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Is cannabis good or bad for you if you have ADHD?

The diverging views of ongoing cannabis research.
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In the age of the internet, social media, and the ever-present access to various distractions via the wonders of the modern smartphone, staying focused on a single task can feel daunting and unnatural for the best of us. This is especially true if you also happen to suffer from "Attention-Deficit/Hyperactivity Disorder (ADHD). In which case, you may have had to re-read that first sentence twice.  Anecdotally, cannabis has been attributed to calming properties, so should you self-medicate with cannabis to mitigate some of the symptoms of ADHD? – Well, that depends on how old you are. If you are older than 28, then a micro-dosing plan may indeed prove beneficial. If you are below 28, then there are risks involved that you should know about. This article will give you a brief overview of the effects of cannabis in ADHD patients.  

ADHD

The definition of ADHD has changed over the years. Traditionally, it was thought to affect children and young adults, but resolve by the end of adolescence. However, since 2013, the definition was updated.

ADHD affects around 5% of children and 3% of adults.

Today, ADHD is classified as a neurodevelopmental disorder, which is a condition that affects the central nervous system's growth and maturation. While it is often missed, adults are now also being diagnosed with it.  

The disorder is characterized by :

  • impairing levels of inattention
  • hyperactivity and impulsivity
  • emotional dysregulation
  • cognitive impairments
  • psychiatric comorbidities (i.e, other additional conditions)

Statistics tell us that young adults experience social consequences due to ADHD. Among the same age group, peers with ADHD are less likely to enroll in college, more likely to be on academic probation, and less likely to graduate. Generally, they report having difficulties in all aspects related to employment, from writing and sending out resumes to interviewing successfully. In other words, ADHD isn't the most fun thing in the world. One second you find yourself writing an article for thepineapple; the next, you are wondering why you just spent an hour watching pandas fall out of trees on YouTube.  

Cannabis and the ADHD brain

Before we begin to discuss the subject, I would like to make one thing very clear. Evidence based, scientific knowledge on the causal effects of cannabis on the ADHD brain are very, very limited at the moment. There aren’t a lot of studies. And many of the studies are quite limited in scope. Furthermore, as with every under-researched topic, there are conflicting opinions and hypotheses. In other words, you’ll need to make your own decisions and understand that no one really knows anything definitive right now. 

ADHD patients often self-medicate with cannabis and report that it provides relief

Physicians report that their ADHD patients often self-medicate with cannabis, alcohol, and other drugs like LSD. A recent study published in the Journal of Attention Disorders (Stueber & Cuttler 2021) surveyed the cannabis consumption of 1738 students with ADHD. The participants self-reported that cannabis helped them cope with their ADHD symptoms like hyperactivity and impulsivity, while also providing some mitigation to the side effects of their other medications.  But the debate around cannabis and ADHD is ongoing, as there is a bit of a chicken and egg problem here. Is cannabis helping to reduce the symptoms, or is ADHD promoting substance use? While it is unclear which comes first, we know that ADHD often occurs alongside cannabis use disorder (CUD).This is particularly troubling when it is diagnosed in children. The body's natural endocannabinoid system (ECS) is quite heavily involved in synaptogenesis and dendrite pruning. This means that it helps regulate the growth of the interface between nerve cells and facilitates the pruning of unused nerve branches or connections. If a child consumes cannabis while its brain isn't fully developed, bad things could potentially happen. THC, which is the most prevalent psychoactive phytocannabinoid, is said to permanently alter the architecture of the developing brain. Clinical studies have shown that this leads to neurons with less branched dendrites, and potentially an average loss of 8 IQ points by the time maturity is reached.  Typically, the brain's development is complete by the age of 25. With ADHD, frontal lobe development is delayed even further to around 28 years of age. 

delta-9 tetrahydrocannabinol (THC) can permanently alter the architecture of the brain during development

Suppose you are an adult above the age of 28 with ADHD and your brain is cooked all the way through. In that case, the situation is not quite as clear. Some early clinical studies with nabiximols, a cannabinoid extract (a 2.7mg THC and 2.5mg CBD-link to THC vs CBD article), showed some improvements in QBT cognitive performance and activity levels. QBT is a computer-based test that combines a test of attention-span with a movement analysis. While it appears as if cognitive functions in adult ADHD patients weren't impaired, the statistics of the study are inconclusive and would require more research. It is important to understand that medical research into the effects of cannabis on the body is still in its infancy. Indeed, even information on how the body's natural endocannabinoid system functions is still very incomplete. That being said, we do know that THC affects the dopamine regulation of the brain, and dopamine transporter proteins play a role in ADHD. In other words, cannabis will most likely have an effect. This effect could mitigate some of the symptoms of ADHD, but there is a real risk that it could also lead to substance abuse issues in adults, as some theorize that THC primes the brain and enhances the effect of other drugs. In fact, studies have shown that it has an additive effect on heart rate and blood pressure when taken together with methylphenidate (MPH), one of the most prescribed stimulants used to treat ADHD. This is something to keep in mind, especially if you are also suffering from unrelated cardiovascular problems, as it may increase the risk of a heart attack.

If you are suffering from ADHD and are below the age of 28, your brain is still developing. So you have to ask yourself the question. Is it worth relieving your symptoms using cannabis in the short term, at the cost of potential long-term consequences? If it was up to me, I would play the long game and avoid cannabis consumption until after brain maturation is achieved. But that does not mean that this is the right option for you. Perhaps your ADHD symptoms are so disruptive that short-term relief would have much greater positive effects on your life. That is something only you can really decide. In that case, you could give cannabis a try.

Treating the underlying condition first, still constitutes the best long-term strategy

In most cases, taking stimulant medications is still considered the best first-line treatment for ADHD. - But if you and your doctor believe that the medicinal properties of cannabis outweigh the risks in your case, then I would still suggest that you do so via microdosing. Doing so limits your intake of phytocannabinoids, just enough to enter into a therapeutic range, but not high enough to saturate and start building tolerance. Finding that range will depend on your own body, the source and ratio of phytocannabinoids, concentrations, as well as the delivery vehicle used to administer the dose of cannabinoids. In other words, the path the cannabinoids take through your body will play a role and you’ll have to figure out whether a nice canna-tea, or maybe a perfectly rolled blunt work better for you.

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