Clinicians face a complex tradeoff when treating ADHD with stimulants in adolescents who use cannabis: untreated ADHD increases substance use risk, but stimulants carry diversion and misuse concerns.
Read this if you are a parent, clinician, or educator navigating ADHD treatment decisions for teens who use cannabis.
11% of youthPercentage of children/adolescents diagnosed with ADHD, many of whom may also use cannabis
What the researchers found
This clinical commentary outlines three key considerations for prescribing stimulants to youth with co-occurring ADHD and cannabis use: (1) cannabis can confound ADHD assessment by mimicking or masking symptoms, (2) properly treating ADHD may actually reduce overall substance use risk, and (3) ongoing cannabis use raises concerns about stimulant misuse and diversion. The authors note that cannabis use is more prevalent among adolescents with ADHD than the general population, and changing legal landscapes have made this clinical scenario increasingly common.
Why it matters
With 11% of children diagnosed with ADHD and cannabis becoming more accessible, this clinical dilemma affects a large and growing patient population. The commentary highlights that withholding stimulant treatment may paradoxically increase substance use risk.
The numbers in context
- 11% of children and adolescents have been diagnosed with ADHD
- Cannabis use is more prevalent in adolescents with ADHD than the general population
- Changing state-level legal status has increased access and social acceptability
How the study worked
Clinical commentary and expert review published in the Journal of the American Academy of Child and Adolescent Psychiatry. Not an original research study.
Who was studied
Children and adolescents with ADHD and co-occurring cannabis use
What this study cannot tell us
This is an expert commentary, not a systematic review or original research. It presents clinical considerations rather than new data. The specific risk-benefit calculations will vary by individual patient.
How to read the evidence
Expert commentary in a peer-reviewed journal. Provides clinical guidance but no new empirical data.
When this study was published
Published in 2023. Timely given rapidly evolving cannabis legislation across US states.
The bigger picture
The intersection of ADHD treatment and cannabis use reflects broader challenges in adolescent psychiatry as cannabis becomes more normalized. Clinicians must weigh incomplete evidence while making real-time treatment decisions for a vulnerable population.
Questions still open
- Does treating ADHD with stimulants reduce cannabis use in adolescents?
- Are non-stimulant ADHD medications safer options for patients with concurrent cannabis use?
- How should cannabis use affect the monitoring protocol for stimulant prescriptions?
Read the original research
Prescribing Stimulants for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder and Co-occurring Cannabis Use: Considerations for Managing a Clinical Dilemma.
Journal of the American Academy of Child and Adolescent Psychiatry, 62(8), 842-846
Citation
Dernbach, Matthew Robert; Gray, Kevin M; Borich, Abbey; Seery, Erin; Russo, Sarah Brice; Lewis, E Thomas; Gwynette, McLeod Frampton. (2023). Prescribing Stimulants for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder and Co-occurring Cannabis Use: Considerations for Managing a Clinical Dilemma.. Journal of the American Academy of Child and Adolescent Psychiatry, 62(8), 842-846. https://doi.org/10.1016/j.jaac.2022.11.014