Treating ADHD with extended-release amphetamine salts in people who also had cocaine dependence was associated with more marijuana-free weeks, suggesting treating underlying ADHD may reduce cannabis use.
Read this if you have ADHD and use cannabis, especially if you wonder whether treating ADHD might affect your cannabis use.
MAS-XR group had significantly more marijuana-free weeks over 14 weeks compared to placebo.
What the researchers found
In a secondary analysis of a 14-week randomized controlled trial, researchers found that people with co-occurring ADHD and cocaine dependence who received mixed amphetamine salts (MAS-XR) had a significant decrease in the proportion of weeks where they used any marijuana, compared to placebo.
However, among the weeks when participants did use marijuana, the proportion of days they used did not change. In other words, the medication helped more people have completely marijuana-free weeks, but when people did use, their pattern of use was similar to placebo.
Why it matters
ADHD, cocaine dependence, and cannabis use frequently co-occur. This finding suggests that effectively treating ADHD with stimulant medication may reduce cannabis use as a secondary benefit, possibly because some people use cannabis to self-medicate attention difficulties. If treating the underlying condition reduces substance use, it supports an integrated treatment approach.
The numbers in context
57 participants total (37 MAS-XR, 20 placebo). Marijuana users were defined as those reporting use in the 30 days before the study. The MAS-XR group showed significantly more marijuana-free weeks over the 14-week trial.
How the study worked
This was a secondary analysis of a 14-week randomized controlled trial. The original trial compared placebo, MAS-XR 60 mg, and MAS-XR 80 mg in people with co-occurring ADHD and cocaine dependence. For this analysis, both MAS-XR groups were combined (n=37) versus placebo (n=20). Marijuana use was tracked using timeline follow-back methods. Analysis used logistic mixed effects models.
What this study cannot tell us
This was a secondary analysis, not the primary aim of the trial. The sample was small (57 participants). All participants also had cocaine dependence, limiting generalizability to people with ADHD and cannabis use without cocaine involvement. The study was not designed or powered to detect cannabis use outcomes.
How to read the evidence
Moderate evidence from a secondary analysis of a well-designed RCT. The small sample size and secondary nature of the analysis limit the strength of conclusions.
When this study was published
Published in 2016. The relationship between ADHD treatment and cannabis use continues to be studied.
The bigger picture
The self-medication hypothesis suggests that some people with ADHD use cannabis to manage their symptoms. If stimulant treatment for ADHD reduces cannabis use, this supports the idea that addressing root neurological conditions may be more effective than targeting substance use alone.
Questions still open
- Would ADHD treatment reduce cannabis use in people without co-occurring cocaine dependence? Do people with ADHD who use cannabis for symptom management see similar reductions with stimulant treatment? Would longer treatment periods produce stronger effects on marijuana use days?
Common questions
Does treating ADHD reduce marijuana use?
Were people using marijuana to self-medicate ADHD?
Read the original research
Mixed-amphetamine salts increase abstinence from marijuana in patients with co-occurring attention-deficit/hyperactivity disorder and cocaine dependence.
The American journal on addictions, 25(8), 666-672
Citation
Notzon, Daniel P; Mariani, John J; Pavlicova, Martina; Glass, Andrew; Mahony, Amy L; Brooks, Daniel J; Grabowski, John; Levin, Frances R. (2016). Mixed-amphetamine salts increase abstinence from marijuana in patients with co-occurring attention-deficit/hyperactivity disorder and cocaine dependence.. The American journal on addictions, 25(8), 666-672. https://doi.org/10.1111/ajad.12467
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