Cannabis Treatment Linked to Improving Quality of Life in ADHD Patients

Cannabis-based medicinal products (CBMPs) are associated with improving anxiety, sleep quality, and health-related quality of life in patients with ADHD, according to a new study.¹

ADHD has a global prevalence of 5% in children and 2.5% in adults. In the United States, the incidence of ADHD diagnosis has increased about 42% in children between 2003 – 2011 and 123% in adults between 2007 and 2016. In 2020, >266 million adults worldwide had ADHD.²

With ADHD comes challenges, hindering with quality of life. ADHD is associated with higher incidences of sleep problems, anxiety, substance abuse, and depression.¹

Currently, ADHD is treated with psychological therapies—some stimulant and others non-stimulant medications. Though, stimulants are commonly prescribed for ADHD as they are relatively safe and effective. However, stimulants are linked to decreased appetite, insomnia, emotional dysregulation, irritability, and an increased risk of adverse cardiovascular events. Because of these adverse events, ADHD medication has low adherence rates.

A new study, led by Pim Ittiphakorn, from the department of surgery and cancer at Imperial College London, sought to evaluate health-related quality of life and safety outcomes in ADHD patients of a new treatment: CBMPs. So far, only 1 placebo-controlled randomized controlled trial on CBMPs has been conducted, which showed CBMP improved symptoms of hyperactivity and impulsivity when treated with nabiximols, an oromucosal spray with delta-9-tetrahydrocannabional (THC) and cannabidiol (CBD). Because of the small sample size, more research was needed.

Ittiphakorn and colleagues first examined measure changes in the EQ-5D-5L index value, generalized anxiety disorder-7 questionnaire, and the single-item sleep quality score from baseline to months 1, 3, 6, and 12. The team also assessed for adverse effects.

The study included 68 patients with 80.88% male (n = 55) and a mean age of 25.63 years old. The patients were selected from the UK Medical Cannabis Registry.

Participants had significant improvements in the EQ-5D-5L at months 1, 3, and 6 (P <.050), as well as for sleep quality scores at months 1, 3, 6, and 12 (P <.010). With the CBMP treatment, less patients had to take concomitant ADHD medication, with a reduction of 38.46% in lisdexamfetamine, 15% in methylphenidate, and 14.29% in dexamfetamine.

The team noted GAD-7 scores had significant improvements in 50% (n = 34) of patients at month 1, 42.65% (n = 29) at month 3 (n = 29), and 39.71% (n = 27) at month 6, and 26.47% (n = 18) at month 12.

Furthermore, 61 participants (89.71%) received adverse events, with 61 recorded accounts. Adverse events were mostly moderate (n = 26 [38.24%]). Common adverse events were insomnia (n = 5 [7.35%]), concentration impairment (n = 5), somnolence (n = 5), lethargy (n = 5), and dry mouth (n = 5). The investigators found no statistically significant difference in patients prescribed oils (n = 1 [25%]), dried flower (n = 9. 23.68%), or both oil and dried flower (n =1 [3.85%]) (P = .095).

The investigators pointed out several limitations of the study, such as how it was not possible to control for confounding factors and how the observed effects could have been caused by these factors. Also, the sample was primarily male, which affects the results. Males and females may respond to the treatment in different ways, but this was not explored. Moreover, 80.88% of patients were already taking cannabis before the treatment and may have developed pharmacological tolerance, reducing the effectiveness of CBMPs.

“These results suggest that CBMPs may play a role in alleviating symptoms and co-morbid anxiety and sleep disruption associated with ADHD, though these are preliminary findings,” the investigators wrote. “Due to limitations in study design, a causal relationship cannot be determined, thus, a definite conclusion cannot be drawn from these results.”

References

1. ^{Ittiphakorn P, Erridge S, Holvey C, Coomber R, Rucker JJ, Sodergren MH. UK Medical Cannabis Registry: An analysis of clinical outcomes of medicinal cannabis therapy for attention-deficit/hyperactivity disorder. Neuropsychopharmacol Rep. Published online December 6, 2023. doi:10.1002/npr2.12400}
2. ^{Wirth, J. ADHD Statistics and Facts in 2023. August 24, 2023. Forbes Health. https://www.forbes.com/health/mind/adhd-statistics/. Accessed December 7, 2023.}