Cannabis and Stimulant Use Policy

Effective Date: 11/01/2025

Last Edited: 11/13/2025

Purpose

To provide clear guidelines for the safe and evidence-based prescribing of stimulant medications for ADHD in patients who use cannabis, in accordance with Idaho State Regulations and current medical literature.

Policy Statement

Prism Family Medicine complies with all state and federal laws and regulations. As a central nervous system depressant, cannabis can impair attention and concentration. Substances that adversely affect concentration make it difficult to accurately evaluate ADHD symptoms. Stimulant medications are approved only for ADHD treatment and are highly regulated. Stimulant treatment requires avoidance or minimal use of cannabis. The use of cannabis in conjunction with stimulant medications for ADHD is associated with increased risks of adverse outcomes, including cognitive impairment, psychiatric complications, and substance use disorders.

Urine Drug Screening (UDS) Requirements

  • Patients prescribed stimulant medications for ADHD are strongly recommended to limit use of cannabis to less than one time per week to minimize risk of interaction between cannabis and stimulants.

  • Patients are expected to complete a negative UDS screen within 30 days of starting stimulant medication and at least once annually, additional testing will be according to provider discretion.

  • Patients will be given at least 10 days’ notice prior to UDS collection. Failure to complete testing may result in a temporary hold on prescriptions.

  • Providers reserve the right to pause or stop stimulant prescriptions at any time.

 

Risks Associated with Cannabis Use in ADHD

Cognitive Decline and Dementia

  • Studies have demonstrated that individuals with ADHD are at an increased risk for developing dementia compared to the general population.

  • Regular cannabis use is also associated with a higher risk of cognitive decline and dementia. A large population-based study found that cannabis users had a significantly increased risk of developing dementia later in life.

  • The combination of ADHD and regular cannabis use may further compound this risk.

Psychosis and Psychiatric Complications

  • Both stimulant medications and cannabis use have been independently associated with an increased risk of psychosis.

  • Meta-analyses have shown that individuals with ADHD who use stimulants and/or cannabis are at a higher risk for developing psychotic symptoms, including hallucinations and delusions.

  • The risk is particularly elevated in those with a personal or family history of psychiatric disorders.

Poor Outcomes in ADHD with Cannabis Use

  • Research indicates that ADHD patients who use cannabis regularly have worse outcomes, including:

    • Lower academic and occupational achievement

    • Increased rates of substance use disorders

    • Higher rates of treatment non-adherence and relapse

  • Longitudinal studies have found that cannabis use in ADHD is associated with worsening of core ADHD symptoms and greater functional impairment.

Cannabis Use Disorder Risk

  • Individuals with ADHD are at a significantly higher risk of developing cannabis use disorder compared to those without ADHD.

  • Early onset of cannabis use and frequent use are strong predictors of developing a substance use disorder in this population.

 

Inconclusive Evidence and Potential Benefits

  • Some studies have explored the potential benefits of cannabis or cannabinoids in managing certain symptoms of ADHD, such as impulsivity or sleep disturbances.

  • The current body of evidence is inconclusive and insufficient to support the routine use of cannabis for ADHD treatment.

  • The potential benefits do not outweigh the well-documented risks, especially given the lack of standardized dosing, product variability, and the legal status of cannabis in Idaho.

 

Summary

Given the increased risks of cognitive decline, psychosis, poor functional outcomes, and substance use disorder, regular cannabis use is not recommended in patients being treated for ADHD with stimulant medications. Patients are expected to maintain a negative UDS for cannabis and are advised to limit use to less than once per week if abstinence is not possible. The clinic will continue to monitor emerging evidence and update this policy as needed.

 

References

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