2021 / Prospective Cohort / Moderate evidenceProspective study of 409 infertility patients found current marijuana use doubled the odds of abnormal sperm shape and tripled the odds of low volume, but was unexpectedly associated with better motility.
2021 / Randomized Controlled Trial / Moderate evidenceMulticenter RCT of 169 people with alcohol or cannabis use disorder found that internet-based attentional bias training added to standard treatment produced no improvements in any outcome over 12 months.
2021 / Animal Study / Preliminary evidenceMouse study found females developed tolerance to THC pain relief faster than males in a chemotherapy-induced neuropathic pain model, with effects mediated primarily through CB1 receptors.
2021 / Systematic Review / Moderate evidenceSystematic review of 12 studies found that nicotine co-use may mask cannabis-related cognitive deficits in young people, while neuroimaging research on co-use effects remains extremely limited.
2021 / Cross Sectional / Strong evidenceNational survey of 4,069 veterans found 11.9% cannabis use overall, rising to 24-30% among those with psychiatric conditions, with depression independently tripling CUD risk.
2021 / Cross Sectional / Strong evidenceStudy of 4,069 veterans found cannabis use disorder was more strongly associated with suicidal ideation and planning than alcohol use disorder alone, independent of psychiatric and trauma factors.
2021 / Cross Sectional / Strong evidenceStudy of 3,157 veterans found cannabis use and cannabis use disorder were associated with 1.5 to 8.3 times higher odds of psychiatric conditions, suicidality, and treatment utilization.
2021 / Longitudinal Cohort / Strong evidenceDanish national registry data showed cannabis-induced psychosis incidence more than doubled from 2006-2016, while alcohol-induced psychosis declined and other substance-induced psychoses remained stable.
2021 / Observational / Strong evidenceStudy of 88,637 individuals found genetic risk for schizophrenia did not predict cannabis use disorder, while genetic risk for ADHD did, challenging the shared-genetics hypothesis for the cannabis-schizophrenia link.
2021 / Randomized Controlled Trial / Strong evidenceStudy of 191 cannabis users found blood THC per se limits performed poorly at detecting recent use, with oral fluid THC at 10 ng/mL showing the best but still imperfect performance.
2021 / Randomized Controlled Trial / Preliminary evidencePhase I trial in 12 volunteers found CBD sublingual wafer achieved equivalent blood levels to oil solution and nabiximols spray, with mild drowsiness as the main side effect.
2021 / Randomized Controlled Trial / Preliminary evidenceSmall crossover trial found vaping 12.5 mg CBD modestly improved verbal memory recall (0.68 additional words) in 34 healthy young adults without affecting attention or working memory.
2021 / Systematic Review / Moderate evidenceSystematic review found multiple endocannabinoid system components show anti-inflammatory potential for IBD in preclinical studies, identifying CB1, CB2, FAAH, and MAGL as therapeutic targets.
2021 / Case Report / Preliminary evidenceCase series of 4 patients found olanzapine resolved treatment-refractory cannabinoid hyperemesis syndrome, suggesting a new option for cases not responding to standard treatments.
2021 / Cross Sectional / Preliminary evidenceUK survey found autistic adults were 3.5 times more likely to use CBD than matched non-autistic adults, while reporting significant barriers to seeking cannabinoid-related healthcare support.
2021 / Randomized Controlled Trial / Strong evidenceControlled trial of 191 cannabis users found oral fluid THC at 10 ng/mL was the best biomarker for detecting use within 3 hours, outperforming blood measures and showing less bias against frequent users.
2021 / Longitudinal Cohort / Moderate evidenceStudy of 367 college students found using alcohol, marijuana, and nicotine together was associated with over 10 times the odds of impaired driving compared to alcohol use alone.
2021 / Animal Study / Preliminary evidenceMouse study found that acute THC did not affect running preference, performance, or motivation, even though CB1 receptors were necessary for running drive, contradicting popular beliefs about cannabis enhancing exercise.
2021 / Prospective Cohort / Moderate evidenceItalian expanded access program found purified CBD achieved 50%+ seizure reduction in 40% of 82 patients with highly treatment-resistant Dravet or Lennox-Gastaut syndrome who had failed a median of 8 prior drugs.
2021 / Animal Study / Preliminary evidenceMice with reduced Reelin protein showed worse social, behavioral, and stress outcomes after adolescent THC exposure than normal mice, suggesting genetic factors influence cannabis vulnerability.
2021 / Case Control / Preliminary evidenceStudy of 50 treatment-resistant schizophrenia patients found THC consumers had nearly double the DNA methylation in the NRXN1 gene promoter compared to non-consumers, suggesting epigenetic links between cannabis and psychosis.
2021 / Observational / Moderate evidenceMendelian randomization found genetic liability to bipolar disorder increased cannabis use risk, but genetic liability to cannabis use did not increase bipolar disorder risk, suggesting a self-medication pathway.
2021 / Cross Sectional / Moderate evidenceSurvey of 1,500 caregivers in Colorado found 11% used marijuana, but 90% of those said their child's pediatrician had never asked about their use.
2021 / Observational / Strong evidenceLarge genetic study found cannabis use disorder (but not simply trying cannabis) was robustly associated with schizophrenia risk after controlling for tobacco, with mixed evidence on whether the relationship is causal.
2021 / Longitudinal Cohort / Strong evidenceAnalysis of over 1 million high school students across 46 states found no evidence that medical marijuana laws or dispensaries increased adolescent marijuana use from 1991-2015.
2021 / Scoping Review / Preliminary evidenceScoping review of only 6 studies found cannabis use was mostly not associated with cognitive impairment in bipolar disorder, with two studies finding better performance in some domains.
2021 / Retrospective Cohort / Preliminary evidenceHospital review found a 5-fold increase in pediatric cannabis edible exposures after dispensaries opened, with 16% of 32 children needing respiratory support and 34% hospitalized.
2021 / Case Report / Preliminary evidenceCase report of a 52-year-old man with no psychiatric history who developed first-episode mania after self-medicating COVID-19 with cannabis-containing home remedies.
2021 / Animal Study / Preliminary evidenceMouse study found twice-daily adolescent CBD exposure caused no harmful effects on locomotion, anxiety, or spatial memory in adulthood, with a possible learning enhancement.
2021 / Animal Study / Preliminary evidenceRat study found hempseed lipid extract improved cholesterol-related kidney damage more safely than simvastatin, modulating inflammatory pathways and oxidative stress.
2021 / Cross Sectional / Strong evidenceNational study found emerging adults, men, Black/African American, Native, and sexual minority groups had the highest risk of co-occurring cannabis use disorder and suicidality.
2021 / Animal Study / Preliminary evidenceMouse study found a brain-sparing CB1 receptor blocker reduced weight gain, improved glucose metabolism, and reversed fatty liver without the psychiatric risks that ended rimonabant.
2021 / Systematic Review / Moderate evidenceSystematic review of 22 studies found medical cannabis shows promise for fibromyalgia pain, with different THC/CBD ratios affecting different symptoms, though dosing and long-term data remain limited.
2021 / Cross Sectional / Moderate evidenceSurvey of 775 MS patients found 37.5% used cannabis, with users reporting twice the odds of improvement in urinary frequency, urgency, leakage, and bladder emptying.
2021 / Prospective Cohort / Moderate evidenceCommunity study of 2,142 people found heavy drinking, cannabis use, and stressful events each independently predicted psychosis, with two co-occurring risk factors raising incidence from 1.6% to 17.7%.
2021 / Prospective Cohort / Moderate evidenceProspective study of 35 children with drug-resistant epilepsy found CBD cut abnormal brain discharges nearly in half and improved sleep microstructure in 85% of those with initial sleep abnormalities.
2021 / Pilot Study / Preliminary evidenceSmall pilot trial of smoked CBD cigarettes for acute psychosis found no significant symptom differences, but the placebo group needed more antipsychotic medication while the CBD group did not.
2021 / Animal Study / Preliminary evidenceLab study found THC reduced glioblastoma cell proliferation through the GPR55 receptor rather than CB1/CB2, and CBD unexpectedly abolished this anti-tumor effect.
2021 / Case Report / Preliminary evidenceCase series of 5 people with FASD found cannabis (mostly CBD) reduced disruptive behavior scores from 18 to 6, suggesting potential for a condition with very few treatment options.
2021 / Systematic Review / Moderate evidenceReview of 37 studies found men are twice as likely to have CUD overall, but certain mental illnesses (anxiety, antisocial personality) reverse or narrow the sex gap.
2021 / Observational / Moderate evidenceNew generation synthetic cannabinoids with alkene modifications showed up to 10x the potency of previous compounds and were found in 25 forensic cases including deaths and impaired driving.
2021 / Cross Sectional / Moderate evidenceDenmark's medical cannabis pilot found users had higher treatment satisfaction and lower depression but higher pain scores compared to matched controls, showing both benefits and potential harms.
2021 / Retrospective Cohort / Moderate evidenceStudy of 201 CHS patients found topical capsaicin achieved symptom relief in 55% vs. 21% without, and shortened time to discharge by over 2 hours.
2021 / Systematic Review / Moderate evidenceSystematic review of 10 studies found medical cannabis was safe and potentially beneficial for fibromyalgia, with only mild side effects and no serious adverse events.
2021 / Cross Sectional / Moderate evidenceSurvey of 2,841 medical cannabis users found over half used cannabis to replace prescriptions, with 38% stopping and 46% reducing their prescription drug use, primarily pain medications.
2021 / Case Report / Preliminary evidenceCase of a 36-year-old with CHS who developed aortic blood clot and coronary disease requiring surgery because CHS vomiting prevented oral antiplatelet therapy.
2021 / Case Report / Preliminary evidenceCase report of a teenager with multiple substance addictions and depression who improved across all domains after switching from antidepressants to CBD, including quitting all illegal drugs.
2021 / Review / Moderate evidenceExpert panel of 17 developed consensus guidelines for managing cannabis users during surgery, emphasizing screening, potential weaning, extra nausea prevention, and higher pain medication needs.
2021 / Narrative Review / Preliminary evidenceReview of how endocannabinoids and dopamine work as partners across Maslow's hierarchy — from survival drives to achievement — and how cannabis disrupts that partnership.
2021 / Animal Study / Preliminary evidenceLab study found CBD protected rat brain tissue from simulated stroke damage while THC worsened it, with different receptor mechanisms mediating each effect.