05 Aug After the legalization of recreational cannabis, there were no significant increases in rates of prescription stimulant use in the U.S
MedicalResearch.com Interview with:
Luke Cavanah
Luke Cavanah, BS
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, PA 18509
MedicalResearch.com: What is the background for this study?
Response: Amphetamine, lisdexamfetamine, and methylphenidate, are first-line treatments for attention-deficit hyperactivity disorder (ADHD) and are classified as Schedule II stimulants due to their risk of addiction. (1–3) There has been high and increasing use and misuse of these medications with inadequate explanation. (4) Since chronic cannabis use can result in similar cognitive effects as ADHD 5–7, we wondered if more stimulants were prescribed for what appeared to be ADHD but was a consequence of chronic cannabis use. In other words, has the legalization of cannabis contributed to this inadequately explained increase in stimulant use? A recent study by our lab group that looked at the slopes of stimulant distribution rates over time — before and after medical cannabis legalization — did not support this.(8)
Given the prevalence and increasing legalization of recreational cannabis, we wanted to determine how slopes of stimulant distribution rates compared before and after recreational cannabis legalization.
MedicalResearch.com: What are the key points of your research?
Response: We classified states (and District of Columbia) as either selling recreational cannabis (RC+) or not (RC-). We looked at the three-year population-corrected slopes of stimulant distribution rates before and after legalization for the RC+ group. For the RC- states, which served as a comparison group, we assessed three-year slopes of stimulant distribution rates before and after the average start of RC sales for RC+ states. We used the comprehensive Drug Enforcement Administration’s Automated Reports and Consolidated Orders System (ARCOS) database to obtain values for amount of stimulant distributed.
The slopes for amphetamine, lisdexamfetamine, methylphenidate, and their sum did not show
significant increases in RC+ states after legalization. These findings suggest that at the population level, recreational cannabis legalization has not contributed to the rise in prescription stimulant use.
MedicalResearch.com: Was the outcome compatible with your premise or were the results surprising?
Response: We hypothesized that we would see a significant increase in slopes of stimulant distribution rates after recreational cannabis legalization for those municipalities that legalized it. For the comparison group (states that did not legalize), we expected slopes of stimulant distribution rates before and after the average start of recreational cannabis sales would not be significantly different. As we previously observed in our related study examining stimulant use before and after medical cannabis legalization, we did not observe this in our current study. It is worth noting, that while our initial hypothesis was based on literature suggesting that chronic cannabis use contributes to cognitive symptoms that can resemble ADHD (5–7), other studies suggest patients with ADHD have improvement in their inattention and that patients may “substitute” cannabis as an alternative to stimulant treatment.(9–11).
MedicalResearch.com: What further questions remain to be answered in this answer? What further research is indicated?
Response: This study and its related study focused on cannabis legalization, but it would be interesting to explore the effect of illicit cannabis use on stimulant rates. Further research could also examine the impacts of cannabis legalization on the utilization of other ADHD pharmacotherapies and ADHD diagnoses.
Additionally, a limitation of this study was that only seven municipalities had sufficient data for three- year pre/post slope analyses for the RC+ group. As more states pass legislation legalizing recreational cannabis, we wonder how, if at all, the observed findings may change.
Read the full recreational cannabis study here:
Alexander GD, Cavanah LR, Goldhirsh JL, Huey LY, Piper BJ. Recreational cannabis legalization: no contribution to rising prescription stimulants in the USA. Pharmacopsychiatry. Published online
July 31, 2024. doi:10.1055/a-2334-6253
Read the full medical cannabis study here:
Alexander GD, Cavanah LR, Goldhirsh JL, Huey LY, Piper BJ. Medical cannabis legalization: no
contribution to rising stimulant rates in the USA. Pharmacopsychiatry. 2023;56(06):214-218.
doi:10.1055/a-2152-7757
References
- Post RE, Kurlansik SL. Diagnosis and Management of Attention-Deficit/Hyperactivity Disorder in Adults. Am Fam Physician. 2012;85(9):890-896. Accessed December 8, 2022.https://www.aafp.org/pubs/afp/issues/2012/0501/p890.html
- Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality
Improvement and Management. ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics.2011;128(5):1007-1022. doi:10.1542/peds.2011-2654 - Drug Enforcement Administration. Drug Scheduling. Published 2018. Accessed April 19, 2023.https://www.dea.gov/drug-information/drug-scheduling
- Piper BJ, Ogden CL, Simoyan OM, et al. Trends in use of prescription stimulants in the United States
and Territories, 2006 to 2016. PLoS ONE. 2018;13(11):e0206100. doi:10.1371/journal.pone.0206100 - Solowij N, Stephens RS, Roffman RA, et al. Cognitive Functioning of Long-term Heavy Cannabis Users
Seeking Treatment. JAMA. 2002;287(9):1123-1131. doi:10.1001/jama.287.9.1123 - Wallace AL, Wade NE, Hatcher KF, Lisdahl KM. Effects of Cannabis Use and Subclinical ADHD
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of cannabis use in adolescents and adults: a systematic meta-review of meta-analyses. Addiction.
2022;117(7):1857-1870. doi:10.1111/add.15764 - Alexander GD, Cavanah LR, Goldhirsh JL, Huey LY, Piper BJ. Medical cannabis legalization: no
contribution to rising stimulant rates in the USA. Pharmacopsychiatry. 2023;56(06):214-218.
doi:10.1055/a-2152-7757 - Mitchell JT, Sweitzer MM, Tunno AM, Kollins SH, McClernon FJ. “I Use Weed for My ADHD”: A
Qualitative Analysis of Online Forum Discussions on Cannabis Use and ADHD. PloS One.
2016;11(5):e0156614. doi:10.1371/journal.pone.0156614 - Stueber A, Cuttler C. Self-reported effects of cannabis on adhd symptoms, adhd medication side
effects, and adhd-related executive dysfunction. J Atten Disord. 2022;26(6):942-955.
doi:10.1177/10870547211050949 - Cooper RE, Williams E, Seegobin S, Tye C, Kuntsi J, Asherson P. Cannabinoids in attention-
deficit/hyperactivity disorder: A randomised-controlled trial. Eur Neuropsychopharmacol J Eur Coll
Neuropsychopharmacol. 2017;27(8):795-808. doi:10.1016/j.euroneuro.2017.05.005
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Last Updated on August 5, 2024 by Marie Benz MD FAAD