseng CH. Impact of changes in regular use of marijuana and/or tobacco on chronic bronchitis. COPD 2012; 9 (04) 367-374
    CrossrefPubMedGoogle Scholar
  • 35 Macleod J, Robertson R, Copeland L, McKenzie J, Elton R, Reid P. Cannabis, tobacco smoking, and lung function: a cross-sectional observational study in a general practice population. Br J Gen Pract 2015; 65 (631) e89-e95
    CrossrefPubMedGoogle Scholar
  • 36 Ghasemiesfe M, Ravi D, Vali M. et al. Marijuana use, respiratory symptoms, and pulmonary function: a systematic review and meta-analysis. Ann Intern Med 2018; 169 (02) 106-115
    CrossrefPubMedGoogle Scholar
  • 37 Morris MA, Jacobson SR, Kinney GL. et al. Marijuana use associations with pulmonary symptoms and function in Tobacco smokers enrolled in the Subpopulations and Intermediate Outcome Measures in COPD study (SPIROMICS). Chronic Obstr Pulm Dis (Miami) 2018; 5 (01) 46-56
    PubMedGoogle Scholar
  • 38 Moir D, Rickert WS, Levasseur G. et al. A comparison of mainstream and sidestream marijuana and tobacco cigarette smoke produced under two machine smoking conditions. Chem Res Toxicol 2008; 21 (02) 494-502
    CrossrefPubMedGoogle Scholar
  • 39 Simonetto DA, Oxentenko AS, Herman ML, Szostek JH. Cannabinoid hyperemesis: a case series of 98 patients. Mayo Clin Proc 2012; 87 (02) 114-119
    CrossrefPubMedGoogle Scholar
  • 40 Testai FD, Gorelick PB, Aparicio HJ. et al; American Heart Association Stroke Brain Health Science Subcommittee of the Stroke Council; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; and Council on Peripheral Vascular Disease. Use of marijuana: effect on brain health: a scientific statement From the American Heart Association. Stroke 2022; 53 (04) e176-e187
    CrossrefPubMedGoogle Scholar
  • 41 Baraniecki R, Panchal P, Malhotra DD, Aliferis A, Zia Z. Acute cannabis intoxication in the emergency department: the effect of legalization. BMC Emerg Med 2021; 21 (01) 32
    CrossrefPubMedGoogle Scholar
  • 42 Marinello S, Powell LM. The impact of recreational cannabis markets on motor vehicle accident, suicide, and opioid overdose fatalities. Soc Sci Med 2023; 320: 115680
    CrossrefPubMedGoogle Scholar
  • 43 Els C, Jackson TD, Tsuyuki RT. et al. Impact of cannabis use on road traffic collisions and safety at work: systematic review and meta-analysis. Can J Addict 2019; 10 (01) 8-15
    CrossrefPubMedGoogle Scholar
  • 44 Benyó Z, Ruisanchez É, Leszl-Ishiguro M, Sándor P, Pacher P. Endocannabinoids in cerebrovascular regulation. Am J Physiol Heart Circ Physiol 2016; 310 (07) H785-H801
    CrossrefPubMedGoogle Scholar
  • 45 Adams MD, Earnhardt JT, Dewey WL, Harris LS. Vasoconstrictor actions of delta8- and delta9-tetrahydrocannabinol in the rat. J Pharmacol Exp Ther 1976; 196 (03) 649-656
    PubMedGoogle Scholar
  • 46 Pacher P, Steffens S, Haskó G, Schindler TH, Kunos G. Cardiovascular effects of marijuana and synthetic cannabinoids: the good, the bad, and the ugly. Nat Rev Cardiol 2018; 15 (03) 151-166
    CrossrefPubMedGoogle Scholar
  • 47 Thanvi BR, Treadwell SD. Cannabis and stroke: is there a link?. Postgrad Med J 2009; 85 (1000): 80-83
    CrossrefPubMedGoogle Scholar
  • 48 Cheung CP, Nardone M, Lee JB, Baker RE, Millar PJ, Burr JF. Cannabis inhalation acutely reduces muscle sympathetic nerve activity in humans. Circulation 2022; 146 (25) 1972-1974
    CrossrefPubMedGoogle Scholar
  • 49 Wolff V, Schlagowski AI, Rouyer O. et al. Tetrahydrocannabinol induces brain mitochondrial respiratory chain dysfunction and increases oxidative stress: a potential mechanism involved in cannabis-related stroke. BioMed Res Int 2015; 2015: 323706
    CrossrefPubMedGoogle Scholar
  • 50 Aronow WS, Cassidy J. Effect of marihuana and placebo-marihuana smoking on angina pectoris. N Engl J Med 1974; 291 (02) 65-67
    CrossrefPubMedGoogle Scholar
  • 51 Jayanthi S, Buie S, Moore S. et al. Heavy marijuana users show increased serum apolipoprotein C-III levels: evidence from proteomic analyses. Mol Psychiatry 2010; 15 (01) 101-112
    CrossrefPubMedGoogle Scholar
  • 52 Singla S, Sachdeva R, Mehta JL. Cannabinoids and atherosclerotic coronary heart disease. Clin Cardiol 2012; 35 (06) 329-335
    CrossrefPubMedGoogle Scholar
  • 53 Deusch E, Kress HG, Kraft B, Kozek-Langenecker SA. The procoagulatory effects of delta-9-tetrahydrocannabinol in human platelets. Anesth Analg 2004; 99 (04) 1127-1130
    CrossrefPubMedGoogle Scholar
  • 54 Subramaniam VN, Menezes AR, DeSchutter A, Lavie CJ. The cardiovascular effects of marijuana: are the potential adverse effects worth the high?. Mo Med 2019; 116 (02) 146-153
    PubMedGoogle Scholar
  • 55 Herning RI, Better WE, Tate K, Cadet JL. Cerebrovascular perfusion in marijuana users during a month of monitored abstinence. Neurology 2005; 64 (03) 488-493
    CrossrefPubMedGoogle Scholar
  • 56 Mathew RJ, Wilson WH, Humphreys D, Lowe JV, Wiethe KE. Middle cerebral artery velocity during upright posture after marijuana smoking. Acta Psychiatr Scand 1992; 86 (02) 173-178
    CrossrefPubMedGoogle Scholar
  • 57 Jaladi PR, Patel V, Kuduva Rajan S. et al. Arrhythmia-related hospitalization and comorbid cannabis use disorder: trend analysis in US hospitals (2010-2014). Cureus 2019; 11 (09) e5607
    PubMedGoogle Scholar
  • 58 Putaala J, Nieminen T. Stroke risk period after acute myocardial infarction revised. J Am Heart Assoc 2018; 7 (22) e011200
    CrossrefPubMedGoogle Scholar
  • 59 Desai R, Singh S, Patel K. et al. Stroke in young cannabis users (18-49 years): national trends in hospitalizations and outcomes. Int J Stroke 2020; 15 (05) 535-539
    CrossrefPubMedGoogle Scholar
  • 60 Agrawal A, Budney AJ, Lynskey MT. The co-occurring use and misuse of cannabis and tobacco: a review. Addiction 2012; 107 (07) 1221-1233
    CrossrefPubMedGoogle Scholar
  • 61 Westover AN, McBride S, Haley RW. Stroke in young adults who abuse amphetamines or cocaine: a population-based study of hospitalized patients. Arch Gen Psychiatry 2007; 64 (04) 495-502
    CrossrefPubMedGoogle Scholar
  • 62 Rumalla K, Reddy AY, Mittal MK. Recreational marijuana use and acute ischemic stroke: a population-based analysis of hospitalized patients in the United States. J Neurol Sci 2016; 364: 191-196
    CrossrefPubMedGoogle Scholar
  • 63 Hemachandra D, McKetin R, Cherbuin N, Anstey KJ. Heavy cannabis users at elevated risk of stroke: evidence from a general population survey. Aust N Z J Public Health 2016; 40 (03) 226-230
    CrossrefPubMedGoogle Scholar
  • 64 Leech J, Sillau S, Leppert M. History of cannabis use is not associated with worse functional outcomes in young adults with ischemic stroke. Neurology 2021;96(15, suppl 1)
    PubMedGoogle Scholar
  • 65 England TJ, Hind WH, Rasid NA, O'Sullivan SE. Cannabinoids in experimental stroke: a systematic review and meta-analysis. J Cereb Blood Flow Metab 2015; 35 (03) 348-358
    CrossrefPubMedGoogle Scholar
  • 66 Choi SH, Mou Y, Silva AC. Cannabis and cannabinoid biology in stroke. Stroke 2019; 50 (09) 2640-2645
    CrossrefPubMedGoogle Scholar
  • 67 Rivers-Auty JR, Smith PF, Ashton JC. The cannabinoid CB2 receptor agonist GW405833 does not ameliorate brain damage induced by hypoxia-ischemia in rats. Neurosci Lett 2014; 569: 104-109
    CrossrefPubMedGoogle Scholar
  • 68 Ducros A. Reversible cerebral vasoconstriction syndrome. Lancet Neurol 2012; 11 (10) 906-917
    CrossrefPubMedGoogle Scholar
  • 69 Wolff V, Jouanjus E. Strokes are possible complications of cannabinoids use. Epilepsy Behav 2017; 70 (Pt B): 355-363
    CrossrefPubMedGoogle Scholar
  • 70 Ducros A, Boukobza M, Porcher R, Sarov M, Valade D, Bousser MG. The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients. Brain 2007; 130 (Pt 12): 3091-3101
    CrossrefPubMedGoogle Scholar
  • 71 Wolff V, Lauer V, Rouyer O. et al. Cannabis use, ischemic stroke, and multifocal intracranial vasoconstriction: a prospective study in 48 consecutive young patients. Stroke 2011; 42 (06) 1778-1780
    CrossrefPubMedGoogle Scholar
  • 72 Wagner J, Leonard J, Jensen J. et al. The impact of marijuana legalization on reversible cerebral vasoconstriction syndrome. Neurology 2016;86(16, suppl 1)
    PubMedGoogle Scholar
  • 73 Jensen J, Leonard J, Salottolo K, McCarthy K, Wagner J, Bar-Or D. The epidemiology of reversible cerebral vasoconstriction syndrome in patients at a Colorado comprehensive stroke center. J Vasc Interv Neurol 2018; 10 (01) 32-38
    PubMedGoogle Scholar
  • 74 Malhotra K, Rumalla K, Mittal MK. Association and clinical outcomes of marijuana in patients with intracerebral hemorrhage. J Stroke Cerebrovasc Dis 2018; 27 (12) 3479-3486
    CrossrefPubMedGoogle Scholar
  • 75 Di Napoli M, Zha AM, Godoy DA. et al; MNEMONICH Registry. Prior cannabis use is associated with outcome after intracerebral hemorrhage. Cerebrovasc Dis 2016; 41 (5-6): 248-255
    CrossrefPubMedGoogle Scholar
  • 76 Auger N, Paradis G, Low N, Ayoub A, He S, Potter BJ. Cannabis use disorder and the future risk of cardiovascular disease in parous women: a longitudinal cohort study. BMC Med 2020; 18 (01) 328
    CrossrefPubMedGoogle Scholar
  • 77 Tan Q, Chen Q, Feng Z. et al. Cannabinoid receptor 2 activation restricts fibrosis and alleviates hydrocephalus after intraventricular hemorrhage. Brain Res 2017; 1654 (Pt A): 24-33
    CrossrefPubMedGoogle Scholar
  • 78 Rumalla K, Reddy AY, Mittal MK. Association of recreational marijuana use with aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2016; 25 (02) 452-460
    CrossrefPubMedGoogle Scholar
  • 79 Lai PMR, Ng I, Gormley WB. et al. Cannabis use and increased nonaneurysmal subarachnoid hemorrhage in the past decade. World Neurosurg 2021; 154: e580-e589
    CrossrefPubMedGoogle Scholar
  • 80 Catapano JS, Rumalla K, Srinivasan VM. et al. Cannabis use and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Stroke 2022; 53 (02) e42-e43
    CrossrefPubMedGoogle Scholar
  • 81 Behrouz R, Birnbaum L, Grandhi R. et al. Cannabis use and outcomes in patients with aneurysmal subarachnoid hemorrhage. Stroke 2016; 47 (05) 1371-1373
    CrossrefPubMedGoogle Scholar
  • 82 Akbik F, Konan HD, Williams KP. et al. Cannabis use is not associated with aneurysmal subarachnoid hemorrhage complications or outcomes. Stroke 2022; 53 (08) e375-e376
    CrossrefPubMedGoogle Scholar
  • 83 Henry N, Fraser JF, Chappell J, Langley T, Roberts JM. Cannabidiol's multifactorial mechanisms has therapeutic potential for aneurysmal subarachnoid hemorrhage: a review. Transl Stroke Res 2023; 14 (03) 283-296
    CrossrefPubMedGoogle Scholar
  • 84 DiBenedetto M, McNamee HB, Kuehnle JC, Mendelson JH. Cannabis and the peripheral nervous system. Br J Psychiatry 1977; 131 (10) 361-365
    CrossrefPubMedGoogle Scholar
  • 85 Katona I, Rancz EA, Acsády L. et al. Distribution of CB1 cannabinoid receptors in the amygdala and their role in the control of GABAergic transmission. J Neurosci 2001; 21 (23) 9506-9518
    CrossrefPubMedGoogle Scholar
  • 86 Lovell ME, Akhurst J, Padgett C, Garry MI, Matthews A. Cognitive outcomes associated with long-term, regular, recreational cannabis use in adults: a meta-analysis. Exp Clin Psychopharmacol 2020; 28 (04) 471-494
    CrossrefPubMedGoogle Scholar
  • 87 Filbey FM, Aslan S, Calhoun VD. et al. Long-term effects of marijuana use on the brain. Proc Natl Acad Sci U S A 2014; 111 (47) 16913-16918
    CrossrefPubMedGoogle Scholar
  • 88 Hurd YL, Manzoni OJ, Pletnikov MV, Lee FS, Bhattacharyya S, Melis M. Cannabis and the developing brain: Insights into its long-lasting effects. J Neurosci 2019; 39 (42) 8250-8258
    CrossrefPubMedGoogle Scholar
  • 89 Ortiz-Medina MB, Perea M, Torales J. et al. Cannabis consumption and psychosis or schizophrenia development. Int J Soc Psychiatry 2018; 64 (07) 690-704
    CrossrefPubMedGoogle Scholar
  • 90 Large M, Sharma S, Compton MT, Slade T, Nielssen O. Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Arch Gen Psychiatry 2011; 68 (06) 555-561
    CrossrefPubMedGoogle Scholar
  • 91 Di Forti M, Marconi A, Carra E. et al. Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study. Lancet Psychiatry 2015; 2 (03) 233-238
    CrossrefPubMedGoogle Scholar
  • 92 de Graaf R, Radovanovic M, van Laar M. et al. Early cannabis use and estimated risk of later onset of depression spells: epidemiologic evidence from the population-based World Health Organization World Mental Health Survey Initiative. Am J Epidemiol 2010; 172 (02) 149-159
    CrossrefPubMedGoogle Scholar
  • 93 Bahji A, Stephenson C, Tyo R, Hawken ER, Seitz DP. Prevalence of cannabis withdrawal symptoms among people with regular or dependent use of cannabinoids: a systematic review and meta-analysis. JAMA Netw Open 2020; 3 (04) e202370
    CrossrefPubMedGoogle Scholar
  • 94 Bonnet U, Preuss UW. The cannabis withdrawal syndrome: current insights. Subst Abuse Rehabil 2017; 8: 9-37
    CrossrefPubMedGoogle Scholar
  • 95 Connor JP, Stjepanović D, Budney AJ, Le Foll B, Hall WD. Clinical management of cannabis withdrawal. Addiction 2022; 117 (07) 2075-2095
    CrossrefPubMedGoogle Scholar
  • 96 Correa F, Wolfson ML, Valchi P, Aisemberg J, Franchi AM. Endocannabinoid system and pregnancy. Reproduction 2016; 152 (06) R191-R200
    CrossrefPubMedGoogle Scholar
  • 97 Corsi DJ, Walsh L, Weiss D. et al. Association between self-reported prenatal cannabis use and maternal, perinatal, and neonatal outcomes. JAMA 2019; 322 (02) 145-152
    CrossrefPubMedGoogle Scholar
  • 98 Wu CS, Jew CP, Lu HC. Lasting impacts of prenatal cannabis exposure and the role of endogenous cannabinoids in the developing brain. Future Neurol 2011; 6 (04) 459-480
    CrossrefPubMedGoogle Scholar
  • 99 Paul SE, Hatoum AS, Fine JD. et al. Associations between prenatal cannabis exposure and childhood outcomes: results from the ABCD study. JAMA Psychiatry 2021; 78 (01) 64-76
    CrossrefPubMedGoogle Scholar
  • 100 Meier MH, Caspi A, Ambler A. et al. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl Acad Sci U S A 2012; 109 (40) E2657-E2664
    CrossrefPubMedGoogle Scholar
  • 101 Antoniou T, Juurlink DN. Synthetic cannabinoids. CMAJ 2014; 186 (03) 210
    CrossrefPubMedGoogle Scholar
  • 102 Winstock AR, Barratt MJ. Synthetic cannabis: a comparison of patterns of use and effect profile with natural cannabis in a large global sample. Drug Alcohol Depend 2013; 131 (1–2): 106-111
    CrossrefPubMedGoogle Scholar
  • 103 Kourouni I, Mourad B, Khouli H, Shapiro JM, Mathew JP, Mathew JP. Critical illness secondary to synthetic cannabinoid ingestion. JAMA Netw Open 2020; 3 (07) e208516
    CrossrefPubMedGoogle Scholar
  • 104 Hurst D, Loeffler G, McLay R. Psychosis associated with synthetic cannabinoid agonists: a case series. Am J Psychiatry 2011; 168 (10) 1119
    CrossrefPubMedGoogle Scholar
  • 105 Ghazanfar H, Muthumanickam A, Qureshi Z, Altaf F, Zeana C, Chilimuri S. A case of synthetic cannabinoid (K2)-induced posterior reversible encephalopathy syndrome (PRES). Am J Case Rep 2022; 23: e936209
    CrossrefPubMedGoogle Scholar
  • 106 Parajuli P, Regmi MR, Lara-Garcia OE, Abu Limon I, Deckard A. Man vs. man-made marijuana: a case of drug-induced posterior reversible encephalopathy syndrome (PRES) due to K2, a ynthetic cannabinoid (SCB). J Community Hosp Intern Med Perspect 2020; 10 (04) 361-364
    CrossrefPubMedGoogle Scholar
  • 107 Ibrahim S, Al-Saffar F, Wannenburg T. A unique case of cardiac arrest following K2 abuse. Case Rep Cardiol 2014; 2014: 120607
    PubMedGoogle Scholar
  • 108 Davis C, Boddington D. Teenage cardiac arrest following abuse of synthetic cannabis. Heart Lung Circ 2015; 24 (10) e162-e163
    CrossrefPubMedGoogle Scholar