Thoughts from the void: Cannabis and Autism

'Studies identified beneficial changes in autism symptoms following cannabinoid therapy, including “decreased bouts of self-mutilation and anger, hyperactivity, sleep problems, anxiety, restlessness, psychomotor agitation, irritability, perseverance, aggressiveness, and depression [and] improvement in sensory sensitivity, cognition, attention, social interaction, and language.” Side-effects were generally “mild to moderate,” including sleep disturbances, fatigue, diarrhea, and increased appetite.

Authors concluded, “Cannabis and cannabinoids have very promising effects in the treatment of autistic symptoms and can be used in the future as an important therapeutic alternative.”'

- NORML

- Nature

Autism Spectrum Disorder (ASD) is a condition that some individuals are born with. We sometimes call these individuals differently-able. This is because the way they approach life is different from the conventional person, that is, if there is even such a thing as a conventional person. Usually autistic individuals take much longer to learn things such as walking, talking, reading, writing, etc. However a number of these individuals display high skills and intelligence in areas such as music, mathematics, etc, often from a young age.

People with ASD are extremely sensitive to their surroundings, and find it difficult to communicate and interact socially. In certain situations where they feel disturbed, they may go through bouts of fear, anger, anxiety, aggression and extreme agitation. It is not uncommon for persons with ASD to also suffer from epilepsy. Society, mainly their parents and family, tries to provide a suitable protective environment but quite often this is a serious lifelong challenge for all involved.

In most places in the recent past, an individual with autism is pumped with powerful pharmaceutical drugs, often a cocktail of them, many times a day, so that the individual is left in a highly sedated, nearly semiconscious state. The side effects of these powerful medications are often very severe, and many persons with autism do not survive for long. Parents and caregivers may feel that they have no other better way to manage their child, so rendering him or her incapacitated by medications may appear to be the best way to keep them from harm.

Some premier medical institutions have been researching the use of cannabis as medicine to treat autism in children and adults. Studies so far have shown positive results, enabling the autistic individual to stay calm, manage stress, pain, anxiety, sleep better, and live a more active and connected life than if put on other conventional treatment methods. The side effects and rejection rates are also supposedly low and cannabis is seen as well tolerated by these patients, quite a few of whom are very young. Autism is included in the qualifying medical conditions for which medical cannabis can be prescribed in a growing number of US states. It remains to be seen if, with growing legalization, cannabis can reach more and more of these autistic individuals, presently suffering untold agony along with their parents and family in every part of the world. Most of these autistic individuals have no access to legal, affordable cannabis that could help them improve the quality of their lives.

Cannabis was used as medicine for children for thousands of years in India, before it was prohibited by the British. We find evidence of its usage for conditions like lack of sleep, restlessness, pain, etc., - conditions which are also associated with ASD today - in the Indian Hemp Commission's report of 1895. This was usually in the form of sweet confectionery - such as majum - or as beverages in the form of bhang. As supporting evidence we see the following statements: Mr. F. Levy, Acting Deputy Commissioner, Salt and Abkari, Southern Division, says "Majum is, however, said to be given to children to make them sleep"; Hospital Assistant Chinny Sreenivasa Rau, Prapanna Komity, L. F. Hospital, Bobbili Vizagapatam District, states that "A confection called kutimajuma is given to children for producing sound sleep, good appetite, and as a remedy in dysentery"; Surgeon-Major H. W. B. Boyd, Superintendent, Colaba Lunatic Asylum, Bombay, says "It is not usual to give these drugs to children, but in exceptional cases bhang is used in the form of bala golee, viz., pills mixed with aromatics, for colic in infants, and also as a sedative in restlessness of new-born infants"; Mr. Purbhuram Jeewanram, Nagar Brahmin, Native Doctor (Vaidya), Bombay, says "Bhang is not very commonly used by children ; but it may be given to them as a medicine in proper doses to their great benefit"; Surgeon-Major G. T. Thomas, Civil Surgeon, Moulmein, says "Children in Upper India are given these drugs to induce sleep."

There is a stigma associated with cannabis because of the decades of propaganda unleashed by selfish interests to get cannabis prohibited, and keep it so. This often raises doubts in the minds of parents and guardians of autistic persons as to the harms, such as addiction, insanity, etc., that may arise from cannabis as medication. It has been proven repeatedly across thousands of years that cannabis does not cause addiction or insanity. Also, parents and guardians fear that cannabis may not be suitable for young children and youth. All these are myths by those who prefer to sell their expensive and dangerous synthetic pharmaceutical medications, rather than see an autistic child or person live a trouble free life in this world.

The following list of articles taken from various media speak about the above subject. Words in italics are the thoughts of yours truly at the time of reading the article.

'Conclusions: Currently, there are no approved medications for the core symptoms of ASD and only two medications Food and Drug Administration approved for associated irritability. Prescribed medications for symptoms associated with ASD display varying levels of efficacy, safety, and tolerability among the heterogeneous ASD population. At the time of this study there are no published placebo-controlled trials of medical cannabis for ASD and the observational studies have limitations. CBD-rich medical cannabis seems to be an effective, tolerable, and relatively safe option for many symptoms associated with ASD, however, the long-term safety is unknown at this time.'

https://www.liebertpub.com/doi/10.1089/can.2020.0154

'Results
We identified eight completed and five ongoing studies meeting the inclusion criteria. All studies reported substantial behaviour and symptom improvement on medicinal cannabis, with 61-93% of subjects showing benefit. In the three studies reporting on concomitant psychotropic medication usage and with cannabis use, up to 80% of participants observed a reduction in concurrent medication use. Adverse events related to cannabis use were reported in up to 27% of participants related, and two participants had psychotic events.

Conclusions
Early reports regarding medicinal cannabis in pediatric ASD symptom management are presented as positive; the evidence, however, is limited to very few retrospective cohort and observational studies. Evidence of safety and efficacy from prospective clinical trials is needed.'

https://onlinelibrary.wiley.com/doi/10.1111/cch.12909

'The administration of the phytocannabinoid CBDV (cannabidivarin) modulates brain chemistry in autistic patients in a manner that is typically associated with better patient outcomes, according to clinical data published in the journal Molecular Autism.

An international team of investigators from Germany, Spain, the Netherlands, and the United Kingdom assessed the administration of CBDV versus placebo in a cohort of male patients with autism spectrum disorder (ASD). Researchers reported that CBDV dosing led to brain changes in the striatum that are typically associated with the mitigation of ASD symptoms.

Authors concluded: “A single dose of CBDV was sufficient to shift atypical striatal FC [functional connectivity] in the mature autistic brain towards the profile found at baseline in neurotypicals. … Future studies are required to determine whether modulation of striatal FC is associated with a change in ASD symptoms.”'

https://norml.org/news/2021/07/08/clinical-trial-single-dose-of-cbdv-modulates-atypical-brain-circuitry-in-patients-with-autism-spectrum-disorder

'Findings: The findings suggest improvement in ASD symptoms, such as social communication (core symptom), noncore behaviors (self-injury, restlessness, rage attacks, agitation, aggressiveness, irritability), and comorbid conditions (anxiety, epilepsy, sleep problems/dysregulation, ADHD/hyperactivity/concentration). An additional benefit with the improvement in comorbid conditions is the reduction of medications used in some participants. Common side effects include sleep disturbance, somnolence, and decreased appetite, restlessness, and a single episode of psychosis requiring treatment. These studies' positive outcomes warrant the use of cannabis as an adjunct treatment in children and provide the impetus for further research studies with large randomized controlled trials to provide higher evidence literature to support the treatment of ASD symptoms with cannabis.'

https://cornerstone.lib.mnsu.edu/etds/1108/

'Authors concluded: “In this study, we have demonstrated for the first time in a placebo-controlled trial that cannabinoid treatment has the potential to decrease disruptive behaviors associated with ASD, with acceptable tolerability. This is specifically important for the many individuals with ASD who are overweight, as cannabinoid treatment was associated with net weight-loss in contrast to the substantial weight gain usually produced by antipsychotics. …

These data suggest that cannabinoids should be further investigated in ASD.”'

https://norml.org/news/2021/02/11/clinical-trial-whole-plant-cannabis-extracts-associated-with-improved-outcomes-in-autistic-patients

'“This case report provides evidence that a lower than previously reported dose of a phytocannabinoid in the form of a cannabidiol-based extract may be capable of aiding in autism spectrum disorder-related behavioral symptoms, core social communication abilities, and comorbid anxiety, sleep difficulties, and weight control,” authors concluded. “Further research is needed to elucidate the clinical role and underlying biological mechanisms of action of cannabidiol-based extract in patients with autism spectrum disorder.”'

https://norml.org/news/2021/01/28/case-report-cannabis-extract-associated-with-improvement-in-autism-related-behavioral-symptoms

'Case presentation
The parents of a 15-year-old boy, of South African descent, with autism spectrum disorder, selective mutism, anxiety, and controlled epilepsy, consulted a medical cannabis physician to trial cannabis extract to replace seizure medications. Incidentally, at a very low cannabidiol-based extract dose, he experienced unanticipated positive effects on behavioral symptoms and core social deficits.

Conclusion
This case report provides evidence that a lower than previously reported dose of a phytocannabinoid in the form of a cannabidiol-based extract may be capable of aiding in autism spectrum disorder-related behavioral symptoms, core social communication abilities, and comorbid anxiety, sleep difficulties, and weight control.'

https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-020-02478-7

'The administration of cannabinoids is associated with symptom improvements in patients with autism spectrum disorder (ASD) and show promise as potential treatment option, according to a systematic review of relevant studies published in the journal Brain Sciences.

Italian investigators reviewed data from ten published studies and four ongoing clinical trials. They reported: “In the present systematic review, we found preliminary evidence showing that cannabinoids might exert beneficial effects on some ASD-associated symptoms, such as behavioral problems, hyperactivity, and sleep disorders, with a lower number of metabolic and neurological side effects than [prescription] medications. Importantly, treatment with cannabinoids allowed [patients] to reduce the number of prescribed medication and significantly reduced the frequency of seizures in participants with comorbid epilepsy.”'

https://norml.org/news/2020/08/27/review-cannabinoids-promising-for-treating-symptoms-of-autism-spectrum-disorder

'Our systematic review was conducted according to the PRISMA guidelines and aimed to summarize the literature regarding the use of cannabinoids in ASD. After searching in Web of KnowledgeTM, PsycINFO, and Embase, we included ten studies (eight papers and two abstracts). Four ongoing trials were retrieved in ClinicalTrials.gov. Findings are promising, as cannabinoids appeared to improve problem behaviors, sleep, hyperactivity, and communication deficits, with limited cardiac and metabolic side effects. Interestingly, they generally allowed to reduce the number of prescribed medications and decreased the frequency of seizures in epileptic patients. Mechanisms of action could be linked to the excitatory/inhibitory imbalance found in people with ASD'

https://www.preprints.org/manuscript/202007.0373/v1

'Autism spectrum disorder (ASD) is a multifactorial, pervasive neurodevelopmental disorder defined by the core symptoms of significant impairment in social interaction and communication as well as restricted, repetitive patterns of behavior. In addition to these core behaviors, persons with ASD frequently have associated non-core behavioral disturbance (i.e. self-injury, aggression), as well as several medical comorbidities. Currently, no effective treatment exists for the core symptoms of ASD. This review reports the available pre-clinical and clinical data regarding the use of cannabis and cannabidiol (CBD) in the treatment of core symptoms, non-core symptoms and comorbidities associated with ASD. Additionally, we describe our clinical experience working with children and young adults with ASD who have used cannabis or CBD. At present, pre-clinical and clinical data suggest a potential for therapeutic benefit amongst some persons with ASD and that it is overall well tolerated. Further research is required to better identify patients who may benefit from treatment without adverse effects.'
https://www.sciencedirect.com/science/article/abs/pii/S1071909120300449

'Cannabis as a treatment for autism spectrum disorders patients appears to be well-tolerated, safe and seemingly effective option to relieve symptoms, mainly: seizures, tics, depression, restlessness and rage attacks. The compliance with the treatment regimen appears to be high with less than 15% stopping the treatment at six months follow-up. Overall, more than 80% of the parents reported at significant or moderate improvement in the child global assessment.'
https://www.nature.com/articles/s41598-018-37570-y

'During the Autism Speaks-hosted conference, the field’s pioneers shared findings, limitations and challenges from their research. State and federal officials discussed their interest in addressing regulatory roadblocks to research with cannabis, which remains a federally controlled substance. Participating members of the autism community shared their personal experiences and hopes for further research.'
https://www.autismspeaks.org/news/autism-speaks-hosts-first-scientific-conference-cannabis-and-autism

'53 children at a median age of 11yr (4-22) received cannabidiol for a median duration of 66 days (30-588). Self-injury and rage attacks (n=34) improved in 67.6% and worsened in 8.8%. Hyperactivity symptoms (n=38) improved in 68.4%, did not change in 28.9% and worsened in 2.6%. Sleep problems (n=21) improved in 71.4% and worsened in 4.7%. Anxiety (n=17) improved in 47.1% and worsened in 23.5%. Adverse effects, mostly somnolence and change in appetite were mild.'
https://www.frontiersin.org/articles/10.3389/fphar.2018.01521/abstract

'Colorado's House has passed a bill allowing medical marijuana use to treat autism spectrum disorders.

The bill had strong bipartisan support, passing 63-0 on Thursday.

The Senate is expected to do the same, and Gov. Jared Polis has pledged to sign it.

Autism spectrum disorders include autism, Asperger syndrome and other developmental disorders whose symptoms range from mild to severe.'
https://www.usnews.com/news/best-states/colorado/articles/2019-02-07/colorado-house-oks-bill-on-medical-marijuana-use-for-autism

'A recent study out of Israel, which approved cannabis research in 2007, gives parents new evidence to back up those claims. Published Jan 17. in the journal Nature, the study found that yes, cannabis can relieve some of the symptoms suffered by many autistic people, including seizures, restlessness, and rage attacks.

The study, “Real Life Experience of Medical Cannabis Treatment in Autism; Analysis of Safety and Efficacy,” followed 188 autism spectrum disorder (ASD) patients over a six-month period. The subjects were mostly male (81.9%) and had a mean age of 12.9 years, with 14 of the participants younger than five, 70 patients between six and 10, and 72 patients between 11 and 18. Their autism symptoms included “restlessness, rage attacks, agitation, speech impairment, cognitive impairment, anxiety, incontinence, depression and more.”

Its conclusion is emphatic: “Cannabis in ASD patients appears to be well tolerated, safe and effective option to relieve symptoms associated with ASD.”'
https://www.leafly.com/news/health/new-study-on-cannabis-and-autism-supports-parents-longtime-claims

'The Iowa Board of Medicine is formally considering approving a rule that would allow certain children with autism to use medical cannabis, if they qualify as having "severe, intractable pediatric autism with self-injurious or aggressive behaviors."

Some family members of people with autism consider the limitations to be too strict. A parent's initial petition to state public health officials was to approve medical marijuana use for patients with Autism Spectrum Disorder writ large.

The Iowa Office of Medical Cannabidiol ultimately pared down the plan to cover only children with severe autism. But some advocates want that access available to everyone with severe autism, whether they’re 9 or 49.'
http://www.iowapublicradio.org/post/advocates-want-medical-marijuana-treatment-severe-autism-patients-regardless-age#stream/0

'"To have the opportunity to have this medication as an option is something that would be absolutely fantastic for families like mine," Roberts said.

In the end, the board approved an amendment that will make patients with a certain form of severe autism, as well as ulcerative colitis, eligible for CBD oil usage.

When the board announced its decision, Gaunt said she couldn't help but cry tears of joy.'
https://www.kcci.com/article/medical-board-to-consider-medical-marijuana-for-autism-treatment/25583618

'Following the cannabis treatment, behavioral outbreaks were much improved or very much improved in 61% of patients. This preliminary study supports feasibility of CBD-based cannabis trials in children with ASD.'
https://link.springer.com/article/10.1007/s10803-018-3808-2

'The Rhode Island Department of Health approved a petition from parents Tuesday which would allow them to use medical marijuana to treat children with autism.'
https://www.wpri.com/community/health/medical-marijuana-approved-in-ri-for-children-adults-with-autism/1528728479

The reaction, she says, was almost immediate. He was calm. He made eye contact. The flapping and tapping stopped. His teachers and therapists noticed a difference. A few weeks passed. Then one night, as she was helping him get ready for bed, Roman said the first word he had said to her in a decade. It was “Mom.”

'Researchers want to partner with families whose children have been diagnosed with Autism Spectrum Disorder (ASD) and are already consuming medical cannabis from state-licensed dispensaries.

Participation will be confidential, said Dr. Athena Zuppa, director of CHOP's Center for Clinical Pharmacology.'
http://www2.philly.com/philly/business/cannabis/autism-medical-marijuana-study-chop-childrens-hospital-philadelphia-cannabis-20180823.html

'The Iowa Board of Medicine is formally considering approving a rule that would allow certain children with autism to use medical cannabis, if they qualify as having "severe, intractable pediatric autism with self-injurious or aggressive behaviors."

Some family members of people with autism consider the limitations to be too strict. A parent's initial petition to state public health officials was to approve medical marijuana use for patients with Autism Spectrum Disorder writ large.

The Iowa Office of Medical Cannabidiol ultimately pared down the plan to cover only children with severe autism. But some advocates want that access available to everyone with severe autism, whether they’re 9 or 49.'
http://www.iowapublicradio.org/post/advocates-want-medical-marijuana-treatment-severe-autism-patients-regardless-age#stream/0

'The board voted to recommend the state add severe pediatric autism to the list of ailments for which Iowans may legally purchase medical marijuana products. But the board declined patients’ requests to also add attention deficit hyperactivity disorder, post-traumatic stress disorder, bipolar disorder and ganglioglioma, which is a type of brain tumor.'
https://www.desmoinesregister.com/story/news/health/2018/11/02/iowa-medical-marijuana-board-thc-limit-medpharm-cbd-cannabidiol-autism-pain-ptsd-cannabis-pot-ptsd/1850109002/

'Opioid addiction, autism, general anxiety, chronic anxiety, depression and insomnia were selected Wednesday for more study as qualifying conditions for medical marijuana in Ohio.

A committee of the Ohio State Medical Board met in Columbus to select those conditions as Ohio prepares for the first sales of medical marijuana, perhaps as early as next week.'
https://www.cincinnati.com/story/news/2019/01/09/ohio-study-more-ailments-medical-marijuana/2529672002/

'Others requested medical marijuana for autism, migraines, lupus, severe acne, hyperthyroidism and arthritis. Two petitions asked the board to consider adding opioid addiction as a qualifying condition, as New York and Pennsylvania did last year.

Tessie Pollock, spokeswoman for the State Medical Board, said board lawyers are reviewing the petitions, and they will make recommendations to a committee set to meet Wednesday in Columbus. The committee will vote on which petitions will get more review by medical specialists for the various conditions and experts in medical marijuana programs in other states.

The committee then will make a recommendation to the full Medical Board by June 30 on which conditions to add to the qualifying list.'
https://www.cincinnati.com/story/news/2019/01/04/ohio-considers-more-conditions-qualify-medical-marijuana/2481844002/

'Currently, only Texans diagnosed with "intractable epilepsy" are allowed to use cannabis that contains low levels of the psychoactive ingredient tetrahydrocannabinol, or THC. Menéndez's bill would dramatically expand this law by legalizing medical marijuana for Texans with certain other debilitating conditions, including cancer, glaucoma, HIV, Alzheimer's, PTSD, autism or chronic pain, nausea and muscle spasms'
https://www.dallasnews.com/news/texas-legislature/2019/01/03/texas-marijuana-advocates-get-fired-decriminalize-pot-2019

Minnesota's list of qualifying conditions for medical marijuana includes autism spectrum disorder

Pennsylvania's list of medical conditions qualifying for medical marijuana includes autism

'There is no cure for autism (although a small percentage of children do appear to outgrow it), and there are few treatments for its symptoms. But, because of the potential promise of cannabis treatments, the Ray and Tye Noorda Foundation, a nonprofit based in Utah, donated $4.7 million to the Center for Medicinal Cannabis Research (CMCR) at the UC San Diego School of Medicine — the largest private gift to date for medicinal cannabis research in the United States, according to an April 25 statement from the university.'
https://www.livescience.com/62455-can-marijuana-treat-autism.html

'A bill that would add autism spectrum disorders to the list of conditions that give patients the green light to use medical marijuana to treat their conditions passed through the Senate on Wednesday.

In a 31-4 vote, the Senate passed the third reading of the bill.'
https://koaa.com/news/capitol-watch/2019/03/20/colorado-senate-passes-bill-for-medical-marijuana-use-to-treat-autism/

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