The papers in this Special Issue address important questions surrounding the medicinal use of cannabis by reviewing the literature on (1) the impact of cannabis on neurocognition across the lifespan, (2) the therapeutic potential of cannabis, and (3) putative harms associated with cannabis use. In the last few years, record numbers of Americans continue to support the legalization of cannabis, with some surveys reporting 60% approval of legalization compared to 30% a decade ago (Gallup, May 2019; https://news.gallup.com/poll/1657/Illegal-Drugs.aspx). Of those who support legalization, an astounding majority (86%) do so for its potential therapeutic benefits. Indeed, use of cannabis for medicinal purposes has dated as far back as 2700 BC. This begs the question of whether public opinion is supported by empirical research. Because the primary psychoactive ingredient in cannabis, tetrahydrocannabinol (THC), exerts its effects via modulation of cannabinoid 1 receptors that are ubiquitous in the brain and underlie several brain functions, hundreds of studies have investigated the putative effects of cannabis on neurocognition. In this Special Issue, Duperrouzel and colleagues reviewed this vast, yet largely mixed literature from meta-analyses of these studies across different cannabis using populations. While the associations between cannabis and brain alterations in adult cannabis users are largely disparate across studies, findings are relatively consistent in adolescent or adolescent-onset populations. This important literature is presented by Chye et al., who described widely replicated findings of structural and functional brain alterations in areas important for reward and inhibitory control in adolescents. Whether these alterations are age-limited effects or general effects of cannabis, however, remain unknown. It may, therefore, be useful to ascertain agerelated changes by examining cannabis users across the lifespan. To date, however, the vast majority of studies have excluded cannabis users in older age—defined as >55 years old. The review by Yoo et al. attempted to summarize this sparse literature by characterizing the interactions between mechanisms related to cannabis and aging across multiple biological systems. This review highlights the limited knowledge on how cannabis use might affect the aging population, thereby, restricting its clinical efficacy in this growing population. What does the current literature show in terms of the clinical applications of cannabis? In populations who use cannabinoids for medicinal purposes, a large majority (i.e., 40%) utilize cannabis for pain (Gallup, June 19–July 12, 2019). To date, the unresolved and complex relationship between the analgesic effects of cannabinoids and their psychoactive effects limit the application of cannabinoids for the treatment and management of pain. An understanding of these two separate mechanisms in the central and peripheral nervous system is provided in the review by Milligan et al. based on the pre-clinical literature. Following pain, alleviation of stress and anxiety is the second most reported motivation for the use of cannabis for medicinal purposes. Hindocha reviewed the evidence on the efficacy of cannabinoids in the treatment of these symptoms in post-traumatic stress disorder (PTSD) that appear to hold promise for cannabinoids in the reduction of PTSD global symptoms. Although pain, and, stress and anxiety are the most common ailments associated with cannabis self-medication, the first FDAapproved cannabis-based prescription drug is indicated for the treatment of pediatric epilepsy. In 2018, the FDA-approved Epidiolex, a CBD solution for Lennox–Gastault syndrome and Dravet syndrome following promising findings from large, double-blind, placebo-controlled studies sponsored by the drug’s manufacturer, GW Pharmaceuticals. In the timely review of the use of cannabinoids for the treatment of epilepsy, Harvey and Doyle provided a review of clinical studies from the first of its kind in 1949–2018, indicating concordant findings of seizure control following cannabinoid treatment in epilepsy. As in other therapeutic compounds, unwanted side effects are important to consider. The literature is unequivocal in that the risk for side effects of cannabis exposure is especially high during adolescence. A principal side effect is cannabis’ abuse liability. In the review by Karoly et al., they addressed the predominant co-use of cannabis and alcohol in adolescents and described the mixed evidence in the literature across neuropsychological, brain imaging, and psychosocial outcomes. Another concern during adolescent development is

中文翻译：

---

介绍大麻特刊

本特刊中的论文通过回顾以下方面的文献来解决与大麻药用相关的重要问题：(1) 大麻对整个生命周期中神经认知的影响，(2) 大麻的治疗潜力，以及 (3) 与大麻相关的推定危害大麻的使用。在过去几年中，创纪录的美国人继续支持大麻合法化，一些调查报告称，大麻合法化的批准率为 60%，而十年前为 30%（盖洛普，2019 年 5 月；https://news.gallup.com/ poll/1657/Illegal-Drugs.aspx）。在支持合法化的人中，惊人的大多数 (86%) 这样做是因为其潜在的治疗益处。事实上，将大麻用于药用的历史可以追溯到公元前 2700 年。这就引出了一个问题，即公众舆论是否得到实证研究的支持。由于大麻中的主要精神活性成分四氢大麻酚 (THC) 通过调节大麻素 1 受体发挥作用，大麻素 1 受体在大脑中无处不在，并且是多种大脑功能的基础，因此数百项研究调查了大麻对神经认知的推定影响。在本期特刊中，Duperrouzel 及其同事审查了这些庞大但大部分混合的文献，这些文献来自对不同大麻使用人群的这些研究的荟萃分析。虽然大麻与成年大麻使用者大脑改变之间的关联在不同研究中大不相同，但在青少年或青少年发病人群中的研究结果相对一致。Chye 等人介绍了这一重要文献，他描述了在对青少年奖励和抑制控制重要的区域中广泛重复的大脑结构和功能改变的发现。然而，这些改变是年龄限制效应还是大麻的一般效应仍然未知。因此，通过检查整个生命周期的大麻使用者来确定与年龄相关的变化可能是有用的。然而，迄今为止，绝大多数研究都排除了年龄较大的大麻使用者——定义为 >55 岁。Yoo 等人的评论。试图通过描述与大麻相关的机制与跨多个生物系统的衰老之间的相互作用来总结这些稀疏的文献。这篇综述强调了关于大麻使用如何影响老龄化人口的有限知识，从而限制了它在这个不断增长的人群中的临床疗效。就大麻的临床应用而言，目前的文献表明了什么？在将大麻素用于药用的人群中，绝大多数（即 40%）使用大麻止痛（盖洛普，2019 年 6 月 19 日至 7 月 12 日）。迄今为止，大麻素的镇痛作用与其精神作用之间尚未解决且复杂的关系限制了大麻素在疼痛治疗和管理中的应用。Milligan 等人的综述提供了对中枢和外周神经系统中这两种独立机制的理解。基于临床前文献。继疼痛之后，减轻压力和焦虑是将大麻用于药用的第二大动机。Hindocha 审查了大麻素在治疗创伤后应激障碍 (PTSD) 中的这些症状方面的功效的证据，这些证据似乎有望使大麻素减少 PTSD 的整体症状。尽管疼痛、压力和焦虑是与大麻自我药疗相关的最常见疾病，但 FDA 批准的第一种基于大麻的处方药适用于治疗小儿癫痫。2018 年，FDA 批准了 Epidiolex，这是一种用于 Lennox-Gastault 综合征和 Dravet 综合征的 CBD 解决方案，此前该药物制造商 GW Pharmaceuticals 赞助的大型、双盲、安慰剂对照研究取得了有希望的结果。在及时审查使用大麻素治疗癫痫时，Harvey 和 Doyle 回顾了 1949 年至 2018 年的首个此类临床研究，表明大麻素治疗癫痫后癫痫发作控制的结果一致。与其他治疗性化合物一样，需要考虑不必要的副作用。文献是明确的，因为在青春期接触大麻的副作用风险特别高。一个主要的副作用是大麻的滥用责任。在 Karoly 等人的评论中，他们解决了青少年主要同时使用大麻和酒精的问题，并描述了神经心理学、大脑成像和社会心理结果的文献中的混合证据。青少年发展过程中的另一个问题是 与其他治疗性化合物一样，需要考虑不必要的副作用。文献是明确的，因为在青春期接触大麻的副作用风险特别高。一个主要的副作用是大麻的滥用责任。在 Karoly 等人的评论中，他们解决了青少年主要同时使用大麻和酒精的问题，并描述了神经心理学、大脑成像和社会心理结果的文献中的混合证据。青少年发展过程中的另一个问题是 与其他治疗性化合物一样，需要考虑不必要的副作用。文献是明确的，因为在青春期接触大麻的副作用风险特别高。一个主要的副作用是大麻的滥用责任。在 Karoly 等人的评论中，他们解决了青少年主要同时使用大麻和酒精的问题，并描述了神经心理学、大脑成像和社会心理结果的文献中的混合证据。青少年发展过程中的另一个问题是 他们讨论了青少年主要同时使用大麻和酒精的问题，并描述了神经心理学、大脑成像和社会心理结果的文献中的混合证据。青少年发展过程中的另一个问题是 他们讨论了青少年主要同时使用大麻和酒精的问题，并描述了神经心理学、大脑成像和社会心理结果的文献中的混合证据。青少年发展过程中的另一个问题是