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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Unfortunately, the same drugs with high potential for abuse are also the ones that work best for certain individuals with neurobehavioral conditions. According to GlobalData, penetrating the stimulant-dominated pharmaceutical market remains challenging without comparable efficacy from non-stimulants. 

The attention deficit hyperactivity disorder (ADHD) market is a lucrative business: Stimulants, amphetamines, and methylphenidates continue to dominate the ADHD drug market across the seven major markets, Express Pharma reports. (The seven major markets are in France, Germany, Italy, Spain, the UK, the US, and Japan.)

Non-addictive drugs demonstrate a “crippling lower” efficacy in treating ADHD.

Drug makers are in a race to develop safer alternatives. Three out of the four late-stage pipeline drug candidates in Phase III development within those markets have non-stimulant properties: Axsome Therapeutics Inc’s solriamfetol, Otsuka Pharmaceutical Co Ltd’s centanafadine and Neurocentria Inc’s L-Threonate Magnesium Salt. 

The lower abuse potential of solriamfetol and centanafadine is a major selling point created by developers, but without displaying efficacy comparable to stimulants, they will struggle to penetrate the market—even if they are approved.

The use of stimulants for ADHD treatment is increasing.

The key opinion leaders (KOLs) in the treatment of ADHD say that patients and parents have been hesitant to use stimulants for the treatment of ADHD in children and adolescents, but this is changing with time, and the use of stimulants for ADHD treatment is increasing.

“Marketing emphasis on abuse potential is common in non-stimulates both marketed and pipeline; this is despite KOLs viewing the abuse potential of ADHD stimulants as overstated,” said Lorraine Palmer, Pharma Analyst at GlobalData. “The KOLs interviewed by GlobalData were not concerned about whether a treatment is a stimulant or a non-stimulant, rather they are focused on the pharmaceuticals efficacy and side-effect profile.”

Four non-stimulants are commonly marketed: guanfacine, clonidine, atomoxetine and viloxazine. Sleep disturbances and a decreased appetite have been reported from both clonidine and atomoxetine. 

“All four display cripplingly lower efficacy in the treatment of ADHD than stimulants,” Express Pharma reports.

“Rather than an emphasis on abuse potential, a better alternative strategy to penetrate the saturated ADHD market would be to target key unmet needs in ADHD treatment such as improving compliance or providing coverage into the evening without affecting sleep.”

Part of this challenge likely includes the impact of addiction itself.  Regarding the popular ADHD drug Adderall, adults and children 6 years of age and older are eligible to take Adderall, beginning at 5 milligrams, while children 3 to 5 years of age are able to start at 2.5 mg per day. Only children under the age of 3 are prohibited from being prescribed the drug in all cases.

Adderall’s active ingredients are dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate and amphetamine sulfate. Columbia University psychiatry professor Carl Hart famously wrote for Vice in 2016 that meth is “almost identical to Adderall” in terms of chemistry and its effects on the brain.

A 2016 study published in the Journal of Clinical Psychiatry indicates that an increasing number of young adults have been checking into emergency rooms over the past few years due to accidental overdoses on Adderall and similar drugs.

Other Reasons for Stimulant Alternatives

High Times reported last September that leading drug makers and pharmaceutical companies are having little luck addressing nationwide shortages of stimulant-based ADHD medications like Adderall, Vyvanse, and Ritalin.

The Adderall shortage began in Fall of 2022, marked by an FDA notice acknowledging the shortages with an estimate that things would be resolved in a month or two. That is not the case, however, as issued a joint notice on August 1 acknowledging that the shortage had been “understandably frustrating” for patients and providers.

“The current shortage of stimulant medications is the result of many factors. It began last fall due to a manufacturing delay experienced by one drug maker,” the joint notice said. “While this delay has since resolved, we are continuing to experience its effects in combination with record-high prescription rates of stimulant medications. Data show that, from 2012 to 2021, overall dispensing of stimulants (including amphetamine products and other stimulants) increased by 45.5 percent in the United States.” 

Teva Pharmaceuticals, Adderall’s biggest manufacturer, reported shortfalls. Teva CEO Richard Francis told Bloomberg that the company is operating at “full capacity” at the moment and blamed their decreased output in previous years to COVID-induced work shortages which they have only just barely recovered from. Should they wish to increase the amount of Adderall they produce, they would have to buy or build more factories as their current infrastructure cannot handle bigger output. The company has declined to comment on whether or not they plan to invest in such infrastructure.

This adds to the multiple reasons less addictive non-stimulant drugs are needed to treat ADHD.

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