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Reply to: Managing the high: developing legislation and detection methods for cannabis impairment

Nature Reviews Neuroscience volume 22, page 585 (2021)Cite this article

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We thank Thomas R. Arkell, Amie C. Hayley and Luke A. Downey for their comments on our recent Review (Ramaekers, J. G., Mason, N. L., Kloft, L. & Theunissen, E. L. The why behind the high: determinants of neurocognition during acute cannabis exposure. Nat. Rev. Neurosci. 22, 439–454 (2021))1 and their contribution to discussions of the implications of this growing field of research (Arkell, T. R., Hayley, A. C. & Downey, L. A. Managing the high: developing legislation and detection methods for cannabis impairment. Nat. Rev. Neurosci. https://doi.org/10.1038/s41583-021-00500-5 (2021))2

In line with others3,4,5, Arkell et al. suggest that uniform standards around Δ9-tetrahydrocannabinol (THC) dosing might increase comparability between scientific studies and support informed decision making among consumers. We have previously argued6,7 that the best way to increase comparability between THC studies on neurocognitive function is to report both THC dose (in mass; mg) and blood THC concentration. The main reason for this suggestion is that comparison between absolute or standard units of THC doses can be misleading because of variations in administration procedures employed across studies. Variations in puff volume, number of puffs and breath-hold duration while smoking cannabis produce dose-related changes in plasma levels of THC8. Likewise, different routes of administration (such as smoking, vaporization and orally ingestion) produce marked differences in bioavailability and the overall pharmacokinetic and neurocognitive profile of THC at any given dose1,9. Moreover, our Review1 also highlights how the impact of THC on neurocognitive function can be impacted by a range of additional factors, such as the cannabinoid composition of the cannabis products and the individual’s cannabis use history, that cannot be deduced from information on THC dose alone. From a consumer perspective, it might therefore be appropriate to provide estimates on the expected strength of the cannabis experience for separate cannabis product types or treatments, while taking into account a multitude of contributory factors such as THC dose, route of administration, cannabinoid composition and frequency of use.

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References

  1. Ramaekers, J. G., Mason, N. L., Kloft, L. & Theunissen, E. L. The why behind the high: determinants of neurocognition during acute cannabis exposure. Nat. Rev. Neurosci. 22, 439–454 (2021).

    Article  CAS  Google Scholar 

  2. Arkell, T. R., Hayley, A. C. & Downey, L. A. Managing the high: developing legislation and detection methods for cannabis impairment. Nat. Rev. Neurosci. https://doi.org/10.1038/s41583-021-00500-5 (2021).

  3. Casajuana, C. et al. Working on a Standard Joint Unit: A pilot test. Adicciones 29, 227–232 (2017).

    Article  Google Scholar 

  4. Freeman, T. P. & Lorenzetti, V. ‘Standard THC units’: a proposal to standardize dose across all cannabis products and methods of administration. Addiction 115, 1207–1216 (2020).

    Article  Google Scholar 

  5. Volkow, N. D. & Weiss, S. R. B. Importance of a standard unit dose for cannabis research. Addiction 115, 1219–1221 (2020).

    Article  Google Scholar 

  6. Ramaekers, J. G., Kauert, G. F., Theunissen, E. L. & Moeller, M. R. Up in Smoke: comparability of THC dosing across performance studies. Neuropsychopharmacology 31, 2800–2801 (2006).

    Article  CAS  Google Scholar 

  7. Ramaekers, J. G., Mason, N. L. & Theunissen, E. L. Blunted highs: pharmacodynamic and behavioral models of cannabis tolerance. Eur. Neuropsychopharmacol. 36, 191–205 (2020).

    Article  CAS  Google Scholar 

  8. Azorlosa, J. L., Greenwald, M. K. & Stitzer, M. L. Marijuana smoking: effects of varying puff volume and breathhold duration. J. Pharmacol. Exp. Ther. 272, 560–569 (1995).

    CAS  PubMed  Google Scholar 

  9. McGilveray, I. J. Pharmacokinetics of cannabinoids. Pain Res. Manag. 10, 15A–22A (2005).

    Article  Google Scholar 

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Authors and Affiliations

  1. Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands

    Johannes G. Ramaekers, Natasha L. Mason, Lilian Kloft & Eef L. Theunissen

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  1. Johannes G. Ramaekers
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  2. Natasha L. Mason
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  3. Lilian Kloft
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  4. Eef L. Theunissen
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Correspondence to Johannes G. Ramaekers.

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Ramaekers, J.G., Mason, N.L., Kloft, L. et al. Reply to: Managing the high: developing legislation and detection methods for cannabis impairment. Nat Rev Neurosci 22, 585 (2021). https://doi.org/10.1038/s41583-021-00501-4

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