Same dose, different impact: acute cannabis intoxication impairs visuospatial working memory in both sexes, with disproportionate male vulnerability

Introduction: With expanding global cannabis legalization and rising usage rates, elucidating the specific neurocognitive impact of acute cannabis intoxication across biological sexes is critical. Methods: Using a 2 × 2 factorial design, we examined 154 adults: 77 individuals who use cannabis regularly (≥ 5 days/week for ≥ 1 year; 46 males, 31 females) and 77 matched controls (32 males, 45 females). Participants completed standardized Wechsler Memory Scale subtests assessing four distinct memory domains during the peak pharmacokinetic window (45 min post-consumption of medical-grade cannabis: 16.1% THC, < 1% CBD). Results: < 0.05). Discussion: These findings advance our understanding of cannabis neuropharmacology by demonstrating that cognitive vulnerability is both domain-specific and sex-dependent, with direct implications for precision medicine approaches to cannabis therapeutics and sex-informed harm reduction strategies.