Attention Deficit Hyperactivity Disorder/Attention Deficit Disorder (ADHD/ADD) and Medical Cannabis
ADHD, which was formerly known as ADD, is a neurodevelopmental mental disorder, characterized by problems paying attention, excessive fidgeting and difficulty controlling behavior.
Potential Efficacy / Quality of Evidence (Low, Average, High) of Medical Marijuana for Attention-Deficit Hyperactivity Disorder / Attention Deficit Disorder (ADHD/ADD)
Cannabinoids, Terpenes/Terpenoids, Strains and Ratios that May Help
CBD:THC 20:1; CBD:THC 3:1; CBD:THC 1:1.
Medical Cannabis Pros
As most medications for ADHD are essentially amphetamines, they come with all sorts of 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, as well as enhancing serotonin receptor activity. Limonene, pinene and beta-caryophyllene are terpenoids that could provide an energizing effect and relieve stress, as well as providing an aid to sleep in high doses in the case of pinene.
Some qualitative evidence for the efficacy of cannabis for ADHD.
Medical Cannabis 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 particularly 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 compromise further. Long-term THC use may potentially have this affect as well. This is more theory, and not every person with ADD/ADHD will necessarily react this way.
Some people may have rebound effects from THC cessation. This suggests that endocannabinoids can play a key 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).
May make keeping focus difficult for some people.
Dry mouth is still an issue.
More About the Condition
Symptoms of ADD/ADHD usually appear before the age of 12 years old and last for at least 6 months, with significant problems at home, school and during recreational activities.
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) suffered from ADHD in 2011-12 in the US.
Treatments include counselling, planned routines and lifestyle changes and stimulant medications such as methylphenidate (Ritalin) and dextroamphetamine (Adderall) . It is thought that ADHD is linked to sub-performance of dopamine and norepinephrine receptors. Methylphenidate is also a weak 5-HT1A agonist.
Quotes from Experts
“The EMA-C trial (Experimental Medicine in ADHD-Cannabinoids) was a pilot randomised placebo-controlled experimental study of a cannabinoid medication, Sativex Oromucosal Spray, in 30 adults with ADHD. The primary outcome was cognitive performance and activity level using the QbTest. Secondary outcomes included ADHD and emotional lability (EL) symptoms. From 17.07.14 to 18.06.15, 30 participants were randomly assigned to the active (n=15) or placebo (n=15) group.
For the primary outcome, no significant difference was found in the ITT analysis although the overall pattern of scores was such that the active group usually had scores that were better than the placebo group (Est=-0.17, 95%CI-0.40 to 0.07, p=0.16, n=15/11 active/placebo). For secondary outcomes Sativex was associated with a nominally significant improvement in hyperactivity/impulsivity (p=0.03) and a cognitive measure of inhibition (p=0.05), and a trend towards improvement for inattention (p=0.10) and EL (p=0.11). Per-protocol effects were higher.
Results did not meet significance following adjustment for multiple testing. One serious (muscular seizures/spasms) and three mild adverse events occurred in the active group and one serious (cardiovascular problems) adverse event in the placebo group. Adults with ADHD may represent a subgroup of individuals who experience a reduction of symptoms and no cognitive impairments following cannabinoid use. While not definitive, this study provides preliminary evidence supporting the self-medication theory of cannabis use in ADHD and the need for further studies of the endocannabinoid system in ADHD.” Source: Cooper RE, Williams E, Seegobin S, Tye C, Kuntsi J, Asherson P. ‘Cannabinoids in attention-deficit/hyperactivity disorder: A randomised-controlled trial‘ Eur Neuropsychopharmacol. 2017 Aug;27(8):795-808. doi: 10.1016/j.euroneuro.2017.05.005. Epub 2017 May 30. PMID: 28576350.
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