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.
Can Weed Help Treat ADHD?
“I felt like someone turned on a light switch in my head,” Joseph Lazarus says of his first time smoking weed. It was a classic scene from American adolescence: He snuck out into woods near his home in York, Pennsylvania, with an older schoolmate who liked to blaze. For Lazarus, the experience was profound: “I heard the birds chirping for [what seemed like] the first time,” he says. The leaves seemed greener. He felt the wind tickle his skin. “I was one with the forest, a wooded forest. I was so calm.” He was 13.
It was one of the first times Lazarus felt normal. At age six, he was diagnosed with attention-deficit/hyperactivity disorder and prescribed the usual stimulants. They didn’t help. “I couldn’t concentrate or retain information,” he says. “I had a hard time with grammar. I couldn’t remember the rules.” He was restless, unable to focus in class and easily bored at home for his entire childhood. He says emotional trauma played a role; he had to process his parents’ divorce at about the same age he was diagnosed. “I felt like there was a stick of dynamite in me ready to go off,” he says.
But his thought pattern after smoking up? “It was like if you are on a four-lane highway with cars coming from everywhere and then you are on a country road.” Lazarus, now a 33-year-old home remodeler and still living in York, has been self-medicating with cannabis since that day in the woods. At the time, the dramatic change in his mannerisms caused a guidance counselor to start a process that got him sent to an institution for troubled teens. But he says weed has been the only treatment that has stabilized him. (Vaping is his current method of choice.) “I’m using a tape measurer and making calculations and plans every day,” he says. “I don’t think that would be possible without cannabis.”
Evidence that cannabis helps with ADHD is emerging and scant, but signs indicate that people are using it to treat their symptoms, anyway. A 2016 Duke University study of 268 ADHD-related internet threads, for instance, found that 25 percent included a post from someone indicating that it was therapeutic for ADHD. (Only eight percent of the threads included a post saying it was harmful, five percent that it was a mix of therapeutic and harmful, and two percent that it had no effect on ADHD symptoms.)
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Other studies also show promise for cannabis-based medicine, if not recreational weed. Last year, researchers at King׳s College London’s Institute of Psychiatry, Psychology and Neuroscience completed a randomized, placebo-controlled experimental study of a cannabinoid medication on adults with ADHD. Subjects who used Sativex Oromucosal Spray—which is an extract of cannabis, and therefore different from recreational weed—experienced some relief in their hyperactivity/impulsivity symptoms. They also reported more inhibition and better attention depth when compared to the group that took a placebo.
Ruth Cooper, the lead author who completed the study as part of her dissertation, says she was motivated by the knowledge that many psychiatrists and psychologists—including her advisor and co-author—recommend cannabis for ADHD. They prefer cannabis to medications often because of the more tolerable side effects, Cooper says. “There’s some research on it, but not very much,” she adds.
Cooper says her study of 30 subjects is small, but promising. “I think in the future if more evidence could be shown that it has greater effects in larger trials, it would become a common treatment,” she says. In the meantime, some physicians aren’t waiting for more scientific input. David Bearman, a private practice physician and certified cannabinoid medicine specialist, has been prescribing medical marijuana in California for 40 years, he says, and working around the laws in place. Bearman says young people and parents often contact him about cannabis-based treatments for ADHD. They complain that drugs like Ritalin increase the restlessness and nervousness that was problematic in the first place.
The effect on students with ADHD who are struggling, he says, tends to be dramatic. “Most of my patients’ [grades] went from Cs and Ds to Bs,” Bearman says. “One credited cannabis with getting his PhD.” Bearman posits—as many other researchers have—that ADHD might be the result of a lack of the neurotransmitter dopamine in the brain’s prefrontal cortex. Nerve signals might be slowed or stagnated, leading to a loss of attention and generally slower thought process. THC causes the brain to produce more dopamine, which means more of it becomes available for the essential tasks of memory and attention.
Celeste Thirlwell, a physician and sleep specialist at Apollo Cannabis Clinics in Toronto, says that the inflammation of the nervous system is a common cause of ADHD, and cannabis is a natural anti-inflammatory agent. Without deep sleep, “the nervous system is not being properly entrenched,” Thirlwell says. “It’s not being turned off properly, so you have problems with memory.”
Thirwell recommends her patients vape with a sativa strain to ease the inflammation and get an attention-renewing night of sleep. Not all medical professionals, however, are quite so bullish on using cannabis to treat attention deficit disorder: “ADHD is a basket of problems,” says Scott Shannon, a physician and holistic medical practitioner in Fort Collins, Colorado. “Saying you can’t pay attention is like saying [to a mechanic], ‘My car isn’t going forward.’ There are many things that could [be] wrong.”
Shannon, however, has recommended hemp-derived CBD, the non-psychoactive compound in the cannabis plant, for ADHD symptoms and other complaints related to restlessness in his patients. (He would prefer to avoid the psychoactive effects of THC.) But he cautions people not to overthink the effect. “We know that engaging the endocannabinoid system has a calming effect,” he says, “so naturally, CBD is useful for that over-arousal.”
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"I felt like someone turned on a light switch in my head."