Medical cannabis for ADHD

Since April 2024, medicinal cannabis such as Sativex (which contains nabiximols, which is extracted from hemp) is no longer subject to the Narcotics Act in Germany. Fully synthetic cannabinoids such as nabilone are still subject to the BtmG.¹

There are initial studies on the therapeutic effect of cannabinoid drugs in terms of a specific positive effect on ADHD symptoms.²

• 1. Cannabinoid medications for ADHD
  • 1.1. THC for ADHD
  • 1.2. CBD (cannabidiol) for ADHD
  • 1.3. CBN (cannabinol) for ADHD
• 2. Cannabinoid medications for other disorders
  • 2.1. CBD for ASD and anxiety
  • 2.2. Cannabis treatment for tic disorders
  • 2.3. Cannabinoids for memory and learning problems
  • 2.4. Cannabinoids for pain / migraine
  • 2.5. CB1R antagonists
• 3. Dosage and application instructions for medicinal cannabis
• 4. Authorization of cannabinoid medicines

1. Cannabinoid medications for ADHD¶

The in the article *Cannabinoids *in the section Neurotransmitters in ADHD In the chapter Neurological aspects show that the CB1 receptor plays a key role in mediating hyperactivity and impulsivity in ADHD.³

Cannabinoid medications may be prescribed in Germany for ADHD if other medications are ineffective. Health insurance companies usually reimburse the costs on application.
We are now aware of a double-digit number of reports from people with ADHD, as well as several people with ADHD personally, for whom medical cannabis has significantly reduced ADHD symptoms after MPH and amphetamine medication had not worked sufficiently.

1.1. THC for ADHD¶

THC also has a psychoactive effect (as a drug) above a certain dosage. One of THC as a drug only concerns doses that remain clearly below the psychoactive effect.
In the case of self-medication, there is a considerable risk that the person with ADHD may intentionally or unintentionally cause psychoactive effects by taking an increased dose.
However, there are a large number of people with ADHD who reliably use medicinal cannabis as a medicine and not as a drug. However, a blanket statement that betriofenics abuse THC-containing cannabis medication as a drug is not justified.

Sativa spray (THC:cannabidiol 9:1) showed improvements in a small RCT, which were no longer significant in the replication, with regard to⁴

• Impulsiveness
• Hyperactivity
• Inattention (trend only, not significant)
• emotional dysregulation (trend only, not significant)

Case reports report helpful effects of cannabinoid medications for ADHD.⁵⁶

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 adverse event (muscle seizures/convulsions) and three mild adverse events occurred in the active group and one serious adverse event (cardiovascular problems) in the placebo group. The study concluded that cannabis medication can reduce ADHD symptoms for some adults with ADHD without cognitive impairment⁴
One comprehensive meta-analysis found insufficient evidence of efficacy for ADHD,⁷ another found that studies support the efficacy and safety of cannabis for ADHD.⁸
A British study found symptom improvements in ADHD from medicinal cannabis over 12 months.⁹

• Dronabinol (Marinol)
  • a synthetic Delta-9-THC
  • partial CB1R and CB2R agonist
  • approved in Europe as an anesthetic for the treatment of chronic pain in cancer patients
  • approved by the FDA in the USA for the treatment of nausea and vomiting in cancer patients
• Nabilon
  • approved by the FDA in the USA for the treatment of nausea and vomiting in cancer patients
• Nabiximols (Sativex)
  • Mixture of Δ9-THC and cannabidiol
  • is often used (off label) in multiple sclerosis for the treatment of spasticity
  • seems to be helpful for tic disorders, especially those with ADHD comorbidity.¹⁰

A comprehensive description of THC medications for ADHD can be found at ADHDpedia.¹¹

1.2. CBD (cannabidiol) for ADHD¶

CBD-enriched cannabis extract (CBD to THC: 75 to 1) often improved ADHD symptoms after 6 to 9 months in a small study of people with ADHD. The improvements were most pronounced in the non-epileptic people with ADHD.¹²
A review reports positive effects of cannabidiol in ADHD¹³
A single dose showed no change in ADHD or attention symptoms in mice.¹⁴
In mice with a targeted gene deletion of a voltage-gated potassium channel, Kv1.3, it also reduced ADHD symptoms.¹⁴

Several people with ADHD told us that CBD oil (without THC) did not improve their ADHD symptoms.

1.3. CBN (cannabinol) for ADHD¶

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.¹⁵

2. Cannabinoid medications for other disorders¶

In addition to the effect of phytocannabinoids and other cannabinoid agonists, cannabinoid reuptake inhibitors and degradation inhibitors are also being researched.

2.1. CBD for ASD and anxiety¶

CBD is being tested in various forms as a medicine. Unlike THC, it is not psychoactive.
For the receptor effect of CBD, see the article Cannabinoids .

A single dose showed a reduction in anxiety symptoms in mice.¹⁴
In mice, injected CBD reduced anxiety behavior, especially in males.¹⁴

Several people with ADHD reported that cannabidiol oil enabled them to significantly reduce the previous dosage of their anxiety medication.

2.2. Cannabis treatment for tic disorders¶

A small study looked at the treatment of tic disorders with cannabis. An improvement in tics of 60% was found in 85% of people with ADHD, an improvement in comorbidities (most frequently OCB / OCD, ADHD and sleep disorders) in 55% and an improvement in quality of life in 93%. The effects were considered to be long-term. Half of the people with ADHD reported side effects, although their severity was judged to be tolerable. THC-rich strains seemed to work better.¹⁶
Tic disorders share a genetic basis with ADHD.

2.3. Cannabinoids for memory and learning problems¶

Depending on the dose and form of administration, cannabinoids show an impairment or improvement of memory in rodents

• A chronic low dose of THC (3 mg/kg per day for 28 days) improves memory and spatial learning in old mice.¹⁷
• A single extremely low dose of THC (0.002 mg/kg) improves memory and spatial learning in 24-month-old mice (equivalent to 80 years in humans).¹⁸

The study situation is far from sufficient to prove effectiveness. We strongly advise against self-treatment attempts to improve memory and learning problems.

2.4. Cannabinoids for pain / migraine¶

PEA (palmitoylethanolamide) had a pain-relieving effect on migraines.¹⁹

2.5. CB1R antagonists¶

The CB1R antagonist rimonabant (Acomplia) was approved in Europe in 2006 for the treatment of obesity and other metabolic diseases.
in 2008, approval was suspended due to side effects such as loss of motivation²⁰, anhedonia, depression and anxiety (severe side effects with every 59th dose) and a case of suicide.²¹²² The drug was subsequently withdrawn from the market.
Rimonabant was not approved in the USA due to the increased risk of suicide.

In principle, CB1R antagonists are discussed for the treatment of addiction.²³
CB1R antagonists show no antipsychotic potential, but could be helpful for the cognitive problems associated with hyperdopaminergic or hypoglutamatergic conditions.²³
CB1R antagonists, which trigger a switch from LTD to LTP in the PFC (presumably via D1R), and which are expected to inhibit endocannabinoid facilitation of D2 signaling, should have a more classic procognitive profile and be helpful in memory impairment.²³

3. Dosage and application instructions for medicinal cannabis¶

Information on dosing medicinal cannabis (Cannabis Flos) using a vaporizer can be found here.²⁴

4. Authorization of cannabinoid medicines¶

In Germany, Sativex, Cannabis Flos, Canemes and Dronabinol are several cannaboid drugs that are approved, but not for ADHD. For off-label use for ADHD, an exemption had to be applied for from the BfArM in the past. Since 2017, a medical prescription of Sativex or Cannabis Flos for ADHD has been permitted under the BtmG without an additional exemption²⁵
Since 2024, a BtM prescription is no longer required for non-synthetic cannabinoids. Synthetic cannabinoids still require a BtM prescription.
Cannabinoid medications may be prescribed in Germany for ADHD if other medications are ineffective. Health insurance companies usually reimburse the costs on application.

By 2017 (when an exemption for use was still required), around 150 people with ADHD had received an exemption (out of a total of 1061 granted).²⁶ Cannabis prescriptions for ADHD have also risen sharply in other countries.²⁷