Cannabis species and cannabinoid concentration preference among sleep-disturbed medicinal cannabis users
Katherine A. Belendiuk, Kimberly A. Babson, Ryan Vandrey, Marcel O. Bonn-Miller
Addictive Behaviors, 2015, 50, 178–181
doi : 10.1016/j.addbeh.2015.06.032
a b s t r a c t
Introduction : Individuals report using cannabis for the promotion of sleep, and the effects of cannabis on sleep may vary by cannabis species. Little research has documented preferences for particular cannabis types or cannabinoid concentrations as a function of use for sleep disturbances.
Methods : 163 adults purchasing medical cannabis for a physical or mental health condition at a cannabis dispensary were recruited. They provided self-report of (a)whether cannabis usewas intended to help with sleep problems (e.g. insomnia, nightmares), (b) sleep quality (PSQI), (c) cannabis use (including preferred type), and (d) symptoms of DSM-5 cannabis dependence.
Results : 81 participants reported using cannabis for the management of insomnia and 14 participants reported using cannabis to reduce nightmares. Individuals using cannabis to manage nightmares preferred sativa to indica strains (Fisher’s exact test (2)=6.83, p b 0.05), and sativa users were less likely to endorse DSM-5 cannabis dependence compared with those who preferred indica strains (χ2(2) = 4.09, p b 0.05). Individuals with current insomnia (t(9)=3.30, p b 0.01) and greater sleep latency (F(3,6)=46.7, p b 0.001) were more likely to report using strains of cannabiswith significantly higher concentrations of CBD. Individuals who reported at leastweekly use of hypnotic medications used cannabis with lower THC concentrations compared to thosewho used sleep medications less frequently than weekly (t(17)= 2.40, p b 0.05).
Conclusions : Associations between sleep characteristics and the type of cannabis usedwere observed in this convenience sample of individuals using cannabis for the management of sleep disturbances. Controlled prospective studies are needed to better characterize the impact that specific components of cannabis have on sleep.
Keywords : Cannabis, Medical marijuana, Marijuana Sleep, Insomnia
The use of cannabis for medical purposes is rapidly expanding, and one of the primary motivations for medicinal cannabis use is tomanage sleep difficulties (Bonn-Miller, Boden, Bucossi, & Babson, 2014; Grella, Rodriguez, & Kim, 2014;Walsh et al., 2013). Cannabis may be beneficial in the promotion of sleep (Babson & Bonn-Miller, 2014), though the extent and mechanisms by which cannabis may improve sleep is unclear (Babson & Bonn-Miller, 2014). Some research has suggested that Δ9-tetrahydrocannabinol (Δ9-THC), the primary psychoactive component of cannabis, is responsible for sleep promotion, while other research has shown Δ9-THC to have an activating effect that can result in poor sleep (Babson & Bonn-Miller, 2014).
The primary limitations of existing work on the use and impact of cannabis for sleep promotion are two-fold. First, the majority of work on cannabis and sleep has focused on administration of isolated cannabinoids (e.g., Δ9-THC; Babson & Bonn-Miller, 2014). While this is an important initial step in the literature, cannabis use by the majority of medicinal patients (i.e., smoking the cannabis flower) includes ingestion of a number of additional cannabinoids present in the cannabis plant (e.g., cannabidiol; CBD). Indeed, cannabinoids such as CBD have both psychoactive and non-psychoactive properties, which may interact with Δ9-THC to produce more nuanced effects (Aizpurua-Olaizola et al., 2014; Englund et al., 2013; Russo, 2011; Vann et al., 2008; Walsh et al., 2013; Zuardi, Hallak, & Crippa, 2012). Similarly, there is a lack of naturalistic observation of cannabis use behavior among those with self-reported sleep problems. Studies have examined sleep effects following laboratory administration of cannabinoids, but laboratorybased studies do not necessarily translate to “real world” behaviors as cannabis choice is not afforded within the laboratory context (Burgdorf, Kilmer, & Pacula, 2011; Mitchell, 2012). As such, it is necessary to document naturalistic choice of particular medical cannabis types among individuals who self-report using cannabis for the treatment of sleep problems.
Cannabis can be categorized by plant sub-species that, within species, can vary considerably with regard to relative cannabinoid concentration. Cannabis strains obtained at dispensaries within the U.S. are typically classified as one of 3 species designations: indica, sativa, and “hybrid” (cross-bred cannabis plants containing characteristics of both indica and sativa varieties). However, little is known regarding differences between indica and sativa in terms of psychoactive effects or variations in cannabinoid concentration (i.e., amount of each cannabinoid).
Indeed, cannabinoid concentration can vary widely between cannabis flowers obtained and used by medicinal patients (Hillig & Mahlberg, 2004). Furthermore, little research has documented species or cannabinoid concentration preferences among individuals who use medical cannabis for particular conditions.
The purpose of the present study was to document cannabis species and cannabinoid concentration preferences among medical cannabis userswho report using cannabis for themanagement of sleep problems.
Because individuals who use cannabis to improve sleep have been shown to be at increased risk for the experience of negative consequences associated with use (Bonn-Miller, Babson, & Vandrey, 2014), we also evaluated the interaction between the type of cannabis used and diagnosis of cannabis use disorder among study participants.