Q: Will cannabis help my attention deficit hyperactivity disorder (ADHD)?
A: This is an interesting question. While there is not a lot of research on the subject, some patients with ADHD say it can help. ADHD is listed as a mental health condition in the American Psychiatric Association’s Diagnostic and Statistical Manual, 5th edition (DSM-5) but it is actually a neurodevelopmental condition.
The diagnosis of ADHD has increased exponentially in the last 50 years with one in 10 children being diagnosed in the US, and it carries over into adulthood. It is characterized by difficulties in maintaining attention, impulsivity, and hyperactivity. Most of the cognitive brain’s function is to regulate input, and with ADHD the brain is basically overwhelmed with too much information coming in too fast, so it can’t properly regulate or prioritize the information. This can put people at risk for other psychiatric conditions such as anxiety and depression and sometimes even substance abuse.
There are three types of ADHD: predominately attention deficit (ADD), predominantly impulsive hyperactivity, and a combination of both.
There is also evidence that patients with ADHD may have abnormal functioning in their endocannabinoid system (ECS). Patients with ADHD have been found to have abnormal or altered anandamide breakdown. Anandamide, our own internal cannabinoid, interacts with the CB1 receptors in areas of the brain affecting memory and learning. Anandamide is involved in modulating the brain’s neurotransmitters, such as dopamine, norepinephrine and serotonin, which are chemical messengers between nerve cells.
Dopamine involves areas in the brain affecting reward and motivation as well as planning, problem-solving and attention. Norepinephrine involves areas in the brain controlling alertness, attention, and memory. Serotonin involves areas in the brain that regulate impulse control and aggression. Any abnormalities with these messages probably contribute to the symptoms of ADHD such as problems with focus, prioritization, impulsivity and completion of tasks, as well as organizational skills.
As stated above, there is not a lot of human clinical research on cannabis and ADHD. However, a 2016 study evaluated an online patient discussion forum where users talked about their cannabis use and ADHD with each other. This review found 25% (99 posts) stated that cannabis helped with their ADHD. Within those 99 posts, there were 62 posts that mentioned improvement of at least one ADHD symptom, such as inattention, hyperactivity, or impulsivity. 8% of the posts found that it is harmful (31 posts), and 5% of the posts found that it is both therapeutic and harmful (19 posts) while only 2% that it no effect on their ADHD (7 posts.)
A clinical trial in the UK in 2017 looked at the drug nabiximols, the brand name Sativex which is a 1:1 CBD to THC product. They found patients did say there was some improvement with many patients reporting better testing scores overall when compared to placebo, as well as improvement in their impulsivity and hyperactivity. However, it was not statistically significant.
A more recent 2020 study out of Israel did find that the treatment of ADHD with cannabinoids, including higher levels of CBN, was associated with decreased symptoms.
Clinically, I have seen patients who have reported that they are able to better focus and complete a task, retain information better, and be more productive and creative when using cannabis. Many patients describe their mind constantly racing between stimuli and thoughts about them, as well as the pressures they can feel from juggling the multiple tasks and activities expected of them. Perhaps the calming effects of cannabis and the reduction in anxiety that can be associated with it quiets the incoming stimuli that ADHD patients can’t turn off or prioritize.
Many describe THC-dominant preparations have been found to help lower their impulsivity and increase attention, focus and memory. Often, they say it has less side effects than prescription drugs they have used. Several have said that cannabis products with higher pinene profiles also help, as do CBG and THCA.
As is usually the case, in pediatric care we try to use CBD-dominant products with around 20-25:1 ratios of CBD to THC. Sometimes parents do start lowering that ratio as needed, especially in children with other conditions such as autism and seizures. But I do remind patients that very high THC content can be a double-edged sword. Over-intoxication can possibly interfere with a person’s ability to remember and learn.
Dr. Leigh Vinocur is a board-certified emergency physician who also has a cannabis consulting practice for patients and industry. She is a member of the Society of Cannabis Clinicians and a graduate of the inaugural class, with the first Master of Science in the country in Medical Cannabis Science and Therapeutics from the University of Maryland School of Pharmacy.
Originally published on greenstate.com, October 18, 2022