Medical Cannabis for Adult Attention Deficit Hyperactivity Disorder: Sociological Patient Case Report of Cannabinoid Therapeutics in Finland

Aleksi Mikael Markunpoika Hupli

Medical Cannabis and Cannabinoids, 2018, 1, 112–118

DOI: 10.1159/000495307

https://www.karger.com/Article/FullText/495307

Abstract :
This paper presents a detailed patient case report of a male patient who was diagnosed in adulthood (aged 33) with attention deficit hyperactivity disorder (ADHD) and treated initially with immediate-release methylphenidate (Ritalin® 10 mg twice daily). After experiencing adverse effects from prolonged use of this medication and afterwards other medications that were prescribed as alternatives, the patient discovered that cannabinoid therapeutics (CT) had been experimented inside the EU area to treat patients with ADHD. Subsequently, he was evaluated by a physician in Germany (June 2010) who prescribed CT (Bedrocan®, Bediol®). A Finnish neurologist later confirmed the two prescribed medicines (Bedrocan®, October 2010; Bediol®, May 2011) in the patient’s own country of permanent residence (Finland). During a 5-year period of access, Bedrocan®, which mainly contains Δ9-tetrahydrocannabinol (Δ9-THC), was found to be helpful in alleviating the patient’s ADHD symptoms, in particular poor tolerance to frustration, outbursts of anger, boredom, and problems related to concentration. The second CT medication, Bediol®, which contains both Δ9-THC and the phytocannabinoid cannabidiol, was found to neutralize the excessive dronabinol effects of Bedrocan® as well as zo offer other medical benefits (e.g., improved sleep). In addition to the case report, this paper also offers a brief review of the literature surrounding the medical benefits of CT for AD(H)D, which includes observational studies, clinical case reports, and one randomized clinical experiment. This
paper also briefly discusses the endocannabinoid system in relation to ADHD, although more preclinical and clinical research is warranted to establish the optimal levels of cannabinoids, terpenes, and dosing regimens, which vary between different ADHD patients.

Keywords :
Cannabinoid therapy · Attention deficit hyperactivity disorder · Case report · Finland · Qualitative research

Introduction

There are numerous qualitative and quantitative studies as well as a recent online study [1] reporting an association between attention deficit hyperactivity disorder (ADHD) and cannabis use [2–4]. Many studies, however, often interpret cannabis use as nonmedical, “recreational,” and/or drug abuse, not as a potential, albeit often illegal, form of (self-)medication. As with all medicines, the potential harms – and the risk of developing a substance abuse disorder – should be considered, especially for this patient group [5]. Nonetheless, it has been demonstrated that use of (non)medical cannabis can also help to keep  adult individuals with ADHD away from other more harmful substances, like cocaine [6]. Observational studies have shown that medical cannabis patients in general use cannabinoids as a substitution for alcohol, illicit drugs, and/or commonly used prescription drugs for better symptom management, as well as to experience fewer side effects [7, 8].

This paper offers a medical sociological case study of a Finnish resident adult male diagnosed with combined-type ADHD. He was treated with standardized cannabinoids in botanical (whole-plant) form between 2010 and 2016, after experiencing adverse effects from immediate release methylphenidate. The patient was prescribed cannabinoid therapeutics (CT) initially by a physician practicing in Germany, and the prescriptions were later confirmed by a Finnish neurologist. In December 2010 and in May 2011 the Finnish Medicines Agency (Fimea) authorized the patient’s access to Bedrocan® and Bediol®, respectively, which he used on a daily basis until 2016.

A single detailed case study, although not generalizable to wider patient populations, brings important insights to further develop clinical practice and research around CT for adult ADHD patients. For a comprehensive review of cannabinoids in other neurological and mental health conditions see Fattore [9]. Before presenting the case report, this paper offers a brief review of the literature surrounding the medical benefits of CT for ADHD, which include observational research, clinical case reports, and one randomized clinical trial. This paper also briefly discusses the endocannabinoid system (ECS) in relation to ADHD. For a more comprehensive review of the ECS and impulsive behavior, see Wiskerke and Pattij
[10].

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