Association of Cannabis With Cognitive Functioning in Adolescents and Young Adults: A Systematic Review and Meta-analysis

Abstract

Importance: Substantial shifts in perception and policy regarding cannabis have recently occurred, with use of cannabis increasing while its perceived harm decreases. One possible risk of increased cannabis use is poorer cognitive functioning, especially in youth.

Objective: To provide the first quantitative synthesis of the literature examining cannabis and cognitive functioning in adolescents and young adults (with a mean age of 26 years and younger).

Data sources: PubMed, PsycInfo, Academic Search Premier, Scopus, and bibliographies of relevant reviews were searched for peer-reviewed, English-language studies from the date the databases began through May 2017.

Study selection: Consensus criteria were used to determine study inclusion through abstract and manuscript review.

Data extraction and synthesis: This study followed Meta-analysis of Observational Studies in Epidemiology guidelines. Effect size estimates were calculated using multivariate mixed-effects models for cognitive functioning outcomes classified into 10 domains.

Main outcomes and measures: Results from neurocognitive tests administered in cross-sectional studies were primary outcomes, and we examined the influence of a priori explanatory variables on variability in effect size.

Results: Sixty-nine studies of 2152 cannabis users (mean [SD] age, 20.6 [2.8] years; 1472 [68.4%] male) and 6575 comparison participants with minimal cannabis exposure were included (mean [SD] age, 20.8 [3.4]; 3669 [55.8%] male). Results indicated a small overall effect size (presented as mean d) for reduced cognitive functioning associated with frequent or heavy cannabis use (d, -0.25; 95% CI, -0.32 to -0.17; P < .001). The magnitude of effect sizes did not vary by sample age or age at cannabis use onset. However, studies requiring an abstinence period longer than 72 hours (15 studies; n = 928) had an overall effect size (d, -0.08; 95% CI, -0.22 to 0.07) that was not significantly different from 0 and smaller than studies with less stringent abstinence criteria (54 studies; n = 7799; d, -0.30; 95% CI, -0.37 to -0.22; P = .01).

Conclusions and relevance: Associations between cannabis use and cognitive functioning in cross-sectional studies of adolescents and young adults are small and may be of questionable clinical importance for most individuals. Furthermore, abstinence of longer than 72 hours diminishes cognitive deficits associated with cannabis use. Although other outcomes (eg, psychosis) were not examined in the included studies, results indicate that previous studies of cannabis in youth may have overstated the magnitude and persistence of cognitive deficits associated with use. Reported deficits may reflect residual effects from acute use or withdrawal. Future studies should examine individual differences in susceptibility to cannabis-associated cognitive dysfunction.

Figure 1.. Flowchart of Searches for Studies Included in the Meta-analysis

Figure 2.. Mean Weighted Effect Sizes for Each Neurocognitive Test Domain

The mean value shown is the grand mean effect size of 69 included studies; d is the standardized mean difference. The shaded area indicates the 95% CI around the mean, −0.247. EF indicates executive functioning; SIP, speed of information processing; WM, working memory. Blue circles indicate the domain effect size d; gray bands, the overall means; error bars, 95% CIs.

Figure 3.. Mean Weighted Effect Sizes for Varying Abstinence Criteria

Subgroup analyses compared effect sizes (standardized mean difference d) from studies with abstinence periods longer than 72 hours to effect sizes from studies with abstinence lengths equal to or less than 72 hours. Data from all 3 groups are presented here to show that the subgroup of studies with unknown or 0 abstinence are not the primary contributor to reported subgroup differences. Blue diamonds indicate the domain effect size d; error bars, 95% CIs.