Hormonal birth control may dampen how strongly women's brains react to cannabis cues | Research

The takeaway

Among 152 frequent cannabis users, women on hormonal contraceptives showed weaker neural responses to cannabis cues than naturally cycling women or men, suggesting hormonal status may influence cannabis cue reactivity.

Addiction researchers, clinicians treating cannabis use disorder, and neuroscientists studying sex differences.

Hormonal contraceptive users showed reduced neural cannabis cue reactivity

What the researchers found

Males and naturally cycling females showed significantly greater neural enhancement (LPP amplitude) to cannabis vs. neutral cues compared to females using hormonal contraceptives. Craving was higher in naturally cycling females than males in unadjusted analyses.

Why it matters

Drug cue reactivity predicts relapse and continued use. If hormonal contraceptives dampen cannabis cue reactivity, this could help explain mixed findings in sex difference research and point toward hormonal mechanisms in cannabis use disorder.

The numbers in context

152 participants: 74 males, 26 naturally cycling females, 52 females on hormonal contraceptives. Hormonal contraceptive users showed significantly reduced LPP enhancement to cannabis cues. Exploratory analyses suggested a progesterone-related mechanism.

How the study worked

As part of a larger study, 152 adults reporting frequent cannabis use completed a drug cue reactivity task during EEG recording. Late positive potential (LPP) amplitude was used to measure neural reactivity to cannabis vs. neutral images. Compared males (n=74), naturally cycling females (n=26), and hormonal contraceptive-using females (n=52).

What this study cannot tell us

Unequal group sizes, with a small naturally cycling female group (n=26). Cross-sectional design. Craving differences did not survive covariate adjustment. Exploratory hormonal mechanism analyses need replication.

How to read the evidence

EEG-based experimental study with a novel hormonal contraceptive comparison, but limited by small group sizes and cross-sectional design.

When this study was published

2024 study of frequent adult cannabis users.

The bigger picture

Sex differences in addiction are increasingly recognized, but hormonal contraceptive use is rarely accounted for. This study suggests that ignoring contraceptive status may obscure real biological differences in how men and women respond to drug cues.

Questions still open

Would progesterone-based treatments reduce cannabis cue reactivity and craving in women trying to quit? Should future addiction studies routinely account for hormonal contraceptive use?

Common questions

How did hormonal birth control affect cannabis cue reactivity?

Women on hormonal contraceptives showed significantly weaker neural responses (LPP amplitude) to cannabis cues compared to both naturally cycling women and men.

Did men and women differ in craving?

Naturally cycling women reported higher craving than men after the cue task, but this difference disappeared after adjusting for covariates.

What might explain this effect?

Exploratory analyses pointed to a progesterone-related mechanism, suggesting that the hormonal profile maintained by contraceptives may reduce how strongly the brain reacts to cannabis cues.

Read the original research

Biological sex and hormonal contraceptive associations with drug cue reactivity in cannabis use disorder.

Journal of psychiatric research, 174, 121-128

View on PubMed ↗Publisher’s paper ↗

Citation

Macatee, Richard J; Cannon, Mallory J; Schermitzler, Brandon S; Preston, Thomas J; Afshar, Kaveh. (2024). Biological sex and hormonal contraceptive associations with drug cue reactivity in cannabis use disorder.. Journal of psychiatric research, 174, 121-128. https://doi.org/10.1016/j.jpsychires.2024.04.016