ADHD and the Cannabis vs. Ritalin Debate

ADHD Hyperactivity, impulsiveness, mood swings, hypersensitivity, crankiness, lack of concentration and organisation, as well as difficulty falling asleep. These are the symptoms that typically determine the lives of ADHD patients. ADHD medication usually comes with a plethora of side effects. Would cannabis be an alternative? 

Is cannabis a reliable alternative to conventional ADHD medication?

Hyperactivity, impulsiveness, mood swings, hypersensitivity, crankiness and aggression, lack of concentration and organisation, as well as difficulty falling asleep at night. These are the symptoms – all of them or some of them – that typically plague the lives of ADHD patients, often causing social problems in everyday life. The ADHD medication which is prescribed as a result usually causes health problems. Reason enough, it seems, to once again examine cannabis as a possible alternative.

Cannabis as a treatment for ADHD – Case studies and their results

This article will start by introducing a number of case studies into cannabis and ADHD (Attention Deficit Hyperactivity Disorder) that were conducted in the past. The research results of the latest study into the use of Sativex as a treatment for ADHD dating from 2015 are not available as yet, but Sensi Seeds will share them with you as soon as they are.

Successful cannabis treatment of therapy-resistant ADHD in adults

Adults suffering from ADHD who were therapy-resistant to conventional pharmacological treatment and who were granted permission to use cannabis flowers between 2012 and 2014 were subjected to an anonymous case study, during which the anonymised medical records of 30 adult patients were analysed. It was established that cannabis resulted in an improvement of a variety of symptoms, such as better concentration and sleep, and reduced impulsiveness.
The 28 male and 2 female patients were between the ages of 21 and 51. For 63% of them, ADHD was only first diagnosed during adulthood, while 37% was already diagnosed in childhood. The patients that were diagnosed between the ages of 6 and 13 had been treated before with methylphenidate, which is sold under the brand name Ritalin, among others. Other pharmacological therapies included atomoxetine, dexamphetamine (an active ingredient of the amphetamine class sold under the brand name Attentin), lisdexamphetamine, a synthetically-produced active stimulant ingredient of the phenethylamine class and amphetamine class, and amphetamine juice. It was established that these treatments were abandoned, mostly because of side effects and often on the grounds of insufficient effectiveness. Eight patients took stimulants in combination with cannabis, while 22 patients only used cannabis.
The conclusion of this case study was that “for adult patients with ADHD, who experience side effects or do not profit from standard medication, cannabis may be an effective and well-tolerated alternative.” Data from the study can be found on page 85 of this conference abstract.

Many people suffering from ADHD treat themselves with cannabis

People who suffer from ADHD are known to have an inclination to practice self-medication, using cannabis among other remedies. In 2012, the Psychology Department of the University of Albany in New York conducted a study in which data was evaluated from a subgroup of individuals suffering from ADHD who self-medicated with cannabis.  The data of 2811 ADHD patients was analysed, originating from a survey among American cannabis users.
What is meant by ‘subgroup’ in this context? Typically, there are three different ADHD subgroups:

• ‘Fidgety Philip’, mostly hyperactive and impulsive;
• ‘Johnny Head-in-the-Clouds’, mostly attention deficient;
• Mixed type: both attention deficient and hyperactive.

The patients were asked about their symptoms when not using cannabis. It was established that the majority of daily consumers satisfied the criteria that comprise the hyperactive-impulsive pathology clinical picture.  For the non-daily consumers, there was no difference between them and consumers with ADHD from the hyperactive and attention deficient subgroups. The researchers concluded that “these results have implications for identifying which individuals with ADHD might be more likely to self-medicate using cannabis.” In addition, the scientists made it clear that said results support further research into the relation between cannabinoid receptors and regulatory control.

Positive effect of moderate cannabis on cocaine-addicted ADHD patients

The New York State Psychiatric Institute discovered in a study conducted in 2006 among 92 cocaine-addicted ADHD patients that moderate cannabis use can have a positive effect on abstaining from cocaine use. The study was held among adults in the age group of 25 to 51, the majority (69%) of whom used cannabis. The patients subjected themselves to a treatment with methylphenidate for their ADHD and cocaine addiction. The effect of cannabis on continuing the therapy and abstaining from cocaine was studied.
57% of the patients who consumed cannabis moderately were still part of the patient group after 14 weeks of treatment. Of the patients who did not use cannabis, only 24% was still part of the group by week 14, compared with 39% of the regular/strong cannabis users.
Furthermore, the consumption of cannabis resulted in greater cocaine abstinence. Of the patients who indicated intermittent cannabis use, 39% had abstained from using cocaine for two or more weeks, compared to 26% of those who indicated not having used cannabis during the treatment.

Cannabis can have a positive effect on adolescents with ADHD

In a study conducted in 2008 in Nottingham, the United Kingdom, scientists observed that adolescents with ADHD who used cannabis showed a trend towards a decline in disorganisation, hyperactivity and lack of attention. The study was conducted with a patient group of 25 individuals and showed that cannabis can have a positive effect.

Tourette’s Syndrome and ADHD – improvement with cannabis

German scientists, while treating a 15-year old with Tourette’s Syndrome and ADHD in 2010, discovered that THC caused a significant improvement in terms of the spasmodic tics without causing side-effects, which, in turn, made it possible to treat his ADHD symptoms with stimulants. The following was concluded: “Our observation suggests that Delta 9-THC might be a successful alternative in patients with severe TS refractory to classic treatment. Particularly in the case of stimulant-induced exacerbation of tics, Delta 9-THC might enable successful treatment of comorbid ADHD.” However, more research is needed to substantiate these findings.

Cannabis vs. stimulant drugs

What can be agreeable and effective ADHD medication, or reasonably so, for one person, can have no effect or the wrong effect on another individual; or it has so many side-effects that its use has to be discontinued. Ritalin is a good example to show what pharmaceutical ADHD prescription drugs are all about.

What is Ritalin?

Ritalin is a good example to show what pharmaceutical ADHD prescription drugs are all about

Ritalin is a central nervous system stimulant and a derivative of the amphetamines class of drugs. These have special pharmaceutical significance, as new and more effective medication can be manufactured from derivatives of existing drugs.
Methylphenidate (in short: MPH) was synthesized for the first time in 1994 and is mainly used as a medicinal treatment for ADD, ADHD and narcolepsy.
In most countries, Ritalin is a prescription drug subject to specific prescription requirements.

How does Ritalin work?

Methylphenidate stimulates and excites. It suppresses tiredness and inhibitions, increases short-term physical performance and inhibits appetite. Furthermore, it restricts the function of the transporters of the dopamine and noradrenalin neurotransmitters. In terms of this property it is similar to cocaine.

Side-effects of Ritalin use

Long-term use of Ritalin by children can lead to reduced growth and weight gain. Appetite and liquid intake may be inhibited. Furthermore, nausea, burning in the oesophagus, belly ache and vomiting can occur. Other reported side-effects are increased sweating, dermatitis, itching and hair loss. Also, taking Ritalin can lead to sleep disorders and sleeplessness, nervousness, headaches, anxiety, depressed mood and depression, restlessness, agitation, aggression, stress, dizziness, disorientation, emotional instability, tachycardia and cardiac dysrhythmia.

A large overdose of Ritalin can result in over-stimulation of the central nervous system, cramps, delirium, and even coma.
Finally, as the effect of Ritalin intake begins to wear off, the original symptoms may worsen significantly, including unwanted behaviour. This is called the rebound effect.

Ritalin criticised

The global independent Cochrane Collaboration network has closely examined ADHD medication such as Ritalin and recently concluded that

• the effectiveness of Ritalin and other similar stimulants is only moderate; and
• the quality of the studies into the deployment of these ADHD drugs is unsatisfactory.

It summarizes: “Although Ritalin has been prescribed for over 50 years, as yet no comprehensive, systematic and therefore scientifically reliable studies into its benefits and dangers have been conducted, as with other psychotropic drugs.”

Rather cannabis, then?

Consuming medicinal cannabis seems to be an obvious treatment for ADHD symptoms. THC and CBD are known to have an anti-depressive anxiety reducing effect. Cannabis relaxes the user and gives them a sense of tranquillity. Hyperactivity, fear and anxiety are reduced. Furthermore, ADHD patients often report that cannabis helps them to unwind and fall asleep at night.

Also, cannabis helps to reduce symptoms such as mood swings, lack of attention and irritability in individuals suffering from neuro-psychiatric disorders such as ADHD.

ADHD rarely in isolation – associated disorders

For many ADHD patients, attention deficit and/or hyperactivity are/is not the only symptom(s) they suffer from. A closer look reveals that bipolar disorders, depression, compulsive behaviour, social behaviour disorders, anxiety, sleep and obsessive-compulsive disorders, as well as illicit drug abuse, often accompany ADHD.

Dopamine: The happiness hormone and illicit drugs

The tendency towards drug abuse among ADHD patients can be explained by low levels of dopamine (the happiness hormone) in their bodies.
Many recreational drugs, such as alcohol, tobacco, cocaine and cannabis, cause an increase in the user’s dopamine level. However, cannabis only has a relatively mild influence on dopamine, which could explain the substance’s low level of dependency potential.

Dr David Bearman

Yes, cannabis use causes a slight increase in the dopamine level. This happens because it cooperates with the dopamine binding sites that can be found on several neurons in the brain. Prescription drugs such as Ritalin work identically.
“Cannabis appears to treat ADD and ADHD by increasing the availability of dopamine. This then has the same effect but is a different mechanism of action than stimulants like Ritalin (methylphenidate) and dexedrine amphetamine, which act by binding to the dopamine and interfering with the metabolic breakdown of dopamine.” – Dr David Bearman, M.D.

The importance of the endocannabinoid system

It is the endocannabinoid system that influences the dopamine level. This interdependence seems to have been altered in ADHD patients. The level of anandamide, a cannabinoid that occurs naturally in the human body, is higher in individuals who suffer from ADHD.
The endogenous substance anandamide, which is produced by the body itself, binds to the cannabinoids receptors of the endocannabinoid system, to which THC binds as well. From this, it follows that the human body is capable of producing more endocannabinoids in a natural way to combat the symptoms of ADHD. Therefore, scientists are convinced that the endocannabinoid system is crucial to the treatment of ADHD. Sensi Seeds has already reported this significance in a previous article.
It was established that the correct functioning of the endocannabinoid anandamide and 2-AG, as well as of the corresponding cannabinoids receptors themselves, is essential for the normal cognitive and psychomotor development of children during growth. The correct functioning of the endocannabinoid system in relation to impulsive behaviour represents a finely attuned and complex system, and disruptions in this careful balance may result in disorders such as ADHD. Italian and American scientists concluded from the studies they conducted in 2011 that “therapeutic strategies that aim to influence the endocannabinoid system might be effective as a treatment for this disorder.”
Cannabinoid receptors can be found in higher concentrations in those parts of the brain that are being associated with the symptoms of ADHD, especially the hippocampus and the amygdala. The amygdala is involved in the development of fear, and plays an important role in emotionally evaluating, recognising situations and analysing possible dangers. It processes external impulses and launches the vegetative reactions to them. The role of the hippocampus is to code information that enters the body from the outside.

Reports from patients and physicians about the deployment of cannabis for ADHD

Below we have provided a few quotes on the use of cannabis as a treatment for children, adolescents and adults with ADHD, both as alternative and complementary medication:
“[From prescribed stimulant medications] I remember having headaches all the time to the point where I wasn’t able to sleep.” Also, Antonio had very poor appetite. With cannabis, things have improved somewhat. The side-effects of the stimulants became less severe and his ADHD symptoms were noticeably reduced. “For the first time ever, I was in the state where I could really get my mind together.” – Antonio Rodriguez (Cannabis and ADD/ADHD)
“It helps combat the problems with falling asleep as a result of methylphenidate use (Mediket) and depression. Thanks to cannabis, I can be calmer even without Mediket. My social environment and family in particular benefit from that. It allows me to wind down, despite Mediket and ADHD. It diminishes the hyperactivity and hurriedness as a result of Mediket and ADHD. It can compensate the ADHD-induced lack of focus in certain situations better than Mediket can. It enables me to introduce Mediket-free periods in order to not feel like a live wire every now and then. It makes me placid and less hurried.” – Maximilian Plenert (How does cannabis help with ADHD?)
“Almost all patients that use cannabis therapeutically report that it helps them to pay attention during lectures and to be able to better concentrate instead of thinking about various things simultaneously. Furthermore, it helps them to keep up with their assignments and do their homework.” – David Bearman, M.D., physician and cannabinoidologist
“The only thing that I could always count on to help me over the past 22 years [of ADHD] has been cannabis. It helps me to find inner calm. I am not aggressive, but friendly and sociable. Without cannabis I am a devil and the pain increases.” – Ralf Hermann (ADHD and cannabis – a portrait)
“Cannabinoids are a totally viable alternative for treating adolescents suffering from ADD and ADHD. …Why would anyone give their child an expensive pill… with unacceptable side-effects when you could go out into the garden, pluck a few leaves from a plant and brew him or her a nice cup of tea instead?” – Dr Claudia Jensen, paediatrician and clinical instructor at the University of Southern California.
“My ADHD was either not treated or was treated incorrectly. From childhood, I was prescribed drops and tablets which were discontinued when I was 13 years old because everything would right itself during adolescence. The consequences: inability to pay attention, 1,000 thoughts in my head, quick to become irritable, aggression and poor concentration! Shortly afterwards, I tried cannabis for the first time and noticed that I was able to concentrate and thus complete my secondary school education…” – Chris Vrzak (Cannabis: a plant with many faces)
“While some apply preconceptions that marijuana exacerbates ADHD, almost all California cannabinologists believe cannabis and cannabinoids have substantially improved the lives of ADHD sufferers, and with less negative side effects than common stimulant drug ADHD treatments.” – David Bearman, M.D.

Summary

Although case studies into the deployment of medicinal cannabis for the treatment of ADHD exist, more scientific substantiation of the results obtained so far is required. However, the justice system is obstructing scientific research into the use of medicinal cannabis for the treatment of ADHD.
In the current medical climate, cannabis is not yet taken seriously. Education and perseverance are needed to make the medical fraternity realise that cannabis is a real and viable alternative. Sensi Seeds will remain vigilant.