Saturday, September 16th 2017
New Mexico State Department of Health
Medical Cannabis Advisory Board
Medical Cannabis Program
PO Box 26110
Santa Fe, NM, 87502-6110
Medical Cannabis Program
PO Box 26110
Santa Fe, NM, 87502-6110
Petition: Requesting The Inclusion Of A New Medical Condition(s): ADD/ADHD And Tourette's Syndrome
Table of Contents
Pg. 1 Cover Page
Pg. 2 Petition Introduction
Pg. 3 Petition Purpose and Background
Pg. 20 Relief Requested In Petition
Pg. 20-21 References
Pg. 21-22 Appendix A
Petition: Requesting The Inclusion Of A New Medical Condition(s): ADD/ADHD And Tourette's Syndrome
New Mexico’s medical cannabis history started in 1978, after public hearings the legislature enacted H.B. 329, the nation’s first law recognizing the medical value of cannabis. The New Mexico’s medical cannabis program (MCP) is the only program in the U.S. that places sole responsibility for regulation on the state’s Department of Health. Doctors must comply with state requirements for patients to be considered for applying to the medical cannabis program.
In the Lynn and Erin Compassionate Use Act, (2007) the law states; The Secretary of Health shall establish an advisory board consisting of eight practitioners representing the fields of neurology, pain management, medical oncology, psychiatry, infectious disease, family medicine and gynecology. The practitioners shall be nationally board-certified in their area of specialty and knowledgeable about the medical use of cannabis. The members shall be chosen for appointment by the Secretary from a list proposed by the New Mexico Medical Society. A quorum of the advisory board shall consist of three members. The advisory board shall:
A. review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis;
B. accept and review petitions to add medical conditions, medical treatments or diseases to the list of debilitating medical conditions that qualify for the medical use of cannabis;
C. convene at least twice per year to conduct public hearings and to evaluate petitions, which shall be maintained as confidential personal health information, to add medical conditions, medical treatments or diseases to the list of debilitating medical conditions that qualify for the medical use of cannabis;
D. issue recommendations concerning rules to be promulgated for the issuance of the registry identification cards; and
E. recommend quantities of cannabis that are necessary to constitute an adequate supply for qualified patients and primary caregivers.
First, do no harm. As an important step in becoming a doctor, medical students must take the Hippocratic Oath. And one of the promises within that oath is “first, do no harm”.
A. review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis;
B. accept and review petitions to add medical conditions, medical treatments or diseases to the list of debilitating medical conditions that qualify for the medical use of cannabis;
C. convene at least twice per year to conduct public hearings and to evaluate petitions, which shall be maintained as confidential personal health information, to add medical conditions, medical treatments or diseases to the list of debilitating medical conditions that qualify for the medical use of cannabis;
D. issue recommendations concerning rules to be promulgated for the issuance of the registry identification cards; and
E. recommend quantities of cannabis that are necessary to constitute an adequate supply for qualified patients and primary caregivers.
First, do no harm. As an important step in becoming a doctor, medical students must take the Hippocratic Oath. And one of the promises within that oath is “first, do no harm”.
We have a sound law in the Lynn and Erin Compassionate Use Act, as Section 2 reads; PURPOSE OF ACT.--The purpose of the Lynn and Erin Compassionate Use Act is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments.
“ARTICLE 2B. LYNN AND ERIN COMPASSIONATE USE ACT
N.M. Stat. Ann. § 26-2B-2 (2009)
§ 26-2B-2. Purpose of act
The purpose of the Lynn and Erin Compassionate Use Act [26-2B-1 NMSA 1978] is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments.
HISTORY: Laws 2007, ch. 210, § 2.
EFFECTIVE DATES. --Laws 2007, ch. 210, § 12 makes the act effective July 1, 2007.”
Mosby’s Medical Dictionary states that “medical treatment” means; the management and care of a patient to combat disease or disorder. Medical treatment includes: Using prescription medications, or use of a non-prescription drug at prescription strength; and or treatment of disease by hygienic and pharmacologic remedies, as distinguished from invasive surgical procedures. Treatment may be pharmacologic, using drugs; surgical, involving operative procedures; or supportive, building the patient's strength. It may be specific for the disorder, or symptomatic to relieve symptoms without effecting a cure.(Mosby's Medical Dictionary, 9th edition.)
What is a chronic medical condition?
A chronic disease is one lasting 3 months or more, by the definition of the U.S. National Center for Health Statistics. Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor do they just disappear. Harvard Medical Dictionary defines chronic as: Any condition that lasts a long time or recurs over time; chronic pain as: Pain that persists after an injury has healed or a disease is over; and chronic pain syndrome as : Long-term, severe pain that doesn't spring from an injury or illness, that interferes with daily life, and is often accompanied by other problems, such as depression, irritability, and anxiety.
A chronic disease is one lasting 3 months or more, by the definition of the U.S. National Center for Health Statistics. Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor do they just disappear. Harvard Medical Dictionary defines chronic as: Any condition that lasts a long time or recurs over time; chronic pain as: Pain that persists after an injury has healed or a disease is over; and chronic pain syndrome as : Long-term, severe pain that doesn't spring from an injury or illness, that interferes with daily life, and is often accompanied by other problems, such as depression, irritability, and anxiety.
What is the meaning of debilitating?
Something that's debilitating seriously affects someone or something's strength or ability to carry on with regular activities, like a debilitating illness. Debilitating comes from the Latin word debilis, meaning "weak." That's why you'll often see the adjective used to describe illness, despite the negative reference.
Something that's debilitating seriously affects someone or something's strength or ability to carry on with regular activities, like a debilitating illness. Debilitating comes from the Latin word debilis, meaning "weak." That's why you'll often see the adjective used to describe illness, despite the negative reference.
Petition Purpose and Background
The purpose of this Petition: Requesting The Inclusion Of A New Medical Condition(s): ADD/ADHD And Tourette's Syndrome
This Petition: Requesting The Inclusion Of A New Medical Condition(s): ADD/ADHD And Tourette's Syndrome is being provided to the state Department of Health Medical Cannabis Program so the advisory board can review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis with the Lynn and Erin Compassionate Use Act.
Who Should Qualify for Medical Cannabis Use?
According to Americans For Safe Access Policy Studies & Research:
Background: The most fundamental aspect of medical cannabis laws is the relationship between a patient and their physician. It is often only the physician and the patient that possess information about a patient’s health condition. However, many public officials and others who oppose medical cannabis laws often make assumptions about people’s health. The media have even fomented such inappropriate assumptions by naming a category of patients “Young Able Bodied Males,” condemning certain patients by visual assessment alone.
Findings: The health care information discussed between a patient and physician is considered private and protected under federal HIPAA laws. It is typically the purview of state medical boards to assess whether a physician has inappropriately recommended cannabis to someone who should not be qualified. Studies have shown in some medical cannabis states that the majority of patients suffer from chronic pain, an ailment that is not obviously detectable by another person. Nevertheless, police will often harass and arrest patients based on the assumption that someone is faking their illness.
Position: Medical professionals should have an unrestricted ability to recommend cannabis therapeutics and that should not be impacted by law enforcement’s perceptions.
According to Americans For Safe Access Policy Studies & Research:
Background: The most fundamental aspect of medical cannabis laws is the relationship between a patient and their physician. It is often only the physician and the patient that possess information about a patient’s health condition. However, many public officials and others who oppose medical cannabis laws often make assumptions about people’s health. The media have even fomented such inappropriate assumptions by naming a category of patients “Young Able Bodied Males,” condemning certain patients by visual assessment alone.
Findings: The health care information discussed between a patient and physician is considered private and protected under federal HIPAA laws. It is typically the purview of state medical boards to assess whether a physician has inappropriately recommended cannabis to someone who should not be qualified. Studies have shown in some medical cannabis states that the majority of patients suffer from chronic pain, an ailment that is not obviously detectable by another person. Nevertheless, police will often harass and arrest patients based on the assumption that someone is faking their illness.
Position: Medical professionals should have an unrestricted ability to recommend cannabis therapeutics and that should not be impacted by law enforcement’s perceptions.
“Qualifying medical condition” shall mean any condition for which treatment with medical cannabis would be beneficial, as determined by a patient's qualified medical professional, including but not limited to cancer, glaucoma, positive status for human immunodeficiency virus, acquired immune deficiency syndrome (AIDS), hepatitis C, amyotrophic lateral sclerosis (ALS), Crohn’s disease, Parkinson’s disease, post-traumatic stress disorder, arthritis, chronic pain, neuropathic and other intractable chronic pain, and multiple sclerosis.
“Qualifying patient” shall mean a person who has a written recommendation from a qualified medical professional for the medical use of cannabis.
ADD/ADHD And Tourette's Syndrome
Tic Disorders and Tourette Syndrome
From the Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)
From the Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)
The Diagnostic and Statistical Manual, Fifth Edition (DSM 5), outlines the symptoms of three tic disorders: provisional tic disorder, persistent (chronic) motor or vocal tic disorder, and Tourette’s disorder. Each of these disorders is characterized by the presence of motor or vocal tics, and which disorder is diagnosed is determined by the severity of the symptoms. The most severe of these is Tourette’s disorder or Tourette’s Syndrome.
Tourette Syndrome is a complex, genetically inherited disorder whose primary symptoms include tics (both motor and vocal) lasting for more than one year, beginning before age 18. Tourette Syndrome is usually mild, and a large number of patients tend to improve as they get older. Tourette Syndrome is often accompanied by other conditions including ADHD and obsessive-compulsive disorder in more than half of the patients as well as learning disabilities and mood disorders. More than half (57.1 percent) of patients with Tourette Syndrome have a family history of the disorder.
Tics or Tourette Syndrome
ADHD frequently co-occurs in children with Tourette Syndrome. Less than 10 percent of those with ADHD have Tourette’s, but 60 to 80 percent of children with Tourette Syndrome have ADHD. The ADHD diagnosis usually precedes the onset of the motor or vocal tics of Tourette’s, although sometimes the two occur together. Some children with ADHD may develop a simple motor tic disorder that first appears during the course of their treatment for ADHD. While these two conditions appear linked in time, most experts believe that the co-occurrence in most cases is purely coincidental and not caused by ADHD or its treatment.
ADHD frequently co-occurs in children with Tourette Syndrome. Less than 10 percent of those with ADHD have Tourette’s, but 60 to 80 percent of children with Tourette Syndrome have ADHD. The ADHD diagnosis usually precedes the onset of the motor or vocal tics of Tourette’s, although sometimes the two occur together. Some children with ADHD may develop a simple motor tic disorder that first appears during the course of their treatment for ADHD. While these two conditions appear linked in time, most experts believe that the co-occurrence in most cases is purely coincidental and not caused by ADHD or its treatment.
ADD/ADHD
ADD is considered an outdated term for ADHD. Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders. ADHD is a broad term, and the condition can vary from person to person. There are an estimated 6.4 million diagnosed children in the United States, according to the Centers for Disease Control and Prevention.
This condition is sometimes called attention deficit disorder (ADD), but this is an outdated term. The term was once used to refer to someone who had trouble focusing but was not hyperactive. The American Psychiatric Association released the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in May 2013. The DSM-5 changed the criteria to diagnose someone with ADHD.
1. Inattentive - Inattentive ADHD is what’s usually meant when someone uses the term ADD. This means a person shows enough symptoms of inattention (or easy distractibility) but isn’t hyperactive or impulsive.
2. Hyperactive/impulsive - This type occurs when a person has symptoms of hyperactivity and impulsivity but not inattention.
3. Combined - Combined ADHD is when a person has symptoms of inattention, hyperactivity, and impulsivity.
Inattention, hyperactivity, and impulsivity are important symptoms for an ADHD diagnosis. In addition, a child or adult must meet the following criteria to be diagnosed with ADHD:
- displays several symptoms before the age of 12
- has symptoms in more than one setting, such as school, at home, with friends, or during other activities
- shows clear evidence that the symptoms interfere with their functioning at school, work, or in social situations
Adults with ADHD have typically had the disorder since childhood, but it may not be diagnosed until later in life. An evaluation usually occurs at the prompting of a peer, family member, or co-worker who observes problems at work or in relationships.
Adults can have any of the three subtypes of ADHD. Adult ADHD symptoms can differ from those of children because of the relative maturity of adults, as well as physical differences between adults and children.
The symptoms of ADHD can range from mild to severe, depending on a person’s unique physiology and environment. Some people are mildly inattentive or hyperactive when they perform a task they don’t enjoy, but they have the ability to focus on tasks they like. Others may experience more severe symptoms. These can affect school, work, and social situations.
Symptoms are often more severe in unstructured group situations than in structured situations with rewards. For example, a playground is a more unstructured group situation. A classroom may represent a structured and rewards-based environment.
Some people report that symptoms go away with age. An adult with ADHD who was hyperactive as a child may find that they’re now able to remain seated or curb some impulsivity.
What is a tic?
Tics are defined as sudden, rapid, non-rhythmic movements or sounds that people do repeatedly. They may commonly include such behaviors as eye blinking, mouth opening, sniffing or throat clearing. Tics are common in childhood but do not continue into adulthood in most cases. Males are more affected than females in a ratio of 4.4 to 1. The occurrence of tics can be temporary, lasting less than 12 months, or chronic.
Tics can be either simple or complex. Simple tics are short in duration and involve a single muscle group. Complex tics are longer in duration and often include a series of simple tics. Motor tics may range from simple movements such as eye blinking, lip licking, or mouth opening to more complex movements like facial grimacing, head movements, shoulder shrugging or combinations of these. Vocal tics many include throat clearing; coughing; barking; unnecessary belching; or more complex vocalizations such as repeating parts of words or phrases or, in rare cases, saying obscene words.
Medication Currently Used
If you’re taking medicine for ADHD or Tourette’s, what you’re taking likely is a controlled substance. That means that the federal government regulates how the drug is made, prescribed, and dispensed.
If you’re taking medicine for ADHD or Tourette’s, what you’re taking likely is a controlled substance. That means that the federal government regulates how the drug is made, prescribed, and dispensed.
The majority of ADHD stimulant medications, such as dextroamphetamine-amphetamine (Adderall, Adderall XR), lisdexamfetamine (Vyvanse), and methylphenidate (Ritalin), fall into the Schedule II category. They're legal, but they’re considered dangerous because of their high risk of abuse and dependence. Other Schedule II drugs include painkillers like OxyContin and Vicodin.(2)
After a proper assessment and trying behavior therapy, medication may still be necessary in children with ADHD and Tourette Syndrome. Mild symptoms can usually be treated with clonidine or guanfacine. Clonidine can be given by skin patch or in pill form. Clonidine or guanfacine have the advantage of treating all the symptoms of TS―the tics, the ADHD, obsessive-compulsive behaviors, and oppositional and other behaviors. The major side effect of these two medications is falling asleep or tiredness if the dose is too high or raised too rapidly.
Any treatment with stimulant medications should be closely monitored for side effects, especially the presence or increase of tics. In the past, the use of stimulants had not been recommended when tics or Tourette Syndrome was present; however, recent studies report that short-term use of stimulant medications, especially methylphenidate (Ritalin, Concerta), seem to be safe and well tolerated in children with chronic tics or Tourette Syndrome with co-occurring ADHD. Children who were given methylphenidate did not develop more frequent tics when compared with those who were not given the medication. However, frequency of tics seems to be higher with dextroamphetamines (Dexedrine, ProCentra) than compared with methylphenidate.
If a child has already been diagnosed and treated with stimulants and significant tics develop, the physician may elect to stop treatment with stimulants, decrease the dose or change to other stimulant medication until the tics are treated and under control. In some cases, the benefits of the stimulant medication outweigh the mild impact of the tics. Other medications may also benefit the ADHD symptoms and have some impact over the tics.
Any treatment with stimulant medications should be closely monitored for side effects, especially the presence or increase of tics. In the past, the use of stimulants had not been recommended when tics or Tourette Syndrome was present; however, recent studies report that short-term use of stimulant medications, especially methylphenidate (Ritalin, Concerta), seem to be safe and well tolerated in children with chronic tics or Tourette Syndrome with co-occurring ADHD. Children who were given methylphenidate did not develop more frequent tics when compared with those who were not given the medication. However, frequency of tics seems to be higher with dextroamphetamines (Dexedrine, ProCentra) than compared with methylphenidate.
If a child has already been diagnosed and treated with stimulants and significant tics develop, the physician may elect to stop treatment with stimulants, decrease the dose or change to other stimulant medication until the tics are treated and under control. In some cases, the benefits of the stimulant medication outweigh the mild impact of the tics. Other medications may also benefit the ADHD symptoms and have some impact over the tics.
Hallucinations such as seeing snakes, insects, or worms that aren't there are another rare side effect of some ADHD medications. And some kids have dramatic behavior changes, ranging from extremely angry, aggressive, anxious, or manic to emotionally flat and unresponsive.
Stimulant medications on the market today, such as Adderall, Ritalin, Concerta, Metadate, Vyvanse, Focalin, Daytrana, are all variations on just two molecules, amphetamine and methylphenidate. Both amphetamine and methylphenidate mimic the action of dopamine in the brain. Many scholarly studies - some of which are listed below - have now demonstrated that methylphenidate and amphetamine can cause lasting changes to those areas of the developing brain where dopamine receptors are found. The disrupting effects appear to be centered on the nucleus accumbens. This is not surprising, because the nucleus accumbens has a high density of dopamine receptors. (3)
William Carlezon at Harvard was one of the early leading investigators in this field. You might begin by reading three of his papers on this topic:
• Carlezon, Mague, and Andersen, “Enduring behavioral effects of early exposure to methylphenidate in rats,” Biological Psychiatry, 2003, 54:1330-1337.
• Carlezon and Konradi, “Understanding the neurobiological consequences of early exposure to psychotropic drugs,” Neuropharmacology, 2004, 47 Suppl 1:47-60
• Mague, Andersen, and Carlezon, “Early developmental exposure to methylphenidate reduces cocaine-induced potentiation of brain stimulation reward in rats,” Biological Psychiatry, 2005, 57:120-125.
More recently, Dr. Carlezon has written a recent review emphasizing the role of the nucleus accumbens in motivation: see his paper, “Biological substrates of reward and aversion: a nucleus accumbens activity hypothesis,” Neuropharmacology, 2009, 56 Supp 1:122-132.
Terry Robinson and Bryan Kolb at the University of Michigan were among the first to demonstrate that low-dose amphetamine leads to damage to dendrites and dendritic spines in the nucleus accumbens. They reviewed this emerging field in their article "Structural plasticity associated with exposure to drugs of abuse,” Neuropharmacology, 2004, 47:33-46. They first documented this finding in their 1997 paper, “Persistent structural modifications in nucleus accumbens and prefrontal cortex neurons produced by previous experiences with amphetamine,” Journal of Neuroscience, 17:8491-8497.
Other relevant articles include:
• S. P. Onn and A. A. Grace, “Amphetamine Withdrawal Alters Bistable States and Cellular Coupling in Rat Prefrontal Cortex and Nucleus Accumbens Neurons Recorded in Vivo”, Journal of Neuroscience, volume 20, pp. 2332–2345, 2000.
• Y. Li and J. A. Kauer, “Repeated Exposure to Amphetamine Disrupts Dopaminergic Modulation of Excitatory Synaptic Plasticity and Neurotransmission in Nucleus Accumbens,” Synapse, volume 51, pp. 1–10, 2004.
• R. Diaz-Heijtz, B. Kolb, and H. Forssberg, “Can a Therapeutic Dose of Amphetamine During Pre-adolescence Modify the Pattern of Synaptic Organization in the Brain?” European Journal of Neuroscience, volume 18, pp. 3394–3399, 2003.
• Louk J. Vanderschuren, E. Donné Schmidt, T. J. De Vries, et al., “ A Single Exposure to Amphetamine is Sufficient to Induce Long-term Behavioral, Neuroendocrine, and Neurochemical Sensitization in Rats,” Journal of Neuroscience, volume 19, pp. 9579–9586, 1999.
Those are some of the “classic” studies on this topic. For more recent updates, you might begin by reading:
· Russo et al., 2010: “The addicted synapse: mechanisms of synaptic and structural plasticity in the nucleus accumbens,” Trends in Neuroscience, 33:267 – 276.
· Mameli & Lüscher, 2011: “Synaptic plasticity and addiction: learning mechanisms gone awry,” Neuropharmacology, 61:1052-1059.
· Margery Pardey et al., 2012 “Long-term effects of chronic oral Ritalin administration on cognitive and neural development in adolescent Wistar Kyoto Rats”, Brain Sciences, 2:375-404.
· Esther Gramage et al., 2013, “Periadolescent amphetamine treatment causes transient cognitive disruptions and long-term changes in hippocampal LTP”, Addiction Biology, 18:19-29.
Studies like these strongly suggest that even short-term, low-dose exposure to amphetamine or to methylphenidate, particularly in the juvenile brain, may induce long-lasting changes both neurally (particularly in the nucleus accumbens and hippocampus) and behaviorally. In some studies, e.g. a 2010 report from Canada, the effects are dramatic in the juvenile or adolescent, but absent in the adult brain. Remember that in humans, longitudinal studies suggest that females do not reach full maturity in terms of brain development until about 20 to 22 years of age; males do not reach full maturity in terms of brain development until 28 to 30 years of age.(3)
Related Clinical Information to ADHD, Tourette Syndrome, and Medical Cannabis
Case Report - Cannabis improves symptoms of ADHD
By Peter Strohbeck-Kuehner, Gisela Skopp, Rainer Mattern
Institute of Legal- and Traffic Medicine, Heidelberg University Medical Centre, Voss Str. 2, D-69115 Heidelberg, Germany
By Peter Strohbeck-Kuehner, Gisela Skopp, Rainer Mattern
Institute of Legal- and Traffic Medicine, Heidelberg University Medical Centre, Voss Str. 2, D-69115 Heidelberg, Germany
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is characterized by attention deficits and an altered
activation level. The purpose of this case investigation was to highlight that people with
ADHD can benefit in some cases from the consumption of THC. A 28-year old male, who showed
improper behaviour and appeared to be very maladjusted and inattentive while sober, appeared to
be completely inconspicuous while having a very high blood plasma level of delta-9-
tetrahydrocannabinol (THC). Performance tests, which were conducted with the test batteries
ART2020 and TAP provided sufficient and partly over-averaged results in driving related performance.
Thus, it has to be considered, that in the case of ADHD, THC can have atypical effects
and can even lead to an enhanced driving related performance.
Keywords: ADHD, cannabis, performance, driving
Attention-deficit/hyperactivity disorder (ADHD) is characterized by attention deficits and an altered
activation level. The purpose of this case investigation was to highlight that people with
ADHD can benefit in some cases from the consumption of THC. A 28-year old male, who showed
improper behaviour and appeared to be very maladjusted and inattentive while sober, appeared to
be completely inconspicuous while having a very high blood plasma level of delta-9-
tetrahydrocannabinol (THC). Performance tests, which were conducted with the test batteries
ART2020 and TAP provided sufficient and partly over-averaged results in driving related performance.
Thus, it has to be considered, that in the case of ADHD, THC can have atypical effects
and can even lead to an enhanced driving related performance.
Keywords: ADHD, cannabis, performance, driving
This article can be downloaded, printed and distributed freely for any non-commercial purposes, provided the original work is properly cited (see copyright info below). Available online at www.cannabis-med.org (http://cannabis-med.org/data/pdf/en_2008_01_1.pdf)
Author's address: Peter Strohbeck-Kuehner, peter.strohbeck@med.uni-heidelberg.de
Author's address: Peter Strohbeck-Kuehner, peter.strohbeck@med.uni-heidelberg.de
Subtypes of attention deficit-hyperactivity disorder (ADHD) and cannabis use.
Abstract
The current study examined the association between subtypes of attention-deficit/hyperactivity disorder (ADHD) and cannabis use within a sample of 2811 current users. Data were collected in 2012 from a national U.S. survey of cannabis users. A series of logistic regression equations and chi-squares were assessed for proportional differences between users. When asked about the ADHD symptoms they have experienced when not using cannabis, a higher proportion of daily users met symptom criteria for an ADHD diagnoses of the subtypes that include hyperactive-impulsive symptoms than the inattentive subtype. For nondaily users, the proportions of users meeting symptom criteria did not differ by subtype. These results have implications for identifying which individuals with ADHD might be more likely to self-medicate using cannabis. Furthermore, these findings indirectly support research linking relevant cannabinoid receptors to regulatory control.
PMID:24093525 DOI: 10.3109/10826084.2013.841251 https://www.ncbi.nlm.nih.gov/pubmed/24093525
Impact of ADHD and cannabis use on executive functioning in young adults.
Tamm L1, Epstein JN, Lisdahl KM, Molina B, Tapert S, Hinshaw SP, Arnold LE, Velanova K, Abikoff H, Swanson JM; MTA Neuroimaging Group. Collaborators (28) Author information
Abstract
BACKGROUND:
Attention-deficit/hyperactivity disorder (ADHD) and cannabis use are each associated with specific cognitive deficits. Few studies have investigated the neurocognitive profile of individuals with both an ADHD history and regular cannabis use. The greatest cognitive impairment is expected among ADHD Cannabis Users compared to those with ADHD-only, Cannabis use-only, or neither.
METHODS:
Young adults (24.2 ± 1.2 years) with a childhood ADHD diagnosis who did (n=42) and did not (n=45) report past year ≥ monthly cannabis use were compared on neuropsychological measures to a local normative comparison group (LNCG) who did (n=20) and did not (n=21) report past year regular cannabis use. Age, gender, IQ, socioeconomic status, and past year alcohol and smoking were statistical covariates.
RESULTS:
The ADHD group performed worse than LNCG on verbal memory, processing speed, cognitive interference, decision-making, working memory, and response inhibition. No significant effects for cannabis use emerged. Interactions between ADHD and cannabis were non-significant. Exploratory analyses revealed that individuals who began using cannabis regularly before age 16 (n=27) may have poorer executive functioning (i.e., decision-making, working memory, and response inhibition), than users who began later (n=32); replication is warranted with a larger sample.
CONCLUSIONS:
A childhood diagnosis of ADHD, but not cannabis use in adulthood, was associated with executive dysfunction. Earlier initiation of cannabis use may be linked to poor cognitive outcomes and a significantly greater proportion of the ADHD group began using cannabis before age 16. Regular cannabis use starting after age 16 may not be sufficient to aggravate longstanding cognitive deficits characteristic of ADHD
https://www.ncbi.nlm.nih.gov/pubmed/23992650
Cannabinoids in attention-deficit/hyperactivity disorder: A randomised-controlled trial.
Abstract
Adults with ADHD describe self-medicating with cannabis, with some reporting a preference for cannabis over ADHD medications. A small number of psychiatrists in the US prescribe cannabis medication for ADHD, despite there being no evidence from randomised controlled studies. The EMA-C trial (Experimental Medicine in ADHD-Cannabinoids) was a pilot randomised placebo-controlled experimental study of a cannabinoid medication, Sativex Oromucosal Spray, in 30 adults with ADHD. The primary outcome was cognitive performance and activity level using the QbTest. Secondary outcomes included ADHD and emotional lability (EL) symptoms. From 17.07.14 to 18.06.15, 30 participants were randomly assigned to the active (n=15) or placebo (n=15) group. For the primary outcome, no significant difference was found in the ITT analysis although the overall pattern of scores was such that the active group usually had scores that were better than the placebo group (Est=-0.17, 95%CI-0.40 to 0.07, p=0.16, n=15/11 active/placebo). For secondary outcomes Sativex was associated with a nominally significant improvement in hyperactivity/impulsivity (p=0.03) and a cognitive measure of inhibition (p=0.05), and a trend towards improvement for inattention (p=0.10) and EL (p=0.11). Per-protocol effects were higher. Results did not meet significance following adjustment for multiple testing. One serious (muscular seizures/spasms) and three mild adverse events occurred in the active group and one serious (cardiovascular problems) adverse event in the placebo group. Adults with ADHD may represent a subgroup of individuals who experience a reduction of symptoms and no cognitive impairments following cannabinoid use. While not definitive, this study provides preliminary evidence supporting the self-medication theory of cannabis use in ADHD and the need for further studies of the endocannabinoid system in ADHD. Copyright © 2017 Elsevier B.V. and ECNP. All rights reserved. KEYWORDS: Attention deficit-hyperactivity disorder; Cannabinoids; Randomised-controlled trial; Self-medication PMID: 28576350 DOI: 10.1016/j.euroneuro.2017.05.005 https://www.ncbi.nlm.nih.gov/pubmed/28576350
Delta 9-tetrahydrocannabinol (THC) is effective in the treatment of tics in Tourette syndrome: a 6-week randomized trial. Müller-Vahl KR1, Schneider U, Prevedel H, Theloe K, Kolbe H, Daldrup T, Emrich HM. Author information
Abstract
BACKGROUND: Preliminary studies suggested that delta-9-tetrahydrocannabinol (THC), the major psychoactive ingredient of Cannabissativa L., might be effective in the treatment of Tourette syndrome (TS). This study was performed to investigate for the first time under controlled conditions, over a longer-term treatment period, whether THC is effective and safe in reducing tics in TS.
METHOD: In this randomized, double-blind, placebo-controlled study, 24 patients with TS, according to DSM-III-R criteria, were treated over a 6-week period with up to 10 mg/day of THC. Tics were rated at 6 visits (visit 1, baseline; visits 2-4, during treatment period; visits 5-6, after withdrawal of medication) using the Tourette Syndrome Clinical Global Impressions scale (TS-CGI), the Shapiro Tourette-Syndrome Severity Scale (STSSS), the Yale Global Tic Severity Scale (YGTSS), the self-rated Tourette Syndrome Symptom List (TSSL), and a videotape-based rating scale.
RESULTS: Seven patients dropped out of the study or had to be excluded, but only 1 due to side effects. Using the TS-CGI, STSSS, YGTSS, and video rating scale, we found a significant difference (p <.05) or a trend toward a significant difference (p <.10) between THC and placebo groups at visits 2, 3, and/or 4. Using the TSSL at 10 treatment days (between days 16 and 41) there was a significant difference (p <.05) between both groups. ANOVA as well demonstrated a significant difference (p =.037). No serious adverse effects occurred.
CONCLUSION: Our results provide more evidence that THC is effective and safe in the treatment of tics. It, therefore, can be hypothesized that the central cannabinoid receptor system might play a role in TS pathology. (https://www.ncbi.nlm.nih.gov/pubmed/12716250)
Cannabinoids: possible role in patho-physiology and therapy of Gilles de la Tourette syndrome.
Abstract
High densities of cannabinoid receptors were found in the basal ganglia and hippocampus, indicating a putative functional role of cannabinoids in movement and behaviour. Anecdotal reports suggested beneficial effects of marijuana in Tourette's syndrome (TS). We therefore interviewed 64 TS patients with regard to use of marijuana and its influence on TS symptomatology. Of 17 patients (27%) who reported prior use of marijuana, 14 subjects (82%) experienced a reduction or complete remission of motor and vocal tics and an amelioration of premonitory urges and obsessive-compulsive symptoms. Our results provide more evidence that marijuana improves tics and behavioural disorders in TS. It can be speculated that cannabinoids might act through specific receptors, and that the cannabinoid system might play a major role in TS pathology. (https://www.ncbi.nlm.nih.gov/pubmed/9879795)
Article: Cannabis and Tourette Syndrome By Dustin Sulak, DO
(Dustin Sulak, D.O. is a renowned integrative medicine physician based in Maine, whose practice balances the principles of osteopathy, mind-body medicine and medical cannabis. Regarded as an expert on medical cannabis nationally, Dr. Sulak educates medical providers and patients on its clinical use, while continuing to explore the therapeutic potential of this ancient yet emerging medicine.)
Dr. Sulak received undergraduate degrees in nutrition science and biology from Indiana University, a doctorate of osteopathy from the Arizona College of Osteopathic Medicine, and completed an internship at Maine-Dartmouth Family Medicine Residency.
Dr. Sulak received undergraduate degrees in nutrition science and biology from Indiana University, a doctorate of osteopathy from the Arizona College of Osteopathic Medicine, and completed an internship at Maine-Dartmouth Family Medicine Residency.
Tourette Syndrome is a common genetic neurological disorder characterized by chronic motor and vocal tics. Affected individuals typically have repetitive, stereotyped movements or vocalizations, such as blinking, sniffing, facial movements, or tensing of the abdomen.
Other manifestations include attention-deficit-hyperactivity disorder, obsessive-compulsive disorder, poor impulse control, and other behavioral problems. Symptoms vary significantly from one patient to another, and the tics are often not the most disabling features of this condition.
While the mechanism of Tourette syndrome remains unknown, research suggests that it is an inherited, developmental disorder of neurotransmission. This disorder affects approximately 1% of the population, and is 5 times more common in males. Symptoms range in severity from annoying to disabling.
Patients with loud vocalizations or large movements either endure substantial criticism or withdraw from many activities. Prejudice in work and school settings is common. Inadvertent injuries, such as broken bones and joint degeneration can also occur after years of simple yet repetitive tics. Accidents are common.
Current treatments of Tourette syndrome are purely symptomatic. No curative or preventive treatments are known. Medications have been used to treat tics, ADHD, OCD, and aggression. These include antipsychotics, dopamine-depleting agents, antihypertensive agents, skeletal muscle relaxants, benzodiazepines, SSRIs at 3-4 times the antidepressant dose, and Botox injections. Neurosurgery is performed in severe cases. All of these treatments carry significant risk and, sadly, offer limited benefit. Many medical authors encourage physicians avoid treating Tourette syndrome with pharmaceutical agents unless the symptoms are debilitating.
A significant body of scientific evidence suggests that the compounds found in cannabis can relieve symptoms of Tourette syndrome.
Animal studies demonstrate that cannabinoids specifically affect the basal ganglia and other areas of the brain known to be involved in Tourette syndrome.
Multiple case reports of patients using cannabis to reduce or eliminate tics and obsessive-compulsive behaviors have been published. One study found that cannabinoids could enhance the effectiveness of antipsychotic medications in this condition.
The randomized, double blind, placebo controlled trial is considered the gold standard in clinic trials for treatment efficacy. Two have been published that evaluated the efficacy of THC in the treatment of Tourette syndrome. The first, which included 12 adult patients, found that 10 of them experienced significant improvement in their symptoms after a single dose of THC, ranging from 20-90% reduction in symptom severity. Another study of 24 patients found similar improvements with no detrimental effects on cognition; verbal memory span actually improved in the cannabis group.
The acute effects of cannabis and THC are well documented, and are considered safer than most of the medications currently used in the treatment of Tourette syndrome. The lethal dose of cannabis and THC in humans is unknown and there are no reported deaths caused directly by cannabis toxicity.
I have personally seen cannabis help in debilitating cases of Tourette syndrome, after other medications had failed.
I would like to share a personal story. My best friend during ages 10-14, gradually developed Tourette syndrome right before my eyes. At first doctors thought he had postnasal drip or acid reflux. Over time, we joked that he was a one-man orchestra. The tics and obsessive-compulsive behavior worsened; the whole family suffered, and eventually he was no longer able to effectively function in a mainstream school environment. He left high school midway through freshman year and moved to a special needs school that was mostly attended by youth criminals. Our friendship quickly dissolved as he also became involved in delinquent activity.
Three years later I saw him and he was apparently tick-free. He confided in me that he had been introduced to marijuana by friends at his new school, and to his surprise, his symptoms had almost completely vanished after smoking. He went on to become a college graduate and successful salesman, an unlikely profession for someone with Tourette syndrome. This was the first case of effective medical cannabis usage I ever observed.
http://healer.com/cannabis-and-tourette-syndrome/
Other manifestations include attention-deficit-hyperactivity disorder, obsessive-compulsive disorder, poor impulse control, and other behavioral problems. Symptoms vary significantly from one patient to another, and the tics are often not the most disabling features of this condition.
While the mechanism of Tourette syndrome remains unknown, research suggests that it is an inherited, developmental disorder of neurotransmission. This disorder affects approximately 1% of the population, and is 5 times more common in males. Symptoms range in severity from annoying to disabling.
Patients with loud vocalizations or large movements either endure substantial criticism or withdraw from many activities. Prejudice in work and school settings is common. Inadvertent injuries, such as broken bones and joint degeneration can also occur after years of simple yet repetitive tics. Accidents are common.
Current treatments of Tourette syndrome are purely symptomatic. No curative or preventive treatments are known. Medications have been used to treat tics, ADHD, OCD, and aggression. These include antipsychotics, dopamine-depleting agents, antihypertensive agents, skeletal muscle relaxants, benzodiazepines, SSRIs at 3-4 times the antidepressant dose, and Botox injections. Neurosurgery is performed in severe cases. All of these treatments carry significant risk and, sadly, offer limited benefit. Many medical authors encourage physicians avoid treating Tourette syndrome with pharmaceutical agents unless the symptoms are debilitating.
A significant body of scientific evidence suggests that the compounds found in cannabis can relieve symptoms of Tourette syndrome.
Animal studies demonstrate that cannabinoids specifically affect the basal ganglia and other areas of the brain known to be involved in Tourette syndrome.
Multiple case reports of patients using cannabis to reduce or eliminate tics and obsessive-compulsive behaviors have been published. One study found that cannabinoids could enhance the effectiveness of antipsychotic medications in this condition.
The randomized, double blind, placebo controlled trial is considered the gold standard in clinic trials for treatment efficacy. Two have been published that evaluated the efficacy of THC in the treatment of Tourette syndrome. The first, which included 12 adult patients, found that 10 of them experienced significant improvement in their symptoms after a single dose of THC, ranging from 20-90% reduction in symptom severity. Another study of 24 patients found similar improvements with no detrimental effects on cognition; verbal memory span actually improved in the cannabis group.
The acute effects of cannabis and THC are well documented, and are considered safer than most of the medications currently used in the treatment of Tourette syndrome. The lethal dose of cannabis and THC in humans is unknown and there are no reported deaths caused directly by cannabis toxicity.
I have personally seen cannabis help in debilitating cases of Tourette syndrome, after other medications had failed.
I would like to share a personal story. My best friend during ages 10-14, gradually developed Tourette syndrome right before my eyes. At first doctors thought he had postnasal drip or acid reflux. Over time, we joked that he was a one-man orchestra. The tics and obsessive-compulsive behavior worsened; the whole family suffered, and eventually he was no longer able to effectively function in a mainstream school environment. He left high school midway through freshman year and moved to a special needs school that was mostly attended by youth criminals. Our friendship quickly dissolved as he also became involved in delinquent activity.
Three years later I saw him and he was apparently tick-free. He confided in me that he had been introduced to marijuana by friends at his new school, and to his surprise, his symptoms had almost completely vanished after smoking. He went on to become a college graduate and successful salesman, an unlikely profession for someone with Tourette syndrome. This was the first case of effective medical cannabis usage I ever observed.
http://healer.com/cannabis-and-tourette-syndrome/
Article: Cannabis can help improve symptoms of ADHD, according to the results of a new study.
Many people with attention deficit hyperactivity disorder (ADHD) find marijuana helpful for managing their symptoms, such as trouble focusing and being impulsive. But few studies have looked at marijuana as a treatment option, until now.
In a 2016 study by researchers at King’s College London, treatment with a cannabis-based spray was shown to reduce symptoms in patients with ADHD. The study involved 30 adults with ADHD, who were given either Sativex or placebo over a four-week period.
Sativex is a pharmaceutical spray made from extracts of the whole cannabis plant. It contains a 1:1 ratio of THC and CBD and is one of the very few cannabis-based treatments to be approved as a prescription drug.
By the end of the study, those who received cannabis treatment showed improvements in symptoms of hyperactivity, impulsivity and inattention. They also scored higher on measures of cognitive performance and emotional stability.
The researchers concluded: “ADHD may represent a subgroup of individuals that gain cognitive enhancement and reduction of ADHD symptoms from the use of cannabinoids.”
Cannabinoids are the active compounds in marijuana that are responsible for its medical properties. While over 80 different cannabinoids are known to exist, THC and CBD are the most common.
Though cannabinoids are available in pharmaceutical forms like Sativex, many people with ADHD find marijuana to be an effective, more accessible option.
Marijuana Use and ADHD
The use of marijuana is extremely common in those who suffer from ADHD. In fact, studies show that young adults with ADHD are three times more likely to use marijuana in their lifetime.
While marijuana is usually seen as a recreational drug, people with ADHD often use marijuana as a way of self-medicating their symptoms.
In a study of 268 separate online discussions, 25% of people said they believed that marijuana was useful for treating ADHD.
Despite the popular belief that marijuana can help ADHD, how it works is still unclear.
People with ADHD are usually prescribed stimulant medications, such as Ritalin or Adderall, to help them focus and be less impulsive. These medications work by boosting dopamine levels in the brain.
Marijuana has also been shown to increase dopamine levels. This has led experts to theorize that marijuana might work in a similar way as stimulants in treating ADHD.
It also explains why some people find cannabis to be just as effective as their prescription medications. Compared to stimulants, marijuana is reported to have less side effects.
Marijuana Helps Manage Symptoms
The reason why most people with ADHD use marijuana is better focus. Indeed, many find that cannabis helps them pay attention and stay on task.
This seems counter-intuitive, since marijuana is thought to interfere with focus and attention in regular users.
However, there are many other reasons why people with ADHD might choose to use marijuana. Besides being able to focus better, studies also suggest that marijuana can help with sleep difficulties, hyperactivity and being impulsive.
Interestingly, studies show that people with the most severe symptoms of ADHD tend to use marijuana more frequently. Men and women also appear to use cannabis for different reasons.
Despite the strong link between marijuana use and ADHD, more research is necessary to determine the specific benefits of marijuana in treating the condition.
Medical Marijuana For ADHD
Medical marijuana is becoming more popular in the U.S. and worldwide. It can be used to treat many conditions, including cancer, multiple sclerosis, chronic pain, Crohn’s disease and epilepsy.
Though using medical marijuana to treat ADHD is not widely accepted, some doctors support the idea.
“I had a patient who credited graduating with his use of marijuana. And I had a PhD candidate who credited marijuana with being able to get his PhD, and that’s because it helped him concentrate,” says Dr. Bearman, a physician in California who regularly prescribes marijuana to patients with ADHD.
David Bearman, M.D. Explains the Positive Relationship Between ADD/ADHD and Medical Cannabis
FINDINGS: EFFECTS OF CANNABIS ON TOURETTE SYNDROME
Research has shown that cannabis can be effective in suppressing tics and also in the treatment of the syndrome’s associated behavioral problems (Muller-Vahl, 2013) (Abi-Jaoude, et al., 2017). One study measuring the effects of a single cannabis treatment on adult Tourette’s syndrome patients found a significant improvement of tics and obsessive-compulsive behavior compared to placebo (Muller-Vahl, et al., 2002). Demonstrating cannabis potential longer-term benefits, another study discovered a significant difference in the reduction of tics compared to placebo in Tourette’s patients after six weeks of cannabis administration (Muller-Vahl, et al., 2003). Another study, also involving six-weeks of cannabis treatments, reported a reduction tics in patients with Tourette’s with no serious adverse effects or impairment on neuropsychological performance (Muller-Vahl, 2003).
Tourette syndrome patients being treated with cannabis have shown to experience no impairments in verbal and visual memory, reaction time, intelligence, sustained attention, divided attention, vigilance or mood compared to placebo treatment (Muller-Vahl, et al., 2002). Therefore, regular cannabis use to manage the symptoms associated with Tourette’s appears to have no acute or long-term cognitive effects (Muller-Vahl, et al., 2003).
STATES THAT HAVE APPROVED MEDICAL MARIJUANA FOR TOURETTE SYNDROME
Currently, Arkansas, Illinois, Minnesota and Ohio have approved medical marijuana specifically for the treatment of Tourette syndrome.
A number of other states will consider allowing medical marijuana to be used for the treatment of Tourette syndrome with the recommendation from a physician. These states include: California (any debilitating illness where the medical use of marijuana has been recommended by a physician), Connecticut (other medical conditions may be approved by the Department of Consumer Protection), Massachusetts (other conditions as determined in writing by a qualifying patient’s physician), Nevada (other conditions subject to approval), Oregon (other conditions subject to approval), Rhode Island (other conditions subject to approval), and Washington (any “terminal or debilitating condition”).
In Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment.
Seventeen states have approved medical marijuana for the treatment of spasms (motor tics), which is a symptom commonly associated with Tourette’s. These states include: Arizona, Arkansas, California, Colorado, Delaware, Florida, Hawaii, Louisiana, Maryland, Michigan, Minnesota, Montana, Nevada, New Hampshire, Oregon, Rhode Island and Washington.
RECENT STUDIES ON CANNABIS’ EFFECT ON TOURETTE SYNDROME
- Six weeks of cannabis treatment reduced tics in patients with Tourette’s with no serious adverse effects or impairment on neuropsychological performance.
- Cannabinoids reduce symptoms of Tourette’s syndrome.
- A significant reduction in tics was seen in Tourette’s syndrome patients after six weeks of cannabis treatment.
- Delta 9-tetrahydrocannabinol (THC) is effective in the treatment of tics in Tourette syndrome: a 6-week randomized trial.
A new 2017 study indeed demonstrates the efficacy of an oral mucosal cannabinoid drug, Sativex, in a small sample of 30 adults diagnosed with ADHD (Cooper et al., 2017). Collectively, these findings begin to define a complex relationship between cannabis use and patients with ADHD, as well as its implications on cannabis/cannabinoids as a potential treatment for patients with this disorder. This article will examine the data from this study while also exploring other relevant and available data surrounding the potential use of cannabis in the treatment of ADHD.
Cannabis and cannabinoid therapy is increasingly being investigated and used in the treatment of a wide variety of pathologies with varying levels of success. While the efficacy of cannabis has been better studied and documented in the treatment of conditions such as epilepsy and glaucoma (Rosenberg et al., 2016; Tomida et al., 2004), other areas of cannabis research and medicine are still in its infancy and offer limited data.
One conditioning gaining popularity as a viable candidate for cannabinoid therapy is Attention Deficit Hyperactivity Disorder (ADHD). A new 2017 study performed by Cooper and colleagues piloted a randomized, placebo-controlled study involving the administration of Sativex, a whole plant cannabinoid medication, to 20 adults diagnosed with ADHD (Cooper et al., 2017). While the results of this study suggest the benefits of cannabis in the treatment of ADHD may be largely subjective, emerging data seems to suggest that the endocannabinoid system may be implicated in the pathophysiology of ADHD and should therefore be further investigated.
The mechanism for cannabinoids in the pathology of ADHD is still largely unknown, however, it is thought to be related to enhanced dopaminergic transmission (Cooper et al., 2017). This enhanced dopamine activity is the reason stimulants are considered the “gold standard” for pharmacotreatment of ADHD (Punja et al., 2016). Physicians, however, are sometimes reluctant to prescribe such psychotropic drugs to a population of patients commonly presenting with a comorbidity for substance abuse.
The same reluctance may be a factor in using cannabis, a widely abused drug, in the treatment of ADHD as well. However, this author argues that the side effect profile of cannabis may be better tolerated than that of stimulants. Insomnia is one of the most commonly reported side effects of stimulant medication and can have significantly detrimental effects on the patient, especially in children (Punja et al., 2016).
A 12-year comprehensive review showed a steep rise in stimulant medications (0.6% in 1987 to 2.7% in 1997) prescribed to children over time for the treatment of ADHD (Zuvekas & Vitiello, 2012). The use of these powerful psychotropic meds in children has begun to spur some controversy. A similar concern presents itself when considering cannabis treatment for ADHD in pediatric patients. More research is beginning to emerge on the role of cannabis in the developing brain and the results warrant further investigation into cannabis therapy in pediatric patients.
In trying to understand the role of cannabis use in the developing brain, it is critical to explore the documented neurocognitive effects of cannabis in children and adolescents. Recent attention has been brought to remarkably dramatic case reports of children with debilitating illnesses failing to respond to traditional medicine and for whom cannabis is the only solution. As such, there are an increasing number of pediatric and adolescent patients being added to the medical cannabis registry, particularly for conditions such as epilepsy (Handland et al., 2016).
According to highly specialized medical cannabis doctor Dr. Bonni Goldstein, ”There are many patients who suffer with Tourette syndrome (TS) who are finding relief of symptoms with cannabis.” Goldstein further added, “A large percentage of people who have been diagnosed with TS also suffer with other significant conditions, such as OCD, ADHD, mood disorders and anxiety. The conventional medications used to treat these conditions are not always helpful and often cause a wide array of unwanted side effects.”
Treating Adult ADHD with Cannabis
The Society of Cannabis Clinicians also states that; The medical certificates of 30 patients with adult ADHD, who were granted approval by the German Health Ministry to use cannabis flowers between 2012 and 2014, were analysed with regard to course of disease, previous treatment efforts, and effects of self-medication with cannabis or therapy with cannabis-based medications. For adult patients with ADHD, who experience side effects or do not profit from standard medication, cannabis may be an effective and well-tolerated alternative. Treating Adult ADHD with Cannabis Cancer PDf
Rules, Regulations, & Policy Solution For This Petition: Requesting The Inclusion Of A New Medical Condition(s): ADD/ADHD And Tourette's Syndrome
The approval of this Petition: Requesting The Inclusion Of A New Medical Condition(s): ADD/ADHD And Tourette's Syndrome, that is being provided to the state Department of Health Medical Cannabis Program so the advisory board can review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis with the Lynn and Erin Compassionate Use Act.
The approval of this petition would bring the Department of Health in compliance with the intent of the law and uphold the spirit of the Lynn and Erin Compassionate Use Act, 2007. Fulfilling both;“ Section 2. PURPOSE OF ACT.--The purpose of the Lynn and Erin Compassionate Use Act is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments” And Section 6. ADVISORY BOARD CREATED--DUTIES: The advisory board shall: A. review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis.” New Mexico’s medical cannabis history started in 1978. After public hearings the legislature enacted H.B. 329, the nation’s first law recognizing the medical value of cannabis...the first law.
References
2 http://www.healthline.com/
3 http://www.leonardsax.com/stimulants.html
Abi-Jaoude, E., Chen, L., Cheung, P., Bhikram, T., and Sandor, P. (2017, May 3). Preliminary evidence on cannabis effectiveness and tolerability for adults with Tourette syndrome. The Journal of Neuropsychiatry and Clinical Neurosciences, appineuropsych16110310. doi: 10.1176/appi.neuropsych.16110310. [Epub ahead of print]. Retrieved from http://neuro.psychiatryonline.org/doi/full/10.1176/appi.neuropsych.16110310.
Curtis, A., Clarke, C.E., and Rickards, H.E. (2009, October 7). Cannabinoids for Tourette’s Syndrome (Review). The Cochrane Database of Systematic Reviews, (4), CD006565, doi: 10.1002/14651858.pub2. Retrieved from http://onlinelibrary.wiley.com/wol1/doi/10.1002/14651858.CD006565.pub2/full.
Facts About Tourette Syndrome. (2015, June 10). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/ncbddd/tourette/facts.html.
Muller-Vahl, K.R., Kolbe, H., Schneider, U., and Emrich, H.M. (1998, December). Cannabinoids: possible role in patho-physiology and therapy of Gilles de la Tourette syndrome. Acta Psychiatra Scandinavica, 98(6), 502-6. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.1998.tb10127.x/pdf.
Muller-Vahl, K.R. (2003, October). Cannabinoids reduce symptoms of Tourette’s syndrome. Expert Opinion on Pharmacology, 4(10), 1717-25. Retrieved from http://www.tandfonline.com/doi/pdf/10.1517/14656566.4.10.1717?needAccess=true.
Muller-Vahl, K.R. (2013). Treatment of Tourette syndrome with cannabinoids. Behavioral Neurology, 27(1), 119-24. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215298/.
Muller-Vahl, K.R., Koblenz, A., Jobges, M., Kolbe, H., Emrich, H.M., and Schneider, U. (2001, January). Influence of treatment of Tourette syndrome with delta9-tetrahydrocannabinol (delta9-THC) on neuropsychological performance. Pharmacopsychiatry, 34(1), 19-24. Retrieved from https://www.thieme-connect.com/DOI/DOI?10.1055/s-2001-15191.
Muller-Vahl, K.R., Prevedel, H., Theloe, K., Kolbe, H., Emrich, H.M., and Schneider, U. (2003, February). Treatment of Tourette syndrome with delta-9-tetrahydrocannabinol (delta 9-THC): no influence on neuropsychological performance. Neuropsychopharmacology, 28(2), 384-8. Retrieved from http://www.nature.com/npp/journal/v28/n2/full/1300047a.html.
Muller-Vahl, K.R., Schneider, U., Koblenz, A., Jobges, M., Kolbe, H., Daldrup, T., and Emrich, H.M. (2002, March). Treatment of Tourette’s syndrome with Delta 9-tetrahydrocannabinol (THC): a randomized crossover trial. Pharmacopsychiatry, 35(2), 57-61. Retrieved from https://www.thieme-connect.com/DOI/DOI?10.1055/s-2002-25028.
Muller-Vahl, K.R., Schneider, U., Prevedel, H., Theloe, K., Kolbe, H., Daldrup, T., and Emrich, H.M. (2003, April). Delta 9-tetrahydrocannabinol (THC) is effective in the treatment of tics in Tourette syndrome: a 6-week randomized trial. The Journal of Clinical Psychiatry, 64(4), 459-65. Retrieved from http://www.psychiatrist.com/jcp/article/Pages/2003/v64n04/v64n0417.aspx.
Tourette syndrome. (2012, August 10). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/tourette-syndrome/basics/definition/con-20043570.
Appendix A:
WHEREAS cannabis (marijuana) has been used as a medicine for at least 5,000 years and can be effective for serious medical conditions for which conventional medications fail to provide relief;
WHEREAS modern medical research has shown that cannabis can slow the progression of such serious diseases as Alzheimer’s and Parkinson’s and stop HIV and cancer cells from spreading; has both anti-inflammatory and pain-relieving properties; can alleviate the symptoms of epilepsy, PTSD and multiple sclerosis; is useful in the treatment of depression, anxiety and other mental disorders; and can help reverse neurological damage from brain injuries and stroke;
WHEREAS the World Health Organization has acknowledged the therapeutic effects of cannabinoids, the primary active compounds found in cannabis, including as an anti-depressant, appetite stimulant, anticonvulsant and anti-spasmodic, and identified cannabinoids as beneficial in the treatment of asthma, glaucoma, and nausea and vomiting related to illnesses such as cancer and AIDS;
WHEREAS the American Medical Association has called for the review of the classification of cannabis as a Schedule I controlled substance to allow for clinical research and the development of cannabinoid-based medicines;
WHEREAS the National Cancer Institute has concluded that cannabis has antiemetic effects and is beneficial for appetite stimulation, pain relief, and improved sleep among cancer patients;
WHEREAS the American Herbal Pharmacopoeia and the American Herbal Products Association have developed qualitative standards for the use of cannabis as a botanical medicine;
WHEREAS the U.S. Supreme Court has long noted that states may operate as “laboratories of democracy” in the development of innovative public policies;
WHEREAS twenty-eight states and the District of Columbia have enacted laws that allow for the medical use of cannabis;
WHEREAS seventeen additional states have enacted laws authorizing the medical use of therapeutic compounds extracted from the cannabis plant;
WHEREAS more than 17 years of state-level experimentation provides a guide for state and federal law and policy related to the medical use of cannabis;
WHEREAS accredited educational curricula concerning the medical use of cannabis have been established that meets Continuing Medical Education requirements for practicing physicians;
WHEREAS Congress has prohibited the federal Department of Justice from using funds to interfere with and prosecute those acting in compliance with their state medical cannabis laws, and the Department of Justice has issued guidance to U.S. Attorneys indicating that enforcement of the Controlled Substances Act is not a priority when individual patients and their care providers are in compliance with state law, and that federal prosecutors should defer to state and local enforcement so long as a viable state regulatory scheme is in place.
WHEREAS modern medical research has shown that cannabis can slow the progression of such serious diseases as Alzheimer’s and Parkinson’s and stop HIV and cancer cells from spreading; has both anti-inflammatory and pain-relieving properties; can alleviate the symptoms of epilepsy, PTSD and multiple sclerosis; is useful in the treatment of depression, anxiety and other mental disorders; and can help reverse neurological damage from brain injuries and stroke;
WHEREAS the World Health Organization has acknowledged the therapeutic effects of cannabinoids, the primary active compounds found in cannabis, including as an anti-depressant, appetite stimulant, anticonvulsant and anti-spasmodic, and identified cannabinoids as beneficial in the treatment of asthma, glaucoma, and nausea and vomiting related to illnesses such as cancer and AIDS;
WHEREAS the American Medical Association has called for the review of the classification of cannabis as a Schedule I controlled substance to allow for clinical research and the development of cannabinoid-based medicines;
WHEREAS the National Cancer Institute has concluded that cannabis has antiemetic effects and is beneficial for appetite stimulation, pain relief, and improved sleep among cancer patients;
WHEREAS the American Herbal Pharmacopoeia and the American Herbal Products Association have developed qualitative standards for the use of cannabis as a botanical medicine;
WHEREAS the U.S. Supreme Court has long noted that states may operate as “laboratories of democracy” in the development of innovative public policies;
WHEREAS twenty-eight states and the District of Columbia have enacted laws that allow for the medical use of cannabis;
WHEREAS seventeen additional states have enacted laws authorizing the medical use of therapeutic compounds extracted from the cannabis plant;
WHEREAS more than 17 years of state-level experimentation provides a guide for state and federal law and policy related to the medical use of cannabis;
WHEREAS accredited educational curricula concerning the medical use of cannabis have been established that meets Continuing Medical Education requirements for practicing physicians;
WHEREAS Congress has prohibited the federal Department of Justice from using funds to interfere with and prosecute those acting in compliance with their state medical cannabis laws, and the Department of Justice has issued guidance to U.S. Attorneys indicating that enforcement of the Controlled Substances Act is not a priority when individual patients and their care providers are in compliance with state law, and that federal prosecutors should defer to state and local enforcement so long as a viable state regulatory scheme is in place.
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