cannabinoids in attention-deficit/hyperactivity disorder ... · –self-medication –alternative...
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Cannabinoids in Attention-Deficit/Hyperactivity Disorder: A Randomised-Controlled Trial
Ruth Cooper
Post-Doctoral Researcher
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Disclosures
• This study was funded through a departmental research account for Prof Asherson. The placebo and active medication were provided free of charge by GW Pharma Ltd. GW Pharma played no role in study design, data collection, data analysis, data interpretation, or writing of the report.
• At the time this work was undertaken, Ruth Cooper was a PhD student at King’s College London, funded by a research grant to Prof Asherson from Vifor Pharma.
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ADHDInattention
Hyperactivity/Impulsivity
Cognitive deficits2
Emotional lability1
1. Skirrow & Asherson (2012), 2. Wilcutt et al (2005)
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ADHD and Cannabis
• Substance abuse:
– stimulants and cannabis1,2
• Self medication?
1. Lee et al (2011), 2. Asherson et al (unpublished data)
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“It makes me more productive”
“I’m able to think clearer”
“Slows my constant thoughts”
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ADHD and Cannabis
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The EMA-C Study• Design:
⁻ Randomised controlled trial
⁻ 6 weeks
• Participants:
⁻ 30 unmedicated adults with ADHD
• Intervention:
⁻ Sativex (THC:CBD)
⁻ Placebo
Cooper et al., under review
• Primary endpoint:⁻ Cognitive performance
/activity
• Secondary endpoints⁻ ADHD symptoms⁻ Emotional lability
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The EMA-C Study
1. Will treatment with Sativex improve cognitive performance?
2. Will treatment with Sativex improve symptoms of ADHD and emotional lability?
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The EMA-C Study
30 adults with ADHD
15Active
15Placebo
15Active
11Placebo
4 Weeks
2 WeeksTitration
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Results: Cognitive performance
Time x group: p = 0.16, Est = -0.2
1
1,1
1,2
1,3
1,4
1,5
1,6
1,7
1,8
Baseline Follow-up
Qb
Te
st
Placebo
Active
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Results: Hyp/Imp
Time x group: p = 0.03, Est = -2.5
0
2
4
6
8
10
12
14
16
18
20
Baseline Follow-up
Hyp
/Im
p
Placebo
Active
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Results: Inattention
Time x group: p = 0.10, Est = -2.4
0
5
10
15
20
25
30
Baseline Follow-up
Inat
ten
tio
n
Placebo
Active
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Results: Emotional lability
Time x group: p = 0.11, Est = -3.8
0
5
10
15
20
25
30
35
Baseline Follow-up
Emo
tio
nal
Lab
ility
Placebo
Active
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Conclusion• First cannabinoid trial
• Feasible
• Promising results
– No negative effects
– Nominally sig/Non-sig improvements
– Similar to improvements after stimulant medication
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Conclusion• Clinical implications
– Self-medication
– Alternative treatment
– Novel treatment mechanism
– Controversial1
• Limitations
– Failure of the blind
– Power
• Future directions
– Larger trial
1. Volkow et al., 2014
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Acknowledgements
• Participants
• Supervisors:
– Philip Asherson
– Charlotte Tye
• Co-Authors:
– Emma Williams
– Seth Seegobin
– Jonna Kuntsi
• GW Pharma