The doctor’s perspective: medical cannabis in ADHD and autism

In his final instalment, consultant psychiatrist and cannabis clinician Dr Tahzid Ahsan, explores the potential of cannabis in managing symptoms of ADHD and autism.

Around three in 10 autistic adults and around 28% of autistic children also have ADHD. The likelihood of someone presenting with both conditions in a cannabis clinic is statistically relevant.

Autism is characterised by a lifelong developmental disability affecting how people communicate and interact with the world. Around one in 100 people in the UK are autistic.  They can struggle with social communication where they find it difficult to interpret what others say, leading them to come across as ‘insensitive’ to others. They may struggle to navigate the social world, hence they fall into patterns of repetitive behaviours and highly focussed interests to cope with overwhelming anxieties. 

ADHD is the more common neuro-behavioural disorder, affecting around 700,000 children and 1.9 million adults in the UK. ADHD is usually defined by unusual over activeness, distractibility, doing things impulsively and unable to concentrate for any length of time. 

Unfortunately, the evidence for the usage of medical cannabis for Autism and ADHD is scarce due to lack of research studies. 

A case study from my cannabis clinic

I reviewed a 32-year-old gentleman in my clinic with a joint diagnosis of autism and ADHD made during his childhood. We shall call him Anthony. 

Anthony  and his family had been under the support of Child and Adolescent Services from the age of nine until 18. He had received extensive educational and psychological support throughout his school years. He had been trialled on several medications for his ADHD such as methylphenidate and atomoxetine that partially helped. 

In the past Anthony had been prescribed benzodiazepines and antidepressants to help him overcome overwhelming experiences of anxiety that had led to ‘meltdowns’, whereby he became verbally hostile and impulsive. He was on Mirtazapine at night to help with his mood and sleep.

Anthony has a partner and a three-year-old daughter with full-time employment working at a factory. 

He presented to me with symptoms of poor concentration and focus, always struggling to make plans. He enjoyed regimented routines; he finds his factory job soothing due to the standardised monotonous nature of his role.  He struggles to engage with his  daughter as her ‘chaos’ impacts on his ability to facilitate meaningful play.

Anthony has occasionally snapped at his daughter, leaving him overwhelmed by feelings of shame. He reported that he had used cannabis for several years, it was the only ‘thing’ that has helped him stay focused and able to socialise in comparison to previous medications and therapy. 

Anthony was already aware of www.medbud.wiki the information website, and was well-versed with which cultivars were available at the time of his initial consultation. 

Quite often, patients will present to us with a list of products they would like before I’ve had a chance to evaluate if these products are medically suitable for them. Anthony had chosen a high-THC sativa for his condition, which I did not agree with. I felt a more balanced flower with a 50:50 mix of sativa and indica with a balance of THC and CBD was more suited.  In theory, this would allow him to feel, think and behave more objectively and balanced. I was willing to prescribe a higher THC pure indica Hindu Kush THC 20: CBD 1 at night to help him sleep.

At Anthony’s one month follow up, he was surprised how well the THC 10:CBD 10 flower worked. He liked that the CBD made him feel calmer and able to focus, but the THC it gave him enough psychoactive motivation and drive to carry out everyday tasks.

The Hindu Kush at night allowed him to have seven to eight solid hours of sleep, which in turn harboured a headspace so that he remained calm and patient around his daughter during playtimes. Anthony’s partner had noted a pleasing difference in his interactions with her; he wasn’t as overwhelmed when she gave him certain social tasks such as taking his daughter to nursery or going shopping.

During his three month follow-up, Anthony reported continued improvements with his focus, concentration and his ability to empathise with others. He reported for the first time in his life he felt ‘he could understand others’. He tended to spend time alone during lunch hours, but now he was interacting with his peers and enjoying getting to know them. He noted no side effects. 

At his six month follow up, Anthony started to note some tolerance to the THC 10:CBD 10. His ADHD symptoms such as lacking focus and concentration worsened during these three months. Anthony was becoming overwhelmed again by his daughter’s boisterous playful nature.  I decided to initiate a hybrid (indica dominant)  flower called Gorilla Glue at THC18 :CBD 1 that had an abundance of linalool as its major terpene. Linalool (lavender) seems to have a very calming effect that works well when taken in the evenings.

Anthony continued with the balanced THC 10 :CBD 10 flower during the day, then used the Gorilla Glue flower when required during early evenings and continued with the pure indica flower for sleep. 

Anthony was very pleased by the effect of the Gorilla Glue at his nine month and annual follow up, so much so that he wanted to replace the THC 10:CBD 10 with the Gorilla Glue cultivar and to continue with the indica (Hindu Kush) at night for sleep. He felt the Gorilla Glue gave him focus and an ability to harbour ‘headspace’ at times of overwhelming, intrusive thoughts and anxieties. 

Anthony’s partner was very thankful by the difference medical cannabis was making in their lives; she described him as a ‘new and happy husband’. She was giving him more responsibilities such as getting their daughter ready for school, which he previously would not have been able to manage. 

Making the case for cannabis in autism and ADHD

Despite the lack of formal evidence for the treatment of autism and ADHD with medical cannabis, from my experience of prescribing I have deduced that medical cannabis can have a profound influence on helping people who suffer with these conditions. In the case of ADHD in particular, I have noted almost instantaneous improvements in patients’ focus, concentration and subsequent abilities to function.  

As clinicians, I and my colleagues strive to do the best for our patients by informing our practice with the ‘best possible evidence.’ That usually involves a randomised control trial as the industry ‘gold standard’.

Many of my colleagues might quickly dismiss medical cannabis as a form of treatment due to the lack of this type of evidence. Yes, we need more compelling good quality research around the safety and effectiveness of medical cannabis to understand more. 

However, the notion of ‘medicine’ did not begin from the onset of ‘evidence-based medicine’ from the late 1990’s. Cannabis is synonymous with ancient forms of medical knowledge that has helped people for thousands of years before the concept of ‘evidence-based’ medicine existed. 

Psychiatrist’s are generally happy to prescribe antidepressants that could potentially increase the risk of suicide within a certain age group, as long as NICE guidelines endorse it. I have personally never seen any patients with suicidal ideation accelerated or a risk when using cannabis. 

I have learned to appreciate the incredible nature and benefits of medical cannabis for patients and prescribers alike. We are at the precipice of a medical revolution, where ‘alternative forms’ of treatments such as cannabis, psilocybin, and ketamine,  are rediscovered and respected as credible medical treatments. 

Our patients deserve better, I believe they deserve access to medical cannabis.      

Dr Tahzid Ahsan

Dr Tahzid Ahsan is a consultant psychiatrist and prescribing cannabis doctor. Dr Ahsan is looking for volunteer cannabis users to be interviewed for a new book about the effects of medical cannabis from the patients perspective. Anyone interested please contact: volunteercannabiscalm@gmail.com