Marijuana and Strattera: Safety Concerns
Combining marijuana with Strattera (atomoxetine) is not recommended due to potential adverse effects on ADHD symptoms, cardiovascular risks, and lack of evidence supporting therapeutic benefit from cannabis in ADHD treatment.
Evidence Against Cannabis Use in ADHD
The current scientific literature does not support cannabis use for ADHD management:
A comprehensive scoping review of 39 studies found that most research indicated cannabis either worsened or had no effect on ADHD symptoms 1. The single randomized, placebo-controlled trial showed no significant improvement in ADHD symptoms (QbTest: Est = -0.17,95% CI -0.40 to 0.07, p = 0.16) 1.
Cannabis use in adolescents is associated with significant neurocognitive impairments, including deficits in attention, learning, memory, planning, and psychomotor speed—the very domains already compromised in ADHD 2. Earlier age of cannabis onset exacerbates these adverse effects 2.
Cannabis use increases risk for psychiatric comorbidities commonly seen with ADHD, including increased risk for anxiety, depression, and ADHD symptom worsening 2.
Cardiovascular Concerns with Combination Use
While direct interaction data between atomoxetine and cannabis is limited, both substances affect cardiovascular parameters:
Atomoxetine causes statistically significant increases in heart rate and blood pressure in pediatric patients with ADHD 3.
Cannabis (THC) produces additive cardiovascular effects when combined with other ADHD medications. A controlled study demonstrated that THC combined with methylphenidate showed additive effects on heart rate and rate pressure product 4.
Given atomoxetine's noradrenergic mechanism and cardiovascular effects 3, 5, combining it with cannabis poses theoretical cardiovascular risks that have not been adequately studied.
Impact on ADHD Treatment Efficacy
Cannabis may undermine the therapeutic benefits of atomoxetine:
Cannabis impairs cognitive performance on measures relevant to ADHD, including increased commission errors on continuous performance tests 4.
The evidence suggests cannabis does not provide therapeutic benefit for ADHD and may worsen symptom control 1.
Clinical Recommendations
For patients currently using both substances:
Counsel patients to discontinue cannabis use while taking atomoxetine, emphasizing that cannabis is not an evidence-based ADHD treatment and may worsen symptoms 1.
If cannabis use continues, educate on harm reduction: avoid high THC-content products, avoid synthetic cannabinoids, choose non-inhalation routes, limit frequency of use, and never drive while impaired 2.
Monitor cardiovascular parameters closely (heart rate, blood pressure) given the potential for additive effects 3, 4.
Assess for worsening ADHD symptoms, mood changes, or cognitive impairment that may result from cannabis use 2, 1.
Common Pitfalls to Avoid
Do not assume patient self-reports of cannabis "helping" ADHD reflect actual therapeutic benefit—subjective perceptions often contradict objective measures 1.
Do not overlook the developmental vulnerability of adolescent and young adult brains to cannabis effects, particularly in those with ADHD who already have neurocognitive challenges 2.
Address substance use in a sensitive, non-judgmental manner to maintain therapeutic alliance while providing evidence-based guidance 2.