A clinical practice guideline using the GRADE approach recommends atomoxetine to improve ADHD symptoms in patients with cannabis use disorder (weak recommendation) but not to reduce cannabis use itself.
Psychiatrists, primary care providers, and patients with co-occurring ADHD and substance use disorders.
Atomoxetine safe and effective for ADHD symptoms in cannabis use disorder
What the researchers found
For ADHD with cannabis use disorder: atomoxetine is weakly recommended to improve ADHD symptoms but weakly recommended against reducing cannabis use. For ADHD with any SUD: both psychostimulants and atomoxetine are weakly recommended for ADHD symptoms but not for reducing substance use. Atomoxetine and psychostimulants are considered safe in patients with SUD (strong recommendation). Neither reduces treatment retention (strong recommendation against).
Why it matters
ADHD and substance use disorders frequently co-occur, but clinicians often hesitate to prescribe ADHD medications due to abuse concerns. This guideline provides evidence-based recommendations with safety reassurance.
The numbers in context
Cannabis-specific: atomoxetine recommended for ADHD symptoms (weak) but not for cannabis use (weak against). Safety of both medication classes in SUD patients: strong recommendation.
How the study worked
Clinical practice guideline synthesizing pharmacological and psychosocial interventions for adults with ADHD and comorbid SUD, using the GRADE approach for recommendation strength.
What this study cannot tell us
Mostly weak recommendations reflecting limited evidence. Few large, multisite RCTs. Cannabis-specific evidence is particularly sparse. GRADE approach penalizes for imprecision and indirectness. May not reflect all clinical scenarios.
How to read the evidence
GRADE-based clinical practice guideline, but most recommendations are weak due to limited evidence.
When this study was published
Published in 2022.
The bigger picture
The finding that ADHD medications can safely improve ADHD symptoms in patients with substance use disorders, even if they do not reduce substance use, supports a treat-the-ADHD approach that may indirectly benefit substance use outcomes.
Questions still open
- Would treating ADHD symptoms indirectly reduce cannabis use over time? Should lisdexamfetamine be evaluated specifically for ADHD+CUD? Are there subgroups that respond better to specific medications?
Common questions
Can ADHD medications be safely used in people who use cannabis?
Will treating ADHD reduce cannabis use?
Read the original research
Clinical practice guideline on pharmacological and psychological management of adult patients with attention deficit and hyperactivity disorder and comorbid substance use.
Adicciones, 34(2), 168-178
Citation
Cunill, Ruth; Castells, Xavier; González-Pinto, Ana; Arrojo, Manuel; Bernardo, Miquel; Sáiz, Pilar A; Flórez, Gerardo; Torrens, Marta; Tirado-Muñoz, Judit; Fonseca, Francia; Arranz, Belén; Garriga, Marina; Goikolea, Jose Manuel; Zorrilla, Iñaki; Becoña, Elisardo; López, Ana; San, Luis. (2022). Clinical practice guideline on pharmacological and psychological management of adult patients with attention deficit and hyperactivity disorder and comorbid substance use.. Adicciones, 34(2), 168-178. https://doi.org/10.20882/adicciones.1569
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