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Rationale  Prolonged use of cannabis, the most widely used illicit drug worldwide, has been consistently associated with impairment in memory and verbal learning. Although the neurophysiological underpinnings of these impairments have been investigated previously using functional magnetic resonance imaging (fMRI), while performing memory tasks, the results of these studies have been inconsistent and no clear picture has emerged yet. Furthermore, no previous studies have investigated trial-by-trial learning.    Objectives  We aimed to investigate the neural underpinnings of impaired verbal learning in cannabis users as estimated over repeated learning trials.    Methods  We studied 21 adolescent-onset regular cannabis users and 21 non-users using fMRI performed at least 12 h after last cannabis use, while they performed a paired associate verbal learning task that allowed us to examine trial-by-trial learning. Brain activation during repeated verbal encoding and recall conditions of the task was indexed using the blood oxygen level-dependent haemodynamic response fMRI signal.    Results  There was a significant improvement in recall score over repeated trials indicating learning occurring across the two groups of participants. However, learning was significantly slower in cannabis users compared to non-users ( p  = 0.032, partial eta-squared = 0.108). While learning verbal stimuli over repeated encoding blocks, non-users displayed progressive increase in recruitment of the midbrain, parahippocampal gyrus and thalamus ( p  = 0.00939, partial eta-squared = 0.180). In contrast, cannabis users displayed a greater but disrupted activation pattern in these regions, which showed a stronger correlation with new word-pairs learnt over the same blocks in cannabis users than in non-users.    Conclusions  These results suggest that disrupted medial temporal and midbrain function underlie slower learning in adolescent-onset cannabis users.    Electronic supplementary material  The online version of this article (10.1007/s00213-019-05407-9) contains supplementary material, which is available to authorized users.

Disrupted parahippocampal and midbrain function underlie slower verbal learning in adolescent-onset regular cannabis use