Grupo Interdisciplinar de Estudos sobre Álcool e Drogas (GREA), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil; Laboratory of Psychiatric Neuroimaging (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil.
Grupo Interdisciplinar de Estudos sobre Álcool e Drogas (GREA), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil; Laboratory of Psychiatric Neuroimaging (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil; Serviço de Psicologia e Neuropsicologia, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil.
Drug Alcohol Depend. 2019 Dec 1;205:107642. doi: 10.1016/j.drugalcdep.2019.107642. Epub 2019 Oct 18.
Cannabis use is frequent among individuals with cocaine use disorder. Despite recent non-controlled studies advocating a therapeutic role of smoked cannabis, there is a paucity of evidence-based data on potential therapeutic and cognitive side-effects of this association.
We examined 63 cocaine-addicted subjects who used cannabis more than 50 times in lifetime (COC + CAN), 24 cocaine-addicted patients who use cannabis less than 50 times (COC), and 36 controls (CON). Participants were evaluated with an extensive battery of neurocognitive tests after two weeks of supervised detoxification in an inpatient treatment program. Patients were followed up in one, three, and six months after discharge.
Both groups of patients performed worse than CON on working memory, processing speed, inhibitory control, mental flexibility, and decision making. COC + CAN performed worse than COC on speed processing, inhibitory control and sustained attention, while COC performed worse than COC + CAN on mental flexibility. Concomitant cannabis use did not decrease relapses to cocaine use after one, three and six months. Among COC + CAN, earlier cocaine and cannabis use, and impaired executive functioning were predictive of relapse on cocaine after six months.
Our results did not support the recommendation of smoked cannabis as a safe therapeutic approach for cocaine-addicted patients due to significant negative cognitive side-effects and absence of efficacy. Further studies investigating frontal brain morphology, neuromaturation, and prescription of the non-psychoactive constituent of cannabis sativa cannabidiol among cocaine-addicted patients who use cannabis are warranted.
可卡因使用障碍患者中经常使用大麻。尽管最近有一些非对照研究提倡吸食大麻具有治疗作用，但关于这种关联的潜在治疗和认知副作用的循证数据仍然很少。
我们检查了 63 名可卡因成瘾者，他们一生中使用大麻超过 50 次（COC+CAN），24 名可卡因成瘾者使用大麻少于 50 次（COC），36 名对照者（CON）。参与者在住院治疗计划中接受了两周的监督戒毒治疗后，接受了广泛的神经认知测试。患者在出院后一个月、三个月和六个月进行随访。
两组患者在工作记忆、处理速度、抑制控制、心理灵活性和决策方面的表现均逊于 CON。COC+CAN 在处理速度、抑制控制和持续性注意力方面的表现均逊于 COC，而 COC 在心理灵活性方面的表现则逊于 COC+CAN。同时使用大麻并不能降低可卡因使用在一个、三个月和六个月后的复发率。在 COC+CAN 中，可卡因和大麻使用的早期以及执行功能受损与六个月后可卡因复发有关。
由于认知方面存在显著的负面影响且疗效不显著，我们的结果不支持推荐吸食大麻作为可卡因成瘾患者的安全治疗方法。需要进一步研究可卡因成瘾患者的额叶脑形态学、神经发育和大麻二酚（大麻的非精神活性成分）的处方，以了解其作用。
