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marijuana and adhd medication

Can Marijuana Treat ADHD?

Marijuana is sometimes used as a self-treatment by individuals with attention deficit hyperactivity disorder (ADHD).

Advocates for marijuana as an ADHD treatment say the drug can help people with the disorder handle some of the more severe symptoms. These include agitation, irritability, and lack of restraint.

They also say that marijuana has fewer side effects than traditional ADHD medications.

Read more about what research has discovered about the use of marijuana in individuals with ADHD.

Laws and research

Marijuana remains illegal at the federal level. Each year, more U.S. states have passed laws allowing the sale of marijuana for medical purposes. Some states have legalized it for recreational purposes, too. Many states still outlaw any use of marijuana. At the same time, research into the effects of the drug on health conditions and diseases has increased. This includes research on marijuana use in individuals who’ve been diagnosed with ADHD.

Online health forums are filled with comments from people saying they use marijuana to treat symptoms of ADHD.

Likewise, individuals who identify as having ADHD say they have few or no additional issues with marijuana use. But they aren’t presenting the research on adolescent use of marijuana. There are concerns for the developing brain’s learning and memory.

“Many adolescents and adults with ADHD are convinced that cannabis does help them and has fewer side effects [than ADHD medications],” says Jack McCue, MD, FACP, an author, physician, and emeritus professor of medicine at the University of California, San Francisco. “It may be that they, not their doctors, are correct.”

Dr. McCue says he’s seen patients who report classic marijuana use effects and benefits. They report intoxication (or being “high”), appetite stimulation, help with sleeping or anxiety, and pain relief, for example.

Dr. McCue says these people sometimes report effects that are often seen with typical ADHD treatments, too.

“The limited research on what patients say cannabis does for ADHD symptoms indicates that it is most helpful for hyperactivity and impulsivity. It may be less helpful for inattentiveness,” Dr. McCue says.

Research in 2016 analyzed some of these online threads or forums. Of the 286 threads the researchers reviewed, 25 percent of posts were from individuals who reported that cannabis use was therapeutic.

Only 8 percent of posts reported negative effects, 5 percent found both benefits and harmful effects, and 2 percent said using marijuana had no effect on their symptoms.

It’s important to remember that these forums and comments aren’t clinically significant. They’re also not evidence-based research. That means they shouldn’t be taken as medical advice. Talk with your doctor first.

“There are descriptive accounts and demographic surveys that report that individuals with ADHD describe marijuana as being helpful in managing inattentiveness, hyperactivity, and impulsivity,” says Elizabeth Evans, MD, psychiatrist and assistant professor of psychiatry at Columbia University Medical Center.

However, Dr. Evans adds, “while there certainly may be individuals who experience benefit in their symptoms of ADHD, or those who are not adversely impacted by marijuana, there is not sufficient evidence that marijuana is a safe or effective substance to treat ADHD.”

Cannabidiol (CBD) is also promoted as a helpful treatment for individuals with ADHD.

CBD is found in marijuana and hemp. Unlike marijuana, CBD doesn’t contain the psychoactive element tetrahydrocannabinol (THC). That means CBD doesn’t produce a “high” the way marijuana does.

CBD is promoted by some as a possible treatment for ADHD. Dr. McCue says that’s because of “anti-anxiety, antipsychotic effects of CBD.”

However, “the lack of a potential paradoxical benefit from the stimulating effects of THC make CBD theoretically less attractive,” he says.

Dr. Evans adds, “There are no large-scale clinical trials looking at CBD for ADHD. It is not considered an evidence-based treatment for ADHD at this time.”

Some people with ADHD report that they find therapeutic benefit from using marijuana. Despite these anecdotal stories, research doesn't support marijuana, or CBD, as a treatment for ADHD. Who's right?

Marijuana and adhd medication

THE PERCEPTION THAT MARIJUANA IS THERAPEUTIC FOR ADHD continues to increase in popularity. Anecdotes from people with ADHD who feel that recreational cannabis use provides therapeutic benefits are common. There is little clinical research to support these claims, however.

Despite an absence of research, there is much chatter online. A relatively recent study looked at the content of online forum threads on ADHD and marijuana use. At least three times as many comments advocated for its therapeutic effects on ADHD compared to comments that cannabis was either harmful, was both therapeutic and harmful, or had no effect on ADHD. (These findings were specific to ADHD. They did not generalize to mood, non-ADHD psychiatric conditions, or general quality of life.)

The study concluded that comments favoring therapeutic effects mostly had to do with the belief that cannabis improved the inattentive symptoms as opposed to the hyperactive-impulsive symptoms of ADHD. Also, while there were relatively few comments comparing cannabis to ADHD medications, many commenters said they considered cannabis “medicinal.”

Although the belief that recreational cannabis is therapeutic for ADHD may be widespread, currently there are no clinical recommendations or evidence supporting this belief. As more jurisdictions legalize cannabis, it remains to be seen whether legalization will also pave the way for systematic clinical research.

A look at the statistics

Marijuana is one of the most widely used psychoactive substances worldwide after tobacco and alcohol. Higher rates of all substance use disorders are well documented among adults with ADHD. Compared to people who do not have ADHD, those with ADHD are at increased risk for early initiation of cannabis use, for heavy use, and for developing a cannabis use disorder.

The National Epidemiological Survey on Alcohol & Related Conditions in the United States determined that adults with ADHD use cannabis two to three times more than adults without ADHD. Some research suggests that over their lifetime, people with ADHD are almost eight times as likely to use cannabis compared to those who do not have ADHD.

Cannabis use disorder is also more common in adults with ADHD. Studies show they are more than twice as likely to meet the criteria than adults without ADHD. Looking at the rates from a different perspective, we learn that among individuals who seek treatment for a cannabis use disorder, the rates of ADHD are estimated to be 34 to 46 percent.

What research says about presentations of ADHD

Are particular presentations of ADHD in childhood more or less predictive of a substance use disorder in adulthood? Some research suggests that impulsivity and oppositionality during childhood seem to predict increased risk of cannabis consumption in adulthood. The combination of ADHD and a substance use disorder is also associated with a worse prognosis and quality of life.

Some research shows that inattentive symptoms are more predictive of substance use disorders. Other research shows that hyperactive/impulsive symptoms are more predictive of substance use disorders.

Research indicates that individuals with ADHD who use cannabis use all categories of substances more commonly than those with ADHD who do not use cannabis. More specifically, rates of nicotine, alcohol, and drug use are significantly greater in those who use cannabis. Rates of alcohol use disorders, nicotine dependence, and drug use disorders are significantly greater among people with ADHD who use cannabis, compared to those with ADHD who do not. The most common drug use disorders in adults with ADHD who use cannabis involve cocaine, followed by opioids, and then amphetamines.

In some studies, no significant differences were found in the prevalence of ADHD subtypes among individuals with ADHD who report cannabis use. However, some research suggests that the average age of initiation of cannabis use is significantly younger among those with ADHD with the hyperactive/impulsive presentation, compared to those with the inattentive presentation.

Research also suggests that individuals with the hyperactive/impulsive presentation tend to begin their most intensive period of cannabis use earlier than those with the inattentive presentation. The age of cannabis abuse tends to be younger among those with the combined presentation of ADHD, compared to those with the inattentive presentation.

Efforts at self-medication

There are several possible explanations for substance use and substance use disorders in adults with ADHD. The risk is particularly striking in people whose childhood ADHD symptoms persist into adulthood, when substances are more readily available. Recreational cannabis use may be associated with impulsivity, sensation-seeking, poor choices in peer groups, impaired occupational and social functioning, and the desire for intoxication.

Both recreational substance use and substance use disorders may be associated with efforts at self-medication of the various ADHD symptoms themselves. The co-occurrence may reflect efforts to self-medicate with respect to negative emotionality, such as anger, sadness, anxiety, and inadequate emotional regulation. Self-medication may not necessarily be specific to ADHD symptoms, but rather a way of relieving co-occurring mood and anxiety-related symptoms that are common in people with ADHD.

For some individuals, stimulant medication for the treatment for ADHD may cause adverse effects such as excessive arousal and insomnia. Cannabis use may be an attempt to try and counter those adverse effects.

Dopamine neurotransmission has been shown to be involved in both ADHD and substance use. In the case of ADHD, this has to do with an underproduction of dopamine and norepinephrine. Studies show that acute use of THC (the psychoactive component of cannabis) causes increased dopamine release, while long-term THC use is associated with blunting of the dopamine system. Thus, cannabis use may also be an attempt at self-medicating—that is, “chasing dopamine.”

In addition, studies show that cannabis use (in particular, early-onset use and ongoing use) and ADHD are both associated with deficits in neurocognition, including attention, memory, and executive functions. Both ADHD and regular cannabis use are associated with motivational issues.

Determining a diagnosis of ADHD in individuals who are actively using cannabis—or in those who have recently been abstinent following active cannabis use—can be quite difficult. The clinician must tease out whether those neurocognitive deficits are more cannabis-induced, true ADHD, or a combination of both.

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