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Canadian Journal of Cardiology

ADHD Symptoms as a Potential Driver to Cannabis Use in Young Persons With Complex Congenital Heart Defects

Published:October 11, 2019DOI:https://doi.org/10.1016/j.cjca.2019.10.004
      To the Editor:
      Adequate health behaviours are a prerequisite for good long-term functioning and longevity. In the recent article titled “Prevalence and effects of cigarette smoking, cannabis consumption, and co-use in adults with congenital heart disease from 15 countries,” Moons et al. provided unique data from a large-scale international study in adults with congenital heart disease (CHD).
      • Moons P.
      • Luyckx K.
      • Kovacs A.H.
      • et al.
      Prevalence and effects of cigarette smoking, cannabis consumption and co-use in adults with congenital heart disease from 15 countries.
      Intriguingly, they found that male patients with complex and moderately complex CHD use cannabis more frequently than counterparts with mild CHD.
      • Moons P.
      • Luyckx K.
      • Kovacs A.H.
      • et al.
      Prevalence and effects of cigarette smoking, cannabis consumption and co-use in adults with congenital heart disease from 15 countries.
      A potential explanation was that cannabis use might be a coping strategy for living with complex CHD.
      • Moons P.
      • Luyckx K.
      • Kovacs A.H.
      • et al.
      Prevalence and effects of cigarette smoking, cannabis consumption and co-use in adults with congenital heart disease from 15 countries.
      Although we do not refute this presumption, we would like to advance another hypothesis.
      We are specialised nurses working as transition coordinators in the Swedish Transition Effects Project Supporting Teenagers With Chronic Medical Conditions (STEPSTONES) project, which evaluates the effectiveness of a transition program for young people with CHD.
      • Acuna Mora M.
      • Sparud-Lundin C.
      • Bratt E.L.
      • et al.
      Person-centred transition programme to empower adolescents with congenital heart disease in the transition to adulthood: a study protocol for a hybrid randomised controlled trial (STEPSTONES project).
      We counsel adolescents aged 16-18 years with CHD before their transition to adult care. It is widely accepted that patients with complex CHD have an increased risk for neurodevelopmental issues, such as difficulties with school performance and executive dysfunctions. Attention-deficit/hyperactivity disorder (ADHD) and anxiety disorders are therefore prevalent,
      • DeMaso D.R.
      • Calderon J.
      • Taylor G.A.
      • et al.
      Psychiatric disorders in adolescents with single ventricle congenital heart disease.
      ,
      • Hansen E.
      • Poole T.A.
      • Nguyen V.
      • et al.
      Prevalence of ADHD symptoms in patients with congenital heart disease.
      with typical symptoms such as hyperactivity and difficulties with concentration and motivation. During transition visits, we have met adolescents who express their frustration over the symptoms of ADHD and over the difficulty to combine ADHD medication with their specific CHD. Furthermore, some adolescents do not receive appropriate ADHD medication owing to the anticipated side-effects. It is our experience that adolescents with ADHD symptoms initiate discussions about cannabis and other drugs with us to a greater extent than adolescents with less or no ADHD symptoms. One boy, aged 18 years, describes his difficulties and frustration with concentration and lack of mental focus. He narrates that friends of his suggested and encouraged him to try cannabis as a way of attaining focus and gathering his thoughts, which he is considering sometimes despite his awareness of its negative effects on his CHD. A girl, aged 17 years, describes problems with concentration, anxiety, and insomnia. She smokes cigarettes as a way of coping with her feelings and she is considering using cannabis as a possible aid for reducing her symptoms.
      As an additional explanation for the findings of Moons et al.,
      • Moons P.
      • Luyckx K.
      • Kovacs A.H.
      • et al.
      Prevalence and effects of cigarette smoking, cannabis consumption and co-use in adults with congenital heart disease from 15 countries.
      we hypothesize that the prevalence of ADHD symptoms contribute to a higher use of cannabis in patients with more complex CHD. This hypothesis warrants further investigation.

      Disclosures

      The authors have no conflicts of interest to disclose.

      References

        • Moons P.
        • Luyckx K.
        • Kovacs A.H.
        • et al.
        Prevalence and effects of cigarette smoking, cannabis consumption and co-use in adults with congenital heart disease from 15 countries.
        Can J Cardiol. 2019; 35: 1842-1850
        • Acuna Mora M.
        • Sparud-Lundin C.
        • Bratt E.L.
        • et al.
        Person-centred transition programme to empower adolescents with congenital heart disease in the transition to adulthood: a study protocol for a hybrid randomised controlled trial (STEPSTONES project).
        BMJ Open. 2017; 7e014593
        • DeMaso D.R.
        • Calderon J.
        • Taylor G.A.
        • et al.
        Psychiatric disorders in adolescents with single ventricle congenital heart disease.
        Pediatrics. 2017; 139e20162241
        • Hansen E.
        • Poole T.A.
        • Nguyen V.
        • et al.
        Prevalence of ADHD symptoms in patients with congenital heart disease.
        Pediatr Int. 2012; 5: 838-843

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