CASE REPORT article
Front. Psychiatry
Sec. Mental Health Occupational Therapy
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1595649
This article is part of the Research TopicLife with Tic Disorders: From Childhood to AdulthoodView all 9 articles
Case report: Effect of Medicinal Cannabis on Fitness to Drive in a Patient with Tourette syndrome and ADHD
Provisionally accepted
Charlotte Marie Streetz1
Natalia Szejko1,2*
Carolin Fremer1Jörg Teske1
Alexander Brunnauer3
Kirsten R Müller-Vahl1- 1Hannover Medical School, Hanover, Lower Saxony, Germany
- 2Medical University of Warsaw, Warsaw, Masovian, Poland
- 3LMU Munich University Hospital, Munich, Bavaria, Germany
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Tourette Syndrome (TS) is a childhood onset chronic disorder in which motor and vocal tics co-occur.Cannabinoids are a potential therapeutic option for otherwise treatment resistant patients. However, there is an ongoing debate regarding potential side effects. This is particularly important in relation to activities being necessary for daily life such as driving a car.We present the case of a 28-year-old male with TS and comorbid attention-deficit/hyperactivity disorder (ADHD) who was medicated by his treating physician with an extremely high dose of inhaled medicinal cannabis (MC) of up to 10 g/d. We were interested in the effects of MC on patient's fitness to drive as well as corresponding serum levels of tetrahydrocannabinol (THC) and its metabolites.Therefore, clinical assessments and computer-based tests (Vienna Test System) were performed at different time points at two consecutive days before and after intake of MC at a dose that was determined by the patient according to clinical need. On day 1, he inhaled a total dose of 3.3 g and 4.1 g MC, respectively, before driving tests were performed. Until the end of the day, he used a total dose of 8.8 g. On day 2, he took no MC before all tests were completed. Remarkably, according to the German Federal Highway Research Institute guidelines, the patient was considered fit to drive in all domains assessed at all time points at day 1 and 2. Higher doses of MC -and corresponding very high THC serum levels -resulted in best results with respect to patient's driving ability. THC serum levels ranged from 19 ng/ml (at day 2 without MC intake at this day) to 364 ng/ml (at day 1 after intake of a total of 3.3 g MC at the same day). No clinically relevant side effects occurred.This case study demonstrates that patients with TS plus comorbid ADHD may be fit to drive even after intake of high doses of MC. In any case, however, every driver, who uses MC, is obliged to check fitness to drive before driving a vehicle.
Keywords: Tourette Syndrome, ADHD, Fitness to drive, Cannabis-based medicine, case report
Received: 18 Mar 2025; Accepted: 21 Jul 2025.
Copyright: © 2025 Streetz, Szejko, Fremer, Teske, Brunnauer and Müller-Vahl. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Natalia Szejko, Hannover Medical School, Hanover, 30625, Lower Saxony, Germany
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