There's a growing interest in using medicinal cannabis for ADHD. Does it have the potential to treat the disorder?
What benefits do medicinal cannabis offer as an alternative to ADHD treatments? It’s vital to assess new treatment options from a practitioner’s perspective.
Explore traditional ADHD treatment and discover why people are seeking other options. Learn how cannabis for ADHD may bring relief to people with the disorder. Understand how to use medical cannabis to minimise the risks.
Understanding ADHD
Attention-deficit/hyperactivity disorder (ADHD) is a mental health condition that affects many children. 1
ADHD is not caused by personal choices or environmental factors. The condition is generally due to differences in how your brain functions. They’re in the genes you inherit from your parents. 2
This fact explains why the disorder runs in families. It’s also why ADHD is a chronic, lifelong issue that isn’t related to discipline or willpower. 2
Symptoms
The main ADHD symptoms include: 1
- Inattention: Having trouble focusing and paying attention for long periods.
- Hyperactivity: Full of energy, feeling restless, and moving a lot.
- Impulsivity: Acting without thinking things through first.
Many children may express such behaviour, but those with ADHD have more intense symptoms.
ADHD symptoms occur during childhood. Many children continue to have the disorder through adolescence and into adulthood. 3
Impact of ADHD
ADHD is a chronic issue that can affect many areas of your life, including: 1
- Performance in school or at work
- Relationships with others
- Ability to function in daily life
A WHO survey shows a link between ADHD and significant workplace impairment. 2
Managing ADHD in children is vital. Otherwise, it can lead to low self-esteem and social interaction difficulties.
Adults with the disorder may also:
- Have feelings of low self-worth
- Be more sensitive to criticism
- Indulge in self-criticism
ADHD can impact a person’s life if not properly managed. Some effects include: 2
- Low self-esteem
- Inability to concentrate
- Difficulty establishing a routine
- Relationship problems
- Problems with authority
- Education issues
- Frequent job changes
ADHD prevalence
ADHD affects about 533,000 adults and 281,000 kids in Australia. There’s been a shift in statistics in recent years. 4
Previous reports showed boys were ten times more likely to have ADHD than girls. There was a wide gap because of misdiagnosis as girls display different symptoms. They’re not hyperactive and disruptive. 4
That gap is smaller now. It’s 2–3 times more prevalent in boys than girls. The ratio in adulthood is almost 1:1. 4
Challenges in managing ADHD
There are many ADHD tests, making diagnosis challenging. The screening tools include clinician observations and reports.
There are conditions with similar symptoms, such as anxiety, sleep problems, and learning disabilities. Doctors need to rule these out.
Some barriers to treatment are due to healthcare system limitations. Patients and their families also have inadequate knowledge of the symptoms.
They’re unaware of the treatments and the consequences of not treating the disorder. Many people fear overdiagnosis and misdiagnosis.
Traditional treatment options for ADHD
ADHD treatment options include medications, behaviour therapy, counselling, and education services. These therapies can relieve many symptoms but won’t cure the disorder. Try them to determine what works best.
Medications
The most common prescriptions for ADHD are stimulant medications (psychostimulants). They may enhance and balance neurotransmitter levels. The drugs help improve inattention and hyperactivity symptoms. 5
These drugs may be short-acting and long-acting and include: 5
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Amphetamines: Dextroamphetamine-amphetamine (Adderall XR, Mydayis), dextroamphetamine (Dexedrine), and lisdexamfetamine (Vyvanse).
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Methylphenidates: Methylphenidate (Concerta, Ritalin, others) and dexmethylphenidate (Focalin).
Stimulant medications may pose certain health risks. Methylphenidate is a Schedule II controlled substance with a potential for abuse. Consult your doctor about the side effects. 6
Non-stimulant medications are for people who can’t take stimulants. Some of these drugs include: 5
- Atomoxetine (Strattera)
- Clonidine (Catapres, Kapvay)
Atomoxetine is FDA-approved.
ADHD behavioural therapy
Children with ADHD often show disruptive behaviour, affecting their relationships with other people. Behaviour therapy can reduce these demeanours and increase self-regulation skills. The goals are to reinforce positive behaviours and stop troubling conduct.
ADHD behaviour therapy is effective if parents and teachers work with the children.
Here are ways you can help children with ADHD:
Create a routine
Follow the same schedule for daily tasks from when your child wakes up till bedtime.
Get organised
Encourage your child to put their belongings in the same place every day. That'll reduce the likelihood of them losing the items.
Manage distractions
Provide a conducive workspace for your child to do their homework. Turn off the TV and limit distractions. Some children learn well with background music or if they're moving. Pay attention and see what works.
Limit choices
Offer a few options when your child has to choose. They won’t feel overwhelmed or overstimulated.
Be clear and specific when talking with your child
Describe what your child says to let them know you're listening. Give concise directions when you want them to do something.
Reduce stress
Organise complicated tasks into simple, shorter steps. Limit stress for long activities by starting early and planning breaks.
Reward efforts
Praise and reward achievements. Be sure to set realistic goals.
Impose constructive discipline
Impose time-outs or remove privileges to discipline inappropriate behaviour. Avoid yelling, scolding, or spanking.
Create positive experiences
Find out what your child does well and encourage them.
Provide a healthy lifestyle
Nutritious food, physical activity, and enough sleep can prevent ADHD symptoms from worsening.
ADHD treatment device
Now, there’s an FDA-approved medical device to treat 7 to 12-year-old children with ADHD. The criterion is that they’re not on prescription medicine for the disorder.
The device is only about the size of a cell phone and is available by prescription. It's the Monarch external Trigeminal Nerve Stimulation (eTNS) System.
The eTNS connects to a disposable patch on your child’s forehead at bedtime. The device sends low stimulating signals to the trigeminal nerve during the night. This nerve is a pathway to critical brain areas related to attention, mood, and behaviour.
The eTNS is a low-risk treatment. Common side effects include drowsiness, increased appetite, trouble sleeping, headache, and fatigue.
Alternative ADHD therapy
More treatment options are necessary due to the limitations of traditional therapy. A key issue is that ADHD medicine increases substance use disorder risk. 6 Patients may also experience other psychiatric issues.
Some alternative treatments include:
- Omega-3 fatty acid
- Melatonin
- Gingko Biloba
- Acupuncture
- Meditation
- Yoga
There’s inconclusive evidence to support the effectiveness of those therapies.
Mechanisms of cannabis in treating ADHD
There’s a growing use of medicinal cannabis to treat ADHD. People are moving away from drugs to natural remedies.
How does cannabis help with ADHD symptom management?
Cannabis has compounds (THC and CBD) that interact with the endocannabinoid system (ECS). The ECS regulates critical body functions, including:
- memory and learning
- sleep
- emotions
- temperature control
- inflammatory and immune responses
- pain relief
- appetite
Your body produces endocannabinoids that keep internal functions running efficiently. These molecules bind to receptors to trigger the ECS to act.
The two key endocannabinoid receptors are:
- CB1 receptors in the central nervous system
- CB2 receptors in your peripheral nervous system
THC interacts with the ECS when it binds to the receptors. The cannabinoid is potent because it connects to both CB1 and CB2 receptors.
THC effects include stimulating appetite and reducing pain. It can produce a buzz due to its psychoactive properties.
CBD is another important cannabis molecule. It acts on the opioid, serotonergic, and cannabinoid systems. Cannabidiol alters the potency of endocannabinoids and THC. CBD is safe, with limited abuse potential. Human and animal studies show mild side effects.
ADHD studies show that medicinal cannabis helps improve concentration and sleep and reduces impulsivity. There's evidence that treatments may also lessen hyperactivity and offer better frustration tolerance. 7
People with ADHD may have low levels of dopamine. Increasing the feel-good chemical in the brain might reduce some ADHD symptoms. 8 Research shows that cannabis increases dopamine in the brain. 9
Cannabis acts on CB1 receptors in the dopamine-producing cells. When activated, these cells become more active and increase dopamine release.
Review of current research
Many studies indicate the possible benefits of medicinal cannabis in ADHD treatment. However, there are research gaps. Some results suggest different outcomes.
Study findings on the relationship between ADHD and cannabis include: 10
- People with ADHD who use cannabis more frequently tend to have more severe ADHD symptoms.
- People with ADHD have a higher Cannabis Use Disorder (CUD) risk than regular users.
- There’s inconclusive evidence on cannabis’ effects on the brain.
Some clinical trials show that cannabis use can cause schizophrenia-like psychosis.
Research studies show a two-fold increase in psychotic outcomes for typical cannabis users. The result is almost four times for the heaviest users compared to non-users. Note that these findings aren’t proof of causation. 11
There’s evidence supporting CBD’s protective nature. A Dutch study found that high-CBD cannabis users have fewer psychotic experiences. 12
Further studies are necessary to understand the impact of cannabis on ADHD therapy.
Risks and considerations for practitioners
Although cannabis may benefit people with ADHD, risks and side effects include:
- increased cancer risk
- lung damage
- bacterial pneumonia
- poor pregnancy
Research shows that non-smoking cannabis can remove many of these side effects.
Medical practitioners must do a thorough patient assessment to minimise the risks. Recommending the proper dosage and consumption methods is vital. It doesn’t stop there. Patient monitoring is critical to identify issues and make adjustments.
There are also legal considerations. Medicinal cannabis is still illegal in many states. Prescribing it to treat ADHD may get practitioners in trouble with the law.
Doctors may be reluctant to prescribe cannabis due to a lack of knowledge of the benefits and risks. Medical professionals should only prescribe cannabis for conditions with enough supporting evidence.
Guidelines for practitioners
Evaluating the suitability of medicinal cannabis for ADHD patients is vital. Patients and doctors must understand how people with ADHD use cannabis. They should also comprehend cannabis’ potential risks and benefits in the following:
- ADHD symptoms
- Cannabis use disorder
- Executive dysfunction
Ways of administering cannabis and the dosage is critical. A study on an ADHD patient showed promising results on his symptoms. The average daily dose was 1–2 g.
A vaporiser administered the cannabinoids for fast absorption and convenient titration. The patient reported that this method provided fast therapeutic effects.
The Australian Clinical Practice Guideline for ADHD is an excellent medical professional resource. The guide offers evidence-based advice on diagnosing, treating, and managing ADHD in children and adolescents.
It also recommends ways to deal with the long-term effects and support patients. The key topics in the ADHD guideline include:
- Outcomes in Australia
- Diagnostic indicators
- Diagnosis methods
- Treatment principles
- Medication management
- ADHD and substance use
- ADHD and the law
Practitioners should integrate cannabis into a comprehensive treatment plan for best results.
The future of medicinal cannabis for ADHD
Ongoing research shows cannabis can reduce hyperactivity, increase focus, and lessen impulsive behaviour. Most results are inconclusive.
With legalisation, more research can boost support for medicinal cannabis in ADHD treatment.
Practitioners must focus on personalised care. It’s vital to consider available treatment options to learn which works.
Sharing experiences and practitioner education are essential for professional development. ADHD courses can enhance knowledge and improve client services.
Visit our website for educational resources on medicinal cannabis for practitioners.
References
- Parekh, Ranna. “What Is ADHD?” American Psychiatric Association, 2022, www.psychiatry.org/patients-families/adhd/what-is-adhd
- Culpepper, Larry, and Gregory Mattingly. “Challenges in Identifying and Managing Attention-Deficit/Hyperactivity Disorder in Adults in the Primary Care Setting.” The Primary Care Companion to the Journal of Clinical Psychiatry, vol. 12, no. 6, 18 Nov. 2010, https://doi.org/10.4088/pcc.10r00951pur
- Reuben, Cynthia, and Nazik Elgaddal. “Products - Data Briefs - Number 499 - March 2024.” www.cdc.gov, 15 Mar. 2024, www.cdc.gov/nchs/products/databriefs/db499.htm#:~:text=During%202020%E2%80%932022%2C%20the%20prevalence
- May, Tamara. “Attention Deficit Hyperactivity Disorder (ADHD).” Brain Foundation, 28 Nov. 2023, brainfoundation.org.au/disorders/adhd/#:~:text=a%20fulfilling%20life.- . Accessed 12 July 2024.
- “Attention-Deficit/Hyperactivity Disorder (ADHD) in Children - Diagnosis and Treatment - Mayo Clinic.” www.mayoclinic.org, 25 June 2019. www.mayoclinic.org/diseases-conditions/adhd/diagnosis-treatment/drc-20350895#:~:text=Children%20with%20ADHD%20often%20benefit.
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Kollins SH. A qualitative review of issues arising in the use of psycho-stimulant medications in patients with ADHD and co-morbid substance use disorders. Curr Med Res Opin. 2008 May;24(5):1345-57. doi: 10.1185/030079908x280707. Epub 2008 Apr 1. PMID: 18384709.
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Hupli, Aleksi Mikael Markunpoika. “Medical Cannabis for Adult Attention Deficit Hyperactivity Disorder: Sociological Patient Case Report of Cannabinoid Therapeutics in Finland.” Medical Cannabis and Cannabinoids, vol. 1, no. 2, 23 Nov. 2018, pp. 112–118, https://doi.org/10.1159/000495307. Accessed 9 Mar. 2019.
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Villines, Zawn. “Increasing Dopamine in People with ADHD.” Www.medicalnewstoday.com, 28 June 2023, www.medicalnewstoday.com/articles/how-to-increase-dopamine-adhd#:~:text=Research%20has%20shown%20that%20people.
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Oleson, E. B., and J. F. Cheer. “A Brain on Cannabinoids: The Role of Dopamine Release in Reward Seeking.” Cold Spring Harbor Perspectives in Medicine, vol. 2, no. 8, 1 Aug. 2012, pp. a012229–a012229, https://doi.org/10.1101/cshperspect.a012229.
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Dhamija, Divyanshu, et al. “Evaluation of Efficacy of Cannabis Use in Patients with Attention Deficit Hyperactivity Disorder: A Systematic Review.” Cureus, vol. 15, no. 6, 26 June 2023, www.cureus.com/articles/151553-cannabis-use-in-patients-with-attention-deficit-hyperactivity-disorder--a-benefit-or-a-curse-a-systematic-review?score_article=true#, https://doi.org/10.7759/cureus.40969.
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A. Marconi, et al. Meta-analysis of the Association Between the Level of Cannabis Use and Risk of Psychosis. Schizophrenia Bulletin, 2016; 42(5): 1262–9.
- C. D. Schubart, et al. Cannabis with High Cannabidiol Content Is Associated with Fewer Psychotic Experiences. Schizophr Res, 2011; 130(1–3): 216–21.