Stimulant medication for ADHD reduced cannabis use days but did not significantly increase quit rates in dual-diagnosis adults | Research

The takeaway

In a small pilot trial of 28 adults with both ADHD and cannabis use disorder, extended-release amphetamine salts significantly reduced weekly cannabis use days compared to placebo, though overall abstinence rates did not significantly differ.

Psychiatrists treating dual ADHD-CUD, addiction medicine specialists, and ADHD researchers

Weekly cannabis use days significantly reduced (p < .0001)

What the researchers found

MAS-ER (80 mg) was well-tolerated. While ADHD symptom reduction was high in both groups (83.3% vs 71.4%, not significant) and abstinence rates were not significantly different (15.4% vs 0%, p = .27), the medication group showed a significant decrease in weekly cannabis use days over time compared to placebo (p < .0001).

Why it matters

ADHD and cannabis use disorder frequently co-occur but have no established pharmacological treatment. This pilot suggests treating the ADHD component may help reduce cannabis use even if it does not achieve full abstinence.

The numbers in context

28 participants; MAS-ER 80 mg vs placebo; ADHD response: 83.3% vs 71.4% (not significant); abstinence: 15.4% vs 0% (p = .27); weekly cannabis use days significantly reduced over time with MAS-ER (p < .0001); well-tolerated

How the study worked

Twelve-week randomized, double-blind pilot feasibility trial of 28 adults with comorbid ADHD and cannabis use disorder. MAS-ER (up to 80 mg) vs placebo. All received computerized behavioral therapy and abstinence-based contingency management. Cannabis use confirmed by quantitative urine testing.

What this study cannot tell us

Very small sample (28); pilot feasibility study not powered for efficacy; high placebo response for ADHD symptoms; treatment retention not detailed; cannot generalize to broader ADHD-CUD population

How to read the evidence

Small pilot RCT with biochemical verification, demonstrating feasibility but not adequately powered for definitive efficacy conclusions.

When this study was published

2024 study

The bigger picture

The reduction in cannabis use days even without full abstinence is clinically meaningful, as harm reduction approaches recognize that reduced frequency may lower overall risk.

Questions still open

Would a larger trial confirm the reduction in use days? Does treating ADHD reduce cannabis use motivation, or do the two respond to treatment independently?

Common questions

Can ADHD medication help with cannabis use disorder?

This small pilot study suggests it may reduce use frequency. Adults receiving extended-release amphetamine salts used cannabis on significantly fewer days per week compared to placebo. However, the study was too small to show a clear difference in complete abstinence (15.4% vs 0%).

Was the ADHD medication safe for people with cannabis use disorder?

Yes, the medication (MAS-ER at up to 80 mg daily) was generally well-tolerated. ADHD symptoms improved substantially in both groups, with 83% of the medication group showing at least 30% symptom reduction.

Read the original research

Extended-Release Mixed Amphetamine Salts for Comorbid Adult Attention-Deficit/Hyperactivity Disorder and Cannabis Use Disorder: A Pilot, Randomized Double-Blind, Placebo-Controlled Trial.

Journal of attention disorders, 28(11), 1467-1481

View on PubMed ↗Publisher’s paper ↗

Citation

Levin, Frances R; Mariani, John J; Pavlicova, Martina; Choi, C Jean; Basaraba, Cale; Mahony, Amy L; Brooks, Daniel J; Brezing, Christina A; Naqvi, Nasir. (2024). Extended-Release Mixed Amphetamine Salts for Comorbid Adult Attention-Deficit/Hyperactivity Disorder and Cannabis Use Disorder: A Pilot, Randomized Double-Blind, Placebo-Controlled Trial.. Journal of attention disorders, 28(11), 1467-1481. https://doi.org/10.1177/10870547241264675