Risks of Using Marijuana and Adderall Together
Using marijuana and Adderall together significantly increases cardiovascular risks including tachycardia, elevated blood pressure, and potentially life-threatening arrhythmias, and should be avoided due to dangerous drug-drug interactions. 1, 2
Cardiovascular Risks
The combination of marijuana (cannabis) and Adderall (amphetamine and dextroamphetamine) presents several serious cardiovascular concerns:
- Additive cardiovascular effects: Both substances independently increase heart rate and blood pressure. When combined, they show additive effects on heart rate and rate pressure product 3
- Tachycardia: Adderall causes palpitations and tachycardia 1, while THC inhalation is associated with orthostatic hypotension and tachycardia 2
- Hypertensive crisis: Amphetamines can potentiate the release of norepinephrine, increasing cardiovascular effects 1, which may be worsened by cannabis use
- Myocardial ischemia: THC inhalation is associated with a greater incidence of myocardial ischemia in at-risk individuals 2
Neurological and Psychiatric Risks
The combination affects the central nervous system in multiple concerning ways:
- Psychotic episodes: Adderall can cause psychotic episodes even at recommended doses 1
- Exacerbation of psychiatric disorders: Cannabis may worsen psychiatric disorders in vulnerable individuals 4
- Impaired cognitive function: THC increases commission errors on performance tests, potentially counteracting some of Adderall's cognitive benefits 3
- Substance use disorder: Cannabis use is associated with a 17% risk of developing cannabis use disorder within 12 weeks 4, while Adderall is a Schedule II controlled substance with high potential for abuse 1, 5
Drug-Drug Interactions
Several concerning metabolic interactions occur between these substances:
- CYP450 enzyme interactions: Cannabis inhibits CYP2C9 and CYP3A4 6, which are involved in the metabolism of amphetamines 1
- Altered drug metabolism: THC can inhibit CYP2C9, potentially altering the metabolism of other medications 7, 6
- Unpredictable effects: The combination may lead to unpredictable plasma concentrations of both substances 8
Safety Concerns
Additional safety issues include:
- Driving impairment: Both substances independently increase the risk of motor vehicle accidents. Cannabis users are more than twice as likely to be involved in crashes 4
- Stroke risk: Cannabis use is associated with increased stroke risk in a dose-dependent manner 2, and amphetamine-type stimulants show adjusted relative risks of 1.6 to 3.4 for stroke 4
- Cardiovascular emergencies: The combination may trigger cardiovascular emergencies requiring immediate medical attention 2, 1
Recommendations for Healthcare Providers
When encountering patients using or considering using both substances:
- Screen for patterns of use and frequency in patients with cardiovascular risk factors 2
- Inform patients about the significant cardiovascular risks of concurrent use
- Consider that higher THC concentrations in modern cannabis products (up to 17% in flower and 70% in concentrates) increase risk 2
- Be aware that CYP2C9 polymorphisms (present in up to 35% of Caucasians) can increase THC bioavailability, potentially worsening interactions 8
Conclusion
The combination of marijuana and Adderall presents significant health risks, particularly to the cardiovascular system. The additive effects on heart rate and blood pressure, potential for serious drug-drug interactions, and increased risk of psychiatric complications make this combination particularly dangerous. Patients should be strongly advised against concurrent use of these substances.