Consumption of Synthetic Cannabinoids in Adult Attention-Deficit/Hyperactivity Disorder: a Pilot Study

Alexandra P Lam,Sebastian Moeller,Martin C Lam,Christine Speitling,Helge H O Müller,Alexandra Philipsen

doi:10.1007/s11469-020-00248-6

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is associated with an increased risk for substance abuse and addiction. Synthetic cannabinoids (SC) have gained rising importance as their consumption increased rapidly in the last few years. However, SC consumption in patients with adult ADHD has not been investigated yet. A prospective clinical pilot study was conducted, including 60 adults with ADHD, assessing the prevalence of SC consumption and its associations with psychiatric comorbidities and patient characteristics. A drug consumption survey was utilized to investigate the use of SC and other drugs. Current ADHD symptoms were evaluated via ADHD Self-Rating Scale (ADHD-SR) and retrospective childhood ADHD symptom severity via Wender Utah Rating Scale (WURS-k) questionnaire. A positive lifetime prevalence of SC consumption was found in 15.0% of the analyzed sample. SC consumption was significantly associated with current smoking, lifetime use of natural cannabis (NC), cocaine, amphetamines, and benzodiazepines. Lifetime NC consumption was indicated by 65.0% and found to antecede SC use in adult ADHD patients. Logistic regression analysis identified substance use disorder and male sex as predictive for SC consumption. Patients with history of SC use scored significantly higher in both WURS-k and ADHD-SR questionnaire compared with nonusers and suffered significantly more frequently from psychiatric comorbidities. Main side-effects of SC included gastrointestinal, cardiovascular, and neuropsychiatric symptoms. SC consumption in adults with ADHD is frequent and associated with stronger ADHD symptom severity. Given the underestimated dangerous effects and related comorbidities, SC use should be subject to scrutiny by clinicians treating ADHD patients. More studies are needed to further elucidate the impact of SC use in ADHD.

Highlights

Attention-deficit/hyperactivity disorder (ADHD) is associated with an increased risk for substance abuse and addiction
This study presented evidence of the elevated risks for Synthetic cannabinoids (SC) use in ADHD patients
As comorbid ADHD and substance use disorders (SUDs) have an impact on the severity of addiction, the therapeutic outcome and risk of further psychiatric disorders, a complete investigation and psychoeducation of legal and illicit substance use, including SC, is absolutely necessary in the treatment of ADHD patients (Dirks et al 2017)

Summary

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is associated with an increased risk for substance abuse and addiction. A prospective clinical pilot study was conducted, including 60 adults with ADHD, assessing the prevalence of SC consumption and its associations with psychiatric comorbidities and patient characteristics. Patients with history of SC use scored significantly higher in both WURS-k and ADHD-SR questionnaire compared with nonusers and suffered significantly more frequently from psychiatric comorbidities. While the impact of THC on mental disorders have been intensively investigated in previous studies (Lowe et al 2019), data on SC consumption among psychiatric patients are scant (Bassir Nia et al 2016; Welter et al 2017). ADHD patients with SUD are at a very high risk to suffer from further psychiatric comorbidities, especially BPD, bipolar disorder, anxiety disorders, and posttraumatic stress disorder (PTSD) (Crunelle et al 2018; van Emmerik-van Oortmerssen et al 2014). NC and SC show dopamine receptor interactions and induce dopamine release in several brain areas, but SC have been found showing even higher potency in releasing dopamine (Miliano et al 2016)

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