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Medical cannabis for ADHD


Medical cannabis for ADHD

There are initial studies on the therapeutic effect of cannabinoid drugs in terms of a specific positive effect on ADHD symptoms.

In terms of cognitive performance and activity level, a slight but non-significant improvement was observed with Sativex. Hyperactivity/impulsivity (p=0.03) and cognitive inhibition (p=0.05) were significantly improved, inattention (p=0.10) and emotional lability (p=0.11) tended to be improved, although after statistical adjustment for multiple testing the significance was removed. One serious side effect (muscle seizures/convulsions) and three mild side effects occurred in the active group and one serious side effect (cardiovascular problems) in the placebo group.
The study concluded that cannabis medication may reduce ADHD symptoms for some adults with ADHD without cognitive impairment.1 One comprehensive meta-study found insufficient evidence of efficacy for ADHD,2 another found that studies support the efficacy and safety of cannabis for ADHD.3
A British study found symptom improvements from medicinal cannabis in ADHD over 12 months.4

One study found a correlation between high doses of cannabinol (CBN) and reduced self-reported ADHD symptoms, as well as a correlation between high doses of medical cannabis and a reduction or complete substitution of other ADHD medications.5

A comprehensive description of THC medication for ADHD can be found at ADHSpedia.6

1. Cannabinoid receptors

There are two cannabinoid receptors.7

1.1. CB1 receptor

The CB1 receptor (cannabinoid 1 receptor) is one of the most common receptors in the brain. It is present in many organs, sometimes in low concentrations.
The CB1 receptor is involved in the regulation of:

  • Coordination of movements
  • Spatial orientation
  • Sensory perception (taste, smell, touch, hearing)
  • Mental performance
  • Motivation
  • Pain
    • Diclofenac inhibits pain via CB1 receptors, GPR55 receptors and mu-opioid receptors of mPFC and ventrolateral periaqueductal gray in the brainstem8
  • Inhibition of excessive signal transmission by neurotransmitters.

Activated CB1 receptors:

  • inhibit GABA neurons, which leads to less inhibition of dopamine neurons. As a result, cannabinoids indirectly increase dopamine levels
  • inhibit the overactivity of pain regulation and thus have a pain-relieving effect
  • THC as a CB1 agonist has a dopamine-increasing effect in the nucleus accumbens. Adenosine A2A receptor antagonists (e.g. caffeine) counteract this.9

Since the CB1 receptor is not present in the brainstem, which regulates the respiratory and cardiovascular systems, an overdose of THC is not thought to cause related deaths.

1.2. CB2 receptor

The CB2 receptor (cannabinoid 1 receptor) is primarily associated with the immune system.

2. Cannabis medication for ADHD

In Germany, Sativex, Cannabis Flos, Canemes and Dronabinol are several cannaboid medications that are approved, but not for ADHD. For an off-label use for ADHD, an exemption had to be applied for at the BfArM in the past. Since 2017, a medical prescription of Sativex and Cannabis Flos for ADHD has been permitted under the BtmG without an additional exemption. 10
By 2017, around 150 ADHD sufferers had received an exemption (out of a total of 1061 granted).11 Cannabis prescriptions for ADHD have also risen sharply in other countries.12

We are now aware of a double-digit number of reports from sufferers, as well as several sufferers personally, for whom medical cannabis has significantly reduced ADHD symptoms after MPH and amphetamine medication had not worked sufficiently.

In the case of an apparently heavily addicted THC user who is allowed to consume THC in a controlled manner, it is unclear whether this is based on the same effect or whether the effect is explained by the fact that the THC has merely eliminated the withdrawal symptoms of an existing THC addiction. This pattern is also known in alcohol addicts, who function “better” with their basic dose because the withdrawal symptoms are masked.

To summarize:
In Germany, cannabinoid medication may be prescribed for ADHD as a BtM prescription (like stimulants) if other medication is ineffective. Health insurance companies usually reimburse the costs on application.

3. Pathway from THC to dopamine

THC indirectly increases dopamine levels in the brain.

The THC cannabinoids do not act directly on dopamine neurons, but on the endocannabinoid system. Cannabinoid receptors are found in many areas of the brain that have dopamine neurons. Dopamine neurons themselves do not have cannabinoid receptors. However, dopamine neurons are inhibited by GABA neurons, which in turn have cannabinoid receptors.
THC activates CB1 receptors on GABA neurons, which inactivate the GABA neurons. This deactivates the GABA neurons that inhibit the dopamine neurons. The dopamine neurons are thus less inhibited and therefore more active.131415
THC as a CB1 agonist has a dopamine-increasing effect in the nucleus accumbens. Adenosine A2A receptor antagonists (e.g. caffeine) counteract this.9

For the difference between medication and drugs, see Medication and drugs - the difference.

4. Inhibition of sensory overload

Endocannabinoids (the body’s own cannabinoids) also act on the CB1 receptors and thus provide protection against sensory overload, among other things.16

5. CBD-containing cannabis extract for ASD, anxiety and ADHD

One study treated a small group of ASD sufferers with a CBD-enriched cannabis extract. The CBD to THC content was 75 to 1. Almost all those affected showed improvements after 6 to 9 months, with ADHD symptoms often improving. The improvements were most pronounced in the non-epileptic patients.17
A review reports positive effects of cannabidiol in ADHD18
A single dose showed no change in ADHD or attention symptoms in mice, but a reduction in anxiety symptoms.19

Several sufferers told us that CBD oil (without THC) did not improve their ADHD symptoms.
However, a significant improvement was reported for anxiety disorders. Several sufferers reported that CBD oil enabled them to significantly reduce the previous dosage of their anxiety medication.

6. Cannabis treatment for tic disorders

A small study looked at the treatment of tic disorders with cannabis. In 85% of those affected, there was a 60% improvement in tics, in 55% an improvement in comorbidities (most frequently OCB / OCD, ADHD and sleep disorders) and in 93% an improvement in quality of life. The effects were assessed as long-term. Half of those affected reported side effects, although their severity was considered tolerable. THC-rich strains seemed to work better.20
Tic disorders share a genetic basis with ADHD.

7. Dosage and application instructions for medicinal cannabis

Information on dosing medicinal cannabis (Cannabis Flos) using a vaporizer can be found here.21

  1. Cooper, Williams, Seegobin, Tye, Kuntsi, Asherson (2017): Cannabinoids in attention-deficit/hyperactivity disorder: A randomised-controlled trial, European Neuropsychopharmacology, Volume 27, Issue 8, 2017, Pages 795-808, ISSN 0924-977X, n = 30

  2. Black, Stockings, Campbell, Tran, Zagic, Hall, Farrell, Degenhardt (2019): Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis. Lancet Psychiatry. 2019 Oct 25. pii: S2215-0366(19)30401-8. doi: 10.1016/S2215-0366(19)30401-8.

  3. Parrella NF, Hill AT, Enticott PG, Barhoun P, Bower IS, Ford TC (2023): A systematic review of cannabidiol trials in neurodevelopmental disorders. Pharmacol Biochem Behav. 2023 Aug 3:173607. doi: 10.1016/j.pbb.2023.173607. PMID: 37543051.

  4. 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. 2023 Dec;43(4):596-606. doi: 10.1002/npr2.12400. PMID: 38058251; PMCID: PMC10739081.

  5. Hergenrather, Aviram, Vysotski, Campisi-Pinto, Lewitus, Meiri (2020): Cannabinoid and Terpenoid Doses are Associated with Adult ADHD Status of Medical Cannabis Patients. Rambam Maimonides Med J. 2020 Jan 30;11(1):10.5041/RMMJ.10384. doi: 10.5041/RMMJ.10384. PMID: 32017685. n = 27


  7. Grotenhermen (2018): Das Endocannabinoidsystem: Körpereigene Cannabinoide und Cannabinoidrezeptoren.

  8. Tamaddonfard, Erfanparast, Salighedar, Tamaddonfard (2020): Medial prefrontal cortex diclofenac-induced antinociception is mediated through GPR55, cannabinoid CB1, and mu-opioid receptors of this area and periaqueductal gray. Naunyn Schmiedebergs Arch Pharmacol. 2020 Mar;393(3):371-379. doi: 10.1007/s00210-019-01735-x. PMID: 31641818.

  9. Justinová, Ferré, Redhi, Mascia, Stroik, Quarta, Yasar, Müller, Franco, Goldberg (2011): Reinforcing and neurochemical effects of cannabinoid CB1 receptor agonists, but not cocaine, are altered by an adenosine A2A receptor antagonist. Addict Biol. 2011 Jul;16(3):405-15. doi: 10.1111/j.1369-1600.2010.00258.x. PMID: 21054689; PMCID: PMC3115444.


  11. Antwort der Bundesregierung auf Kleine Anfrage – Drucksache 18/11485 – Cannabismedizin und Straßenverkehr

  12. Cairns EA, Benson MJ, Bedoya-Pérez MA, Macphail SL, Mohan A, Cohen R, Sachdev PS, McGregor IS (2023): Medicinal cannabis for psychiatry-related conditions: an overview of current Australian prescribing. Front Pharmacol. 2023 Jun 6;14:1142680. doi: 10.3389/fphar.2023.1142680. PMID: 37346297; PMCID: PMC10279775.

  13. Leafscience (2018): Marijuana and Dopamine: What’s The Link?

  14. Friend, Weed, Sandoval, Nufer, Ostlund, Edwards (2017): CB1-Dependent Long-Term Depression in Ventral Tegmental Area GABA Neurons: A Novel Target for Marijuana. J Neurosci. 2017 Nov 8;37(45):10943-10954. doi: 10.1523/JNEUROSCI.0190-17.2017.

  15. Gessa GL, Melis M, Muntoni AL, Diana M (1998): Cannabinoids activate mesolimbic dopamine neurons by an action on cannabinoid CB1 receptors. Eur J Pharmacol. 1998 Jan 2;341(1):39-44. doi: 10.1016/s0014-2999(97)01442-8. PMID: 9489854.

  16. Gießen (2007): Endocannabinoide als Schutz vor Reizüberflutung, Pharmazeutische Zeitung, 27.04.2007

  17. Fleury-Teixeira, Caixeta, Ramires da Silva, Brasil-Neto, Malcher-Lopes (2019): Effects of CBD-Enriched Cannabis sativa Extract on Autism Spectrum Disorder Symptoms: An Observational Study of 18 Participants Undergoing Compassionate Use. Front Neurol. 2019 Oct 31;10:1145. doi: 10.3389/fneur.2019.01145. eCollection 2019.

  18. Dias-de Freitas, Pimenta, Soares, Gonzaga, Vaz-Matos, Prior (2022): The role of cannabinoids in neurodevelopmental disorders of children and adolescents. Rev Neurol. 2022 Oct 1;75(7):189-197. Spanish, English. doi: 10.33588/rn.7507.2022123. PMID: 36169325.

  19. Huffstetler CM, Cochran B, May CA, Maykut N, Silver CR, Cedeno C, Franck E, Cox A, Fadool DA (2022): Single cannabidiol administration affects anxiety-, obsessive compulsive-, object memory-, and attention-like behaviors in mice in a sex and concentration dependent manner. Pharmacol Biochem Behav. 2022 Nov 29;222:173498. doi: 10.1016/j.pbb.2022.173498. PMID: 36455670.

  20. Milosev, Psathakis, Szejko, Jakubovski, Müller-Vahl (2019): Treatment of Gilles de la Tourette Syndrome with Cannabis-Based Medicine: Results from a Retrospective Analysis and Online Survey. Cannabis Cannabinoid Res. 2019 Dec 9;4(4):265-274. doi: 10.1089/can.2018.0050. eCollection 2019.

  21. Dreyer (2020): Die Titrationsphase bei Vaporisation von Cannabis Flos, Hanf-Magazin.