An analysis of DEA prescription data from 2006 to 2021 found that medical cannabis legalization did not contribute to rising rates of ADHD stimulant distribution, despite concerns that cannabis-induced cognitive impairment might increase ADHD diagnoses.
Policymakers and clinicians concerned about unintended consequences of medical cannabis legalization
No effect on stimulant prescriptions
What the researchers found
While there was a significant increase in stimulant distribution over time (methylphenidate, amphetamine, lisdexamfetamine), there was no significant main effect of medical cannabis legalization status. The stimulant increase was driven by other factors, likely including broadened ADHD diagnostic criteria in DSM-5 and the addition of binge eating disorder as a stimulant indication.
Why it matters
Concerns have been raised that medical cannabis might worsen attention problems, potentially leading to more ADHD diagnoses and stimulant prescriptions. This study provides reassurance that this feared consequence has not materialized at a population level.
The numbers in context
DEA data from 2006-2021; significant time effect on stimulant distribution (p<0.05); no significant main effect of MC legalization (p=0.391); no significant difference between states with and without MC sales (p=0.355)
How the study worked
Retrospective analysis of DEA comprehensive database tracking methylphenidate, amphetamine, and lisdexamfetamine distribution from 2006-2021. Compared three-year population-corrected slopes before and after medical cannabis program implementation across states.
What this study cannot tell us
Ecological study using state-level distribution data rather than individual patient prescriptions. Cannot determine whether specific cannabis users received stimulant prescriptions. Medical cannabis programs vary widely in structure and patient populations across states.
How to read the evidence
Population-level analysis using comprehensive federal data, but ecological design cannot link individual cannabis use to prescriptions
When this study was published
2023 study
The bigger picture
This study joins others suggesting that many feared public health consequences of medical cannabis legalization have not materialized. The rising stimulant prescriptions appear driven by diagnostic changes rather than cannabis-related cognitive decline.
Questions still open
- Could recreational legalization have a different effect on stimulant prescriptions? Do individual cannabis users have higher rates of subsequent ADHD diagnosis? What is driving the continued increase in stimulant distribution?
Common questions
Can cannabis use lead to ADHD?
Why are ADHD stimulant prescriptions rising?
Read the original research
Medical Cannabis Legalization: No Contribution to Rising Stimulant Rates in the USA.
Pharmacopsychiatry, 56(6), 214-218
Citation
Alexander, Garrett D; Cavanah, Luke R; Goldhirsh, Jessica L; Huey, Leighton Y; Piper, Brian J. (2023). Medical Cannabis Legalization: No Contribution to Rising Stimulant Rates in the USA.. Pharmacopsychiatry, 56(6), 214-218. https://doi.org/10.1055/a-2152-7757