What the DEA’s Marijuana Rescheduling May Mean for People with ADHD
The DEA’s historic shift to reclassify marijuana as a Schedule III drug would ease restrictions on research and accessibility to medical cannabis — and some worry it could increase the risk of substance use disorder in people with ADHD.
May 2, 2024
The U.S. Drug Enforcement Administration (DEA) has issued a proposal to reclassify marijuana from the most tightly regulated Schedule I category to the less stringent Schedule III group of the Controlled Substances Act (CSA). The historic reclassification, if enacted, would recognize the medical uses of cannabis and acknowledge that its potential for abuse is lower than that of other drugs. However, some worry that reclassification could also increase the risk for substance use disorder, particularly in individuals with ADHD.
Marijuana has fallen under the Schedule I classification since 1971. DEA defines Schedule I substances as drugs with no accepted medical use and a high potential for abuse; the category includes heroin, methamphetamines, and LSD, among other drugs. The move to a Schedule III classification puts cannabis in the same category as Tylenol with codeine, steroids, and testosterone.
Cannabis and ADHD
A Schedule III reclassification would not legalize marijuana for recreational use, but it would make it easier to conduct studies and research the medical benefits of the drug.
Looser restrictions could make cannabis seem less harmful than it is, which concerns some ADHD experts.
In a statement provided to ADDitude, Roberto Olivardia, Ph.D., clinical psychologist and clinical instructor of psychology at Harvard Medical School, said:
“In regard to the U.S. DEA’s easing of restrictions and reclassification of marijuana, it is first important to distinguish between the issues of criminalization, the cultural moralization of addiction, and harmful effects of cannabis on a developing brain.
I support decriminalization efforts around cannabis, as sentencing and legal consequences for possession can result in barriers to employment, housing, and education for many young people. I support better access to treatment and sober resources. I am against the cultural moralization of addiction, which presupposes that people who struggle with substance abuse and dependence are also struggling with a moral defect. Addiction is an equal opportunity enemy and an issue that particularly affects the ADHD community, as individuals with ADHD have a significantly higher risk of substance abuse and dependence than their neurotypical counterparts.
My main concern is not around the reclassification or restriction ease, per se. I am more concerned about the message this sends about the harm that cannabis can incur in a young person’s life. This reclassification should come with a strong education about the neurological harm that cannabis can incur in a developing brain. Although no one has died from a cannabis overdose, citing it as less dangerous than other substances, the public is misled by the message that it is not only not harmful, but can be wholly therapeutic and medicinal for a range of conditions. This is simply not supported by empirical studies, especially when it comes to ADHD.
Research has shown that cannabis is being used by younger individuals more than we have ever seen, with higher frequency and higher potency than ever before. This triple impact is concerning, as we have seen increasing correlations between cannabis abuse and worsening ADHD symptoms, as well as increased risk for depression, psychosis, and cognitive issues. A recent 2024 study published in the Journal of the American Heart Association found among never‐tobacco smokers, daily cannabis use was associated with adverse cardiovascular outcomes, including myocardial infarction and stroke.1
Let us not confuse less restrictive laws and reclassification of cannabis with the notion that it is harmless when studies and clinical experience from physicians and mental health providers across the country are seeing otherwise.”
Olivadia explained in the ADDitude webinar “Marijuana and the ADHD Brain: How to Identify and Treat Cannabis Use Disorder in Teens and Young Adults” that “the adverse effects of cannabis are especially amplified in people with ADHD…Contemporary marijuana has concentrations of THC higher than historically reported, which exacerbates this.”
Studies show that more than half of daily and non-daily cannabis users have ADHD,2and about one-third of adolescents with ADHD report cannabis use.3 People with ADHD are also three times more likely than their neurotypical peers to have ever used marijuana.4 The risk of developing cannabis use disorder (CUD), a problematic pattern of cannabis use linked to clinically significant impairment, is twice as high in people with ADHD3.
Further, a new study presented in April at the European Psychiatric Association Congress 2024 found that offspring of mothers with prenatal CUD have up to a 98% increased risk of developing ADHD, a 94% increased risk of autism spectrum disorder (ASD), and a 46% increased risk of intellectual disability (ID) compared to non-exposed offspring. Researchers from Curtin University in Australia analyzed data from more than 222,000 mother-offspring pairs for the study.
“Cannabis can also interact significantly with some ADHD medications,” Olivardia said in the ADDitude webinar.
Research studies have shown that methylphenidate (Ritalin, Concerta) reacts significantly with cannabis and may increase strain on the heart.5 Other studies have found that cannabis use can decrease the effect of a stimulant medication.6
The increased risk of suicide associated with cannabis use further complicates the use of marijuana by individuals with ADHD, who already face an elevated risk for self-harm and suicide compared to neurotypical individuals.7
“I am not so concerned about the reclassification, in part, because it will be much easier for scientists to examine the positive and negative impact of cannabis in randomized controlled trials,” says Timothy Wilens, M.D., chief of child and adolescent psychiatry, and co-director of the Center for Addiction Medicine at the Massachusetts General Hospital. “Currently, it is very difficult to study cannabis, due to very tight restrictions given its Schedule I status. With reclassification, one will be able to study cannabis under the typical regulations for any controlled substance, which will inevitably enhance our understanding of basic mechanisms, medicinal uses, and/or potential harm of cannabis.”
In March, Wilens co-authored a paper published in the Journal of the American Academy of Child and Adolescent Psychiatry that found legalization of recreational marijuana, but not medicinal cannabis, increases the use of cannabis by youth, the effects of which are more dire for young adults and teenagers.8
“Youth using cannabis has a number of negative outcomes,” Wilens says. “Our group and others have also shown longer-term negative effects of early cannabis use on cognitive executive functioning — already a problem for many kids with ADHD — and structural brain changes. Other concerns are functional changes in how the brain operates, which highlight difficulties with cognitive performance, such as driving for up to six to eight hours after ingesting cannabis. Such findings are not surprising given the increased rate of minor and fatal motor vehicle accidents associated with cannabis consumption.”9, 10, 11
Another study of young adults with and without ADHD found that individuals who started using before age 16 fared worse on measures of executive functioning and other cognitive outcomes than did those who began using marijuana later — an especially worrisome finding given that the study participants with ADHD were more likely than their counterparts to report cannabis use before age 16.12
Wilens noted that researchers at the National Institutes of Health are studying this issue as part of a project called the Adolescent Brain and Cognitive Development Study (ABCD), the largest long-term study of brain development and child health ever conducted in the United States.
What Draws People with ADHD to Cannabis?
“Cannabis activates the brain’s reward system and releases dopamine at levels higher than typically observed. In low-dopamine ADHD brains, THC thus can be very rewarding,” Olivardia explained. “People with ADHD, whose brain development is delayed by slowly maturing frontal lobes, are thus more vulnerable to cannabis’ effects on neuronal connections.”
ADDitude asked members of its Reader Panel to report their experiences using cannabis. Several readers reported that the benefits of using cannabis outweighed the negatives.
“I self-medicated with weed for many years for mood swings, PMDD, endometriosis, and ADHD before I was diagnosed,” a reader said. “I have a medical card now for my PMDD and other chronic pain issues. It can be a very helpful tool, but I am mindful of my use. If I’m not, it is easy to watch my day — and my energy — slip from my grasp.”
“I have begun trying marijuana edibles about an hour before bedtime after recreational marijuana was legalized in my state this year,” wrote another ADDitude reader. “I have found that a nano-dose of 2 to 3 milligrams of THC clears my head of the usual noise and lets me drop into a deep and restful sleep. I am 45 and (insufficiently) manage my ADHD with non-stimulant medication only.”
Another reader first tried cannabis during the early months of the pandemic and now uses it alongside Strattera. “I do not consume cannabis while working, but I do occasionally use CBG and/or CBD,” the reader said. “THC helps with my symptoms a great deal. Sativa strains are energizing; they help me get up and get things done around the house that I would otherwise procrastinate, such as chores and yard work. Indica strains are relaxing; they help quiet my inner chatter and make it easier for me to meditate and do gentle forms of yoga… Some strains amplify my hyperactive/impulsive tendencies… [but] with the right strains, cannabis can help a great deal with ADHD symptoms.”
Marijuana Rescheduling Next Steps
It’s unlikely that the DEA will reclassify cannabis as a Schedule III drug quickly. First, the White House Office of Management and Budget must review the reclassification proposal and conduct a 60-day public comment period. The proposal then will be reviewed by an administrative law judge, who could decide to hold a hearing before the rule is approved.
The marijuana rescheduling decision was the result of President Joe Biden’s 2022 request for the U.S. Department of Health and Human Services (HHS) and the Attorney General (who oversees the DEA) to review the drug’s classification.
The recreational use of cannabis is legal in 24 states, and 38 states have legal medical marijuana programs.
View Article Sources
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