Due to a shortage in stimulant-based drugs for ADHD (attention-deficit/hyperactivity disorder), the U.K.’s limited medical cannabis industry is seeing a spike in patients using cannabis for relief as an alternative. The exodus of patients resorting to medical cannabis shows its growing need.

The Guardian reported last September that doctors in England were told not to prescribe ADHD drugs to new patients because of a national shortage. The medications affected include four out of the five top stimulants prescribed to ADHD patients in the U.K.: methylphenidate, lisdexamfetamine, guanfacine,  and atomoxetine.

It’s been compared to the Adderall (amphetamine/dextroamphetamine salts) shortage impacting the U.S. U.S. brand-name drug makers behind Adderall, Vyvanse and Concerta are able to keep up with the shortage, but the generic versions of all three drugs are struggling to keep up. Is it time to panic? Even with these shortages in medication, doctors still say ADHD is under-diagnosed and patients are under-prescribed.

Some of them are turning to cannabis. BBC reports that a medical cannabis clinic said the U.K.’s medical cannabis industry had seen an 86% increase in ADHD patients nationally over the last year.

Some people believe cannabis can alleviate many of the symptoms associated with ADHD as research advances.

Medical Cannabis Is Better Than No Medicine

Medical cannabis, when prescribed by a registered specialist doctor, was legalized in the U.K., mostly in the form of oils and flower, in November 2018. Since then, treatments, including medical cannabis, that meet “appropriate standards” have been reclassified under Schedule 2, meaning that they have medical value. And while the U.K. has very limited availability for medical use, exports are another story: the U.K. was the world’s largest exporter of legal cannabis in 2016.

Research director Dr. Simon Erridge, who also works at Curaleaf Clinic, said it was “natural for people to explore other options” amid the shortage.

The Department of Health and Social Care (DHSC) told the BBC that while there were no cannabis-based medicines licensed for the treatment of ADHD on the NHS, specialist clinicians “can prescribe cannabis-based products where clinically appropriate and in the best interests of patients.”

“Other ADHD products remain available but cannot meet excessive increases in demand,” the DHSC alert states. “At present, the supply disruptions are expected to resolve at various dates between October and December 2023.”

Suddenly losing access to a stimulant-based drug that patients rely on leaves them with few options.

“A lot of people with ADHD may try a number of different medications to find the one that works best for them, if that is suddenly taken away by shortages it’s only natural for people to explore other options and there’s no reason why that might not include medical cannabis,” Erridge said.

Cannabis for ADHD

Depending on the person, cannabis can both help and distract people from focusing.

A January 2020 study called “Cannabinoid and Terpenoid Doses are Associated with Adult ADHD Status of Medical Cannabis Patients” arrived at mixed results, finding that whole-plant cannabis seemed to be more effective.

“The use of purified THC:CBD in a 1:1 ratio (nabiximols) showed no effect on ADHD symptom severity; however, in a qualitative study, 25% of responses indicated that whole-plant cannabis was therapeutic for ADHD,” researchers wrote. “Here, we demonstrated an association between higher CBN and lower ADHD symptoms frequency. It has been previously demonstrated that the combination of CBN and THC is associated with increased psycho-activity of THC in humans. This indicates a more complex story than simply stratifying treatment based on THC and CBD alone.”

Researchers acknowledged that there’s no one-size-fits-all solution to tackling ADHD when it comes to cannabis. 

“There is no ‘simplistic’ method for tracking only the dominant constituents of cannabis to better understand the medical potential of a cannabis cultivar,” researchers continued. “Thus, the novel perspective of our study is extremely valuable for the [medical cannabis] research field.”

Medical professionals who spoke to High Times for an October 2019 article agreed that ADHD treatments are not one-size-fits-all. Brooke Alpert is a licensed cannabis practitioner and founder of Daily Habit. Alpert touched on the correlation between CBD and ADHD. “The studies that focus on ADHD and CBD have shown some conflicting evidence.” 

She added, “I think more research needs to look at what relief people are finding with cannabis so we can have a better picture of how to further recommend CBD and cannabis for those with ADHD.”

Energizing strains like Sour Diesel, Jack Herer, Green Crack have been reported to actually have calming effects on people living with ADHD, even if they make others jittery.

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Anyone who is prescribed the ADHD and narcolepsy medication Adderall has been advised to seek alternative medication after a nationwide shortage was confirmed by the FDA last week, but the reasons behind the shortage remain a bit of a mystery.

The FDA didn’t give much of an explanation for the shortage other than to say one of the main manufacturers of Adderall (which is the brand name given to a particular combination of amphetamine and dextroamphetamine salts), Teva, was experiencing “ongoing intermittent manufacturing delays” and “other manufacturers continue to produce amphetamine mixed salts, but there is not sufficient supply to continue to meet U.S. market demand through those producers.”

The good news is, at the moment most of those delays are scheduled to be resolved by October or November, which is an updated ETA originally slated for March of 2023. This means we will likely avoid running out entirely. Nonetheless, the FDA did advise patients to seek alternative treatments all the same. 

A New York Times article cited the nationwide rise in ADHD as the main cause of the shortage, and it cannot be overstated that reported cases of ADHD are indeed on the rise. As a heavily regulated Schedule 2 drug, Adderall manufacture is often slow in response to demand because of the red tape required in order to produce it, so the rise in ADHD may indeed be to blame but in terms of the shortage of Adderall itself, it is likely a bit of a mixed bag.

The usual suspects when things are in short supply lately are COVID-related supply chain issues or the ongoing war in Ukraine, but Hamilton Morris, a journalist and scientific researcher known for his TV show Hamilton’s Pharmacopeia, indicated on Twitter that the Adderall shortage could be due to a shortage of nitroethane, one of the potential raw ingredients used to make it. One of the main distributors of nitroethane, Sigma Aldrich, has it listed as unavailable on their website. A phone call to the media department at Sigma Aldrich was, alas, not returned fast enough to meet my deadline.

Others disagreed, saying there’s no reason to believe there is a nitroethane shortage quite yet, but it would certainly explain things if it turns out to be true. Chemjobber, a blog dedicated to chemistry news and chemistry jobs, told High Times that while low nitroethane supply may be a potential factor, it’s essentially way more complicated than that.

“I strongly believe it is rarely API (active pharmaceutical ingredient) manufacturing that is the problem,” Chemjobber said. “That is a problem at the back of the chain, and there are 4-5 steps in front of it i.e. you could have a problem with tableting, or shipping, or labor etc.”

To that point, Teva did report earlier this year that they were having issues with labor shortages, a common complaint in the era of COVID-19. Thus, it’s not necessarily a shortage of one chemical as much as it seems to be a perfect storm of bad luck and the basic production limitations of any heavily regulated industry.

In terms of whether or not America will run out of Adderall, Chemjobber likened it to the toilet paper craze of early COVID and projected this too shall pass. It does also appear to be a good sign that Teva moved up its ETA by several months in the span of a week. Unfortunately, they didn’t call me back either.

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