Introduction Craving, a potent driving force behind drug-seeking and consumption behaviors, represents a dynamic emotional-motivational response primarily elicited by drug-related cues. In laboratory settings, the drug cue reactivity (DCR) paradigm is frequently employed to evoke craving and investigate the neural and behavioral responses to drug cues. This study adopts functional magnetic resonance imaging (fMRI) alongside behavioral assessments to establish a collection of validated pictorial cues encompassing both cannabis and neutral images.

Methods 110 cannabis-related images were selected across cannabis flowers and powder, cannabis use methods, and paraphernalia categories. Participants with a history of cannabis use were then asked to assess the selected images for craving, valence, and arousal using both the visual analog scale and the self-assessment Manikin. Using fMRI, the neural mechanisms underlying cannabis cue-reactivity were investigated at the whole-brain level and within Brainnetome atlas areas in a subgroup of 31 cannabis users.

Results The selected cannabis-related images (n = 110) received significantly higher craving (t = 6.56; p<0.001) and arousal (t = 17.46; p<0.001) ratings compared to the neutral ones (n = 30). Fifty regular cannabis users (19.9 ± 4.8 years; 10 females and 40 males) with at least a one-year history of use were included. Investigating blood oxygenation level-dependent (BOLD) responses to cannabis compared with neutral cues yielded significant activations in the inferior/medial frontal gyrus, fusiform gyrus, parahippocampal gyrus, orbital gyrus, postcentral gyrus, insula, precuneus, superior/middle temporal gyrus, and cerebellar tonsil.

Conclusion This study provides a resource of ecologically validated cannabis-related images useful for studies applying DCR as interventions or assessments for cannabis users.

The authors have declared no competing interest.

This study has received financial supports from the Cognitive Science and Technologies Council (CSTC) of Iran.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was carried out in accordance with the recommendations of the ethics board of the Iran University of Medical Sciences with written informed consent from all subjects. The protocol was approved by the ethics board of the Iran University of Medical Sciences.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Publicly available datasets were analyzed in this study. This data can be found here: https://osf.io/85j6k/