Anxiety, Inflammation, and Stress

Study Overview
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Brief Summary
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This study investigates whether the anxiolytic effects and anti-inflammatory properties of cannabis vary as a function of the ratio of CBD to THC, with the goal that these effects may shed light on the mixed data linking cannabis use and anxiety. Individuals with mild to moderate anxiety who elect to use cannabis (smoked flower or edible) will complete four weeks of observation. Participants complete cognitive tasks, a substance use history, health questionnaires concerning sleep and physical activity, and a blood draw at four different time points (Baseline, after 2 weeks of cannabis use, and immediately before and after self-administration after 4 weeks of use) with the use of a mobile pharmacology laboratory, which goes to a convenient location for each participant to self-administer their cannabis. Participants are then followed for five months to self-report on cannabis use, anxiety, subjective cognitive functioning, sleep quality, and other mental health symptoms.

Detailed Description
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Marijuana use is on the rise with the number of adults reporting medical and recreational use doubling in the past decade. Among adult medical marijuana users, 39% report using marijuana for the purposes of self-treating or coping with anxiety. Marijuana is approved for medical use in over half the states and is gaining traction for use as an off-label add-on therapy for treatment-resistant anxiety and stress-related disorders. Paradoxically, however, while data suggest that marijuana, in particular ∆9-tetrahydrocannabinol (THC), increases anxiety acutely, cross sectional and longitudinal data suggest associations between marijuana use and lower risk for anxiety disorders. There is some evidence demonstrating that marijuana use is associated with increases in acute anxiety and anxiety disorders. However, other data suggests that marijuana use may be protective for adolescents at-risk for anxiety and decrease the chances of developing an anxiety disorder during college. This finding is consistent with a growing body of evidence from animal models suggesting that marijuana has anxiolytic and anti-inflammatory properties. Clarifying the anxiolytic effects of specific strains that differ in their cannabinoid composition may explain these discrepant findings. Thus, regardless of whether results support or refute the anxiolytic properties of marijuana, findings from this study fill a critical void and can inform public perception. The study goal is to understand the anxiolytic effects of cannabinoids, in particular the effects of THC-based strains vs. CBD-based strains vs strains containing both THC and CBD in different ratios (1:0, 1:1, or 0:1) on inflammation, cognitive functioning, and anxiety/negative affect. This design will capitalize on the novel opportunity to examine the effects of real world marijuana strains on key outcomes.

Official Title
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Novel Approaches to Understanding the Role of Cannabinoids and Inflammation in Anxiety

Conditions
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Inflammation, Anxiety, Anxiety Disorders, Anxiety Generalized, Anxiety Chronic, Inflammatory Response

Intervention / Treatment
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* Drug: Cannabis (smoked flower, ingested edible)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Non-users of cannabis must have been a non-user of cannabis for at least six months If a user of cannabis, at least one episode of lifetime cannabis use and a desire to use cannabis to cope with anxiety. Reports at least mild to moderate anxiety (≥5 on GAD-7) Exclusion Criteria: Seeking treatment for a substance use disorder Current use of other drugs (e.g., cocaine, methamphetamine) Current use psychotropic or steroid-based medications Has an immune-relevant disease (e.g. HIV) Daily tobacco user Currently pregnant or trying to become pregnant In treatment for psychotic disorder, bipolar disorder or major depression disorder with suicidal ideation; or a history with these disorders.

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: Cannabis (smoked flower, ingested edible)|Self-Directed Use (ad-libitum)|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Anxiety/Negative Affect: Depression Anxiety Stress Scale (DASS21). | The DASS21 is a 21-item scale that measures self-reported change in anxiety, depression, and stress symptoms. Subjects are asked to use 4-point severity/frequency scales (higher values indicate greater severity) to rate the extent to which they have experienced each state. Scores for Depression, Anxiety and Stress are calculated by summing the scores for the relevant items. Changes in DASS self-report will be tested in relation to THC and CBD blood levels. | Change over three time points over 4 weeks: Baseline (before 4 weeks of cannabis use), Pre-Administration (after 4 weeks of use, but before acute self-administration), and Post-Administration (after 4 weeks of use and after acute self-administration) | 
| Change in Inflammation: Circulating Levels of cytokines (panel of inflammatory markers). | Change in inflammation from before to after cannabis use will be tested in relation to THC and CBD blood levels. | Change over three time points over 4 weeks: Baseline (before 4 weeks of cannabis use), Pre-Administration (after 4 weeks of use, but before acute self-administration), and Post-Administration (after 4 weeks of use and after acute self-administration) | 
| Patient Global Impression of Change: Global Impression of Change Scale (PGIC). | Patient Global Impression of Change Scale (PGIC) measures self-reported change on a 1-7 scale (i.e. from 1 (very much worse) to 7 (very much improved)) in anxiety. Changes in this measure will be tested in relation to THC and CBD blood levels. | Change over three time points over 4 weeks: Baseline (before 4 weeks of cannabis use), Pre-Administration (after 4 weeks of use, but before acute self-administration), and Post-Administration (after 4 weeks of use and after acute self-administration) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cognitive Impairment: NIH Toolbox Cognitive Battery, Flanker Inhibitory Control Attention Task (FICA), International Shopping List Test (ISLT), and Functional Assessment of Cancer Therapy Cognitive Scale (FACT-Cog). | Co-outcomes testing multiple domains of thinking, memory, and perception (NIH Toolbox), cognitive impairment in the domains of immediate and delayed recall (ISLT), attention and inhibitory control (FICA), and a subjective report of cognitive complaint (FACT-Cog). Cognitive outcomes are measured in standard scores (e.g. Range of >70 to >140 (Mean of 100 and SD of 15) with higher scores indicating better performance) and can be averaged to reflect a Standard score of overall cognitive function. | Change over three time points over 4 weeks: Baseline (before 4 weeks of cannabis use), Pre-Administration (after 4 weeks of use, but before acute self-administration), and Post-Administration (after 4 weeks of use and after acute self-administration) | 
| Stress reactivity induction | Measure affective and stress reactivity responses through lab paradigm assessing attention to affective/stress inducing cues. | Change over three time points over 4 weeks: Baseline (before 4 weeks of cannabis use), Pre-Administration (after 4 weeks of use, but before acute self-administration), and Post-Administration (after 4 weeks of use and after acute self-administration). | 
| Depression and Mood | Self-report of depression and mood states will be assessed at baseline and the four-week appointment. Given the observational nature of the study, co-outcomes are appropriate to comprehensively assess change in depression/negative affect over the course of the study. | Change over three time points over 4 weeks: Baseline (before 4 weeks of cannabis use), Pre-Administration (after 4 weeks of use, but before acute self-administration), and Post-Administration (after 4 weeks of use and after acute self-administration) | 
| Health and Wellbeing | Self-report measure across primary domains of health-related well-being, diet, and assessment of sleep quality. | Change over three time points over 4 weeks: Baseline (before 4 weeks of cannabis use), Pre-Administration (after 4 weeks of use, but before acute self-administration), and Post-Administration (after 4 weeks of use and after acute self-administration) | 
| Motor Battery: Balance and Motor Function | Motor control assessed via dynamic sway, proprioception, and finger tapping rate. Motor outcomes can be aggregated via Z-score to reflect a Z-score of overall motor function. | Change over three time points over 4 weeks. | 
| Objective physical activity/exercise | Physical activity via objective daily data on wearable watch. | Change over 2 weeks. | 
| Physical activity/exercise | Physical activity via subjective self-report data. | Change over 4 weeks. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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anxiety, inflammation, cannabis, marijuana, stress