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users have also been reported.140 Although these studies have attempted to match heavy marijuana users with subjects of similar cognitive abilities before exposure to marijuana use, the adequacy of this matching has been questioned.133 The complex methodological issues facing research in this area are well reviewed in an article by Pope and colleagues.121 Care must be exercised so that studies are designed to differentiate between changes in brain function caused the effects of marijuana and by the illness for which marijuana is being given. AIDS dementia is an obvious example of this possible confusion. It is also important to determine whether repeated use of marijuana at therapeutic dosages produces any irreversible cognitive effects.

Psychomotor Performance

Marijuana administration has been reported to affect psychomotor performance on a number of tasks. The review by Chait and Pierri23 not only details the studies that have been done but also points out the inconsistencies among studies, the methodological shortcomings of many studies, and the large individual differences among the studies attributable to subject, situational, and methodological factors. Those factors must be considered in studies of psychomotor performance when participants are involved in a clinical trial of the efficacy of marijuana. The types of psychomotor functions that have been shown to be disrupted by the acute administration of marijuana include body sway, hand steadiness, rotary pursuit, driving and flying simulation, divided attention, sustained attention, and the digit-symbol substitution test. A study of experienced airplane pilots showed that even 24 hours after a single marijuana cigarette their performance on flight simulator tests was impaired.163 Before the tests, however, they told the study investigators that they were sure their performance would be unaffected.

Cognitive impairments associated with acutely administered marijuana limit the activities that people would be able to do safely or productively. For example, no one under the influence of marijuana or THC should drive a vehicle or operate potentially dangerous equipment.

Amotivational Syndrome

One of the more controversial effects claimed for marijuana is the production of an "amotivational syndrome." This syndrome is not a medical diagnosis, but it has been used to describe young people who drop out of social activities and show little interest in school, work, or other goal-directed activity. When heavy marijuana use accompanies these symptoms, the drug is often cited as the cause, but no convincing data demon-

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