Cannabis and Attention-Deficit Hyperactivity Disorder

Medical Cannabis and Attention-Deficit Hyperactivity Disorder (ADHD)

Attention-deficit hyperactivity disorder (ADHD) — formerly known as attention-deficit disorder (ADD) — is a neurodevelopmental mental disorder characterized by problems paying attention, excessive fidgeting, and difficulty controlling behavior. Medical cannabis could help manage some of the challenges ADHD patients have, such as dealing with stress, completing tasks, and focusing.

What is Attention-Deficit Hyperactivity Disorder (ADHD)?

ADHD is a common neurodevelopmental disorder with symptoms such as restlessness and trouble concentrating. ADHD is estimated to affect 51.1 million people globally. It is estimated that ADHD affects about 5%-7% of children and 2%-5% of adults, depending upon which criteria are used. According to the CDC, around 11% of children (6.4 million) had ADHD in 2011-12 in the U.S.

Its believed that ADHD is linked to the sub-performance of dopamine and norepinephrine receptors, leading to improperly-used dopamine in the brain. This causes the brain to constantly seek reward, jumping from unfinished task to unfinished task to get the dopamine rush starting new and novel activities gives.

ADHD shares some of the same signs and symptoms as autism, although they are two different conditions. However, both conditions are associated with mutations in the neurofibromatosis type 1 (NF1) gene. Tourette syndrome (TS) is also associated with ADHD, with up to 50% of children diagnosed with ADHD having a tic disorder. Those with ADHD are more prone to substance misuse disorder.

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Brief Summary of Current Treatments

Non-drug interventions include forming and keeping to a daily schedule, regular exercise, reducing intake of processed foods and sugars, and various modes of therapy such as talking therapy. Herbal supplements include Ginkgo Biloba, ginseng, and herbal teas (e.g., chamomile).

Stimulant medications such as methylphenidate (Ritalin) and dextroamphetamine (Adderall) are often prescribed. Non-stimulant prescription medications include anxiolytics (anti-anxiety) drugs like buspirone, a 5-HT1A agonist.

How Might Medical Cannabis Help?

ADHD is associated with neurofibromatosis and mutations in the NF1 gene. This gene may be involved in encoding for a specific endocannabinoid or cannabinoid receptor. Utilizing CBD and other phytocannabinoids and terpenes in cannabis may help replace the lost endocannabinoids, helping treat pain and mood disorders associated with NF1 gene mutations. Using THC may help boost dopamine levels in the brain.

Medical cannabis may also help reduce the intake of stimulant medications. Terpenes like beta-caryophyllene and limonene may be beneficial for reducing the intake of stimulants and addiction in general.

Cannabinoids

Tetrahydrocannabinol (THC) for its dopamine-boosting effects.
Cannabidiol (CBD) for its anxiolytic and anti-inflammatory effects.
Cannabinol (CBN) for its sedative effects.

Cannabinoid Ratios

THC:CBD 1:20
THC:CBD 1:3
THC:CBD 1:1
THC:CBD 2:1

Terpenes and Terpenoids

Pinene, limonene, and beta-caryophyllene may be of particular use for reducing the intake of stimulants and helping those with ADHD relax.

Flavonoids

Flavonoids have antioxidative properties that could help with various neurological disorders, including ADHD. Some dietary flavonoids that could be helpful include:

Effective Ways of Taking Medical Cannabis for Attention-Deficit Hyperactivity Disorder (ADHD)

Routes of Administration

Inhalation
Ingestion
Sublingual

Special Formulations

A CBD, CBN, beta-caryophyllene, and limonene-rich cannabis cultivar (strain) extract or product may be ideal for managing ADHD symptoms.

Dosing Methods

Vaporization
Inhaler
Tincture
Edible

What are the Pros and Cons of Taking Medical Cannabis for Attention-Deficit Hyperactivity Disorder (ADHD)?

Potential Pros

As most medications for ADHD are essentially amphetamines, they come with nasty side effects, such as insomnia, nausea, vomiting, headaches, numbness, tingling, heart palpitations, and more. Cannabis does not have the range of negative side effects Ritalin, Adderall, and similar medications have. Cannabinoids may be used to control hyperactivity and impulsivity.
CBD and THC act on dopamine and norepinephrine receptors in a non-direct way, enhancing serotonin receptor activity, helping alleviate ADHD symptoms, and reducing ADHD medication intake. CBN could be beneficial.
Limonene, pinene, and beta-caryophyllene are terpenoids that could provide an energizing effect, relieve stress, and aid to sleep in high doses in the case of pinene.
THC stimulates appetite, which can be diminished in those using stimulants.
Some qualitative evidence exists for the efficacy of cannabis for ADHD.

Potential Cons

Might not be effective for everyone with ADHD – adults with ADHD may respond better to cannabinoid treatment than children with ADHD. This could be due to THC sensitivity.
Some people with ADHD/ADD may be sensitive to THC due to a compromised hypothalamic-pituitary-adrenal axis (HPA axis), which controls reactions to stress. Too much THC may cause anxiety and further compromise the HPA axis, and long-term THC use may also have this effect. This is more theory, and not every person with ADD/ADHD will necessarily react this way.
Reward-seeking behavior in ADHD may lead to cannabis use disorder (CUD).
Some people may have rebound effects from THC cessation. This suggests that endocannabinoids can play a crucial role in regulating the HPA axis and stress responses, but care must be taken in which cannabinoid-terpene profile is used and how much (and at what age).
High doses of THC may make keeping focus difficult for some people.
Dry mouth is still an issue, and this problem worsens when combining stimulants and cannabis. This can lead to dental health problems.

Useful Anecdotal Information

“Medical pot could be used to treat ADHD.” KOAT, Oct. 30 2015
“Using THC to Treat ADHD.” Midas Letter, Nov. 7 2018

Scientific Data Overview and Studies

Total Studies = 12
Positive Studies = 10
Inconclusive Studies = 2
Negative Studies = 0
7 Meta-Analyses (5 positive, 2 inconclusive); 3 Animal Studies (all positive); 1 Double-Blind Human Trial (positive); 1 Human Trial (positive);
2 studies include CBD (both positive); 2 studies include THC (both positive); 1 study includes CBN (positive); 1 study includes a THC:CBD 1:1 ratio (positive)
Possible Overall Efficacy: Moderate

Quotes from Studies

“Semistructured interviews conducted with the patients describe subjective improvements in symptoms and quality of life. Improvements on validated rating scales conducted post-cannabis initiation, compared to pre-cannabis initiation obtained from the medical chart, corroborated their personal accounts. Scores on the PHQ-9 (measuring depression) improved by 8–22 points (30–81%), and the SCARED (measuring anxiety) ranged from 0 to 27 points (up to 33%). Improvements on the CEER-9 scale (measuring regulation) ranged from 2 to 7 points (22–78%), and the 9-item SNAP scale (measuring inattention) showed improvements of 2–8 points (7–30%). Mild adverse events including short-term memory problems, dry mouth, and sleepiness were reported.”

Source: Mansell, H. et al. “Cannabis for the Treatment of Attention Deficit Hyperactivity Disorder: A Report of 3 Cases.” Med Cannabis Cannabinoids 2022;5:1–6

https://doi.org/10.1159/000521370

“Twenty-five (25%) percent of individual posts indicated that cannabis is therapeutic for ADHD, as opposed to 8% that it is harmful, 5% that it is both therapeutic and harmful, and 2% that it has no effect on ADHD. This pattern was generally consistent when the year of each post was considered. The greater endorsement of therapeutic versus harmful effects of cannabis did not generalize to mood, other (non-ADHD) psychiatric conditions, or overall domains of daily life. Additional themes emerged (e.g., cannabis being considered sanctioned by healthcare providers).”

Source: Mitchell, John T et al. “I Use Weed for My ADHD”: A Qualitative Analysis of Online Forum Discussions on Cannabis Use and ADHD.” PloS one vol. 11,5 e0156614. 26 May. 2016, doi:10.1371/journal.pone.0156614

Conclusion

There is some anecdotal evidence that medical cannabis could help manage ADHD symptoms and reduce the intake of stimulant medications. However, more clinical trials are needed to confirm medical cannabis’ efficacy and assess potential short- and long-term harm.

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Tourette Syndrome and Medical Cannabis