Luke Cavanah, BS Geisinger Commonwealth School of Medicine Scranton, PA

No Observed Increase in Prescription Stimulant Use After Legalization of Medical Marijuana Interview with:

Luke Cavanah, BSGeisinger Commonwealth School of Medicine Scranton, PA

Luke Cavanah

Luke Cavanah, BS
Geisinger Commonwealth School of Medicine
Scranton, PA What is the background for this study?

Response: It is well-known that schedule II stimulants, which are those that are highly addictive and include amphetamine, methylphenidate, and lisdexamfetamine, have had increasing use and misuse in the US.

Despite understanding the presence of this phenomenon, the reason for it is poorly understood. The purpose of this study was to see if rising rates of schedule II stimulants are related to the legalization of medical marijuana. We were interested in this because schedule II stimulants are primarily used as the treatment for attention-deficit hyperactivity disorder (ADHD), chronic cannabis use has been demonstrated to cause neurocognitive deficits resembling that of ADHD, and the conditions have been shown to affect similar brain regions. What are the key points of your research?

Response: In our study, there were twenty-seven municipalities in the US that implemented medical cannabis (MC+), and twenty-four that did not (MC-). MC+ states had slopes of stimulant distribution as reported by a national (US) database of stimulant distribution of 6.11 (SD = 4.48) daily doses per hundred million people per year, and this number surprisingly declined to 2.67 (SD = 4.62) after legalization. We also interestingly found a decrease in stimulant distribution for MC- states after the average start of MC sales: before they had slopes of stimulant distribution of 9.33 (SD = 5.22) daily doses per hundred million people per year, and after that value was 1.47 (SD = 4.48). Slopes of stimulant distribution rates were significantly lower in states that went on to legalize medical cannabis prior to program implementation compared to those municipalities that did not. After MC program implementation, though, there was no significant difference between MC+ states and MC- states in distribution rates of schedule II stimulants. Overall, we found a large main effect of time (p<0.001) but not states’ MC sale status (p=0.391) on prescription stimulant distribution.

The simplest explanation for our findings is that, at a population level, medical cannabis program legalization did not contribute to states experiencing quicker increases in schedule II stimulant distribution rates. Was the outcome compatible with your premise or were the results surprising?

Response: We hypothesized that we would observe significant increases in schedule II stimulant use after medical cannabis legalization for those states that legalized it. For states that did not legalize medical cannabis, we hypothesized that they would not see any statistically significant difference before and after the average medical cannabis legalization date. Our findings did not support our hypothesis. What further questions remain to be answered in this answer? What further research is indicated?

Response: Although this study suggests that at an ecological level, medical cannabis legalization did not contribute to the rising use of schedule II stimulants, commentary on the individual level is not possible. To gain insight into such a question, research at an individual (i.e., patient) level using electronic medical records would be helpful. Additionally, future studies that investigate the potential impact of recreational cannabis legalization on schedule II stimulant use would be beneficial given that many people who use cannabis do so recreationally and continued expansion by states of recreational cannabis is likely. Assessing the number of ADHD diagnoses before and after cannabis legalization would also be a shrewd endeavor.


Alexander, G. D., Cavanah, L. R., Goldhirsh, J. L., Huey, L. Y., & Piper, B. J. (in press). Medical cannabis legalization: No contribution to rising stimulant rates. Pharmacopsychiatry.

Artigas, M. S., Sánchez-Mora, C., Rovira, P., Richarte, V., García-Martínez, I., Pagerols, M., Demontis, D., Stringer, S., Vink, J., Børglum, A., Neale, B. M., Franke, B., Faraone, S. V., Casas, M., Ramos-Quiroga, J. A., & Ribasés, M. (2020). Attention-deficit/hyperactivity disorder and lifetime cannabis use: Genetic overlap and causality. Molecular Psychiatry, 25(10), 2493–2503.

Board, A. R., Guy, G., Jones, C. M., & Hoots, B. (2020). Trends in stimulant dispensing by age, sex, state of residence, and prescriber specialty—United States, 2014–2019. Drug and Alcohol Dependence, 217, 108297.

Cawkwell, P. B., Hong, D. S., & Leikauf, J. E. (2021). Neurodevelopmental effects of cannabis use in adolescents and emerging adults with adhd: A systematic review. Harvard Review of Psychiatry, 29(4), 251–261.

Drug Enforcement Administration. (n.d.). Drug Scheduling. Retrieved April 19, 2023, from

Jacobus, J., & Tapert, S. F. (2014). Effects of cannabis on the adolescent brain. Current Pharmaceutical Design, 20(13), 2186–2193.

Piper, B. J., Ogden, C. L., Simoyan, O. M., Chung, D. Y., Caggiano, J. F., Nichols, S. D., & McCall, K. L. (2018). Trends in use of prescription stimulants in the United States and Territories, 2006 to 2016. PLoS ONE, 13(11), e0206100.


The information on is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition.

Some links may be sponsored. Products are not endorsed.

Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.


Last Updated on September 11, 2023 by Marie Benz