6 Monday December 6 2021 | the times
life
schizophrenia and ADHD are three
areas in which medical cannabis is
starting to show promising results, but
evidence is still limited.
Any doctor on the specialist register
of the General Medical Council can
prescribe cannabis for conditions such
as anxiety, depression, panic attacks,
chronic pain and neuropathy, epilepsy,
PTSD and ADHD. However, cannabis
is offered only as a last resort
treatment, when other frontline
medications have not been effective or
have produced adverse side effects.
(Visit england.nhs.uk, search for
“cannabis-based products for
medicinal use” and look at the FAQs.)
Pulling all this together, I advise that
your son’s ADHD is revisited now he
faces greater academic pressure, which
might be a contributory factor to his
cannabis use as he may be self-
medicating to boost neurotransmitters
in his brain. This would be because
with ADHD there is an imbalance of
the neurotransmitters dopamine and
noradrenaline that control brain
states, vigilance, action, reward,
learning and memory processes.
A child and adolescent psychiatrist
can assess and prescribe ADHD
medication. I’d also advise that he
works with a clinical psychologist to
address issues relating to mood,
impulse control, anger (if relevant) and
also executive function skills, ie the
skills that enable us to plan, focus,
remember instructions and manage
multiple tasks. Up to 90 per cent of
young people with ADHD struggle
with executive dysfunction, which
impairs goal-directed behaviour.
The hypothesis would be, therefore,
that by addressing why your son uses
cannabis and managing it safely both
pharmacologically and also via
cognitive behavioural therapy (CBT),
his compulsion to use will be reduced
and he can make a more informed
decision about this.
For further tips on how to support
your son, see youngminds.org.uk and
talktofrank.com.has clearly had an impact in terms of
his engagement at school and his
behaviour. Your son is clearly bright
(having achieved well at GCSEs) but is
now struggling with A-levels, which
require greater independent learning
and focus. It may be that the academic
challenges he now faces mean that he
experiences the negative impacts of
ADHD more keenly. This could relate
to his use of cannabis, which is used by
some as a self-treatment for ADHD.
It is estimated that one million
people in the UK self-medicate with
cannabis for a variety of conditions.
Research analyses have found that
people who had been diagnosed with
ADHD in their youth were three
times as likely to report cannabis use
and are also 1.5 times more likely to
develop cannabis use disorder (CUD).
Your son reports that cannabis use
helps him to think more clearly. As
you may be aware, there are two key
components, with differing effects:
it is well documented that the CBD
component of cannabis has a calming/
anxiolytic effect, while the THC
(tetrahydrocannabinol)
component has a dopaminergic
effect that can help with focus,
as well as helping to promote
better quality sleep. It is for
this reason that medical
cannabis prescribing is now
an emerging alternative
“last resort” treatment option
that can be considered as
“off-licence” medication
for ADHD.
In November 2018 it
became legal to prescribe
medical cannabis. A report
commissioned by NHS
England and NHS
Improvement, published in
August 2019, concluded that if
cannabis-based medical products
“are to be routinely commissioned
across the NHS, the science and the
evidence base supporting use needs
to be significantly better developed”.
Post-traumatic stress disorder (PTSD),I can’t persuade my ADHD son to stop smoking cannabis
Q
NN
QQQ
I was hoping you
could provide some
guidance on how I
can encourage my
teenage son to stop
smoking cannabis.
I have gone through all the risks to
both physical and mental health with
him as well as stressing that it is
illegal. I was initially angry and tried
to approach it by putting boundaries
in place, for example reducing the
amount of time he went out to meet
friends. However, I was worried
trying to keep him in would have a
negative impact on him and it was
straining our relationship.
He has read a lot about cannabis
but only seems to register the
positive effects and says the negative
effects such as psychosis only happen
to a few unfortunate people who
probably had underlying mental
illness. He believes it helps him to
think clearer.
I adopted my son when he was
18 months old and when he started
school the teachers noted he had
problems with his attention. He
was diagnosed by a paediatrician
with ADHD [attention deficit
hyperactivity disorder], although he
was not particularly hyperactive.
Medication was mentioned but I
didn’t take that path because he was
a lovely sociable child and I was
worried it would alter his personality.
He got quite good grades in his
GCSEs and is now in sixth form,
though I know he still struggles with
applying himself to studying.
I have always worried that he can
be a bit easily led. He was initially
bullied a little at school but then
became very popular by being the
class clown. He spent a lot of time
in detention.
My greatest fear is that starting to
smoke cannabis at such a young age
could either cause issues with his
brain development or lead on to
stronger substances.
Sarah
Ask Professor Tanya Byron
A
NN
A
I can understand your
concerns and
congratulate both you
and your son that you
can actually have
conversations, even if
he doesn’t agree with your views.
The reality here, however, is that
while you can guide and advise, unless
you lay down extreme boundaries that
disable him from socialising with
anyone who uses — which are
unlikely to be enforceable and will
probably backfire — your challenge is
to keep conversation going in a way
that enables your son to question his
mindset. You can buy drug testing
urine kits online and set out clear
consequences for a positive result but
again you need to decide if that will
help or hinder in the long term.
The rest of your letter is clinically
relevant as it points to reasons why
your son finds cannabis important.
Statistics from December 2020
revealed that the proportion of people
aged 16-19 who said they had used
cannabis at least once in the past
12 months had increased to nearly
one in five, the highest since 2010-11.
While, as your son points out, it is
more unusual for cannabis use to
lead to a significant mental health
breakdown like psychosis, there
are growing numbers of young
people where this is the outcome.
You are right when you raise the
fact that using a mind-altering
substance at his age, when the
brain is still in development, can
have adverse impacts. There is
also a higher risk of depression
and longer-term misuse.
We don’t know exactly what
he is smoking in terms of
strength, and also his genetic
underlying predisposition in
terms of mental health might
not be fully understood given
that he was adopted.
The clue you offer sits
around his ADHD, which has
never been actively treated butYour
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heanntIf you would like
Professor Tanya Byron’s
help, email proftanya
[email protected]