Dr Kenneth Finn: The Things They Don't Tell You About Medical Cannabis

Headlines, once not reported in our rush for the legalisation of the highly lauded (and to many advocates) panacea of most ills – cannabis – are now begrudgingly starting to emerge.

Doctors warn of significant increase in people hospitalised with psychosis after being prescribed medicinal cannabis (msn.com)

(North America reporting this more, Marijuana Overdoses on the Rise Among Elderly in Canada, Raising Concerns for the US – WRD News and Rising Rates of Cannabis-Related Disorders Seen in Older Adults – WRD News)

The evidence of this growing public health disaster has always been gathering just not reported in the mainstream media.  However, the pro-pot gag is starting to slip, and the many inescapable harms are now emerging more in the public square. It’s way past time that our community demands a better public health response to the ‘vote for medicine’ debacle that has facilitated much of this growing mess. 

Recent reports have highlighted a concerning trend: a significant increase in hospitalisations due to psychosis among patients prescribed ‘medicinal’ cannabis. Doctors have observed that some patients, particularly those with pre-existing psychotic conditions, are experiencing severe relapses after using medicinal cannabis. This rise in psychosis cases has been attributed to the proliferation of “single-issue” cannabis clinics, which often prescribe cannabis without thorough patient evaluations.

‘Medicinal’ Marijuana and Self-Medication Outcomes

The debate over medicinal marijuana continues to evolve, with recent discussions focusing on the outcomes of self-medication. A key point of contention is whether medicinal cannabis truly benefits patients or if it leads to unintended consequences like cannabis use disorder (CUD). Studies have shown that while some patients report relief from symptoms such as pain and insomnia, others develop dependency issues. This dichotomy underscores the need for more regulated and evidence-based approaches to prescribing medicinal cannabis.

A recent 9-month follow-up study on medical cannabis users has provided valuable insights into the long-term effects of cannabis use. The study found that frequent cannabis use did not significantly improve symptoms of pain, anxiety, or depression. However, it did lead to the development of cannabis use disorder in a notable minority of participants. This finding highlights the importance of monitoring and regulating cannabis use among patients to prevent dependency and other adverse effects.

We could go into the mounting evidence of harms during pregnancy, the growing cancer risk related to the use of cannabis, and the now confirmed multiple journal published evidence-based research on the Genotoxicity and Neurotoxicity of this ‘medicine’.

Even before this growing and alarming research was published and it was becoming clear that cannabis as ‘medicine’ was falling spectacularly short of its propaganda promises, and sometime after the vote for medicine protocol had unleashed this unwisely ‘medically’ validated substance, the Royal Australian College of General PractitionersRoyal Australian College of General Practitioners (RACGP) released its primer on this new ‘medicinal’ offering.

It’s important to note that this 2021 publishing is now three years behind the new concerning evidence about the harms of this recreational substance, turned medicine. Not least the new research revealing that CBD (Cannabidiol) is not the benign substance it was touted to be, even in this publication. It is research emerging in the last three years that have raised serious alarms about the long-term harms of this cannabis component and other cannabinoids.

The primary sentiment behind this generalised classification of CBD as ‘harmless’ was that around the fact that it it’s unadulterated form it doesn’t get you ‘high’; but that outcome is only one side-effect of this psychotropic toxin.

RACGP - A primer on medicinal cannabis safety and potential adverse effects

Even back then the somewhat muted concerns of the RACGP were clear. On reading their publication it is important to also note that this peak medical body made the very clear distinction between fully trialled pharmaceutical prescribable medicines, and the new more ‘holistic’ offerings allowed by the TGA.

While medicinal cannabis offers very few benefits other than mere temporary relief of symptoms of a small number of medical conditions, it more concerningly poses significant risks, particularly in relation to mental health. The increase in psychosis cases and the development of cannabis use disorder among users alone, call for stricter regulations and more comprehensive patient evaluations.

The very few positive benefits associated with medicinal cannabis are outweighed by the growing number of short- and longer-term harms of this highly engineered and increasingly under-performing therapeutic and they can no longer be ignored or easily dismissed as outliers.

Manufacturing consensus – The Start of ‘Vote for Medicine’ Protocol

Where did this very concerning and inevitable public health issue begin?

I’ll start the journey here back in December 2014, the Victorian Law Reform Commission Consultation on ‘medicinal’ cannabis released its report. It drew from a miniscule 9 very poorly attended public hearings in Victoria and a mere 99 submissions, mostly from then illicit cannabis users.

This exceedingly small sampling of a community largely unaware, and arguably disinterested in, this issue was to become the basis for simply ‘rubber stamping’ (as we’ll see) a fait accompli of predetermined government decision. A being ‘seen to do the due diligence’ pantomime.

As mentioned, these ‘town halls’ drew very small numbers, with the major one in the city of Melbourne, having less than one hundred people attending, and all but a few clearly pro-cannabis delegates.

At this particular consultation, the Dalgarno Institute was represented by Drug Free Australia Research Fellow who was deeply concerned, but not surprised, by this small Melbourne consultation.  Prepared evidence-based research on the harms of cannabis was ready to be shared, but our representative was quickly marginalised and/or managed, by the facilitators when they noted his voice was a dissenting one.

Repeated attempts to have his well-prepared evidence tabled were no less than stifled. However, our affiliate in the room experienced, observed and noted the following,

Emotive tone seemed not merely permitted but set for meeting by facilitators.  The meeting was facilitated by representatives of the VLRC who appeared to have a bias toward the legalisation of ‘medical marijuana’ in manner that suited the self-medicating option, regardless of evidence-based science.

When attempts were made to present evidence contrary to the seemingly predetermined agenda of these facilitators, he was either quickly shut down (after daring to speak in the first place) or continually ignored; apparently, dissenting opinions were not welcome. Whilst at the same time, proponents for ‘self-medication’ use of cannabis were given complete and unfettered access to the floor, producing statements such as:

“Many, many people have been cured – from just about anything and everything.”
“What would you rather have – infertility or 35 seizures a day?”
“Random workplace drug testing is wrong.”

Not only are these statements (now on record) outrageous, but they are also utterly unsubstantiated by any legitimate clinical research, as the overwhelming evidence from the last 10 years has utterly confirmed. This small contingent of pro-cannabis lobbyists was permitted to simply spruik anecdotes with no evidence-based presentation yet also had their evidenced-deprived opinions affirmed and validated by the consultants.

The facilitators inferred that the Government (of Victoria, at least) already has legislation in place with this current ‘consultation’ process simply in play to validate those changes and therefore it is in essence a forgone conclusion.

Beyond these confirmation-bias laden gatherings, there was also a strong indication that either the A.M.A. or T.G.A. recommendations or processes would be side-stepped and/or negated wherever possible by simple legislative changes.

So, to assist with framing these potential science negating changes, new language and concepts had to be introduced by these lawyers. The following ideas and terms were introduced to help leverage the consensus manufacturing process.

The idea of ’exceptionality’ and of ‘compassion as a basis for action’.

Not science, or best practice, but sentiment, anecdote and impassioned pleas, as we saw in our live snapshot of the community consultation shared above.

Cowboy Legislation in a Cowboy State?

Once this box-ticking ‘consultation’ was completed, it was then time to introduce the already drafted – Access to Medicinal Cannabis Bill 2015

The Victorian Labor Government had decided, against better practice national option  and instead to create its own Medicinal Cannabis industry, even after assurances from the Federal Health Minister at the time that a National Scheme under T.G.A. purview would be a better option. The Labor government, at the taxpayers’ expense, was setting up another bureaucracy and self-styled pharmaceutical practice/process that will, if not run parallel to T.G.A., most likely negate it. Dalgarno Institute raised many concerns directly with Health Minister and was systematically acknowledged and then ignored.

Dalgarno Institute was able to liaise with Opposition Health Minister and through several correspondences and evidence/concern exchange, she was able to be part of a group that saw seven hours of debate in the Senate resulting  in over 400 Government amendments (believed to be a new record according to  Clerk of Court) the revised bill was passed. One such amendment is that at no point or occasion will cannabis be prescribed for delivery via ‘smoking’.

According to the then Shadow Minister for Health, Mary Wooldridge, the bill also provides that if the T.G.A. down schedules Medicinal Cannabis from a Schedule 9 drug to Schedule 8 (which is proposed to happen) that it will not be down scheduled in Victoria.  The Victorian Government argues that they would rather regulate it via our State specific, purpose-built scheme than participate at a national level.  ‘I am concerned that the opportunity to ultimately be part of a national scheme will be missed if Victoria insists on going it alone’ the Shadow Minister stated.

However, launch their own trial they did and with great expense, and all but zero positive outcomes for the Victoria Taxpayer. The following newspaper article revealed just how fruitless this cowboy action proved to be.

• MORE than a third of children receiving medicinal cannabis from the Victorian Government have discontinued their taxpayer funded treatment after the drugs failed to work.
• It was revealed this week that 13 out of 34 children have left the Government's subsidised medicinal cannabis program since it began in March last year.
• The Opposition's health spokesperson, Mary Wooldridge, said the dropouts are proof the policy — which the Government says costs around $35,000 per child — has not delivered good value for Victorian taxpayers.

Herald Sun/The Age/SBS , 7^th June 2018

What highlights the cowboy culture even more, was that the fully clinically trialled pharmaceutical grade cannabis based medicine Epidiolex® epilepsy drug had been approved by the Food and Drug Administration in the US in the very same month. This product went through a near 10-year full clinical investigation. This medicine had been thoroughly, double-blind, placebo accounted for trial giving it a full understanding of its capacity, limitations and its shortcomings.  They followed the complete quality of evidence research pyramid to the very top as outlined in the following graphic.

Western Australia was to soon follow suit in this new Vote for Medicine protocol, with the State government there, becoming the actual ‘pusher’ of this now untrialled substance.

In 2017, when freshly minted vote for medicine legislation let non-clinically trialled cannabis products off the leash as ‘medicine’, there was no clinical takers. Get this, it is important to note that not a single one of the 10,000 plus Doctors in W.A would prescribe cannabis, as revealed by the following news article…

• West Australian patients are finding it almost impossible to obtain medicinal cannabis more than eight months after it was legalised, advocates say.
• By May, no health professional had applied to prescribe the drug, despite it being made legal in November.
• The Department of Health confirmed this week it has granted permission to three doctors to prescribe cannabinoid-based drugs and is in the process of assessing two more applications.
• "The AMA is certainly not supportive of shortcuts, and instead of avoiding all the regulatory steps, we should be investigating cannabis-based products, how good they are, how safe they are, and once that's been done, they should available just like any other drug,"    AMA WA president Omar Khorshid

The then State Premier, Mark McGowan, was very vocal about this unacceptable scenario and effective became the government ‘pusher’ of this drug as they try to create an ‘industry’ from this now voted for medicine, despite clinicians serious concerns.

The New Vote for Medicine TGA Play Book

One of the further consequences of the ‘anecdata’ driven socio-political sentiment in medical legislation making, has seen our peak medicine approving body the Therapeutic Goods Administration (TGA) fall in line with said sentiment. In this context, again, science and best-practice research are not the cornerstone of this new procedural approval system, but, as with the Victorian consultation it appears that compassion now becomes the preferred basis for action, regardless of any unforeseen side-effects.

So, for all intents and purposes, a loophole for ‘medicinal’ cannabis was created in this regulatory setting. A caveat that enables concoctions to be made and dispensed outside the long-held gold-standard of clinical pharmaceutical research process. This then enables side-stepping the need for full double-blind, placebo accounted for and exhaustive clinical trials, like the ones conducted by G.W. Pharmaceuticals on their Epidiolex® product.

The following is an excerpt from recent correspondence sent from the Prime Minister’s office to the Taskforce for Drug Prevention to clarify this new TGA cannabis protocol.

“The Therapeutic Goods Administration (TGA) also administers several mechanisms to enable access to therapeutic goods which are not registered on the Australian Register of Therapeutic Goods (ARTG) and are otherwise termed as ‘unapproved’ therapeutic goods.

These mechanisms include the Special Access Scheme (SAS), the Authorised Prescriber (AP) pathway, the Clinical Trial Notification (CTN) scheme and the Clinical Trial Approval (CTA) scheme. It is a condition of TGA approval or authorisation that the prescribing health practitioner (applicant) assumes responsibility for any adverse outcome associated with use of any ‘unapproved’ therapeutic good. Any Australian registered medical practitioner can make an application under these schemes.”

“Importantly, unapproved therapeutic goods accessed through these pathways have not been evaluated by the TGA for safety, quality and efficacy. As such health practitioners who engage in the prescribing of an unapproved therapeutic good are required to do so in accordance with Good Medical Practice and the code of conduct published by the Medical Board of Australia (MBA).

It is expected that prescribing health practitioners will have considered clinically appropriate treatment options that are included in the ARTG before applying to access unapproved therapeutic goods. These considerations apply to accessing any ‘unapproved’ product, not just medicinal cannabis.” 

(Prime Minister’s Office 18^th June 2024)

REMS – The Minimum Filter for Public Health Protection

Making plain here just some of the catastrophic medical flaws of this vote for medicine debacle is not difficult, nor is it the fix, if the political will isn’t there to conform with best-practice medicine.

For any substance to be properly considered for release as medicine in the public square, requires – well at least it SHOULD require – not only rigorous testing, but on review by public health watch dogs, should at the very least go through what is known as a REMS review Risk Evaluation and Mitigation Strategies .

What is a REMS? A Risk Evaluation and Mitigation Strategy (REMS) is a drug safety program implemented by the U.S. Food and Drug Administration (FDA) for specific medications with serious safety concerns. Essentially, REMS are designed to reduce the occurrence or severity of particular serious adverse events associated with these drugs.

REMS a Minimum Imperative: When a medication poses significant risks, the FDA may require a REMS to ensure that the benefits of the drug outweigh its potential harms. These risks could include severe allergic reactions, dangerous side effects, or other safety concerns. REMS are particularly relevant for prescription drugs and biologics. Without a REMS, some medications might not be approved or would even be withdrawn from the market due to known or potential risks.

How Do REMS Work? REMS involve various interventions to support the safe use of a medication. Here are a couple of examples:

• Controlled Administration Settings: For drugs that can cause severe allergic reactions immediately after administration, a REMS might mandate that the drug be administered only in healthcare facilities with trained personnel who can manage such reactions. These facilities would have immediate access to necessary treatments and equipment.
• Lab Testing Requirements: Another scenario involves ensuring that specific lab tests are completed and their results checked before a medication prescription is refilled. This helps monitor patient safety and tailor treatment appropriately.

REMS as a Safeguard Involves:

• Healthcare Providers: They receive education and guidance on safe prescribing practices.
• Patients: They may receive educational materials about the risks and safe use of the medication.
• Pharmacists: They play a crucial role in dispensing medications according to REMS requirements.
• Healthcare SettingsHealthcare Settings: These settings must adhere to specific protocols for administering the drug safely.

In summary, Risk Evaluation and Mitigation Strategies should be a minimum and vital part of ensuring that anything promoted as medicine or medications with serious risks are used safely or not at all. These protocols can bridge the gap between medical innovation and patient well-being, emphasizing the importance of balancing benefits and risks in the realm of public health. 

Epilogue – The Final Diagnosis?

These growing public-health predicaments (and arguably culpable failings) around this super-hyped substance are beyond concerning.  We have labelled this propagandized ‘medicinal’ promoting as the new Reefer Madness. All this was foreseen by anyone who refused to buy said cannabis culture and cannabis industry palaver – such as those medically trained and not in the pocket of big cannabis physicians of Western Australia some seven years ago.

What the average ‘Jo Public’ is unaware of, is that there has been a fifty plus year war for this drug. It was only the Trojan Horse strategy of the ‘Medicinal Marijuana’ campaign, introduced by such actors as NORML, in the early 1990’s that saw more people be drawn and this new tactic of ‘medicalising’ cannabis to shift momentum back in favour of the pro-cannabis recreational use lobby.

What is also essentially unknown by almost all, is that since around 1997 up until March 2024 there have been 11,420 studies11,420 studies conducted on Cannabis THC alone, (not including Cannabis CBD or other cannabinoids) at a cost of  $4.877 billion (USD) and the very best we can come up with from all this promised panacea of all ills is essentially the same therapeutics that were already available for prescription, with the exception of the newest pharmaceutical Epidiolex ®

In this brief expose, we have not spelunked the thousands of published research on the environmental, community and productivity harms of this psychotropic toxin, parading as medicine, but we do seriously encourage, no, goad you into looking at this issue and discover the unrobust nature of pro-cannabis literature and the short-cuts being taken to promote this addiction for profit enterprise – You, your family and your community deserve to know what is really happening and get the heads up you need for what ramifications this will mean for public and community health in the future.

Shane Varcoe - Executive Director, Dalgarno Institute.

Further Reading

• Cannabis as ‘Medicine’: Pot Propaganda, Emotive Anecdote, Marketing Manipulation and the Side-Stepping of Science’
• Big Tobacco 2.0 Playbook Spin (Video)
• Effects of Cannabis Abstinence on Cognition and Resting State Network Activity in People With MS | PracticeUpdate

Endnotes - Sources

• Medicinal cannabis access a challenge for WA patients despite legalisation last year - ABC News
• McGowan to discuss medicinal cannabis | SBS News
• Dalgarno Institute Website - Massive Population Studies Confirm Alarming Cannabis Harm
• Dalgarno Institute Website - Genotoxicity and Neurotoxicity of Cannabis: 66th CND – Vienna UN 2023
• RACGP - A primer on medicinal cannabis safety and potential adverse effects
• Dalgarno Institute Website - Toxicity Concerns on Cannabidiol (CBD)
• Development of cannabis use disorder in medical cannabis users: A 9-month follow-up of a randomized clinical trial testing effects of medical cannabis card ownership (frontiersin.org)
• https://www.lawreform.vic.gov.au/wp-content/uploads/2021/07/VLRC_Medicinal_Cannabis_Report_web.pdf
• https://www.ema.europa.eu/en/documents/other/regulatory-experience-handling-risk-management-plans-rmps-medicinal-products-eu-expert-opinion-drug-safety_en.pdf
• https://www.fda.gov/drugs/drug-safety-and-availability/risk-evaluation-and-mitigation-strategies-rems

Attention-Deficit/Hyperactivity Disorder (ADHD) and cannabis use have become increasingly intertwined topics of research in recent years. As the prevalence of both ADHD diagnoses and cannabis use continues to rise, understanding the relationship between these two phenomena has become crucial for healthcare professionals, researchers, and individuals affected by ADHD. This report aims to explore the complex interplay between ADHD and cannabis use, examining genetic factors, potential causal relationships, and the current state of research on cannabis as a potential treatment for ADHD symptoms.

ADHD is a neurodevelopmental disorder characterised by persistent inattention, hyperactivity, and impulsivity. It affects approximately 5% of children and adolescents and 2.5% of adults worldwide. On the other hand, cannabis use has become increasingly prevalent, with many individuals reporting recreational and medicinal use. The intersection of these two areas presents a unique challenge for researchers and clinicians alike, as they attempt to unravel the complexities of their relationship and potential implications for treatment and management of ADHD.

Genetic Overlap between ADHD and Cannabis Use
Recent genome-wide association studies (GWAS) have shed light on the genetic underpinnings of both ADHD and cannabis use. A cross-disorder GWAS reported in Nature Mental Health (2024) identified significant genetic overlap between ADHD, cannabis use disorder (CUD), and cannabis use (CU).
The study identified 36 concordant genome-wide significant loci for ADHD-CUD and ten loci for ADHD-CU. One notable finding was the identification of DRD2 as an ADHD-CUD risk gene. This gene is known to play a role in dopamine signalling, which is implicated in both ADHD and substance use disorders. The discovery of shared genetic loci suggests that there may be common biological pathways underlying both ADHD and cannabis-related behaviours.
Interestingly, the study found that ADHD-CUD risk genes showed high expression across various brain tissues and developmental stages. This pattern was not observed for ADHD-CU genes, indicating that the genetic basis for cannabis use disorder in individuals with ADHD may involve more extensive alterations in brain function compared to cannabis use alone.
These genetic findings provide a foundation for understanding the biological mechanisms that may contribute to the increased prevalence of cannabis use and cannabis use disorder among individuals with ADHD. By identifying specific genes and pathways involved, researchers may be able to develop more targeted interventions and treatments for individuals with comorbid ADHD and cannabis-related issues.

Genetic Correlations and Risk Assessment
The genetic studies have revealed important correlations between ADHD, cannabis use, and other related traits. Both ADHD-CUD and ADHD-CU showed similar genetic correlations with substance use in general. However, they differed in their genetic correlations with substance use disorders, suggesting that the genetic factors contributing to problematic cannabis use in ADHD may be distinct from those involved in casual use.
One of the most striking findings from the genetic research is the potential for using polygenic scores (PGS) to assess the risk of comorbid cannabis use disorder in individuals with ADHD. The study found that individuals with ADHD who had high CUD polygenic scores had a substantially increased risk of developing cannabis use disorder. Specifically, those in the highest CUD-PGS bin had an absolute risk of 22% for comorbid CUD, compared to a risk of only 1.6% among controls.
These findings have significant implications for clinical practice. The ability to stratify individuals with ADHD based on their genetic risk for cannabis use disorder could allow for more personalised prevention and intervention strategies. For example, clinicians could provide targeted education and support to those at highest genetic risk for developing problematic cannabis use.
It’s important to note that there were substantial sex-specific differences in the genetic risk assessment. Men in the highest CUD-PGS bin showed an approximately 10% higher risk of cannabis use disorder compared to women in the same risk category. This underscores the need for sex-specific approaches in both research and clinical interventions related to ADHD and cannabis use.

Causal Relationships between ADHD and Cannabis Use
While genetic overlap provides insight into shared biological mechanisms, it doesn’t necessarily imply a causal relationship between ADHD and cannabis use. To address this question, researchers have employed sophisticated statistical techniques, such as Mendelian randomisation, to infer potential causal links.
A study published in Molecular Psychiatry (2021) used a two-sample Mendelian randomisation approach to investigate the causal relationship between ADHD and lifetime cannabis use. The results provided support for the hypothesis that ADHD is causal for lifetime cannabis use. The study estimated an odds ratio of 7.9 for cannabis use in individuals with ADHD compared to those without ADHD (95% CI: 3.72-15.51, P=5.88×10−5).
This finding is particularly important as it substantiates the temporal relationship between ADHD and future cannabis use. It suggests that individuals with ADHD are at significantly higher risk of engaging in cannabis use later in life, potentially as a form of self-medication or due to impulsivity associated with the disorder.
The causal relationship between ADHD and cannabis use has important implications for clinical interventions and public health strategies. It reinforces the need to consider substance misuse prevention and treatment in the context of ADHD management. Early intervention and targeted support for individuals with ADHD may be crucial in reducing the risk of later cannabis use and associated problems.

Cannabis as a Potential Treatment for ADHD
Despite anecdotal reports from some individuals with ADHD claiming that cannabis helps alleviate their symptoms, the scientific evidence supporting cannabis as a treatment for ADHD is limited and inconclusive. A scoping review published in the Journal of Psychiatric Research (2022) examined the current state of research on this topic.
The review identified only one randomised controlled trial (RCT) that directly measured the effect of cannabis on ADHD symptoms. This study found no significant effect of cannabis on the primary outcome measure, the QbTest (Est = −0.17, 95% CI -0.40 to 0.07, p = 0.16). The lack of well-designed RCTs in this area highlights the need for more rigorous research to evaluate the potential therapeutic effects of cannabis on ADHD symptoms.
While some individuals with ADHD report subjective improvements in their symptoms with cannabis use, the majority of studies included in the review indicated that cannabis either worsened ADHD symptoms or had no effect. This discrepancy between anecdotal reports and empirical evidence underscores the complexity of the relationship between cannabis and ADHD, and the potential for placebo effects or other factors to influence subjective experiences.
One significant limitation in the current research is the lack of standardisation in cannabis preparations used across studies. The concentration and amount of THC (tetrahydrocannabinol) and CBD (cannabidiol) were not well measured in most studies, making it difficult to draw conclusions about the specific effects of different cannabis components on ADHD symptoms.
Neuropsychiatric Effects and Imaging Studies
To better understand the potential impact of cannabis on ADHD, several studies have employed neuropsychiatric tests and neuroimaging techniques. These approaches aim to elucidate the effects of cannabis use on cognitive function and brain structure in individuals with ADHD.
Neuropsychiatric tests have provided mixed results, with some studies suggesting potential cognitive improvements with cannabis use in ADHD, while others indicate detrimental effects or no significant change. The variability in these findings may be due to differences in study designs, cannabis preparations used, and the specific cognitive domains assessed.
Neuroimaging studies have begun to shed light on the structural and functional brain changes associated with cannabis use in individuals with ADHD. Some research has suggested alterations in brain regions involved in attention, impulse control, and reward processing. However, the long-term implications of these changes and their relationship to ADHD symptoms remain unclear.
One area of particular interest is the potential differential effects of THC and CBD on ADHD-related brain function. While THC is known for its psychoactive properties, CBD has been associated with potential neuroprotective and anxiolytic effects. Future research focusing on the isolated effects of CBD on ADHD symptoms and pathophysiology may provide valuable insights into potential therapeutic applications.

Clinical Implications and Future Directions
Given the current state of evidence, cannabis is not recommended as a treatment for ADHD. The potential risks associated with cannabis use, particularly in young people with developing brains, outweigh any potential benefits suggested by anecdotal reports. Clinicians should be aware of the increased risk of cannabis use and cannabis use disorder among individuals with ADHD and incorporate substance use screening and prevention strategies into their ADHD management plans.

Future research in this area should focus on several key areas:

1. Well-designed randomised controlled trials examining the effects of standardised cannabis preparations on ADHD symptoms.
2. Longitudinal studies to better understand the long-term impacts of cannabis use on ADHD symptom progression and overall functioning.
3. Investigation of the potential therapeutic effects of isolated cannabinoids, particularly CBD, on ADHD symptoms.
4. Development and validation of objective measures for both cannabis exposure and ADHD symptom assessment to improve the quality of research in this field.
5. Exploration of sex-specific effects and personalised approaches to ADHD management in the context of cannabis use risk.

As our understanding of the genetic and neurobiological underpinnings of both ADHD and cannabis use continues to grow, there is potential for the development of more targeted interventions. This may include personalised risk assessments based on genetic profiles and tailored prevention strategies for individuals with ADHD who are at high risk for problematic cannabis use.
The relationship between ADHD and cannabis use is complex and multifaceted. Recent genetic studies have revealed significant overlap between the two, suggesting shared biological pathways. While there is evidence for a causal relationship between ADHD and future cannabis use, the efficacy of cannabis as a treatment for ADHD remains unproven and potentially risky. Ultimately, addressing the intersection of ADHD and cannabis use will require a multidisciplinary approach, combining insights from genetics, neuroscience, clinical psychology, and public health.

References

• Shared genetics of ADHD, cannabis use disorder and cannabis use and prediction of cannabis use disorder in ADHD
• Attention-Deficit/Hyperactivity Disorder and lifetime cannabis use: genetic overlap and causality
• Cannabis use in Attention – Deficit/Hyperactivity Disorder (ADHD): A scoping review

Dalgarno Institute

A recent article from PracticeUpdate examines the effects of a high cannabidiol (CBD) and low Δ-9-tetrahydrocannabinol (THC) formulation on patients with Parkinson’s disease through a randomised trial. The study aimed to assess whether this specific CBD/THC formulation could improve motor symptoms in Parkinson’s disease patients compared to a placebo.

Motor Symptoms Analysis: According to the findings, the results indicated that the motor symptoms, as measured by the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), reduced by 4.57 points in the CBD/THC group, while the placebo group experienced a reduction of 2.77 points. Despite these numbers, the study concluded that these reductions were not statistically significant enough to demonstrate a clear benefit from the CBD/THC treatment.

Impact on Cognitive Function and Sleep: Moreover, the study reported that cognitive function and sleep appeared to worsen in the CBD/THC group. It doesn’t help. It actually worsens cognitive function in patients with PD. This was an important finding as it contradicted the hypothesis that CBD might have neuroprotective effects. Additionally, the CBD/THC group reported more adverse events compared to the placebo group. The reported adverse events raise concerns about the safety profile of this formulation for patients with Parkinson’s disease.

The plasma levels of CBD and THC in the patients were also measured during the study. In the CBD/THC group, the CBD plasma level was found to be 54.0 ng/mL, while the THC level was significantly lower at 1.06 ng/mL. These levels highlight the intended high CBD to low THC ratio of the formulation used in the trial.

Summary of Findings: In summary, the study reveals that short-term therapy with a high CBD/low THC formulation does not significantly improve motor symptoms in Parkinson’s disease patients. It doesn’t help. It actually worsens cognitive function and sleep, highlighting the need for further research into the efficacy and safety of cannabinoids in treating Parkinson’s disease.

Source: PracticeUpdate

The legalisation of cannabis has swept across North America, with Canada, and many U.S states and provinces embracing it’s not only it’s ‘medicinal’ offerings but also recreational use and particularly in the deceptively benign offerings of cannabis edibles. While these growing permission models seem ‘progressive’, the shift has convinced many older adults to open the door of use on this highly engineered and completely unnatural product and explore cannabis. 

Not unsurprisingly, unintended harms are emerging – not least a rise in emergency department (ED) visits for cannabis poisoning in this demographic. This article explores the data, explores the reasons behind this phenomenon, and examines the potential consequences for public health.

The Dalgarno Institute presents a synoptic introduction to this growing problem.