I see many patients in my office who have been diagnosed with Attention Deficit Disorder and/or Attention Deficit Hyperactivity Disorder. They report that certain chemovars of cannabis help with focus, improve concentration, and help them finish tasks. Obviously this is not the effect of cannabis on everyone, but you must remember that people diagnosed with ADD/ADHD have been found to have neurotransmitter dysfunction involving dopamine, norepinephrine and/or choline.1 Recent evidence has also found that these patients have a genetically based endocannabinoid system dysfunction.2 Many people with ADD/ADHD can find relief from their symptoms by targeting the dysfunctional endocannabinoid system with plant cannabinoids. The result is balanced neurotransmitters.
Conventional ADD/ADHD medications target dopamine (stimulants) or norepinephrine (non-stimulants); there are no approved medications that target choline. These medications, although effective for some, can have side effects of poor appetite, insomnia, high blood pressure, weight loss, tics, headache and stomach upset. In my experience, some patients find that cannabis by itself is very effective in treating the symptoms of ADD/ADHD. Other patients find that cannabis treatment works best by counteracting the unwanted side effects of their prescription ADD/ADHD medications, which are otherwise effective.
Many patients report that stimulating THC-rich chemovars (often referred to as Sativa) and those that contain higher amounts of pinene, a terpenoid that helps to increase focus and aids in memory, work well for ADD/ADHD sufferers. For some, the less stimulating chemovars work better, especially if they are trying to combat co-existing symptoms such as insomnia and anxiety. I encourage adult patients to try different THC-rich products to find those that work the best for them. As mentioned before, finding the correct chemovar for a particular patient usually requires a “trial and error” approach.
I have found that some pediatric patients with severe ADD/ADHD have good results with CBD-rich cannabis. Many of these patients have other diagnoses such as seizure disorders, Tourette syndrome or severe anxiety (these conditions are due to the same neurotransmitters that are imbalanced) that also improve with CBD treatment. Some children do well with higher CBD:THC ratios (for example 25:1) and others show improvement with lower ratios. Due to concerns of THC use in the developing brain, my approach for children and teenagers with severe ADD/ADHD symptoms is to start with high CBD:THC ratio preparations, assess response, and add THC in small amounts for desired effects.
Centonze, D., et al. “Altered anandamide degradation in attention-deficit/hyperactivity disorder.” Neurology 72.17 (2009): 1526-1527.
Lu, Ake T., et al. “Association of the cannabinoid receptor gene (CNR1) with ADHD and post‐traumatic stress disorder.” American Journal of Medical Genetics Part B: Neuropsychiatric Genetics 147.8 (2008): 1488-1494.