Muted stress response linked to long-term cannabis use

July 31, 2017

Science Daily/Washington State University

A new study by Washington State University psychology researchers reveals a dampened physiological response to stress in chronic cannabis users.

Using a nationally recognized procedure designed to provoke elevated levels of stress, Carrie Cuttler, clinical assistant professor of psychology, Ryan McLaughlin, assistant professor of integrative physiology and neuroscience, and colleagues in the WSU Department of Psychology examined levels of the stress hormone cortisol in both chronic cannabis users and non-users.

"To the best of our knowledge, this is the first study to examine the effects of acute stress on salivary cortisol levels in chronic cannabis users compared to non-users," Cuttler said. "While we are not at a point where we are comfortable saying whether this muted stress response is a good thing or a bad thing, our work is an important first step in investigating potential therapeutic benefits of cannabis at a time when its use is spreading faster than ever before."

The WSU researchers found virtually no difference in the salivary cortisol levels of two groups of heavy cannabis users confronted with either a psychologically and physiologically stressful situation or a non-stressful one.

In contrast, cortisol levels among non-users of cannabis who experienced the same simulated stressful situation were found to be much greater than the cortisol level of non-users in the no-stress scenario.

The findings are consistent with a growing body of literature that indicates chronic cannabis use is associated with dulled adrenal and emotional reactivity. The study was published recently in the journal Psychopharmacology.

The stress test

Research participants self-identified as either a chronic cannabis consumer, with daily or nearly daily use for the previous year, or as a non-user who had consumed cannabis 10 or fewer times in their life and not at all within the previous year. Forty daily cannabis users and 42 non-users participated in the study. All were required to abstain from consuming cannabis on the day of testing.

Upon arrival at the lab, participants provided a saliva sample and were asked to rate their current level of stress. The chronic cannabis users and non-users were randomly assigned to experience either the high-stress or no-stress version of the Maastricht Acute Stress Test. Known by its acronym MAST, it is a commonly used procedure for stress-related research which combines elements of physical, psychosocial and unpredictable types of stress.

The no-stress version was simple: participants placed one hand in lukewarm water for 45-90 seconds and then were asked to count from 1 to 25.

The high-stress version upped the stakes significantly. Participants placed their hand in ice cold water for 45-90 seconds. They were then asked to count backwards from 2043 by 17 and were given negative verbal feedback when they made a mistake. On top of this, subjects were monitored by a web camera and the video feed was displayed on a screen directly in front of the participants so they couldn't help but see themselves.

Immediately following the stress manipulation, all participants once again provided a saliva sample and were asked to rate their current level of stress. Before departing the testing facility, participants also provided a urine sample so researchers could corroborate self-reported use with bodily THC levels.

Interpreting the results

Cuttler and her colleagues' work suggests cannabis may have benefits in conferring resilience to stress, particularly in individuals who already have heightened emotional reactivity to stressful situations.

However, the researchers emphasized the release of cortisol typically serves an adaptive purpose, allowing an individual to mobilize energy stores and respond appropriately to threats in the environment.

"Thus, an inability to mount a proper hormonal response to stress could also have detrimental effects that could potentially be harmful to the individual," Cuttler said. "Research on cannabis is really just now ramping up because of legalization and our work going forward will play an important role in investigating both the short-term benefits and potential long-term consequences of chronic cannabis use."

Next steps in the research will include investigating various factors, such as the presence of residual THC, which may be influencing the muted stress response in cannabis users.

https://www.sciencedaily.com/releases/2017/07/170731090828.htm

Marijuana use may cause severe cyclic nausea, vomiting, a little-known, but costly effect

October 22, 2012

Science Daily/American College of Gastroenterology (ACG)

Marijuana use -- both natural and synthetic -- may cause cannabinoid hyperemesis (CH) a little-known but costly effect that researchers suggest is a serious burden to the health care system as it often leads to expensive diagnostic tests and ineffective treatments in an effort to find the cause of a patient's symptoms and provide relief, according to two separate case reports unveiled October 22 at the American College of Gastroenterology's (ACG) 77th Annual Scientific meeting in Las Vegas. Cannabinoid hyperemesis is characterized by a history of chronic cannabis use followed by a cyclic pattern of nausea, vomiting and colicky abdominal pain. Interestingly, compulsive hot baths or showers temporarily relieve symptoms, another characteristic which aids clinicians in diagnosis.

"Most healthcare providers are unaware of the link between marijuana use and these episodes of cyclic nausea and vomiting so they are not asking about natural or synthetic cannabinoid use when a patient comes to the emergency room or their doctor's office with these symptoms," said co-investigator Ana Maria Crissien-Martinez, M.D. of Scripps Green Hospital and Clinic in San Diego. She said CH was first described in a 2004 case series of 9 patients in Australia and since then, 14 case reports and 4 case series have been published, including a prospective series of 98 patients published by Mayo Clinic in February 2012.

"Patients who use cannabis whether natural or in synthetic form called 'Spice' also don't realize their unexplained episodes of cyclic nausea and vomiting may be a result of this use, with some increasing their cannabis use because they may think it will help alleviate their symptoms -- and it actually makes them worse," said Dr. Crissien-Martinez. "The only resolution is cannabis cessation."

Dr. Crissien-Martinez co-authored the case report, "Marijuana: Anti-Emetic or Pro-Emetic" which described a series of 9 patients with cannabinoid hyperemesis at Scripps Green Hospital with average age at diagnosis 30 years-old; 88 percent male; onset of cannabis use during teen years; 88 percent used cannabis daily; 56 percent compulsive bathing behavior; and 80 percent symptom resolution with cannabis cessation.

The other case report, "Spicing Up the Differential for Cyclic Vomiting: A Case of Synthetic-Cannabinoid Induced Hyperemesis Syndrome (CHS)," may be the first reported case of CH attributed to synthetic cannabinoid, according to Fong-Kuei Cheng, M.D. and his research team from Walter Reed Walter Reed National Military Medical Center/Uniformed Services University of the Health Sciences in Bethesda, MD.

"Legal synthetic cannabinoids became available in the United States by 2009 with widespread usage among military personnel due to its ability to elude standard drug testing. It is important to recognize that routine urine drug testing does not include JWH-018 and JWH 073, which are the primary components in synthetic cannabinoids," said Dr. Cheng.

The case report described a 22-year active duty military male who was admitted with a 10-month history of progressive, intermittent abdominal pain, nausea and vomiting, with episodes occurring every two months and lasting up to a week. He underwent several diagnostic tests before a urine synthetic cannabinoid test confirmed the diagnosis of cannabinoid hyperemesis syndrome (CHS). Since discontinuing these drugs, the patient has remained symptom-free, according to the case report.

"This case illustrates that CHS should be in the differential diagnosis of unexplained, episodic abdominal pain with nausea and vomiting, particularly if relieved with compulsive hot showers. Recognition of this syndrome is important to prevent unnecessary testing and to reduce health care expenditures," said Dr. Cheng. "We have also noted, particularly in the active duty population where drug testing for cannabis usage is done routinely, that there appears to be an increased usage instead of the synthetic cannabinoids, so we would advocate routine additional testing for them when the clinical suspicion is high."

Patients frequently have multiple hospital, clinic and emergency room visits with extensive negative work-up to include imaging studies, endoscopies, and laboratory testing before they are finally diagnosed with cannabinoid hyperemesis, according to the researchers of both case reports.

"We estimate $10,000 to be the minimum cost of one admission -- but on average our patients required admission to the hospital 2.8 times, a total of almost $30,000 for workup," said Dr. Crissien-Martinez, who added that that cost does not include the added costs of primary care physician and/or gastroenterologist and emergency room visits, which averaged 2.5 and 6 times respectively.

Dr. Crissien-Martinez said that 80 percent of the Scripps Green patients who stopped cannabis experienced symptom resolution; however, only one of them remained abstinent and consequently symptom-free.

"As health care providers, we must be aware of the potential side effects of chronic cannabis use and understand that cannabinoid hyperemesis is diagnosed clinically to avoid expensive diagnostic and therapeutic modalities," said Dr. Crissien-Martinez. "Instead the focus should be shifted towards counseling and resources allocated towards marijuana cessation."

https://www.sciencedaily.com/releases/2012/10/121022081353.htm