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Some parents are turning to medical marijuana to treat ADHD instead of Adderall

Some parents of children with attention deficit hyperactivity disorder (ADHD) have grown wary of Ritalin and Adderall, common treatments for the condition, because of the stimulants’ side effects and potential for long-term abuse. Now they’re turning to doctors who will prescribe medical marijuana instead.

“They’ve seen improved performance in school and happier and calmer kids at home,” Elizabeth Spaar, a family-medicine physician in Verona, Pennsylvania, told Insider, referring to how her pediatric patients and her own children with ADHD have responded to medical marijuana.

While these drugs help some children with attention issues to concentrate — and have the approval of the US Food and Drug Administration (FDA) — they are not without risks.

Adderall, for example, is a schedule 2 drug, which means it has a “high potential for abuse” or harm. Stimulants also come with a litany of side effects, including sleeplessness, lethargy, suppressed appetite, and stunted growth. Over time, children can develop resistance, leading to increased doses. Other kids eventually experience decreased effectiveness.

As with Adderal and Ritalin, cannabis increases dopamine levels, which can help a person with ADHD to focus. But unlike those drugs, medical marijuana is less likely to impair sleep and appetite, and addiction may be less of a risk. Yet questions remain about its effectiveness, the associated long-term health effects, and whether medical marijuana could exacerbate issues associated with ADHD.

The evidence for marijuana’s effectiveness on ADHD symptoms is unclear

Diagnoses for ADHD — a condition characterized by inattention, hyperactivity, and impulsivity — are on the rise among young people in the US. In 2016, 6 million children, or nearly 10% of all kids, were diagnosed with ADHD. That’s up from 6.1% in the late 1990s, according to the Centers for Disease Control and Prevention (CDC). About that same time, stimulants started to become the standard treatment for ADHD.

There’s only scant research to support the usefulness of treating ADHD with medical marijuana, and the course of treatment isn’t without its share of risks. Some medical experts are concerned about how it can affect cognitive development, especially in developing brains, as well as how it could impair short-term memory.

Roni Sharon, a neurologist in New York, prescribes medical marijuana for some conditions in adults, including post-traumatic stress disorder (PTSD). But Sharon told Insider he’s opposed to prescribing it to younger patients because of the risks. “With adolescent brains, you have to be very careful,” Sharon said.

A recent study published in the Lancet concluded that there’s inadequate evidence to suggest that cannabis can relieve mental-health disorders, including ADHD. At this point, the American Academy of Pediatrics has said it supports the use of medical marijuana only in children facing life-threatening situations.

Still, none of this has deterred parents who say they have seen firsthand how medical marijuana has helped their children who are struggling with ADHD.

One doctor says cannabis can help with attention issues and may calm racing thoughts

Spaar owns Spectrum Family Practice, which specializes in medical marijuana and addiction recovery. Since opening her marijuana program a year and a half ago, Spaar said she has prescribed medical marijuana to about 75 pediatric patients with a variety of conditions, including ADHD, PTSD, autism, and Tourette syndrome.

When Spaar talks to patients about the pros and cons of treating ADHD with medical marijuana, she points to personal experience.

Spaar’s two teenage sons both have ADHD and high-functioning autism. For several months, Spaar’s younger son tried a variety of stimulants — Adderall, Ritalin, Concerta — to treat symptoms associated with the conditions.

While the drugs helped somewhat, Spaar said she was concerned with the side effects, which included a suppressed appetite and difficulty falling and staying asleep. Both are common effects of stimulants.

Some medical professionals say that medical marijuana is useful if only to get their ADHD patients off stimulants.

David Berger, a pediatrician and the medical director of Wholistic Releaf, a medical-cannabis clinic in Tampa, Florida, told Insider that he’s using it for that very purpose.

In total, Berger said 20 of his pediatric patients have been able to stop taking drugs such as Ritalin and Adderall by taking a combination of THC, the chemical responsible for marijuana’s mind and body high, and CBD, a chemical compound that doesn’t get patients high but can help to address some medical and mental-health issues.

Spaar decided last year to give her sons a microdose of THC and CBD as an alternative to stimulants. Twice a day, Spaar’s sons, who are 13 and 15, take five milligrams of the medication orally in an oil form.

Spaar said that some families will work with pharmacists and consultants at a dispensary to figure out an appropriate dose. She confers with her children’s psychiatrist about the issue, but he doesn’t handle specifics of the case.

Since starting to take medical marijuana, Spaar said her younger son is now less anxious and better able to focus on his school work. She said it’s also helped with his tics. The 14-year-old’s sleep has improved and so has his appetite since he ceased taking stimulants.

Spaar’s older son, who has more severe autism-related and ADHD symptoms than his younger brother, has seen noticeable improvement in many areas, his mother said, since being introduced to medical marijuana. The 15-year-old’s grades are up, he’s having an easier time focusing and completing tasks at school and at home, she said.

Spaar said the marijuana has also decreased his hyperactivity and calmed his racing thoughts and restlessness.

She said she has “no doubt” that she will be seeing more cases where medical cannabis is used to treat children with attention issues.

Spaar said her peers have been vocal about their disapproval

Spaar said her patients have been pleased with the results, especially because it has allowed many of them to cut back on, if not fully cut out, stimulants. Still, Spaar said some of her peers have been vocal about their disapproval.

“There are people who say, ‘You’re just getting your kid high.’ That’s what they think of when they think of marijuana,” Spaar said. “But once I tell them the dramatic improvement I’ve seen, it tends to open people’s eyes.”

Even if parents make the choice to treat their children with medical marijuana, accessing it can be a major challenge. Every state has different laws about which medical conditions qualify a patient for a marijuana card, and they’re especially strict for pediatric patients. Right now, ADHD isn’t considered a qualifying condition in any state. This means that using using marijuana to treat ADHD is illegal, even in states where medical cannabis has been approved for the treatment of some conditions.

A child with ADHD may have an additional diagnosis that qualifies for a medical-marijuana card

Children diagnosed with ADHD may also be diagnosed with another condition that qualifies a patient for a marijuana card, including autism or PTSD.

Physicians in favor of prescribing cannabis to treat ADHD believe it will soon become a more standard treatment for this condition, and others, in pediatric patients.

Anand Dugar, an anesthesiologist and pain-medicine physician who owns Green Health Docs, in Frederick, Maryland, is one of those hopeful physicians.

Dugar said he has prescribed medical marijuana to as many as 20,000 patients. He said he’s consulted with a number of parents who want to try treating ADHD with cannabis to help their children stay calm, relaxed, and more focused.

“People who were naysayers see that the sky hasn’t fallen,” Berger said. “Of course it means more people are going to try it.”

Steve Smith, the medical director of Essential Nutrition and Wellness, an alternative wellness practice in Illinois, also believes there are situations in which prescribing marijuana is appropriate. He’s also in the camp of those who think medical marijuana is best used to wean patients off stimulants.

Too often, Smith said, conditions related to attention issues are overdiagnosed or misdiagnosed in children. Many of these children are “pliable,” Smith said, able to improve their focus with more natural treatments. In pediatric patients with ADHD, Smith has seen dramatic improvements through behavioral therapy and with better diet and sleep hygiene.

“I’d like to get to a point where we don’t dope kids up on anything,” he said.

Adderall has a host of side effects, from sleeplessness to sudden death. Medical marijuana isn't risk-free, but some parents find it less concerning.

The Damaging Effects of Cannabis on the ADHD Brain

Cannabis use has grown in popularity among people with ADHD, some of whom report that marijuana helps them manage symptoms of anxiety, rejection sensitive dysphoria, and poor sleep without a prescription medication. What many teens and adults do not realize is that cannabis consumption is associated with dangerous risks — like cannabis use disorder — that disproportionately affect ADHD brains.

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Cannabis is used by a startling number of people with attention deficit hyperactivity disorder (ADHD). Studies show that more than half of daily and non-daily cannabis users have ADHD 1 , and about one-third of adolescents with ADHD report cannabis use 2 . People with ADHD are also three times as likely as their neurotypical peers to have ever used marijuana. 3

As with other popular substances, cannabis is commonly abused. In fact, the risk of developing cannabis use disorder (CUD), a problematic pattern of cannabis use linked to clinically significant impairment, is twice as high in people with ADHD 3 . Contrary to popular belief, individuals can be mentally and chemically dependent on and addicted to cannabis. Contemporary marijuana has concentrations of THC higher than historically reported, which exacerbates this. What’s more, the adverse effects of cannabis are especially amplified in people with ADHD.

What are the Negative Effects of Cannabis?

Tetrahydrocannabinol (THC), one of cannabis’ active compounds, inhibits neuronal connections and effectively slows the brain’s signaling process. THC also affects the brain’s dendrite architecture, which controls processing, learning, and the overall health of the brain. Science has not yet fully determined whether THC’s effects are reversible; some parts of the brain show healthy neuronal growth after cannabis use stops, but other parts do not.

Short-term and long-term cannabis use also impairs:

  • Motivation (hampering effect)
  • Memory, especially in people under 25, by altering the function of the hippocampus and orbitolfrontal cortex, where much of memory is processed
  • Performance on complicated task performance with many executive steps. Studies have shown, for example, that driving ability, even while not under the influence, can be impaired in regular marijuana users

Cannabis use may also lead to the following health-related impairments:

  • Chronic bronchitis
  • Chronic obstructive pulmonary disease (COPD)
  • Emphysema
  • Cannabinoid hyperemesis syndrome (characterized by severe bouts of vomiting and dehydration)
  • Elevated resting heart rate

Cannabis use may exacerbate disorders like paranoia, panic, and mood disorder. Studies have also found that increased cannabis consumption can uniquely contribute to elevating suicide risk, even when controlling for underlying mental health disorders, like mood disorder or anxiety 4 5 . Individuals who begin regular cannabis use also exhibit more suicidal ideation, even when controlling for pre-existing mood disorders, studies show. 6 7

What is Cannabis Use Disorder (CUD)?

Cannabis is addictive — 9 percent of people who use cannabis regularly will become dependent on it 8 . This figure rises to 17 percent in those who start using cannabis in adolescence. 9

CUD can develop after extended cannabis use. It is diagnosed when at least two of the following occur within a 12-month period:

  • Taking cannabis in larger amounts over longer periods of time
  • Difficulty quitting cannabis use
  • Strong desires or cravings to use cannabis
  • Lots of time spent trying to obtain, use, or recover from cannabis
  • Problems with work, school, or home because of interference from cannabis use
  • Social or interpersonal problems due to cannabis use
  • Activities given up or reduced because of cannabis use
  • Recurrent cannabis use in physically hazardous situations, such as driving
  • Physical or psychological problems caused or exacerbated by cannabis use
  • Tolerance to cannabis
  • Withdrawal from cannabis

How Does Cannabis Affect the ADHD Brain?

Cannabis use impairs areas and functions of the brain that are also uniquely impaired by ADHD.

The substance’s negative effects are most harmful to developing brains. Many studies show that usage earlier in life, particularly before the age of 25, predicts worse outcomes. One study found that heavy marijuana use in adolescence was associated with a loss of 8 IQ points, on average, in adulthood 10 . Another study found that people under age 18 are four to seven more times at risk for CUD compared to adults. 11

People with ADHD, whose brain development is delayed by slowly maturing frontal lobes, are thus more vulnerable to cannabis’ effects on neuronal connections. Some of these impairments may be irreversible.

Cannabis can also interact significantly with some ADHD medications. Research studies have shown that methylphenidate (Ritalin, Concerta) reacts significantly with the substance, and can cause increased strain on the heart. 12

Other studies show that the use of cannabis can decrease the effect of a stimulant medication 13 . An individual trying to treat their ADHD with stimulants is actually placing themselves at a disadvantage, since the cannabis is impacting them negatively and making the medication less effective.

The increased risk of suicide associated with cannabis use further complicates marijuana among individuals with ADHD, who already face an elevated risk for suicide compared to neurotypical individuals 14 .

What Draws People with ADHD to Cannabis?

Cannabis activates the brain’s reward system, and releases dopamine at levels higher than typically observed. In low-dopamine ADHD brains, THC thus can be very rewarding.

Many people with ADHD also claim that cannabis helps them focus, sleep, or seemingly slow the pace of their thoughts. One analysis of internet threads found that 25 percent of relevant posts described cannabis as therapeutic for ADHD, while 5 percent indicated that it is both therapeutic and harmful 15 . Despite some users reporting short-term improvement in symptoms, there is currently no evidence that suggests cannabis is medically or psychologically helpful for managing ADHD in the long-term.

Cannabis’ increased availability and legalization have increased accessibility; many cannabis products are falsely marketed as medicinal for ADHD.

Also contributing to an increased likelihood of cannabis use and CUD among individuals with ADHD is the prevalence of low self-esteem, sleep problems, poor impulse control, and sensation-seeking tendencies in this population.

How is Cannabis Use Disorder Treated in People with ADHD?

There is no approved medication to treat CUD — treatment generally means teaching patients strategies to maintain sobriety. Treatment can include talk therapies, like cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT), and participating in support groups like Marijuana Anonymous.

One small but insightful study looking at motivations to quit cannabis use in a group of adults with ADHD found that saving money was a major contributing factor 16 . The same study found that the most common strategy for maintaining abstinence was breaking social connections with people who smoke marijuana.

Treating and targeting ADHD itself in a patient that has CUD is also essential. Stimulant medication can be implemented as part of ADHD treatment, and it is not considered a violation of sobriety.

How Should a Parent Help a Teen with ADHD Who Is Using Cannabis?

It’s normal for parents to experience a range of emotions after discovering that their child is using cannabis. The initial gut reaction or emotion is understandably anger and disappointment, but it’s best to release these feelings prior to engaging in conversation. Any dialogue with teens must be done in a controlled, calm way — teens will not listen to parents who are yelling and blurting out things they will later regret.

Seeking consultation with a doctor, pediatrician, or therapist who has experience in substance abuse can help, especially for parents who are struggling with their owns feelings and reactions toward their child.

The next step is for parents to educate themselves on cannabis and how it can be appealing. Parents should try to proactively see what their child might be experiencing, and why they might have turned to the substance. When the conversation does start, parents should work deliberately not to shame their child, and instead focus on understanding their child’s experience on cannabis.

Parents should calmly ask questions like:

  • “I found this and I’m concerned, but I’d like to know what the appeal of this is for you?”
  • “What does this do for you?”
  • “How did you feel the very first time that you did this?”

While parents are encouraged to have calm and thoughtful conversations with their teen, they should also set boundaries and consequences for substance use to remind their child that it is not acceptable. Without shaming, parents must establish rules that discourage substance use, especially in the household.

Many parents will say that they would rather have their child smoke in the house than outside with others. But this mentality doesn’t stop teens from smoking or using anywhere else. Instead, allowing at-home use communicates a sense of permission associated with substance use.

If teens say they are simply experimenting, they should know that experimentation can quickly turn into something more dangerous. Parents should inform them that teens with ADHD are at higher risk for addiction. Teens should also be aware, if they aren’t by this point, of any family history of addiction, which also has a genetic component.

Placing limits on smoking can create some backlash. Teens and young adult may be so gripped by the substance they they are willing to lie about using it to parents. Parents should approach their child if they suspect they are using, even after rules are in place, but should keep in mind that this substance, like any, can have people not always be truthful. That’s very different from thinking that their child can’t be trusted and is a liar.

Children should be reminded that they are loved and that their health is most important. Smoking marijuana doesn’t mean that parents have failed or that they’ve done a bad job with their children. There’s a terrible stigma on addiction surrounding character and morality — it’s important to remember that teens aren’t using drugs because they are bad people. Very, very good people are addicted to substances or experiment with them.

The information in this article is based on Dr. Roberto Olivardia’s two-part Marijuana and the ADHD Brain webinar series. The first part, “Marijuana and the ADHD Brain: How to Identify and Treat Cannabis Use Disorder in Teens and Young Adults” was broadcast live on February 26, 2020. “Marijuana and the ADHD Brain, Part 2” was broadcast live on March 26, 2020.

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2 Molina, B. S. et. al. (2013). Adolescent substance use in the multimodal treatment study of attention-deficit/hyperactivity disorder (ADHD) (MTA) as a function of childhood ADHD, random assignment to childhood treatments, and subsequent medication. Journal of the American Academy of Child and Adolescent Psychiatry, 52(3), 250–263. https://doi.org/10.1016/j.jaac.2012.12.014

3 Lee, S. et. al. (2011). Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clinical psychology review, 31(3), 328–341. https://doi.org/10.1016/j.cpr.2011.01.006

4 W. Pedersen, “Does cannabis use lead to mood disorder and suicidal behaviors? A population-based longitudinal study,” Acta Psychiatrica Scandinavica, vol. 118, no. 5, pp. 395–403, 2008.https://doi.org/10.1111/j.1600-0447.2008.01259.x

5 Schmidt, K., Tseng, I., Phan, A., Fong, T., & Tsuang, J. (2020, Feb.). A Systematic Review: Adolescent Cannabis Use and Suicide. Addictive Disorders & Their Treatment. doi: 10.1097/ADT.0000000000000196

6 H. Chabrol, J. D. Mabila, and E. Chauchard, “Influence of cannabis use on suicidal ideations among 491 high-school students,” Encephale, vol. 34, no. 3, pp. 270–273, 2008. Doi : 10.1016/j.encep.2007.04.002

7 Raja, M., & Azzoni, A. (2009). Suicidal ideation induced by episodic cannabis use. Case reports in medicine, 2009, 321456. https://doi.org/10.1155/2009/321456

8 Lopez-Quintero, C., et. al. (2011). Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug and alcohol dependence, 115(1-2), 120–130. https://doi.org/10.1016/j.drugalcdep.2010.11.004

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Cannabis use disorder uniquely affects people with ADHD. Learn about how marijuana impacts the ADD brain and the risks of abuse. ]]>