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Diminished Structural Brain Integrity in Long-term Cannabis Users Reflects a History of Polysubstance Use

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Annchen R. Knodt, Madeline H. Meier, Antony Ambler, Maria Z. Gehred, Hona Lee Harrington, David Ireland, Richie Poulton, Sandhya Ramrakha, Avshalom Caspi, Terrie E. Moffitt, Ahmad R. Hariri

Original languageEnglish
Pages (from-to)861-870
Number of pages10
JournalBiological psychiatry
Issue number11
Accepted/In press2022
Published1 Dec 2022

Bibliographical note

Funding Information: This research received support from U.S. National Institute on Aging Grant Nos. R01AG069939 (to TEM), R01AG032282 (to AC, TEM), and R01AG049789 (to ARH, TEM) and UK Medical Research Council Grant No. MR/P005918/1 . The Dunedin Multidisciplinary Health and Development Research Unit is supported by the New Zealand Health Research Council (Program Grant No. 16–604) and New Zealand Ministry of Business, Innovation and Employment. Publisher Copyright: © 2022 Society of Biological Psychiatry

King's Authors


Background: Cannabis legalization and use are outpacing our understanding of its long-term effects on brain and behavior, which is fundamental for effective policy and health practices. Existing studies are limited by small samples, cross-sectional measures, failure to separate long-term from recreational use, and inadequate control for other substance use. Here, we address these limitations by determining the structural brain integrity of long-term cannabis users in the Dunedin Study, a longitudinal investigation of a population-representative birth cohort followed to midlife. Methods: We leveraged prospective measures of cannabis, alcohol, tobacco, and other illicit drug use in addition to structural neuroimaging in 875 study members at age 45 to test for differences in both global and regional gray and white matter integrity between long-term cannabis users and lifelong nonusers. We additionally tested for dose-response associations between continuous measures of cannabis use and brain structure, including careful adjustments for use of other substances. Results: Long-term cannabis users had a thinner cortex, smaller subcortical gray matter volumes, and higher machine learning–predicted brain age than nonusers. However, these differences in structural brain integrity were explained by the propensity of long-term cannabis users to engage in polysubstance use, especially with alcohol and tobacco. Conclusions: These findings suggest that diminished midlife structural brain integrity in long-term cannabis users reflects a broader pattern of polysubstance use, underlining the importance of understanding comorbid substance use in efforts to curb the negative effects of cannabis on brain and behavior as well as establish more effective policy and health practices.

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