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—16— O’Shaughnessy’s • Summer 2010

A Novel Approach to the Symptomatic Treatment of Autism

Parents of some autistic children report that cannabis eases behavioral
problems more effectively than conventional pharmaceuticals. Their
anecdotal evidence should be taken seriously by medical researchers.
by Lester Grinspoon M.D.
Autism is one of a group of conditions known as lecting, and arranging. Unfortunately, little is known
pervasive developmental disorders. This mysterious about the long-term effects of drugs in autistic chil- Since we started him on his ‘special tea,’
disability, first described and named more than 60 years dren, and no known drug has any effect on the under- J’s face, which is sometimes a mask of pain,
ago, is characterized by striking emotional and cogni- lying lack of capacity for empathy and communica- has softened.
tive isolation and detachment. tion.
Autistic children are characterized by their appar- The last time she came, J hit her. This time, she re-
ent inability to form human relationships, abnormal or A Mother’s Report marked that J seems calmer. As we were preparing for
absent speech, and an unusually limited range of ac- With the explosive growth of interest in exploring a trip to the park, J disappeared, and we wondered if
tivities and interests. It is estimated that three to six the medicinal capacities of marijuana, some coura- he was going to throw one of his tantrums. Instead, he
out of every 1000 children in the United States has geous parents, concerned about the toxicity of the returned with Grandma’s shoes, laying them in front
autism, about three quarters of them are boys, and the above-mentioned drugs, and desperate to find pharma- of her, even carefully adjusting them so that they were
number of cases appears to be rising. It is not clear ceutical means of relieving their children of some of parallel. He looked into her face, and smiled.
whether this is due to better detection and reporting of the harsh symptoms of autism, have been experiment- “It’s strange, I’ve come to think, that the virtues of
autism, a real increase in the prevalence, or both. ing with oral doses of cannabis. The following anec- such a useful and harmless botanical have been so
While symptoms of autism often occur in the first dote was provided by Marie Myung-Ok Lee who clouded by stigma. Meanwhile, in treating J with pot,
months of life, they may be disregarded at first, but by teaches at Brown University. She is the author of the we are following the law — and the Hippocratic oath:
the age of two or three it is clear that something is se- novel Somebody’s Daughter and is a winner of the Ri- first, do no harm. The drugs that our insurance would
riously wrong. Autistic children show little interest in chard Margolis award for social justice reporting. pay for — and that the people around us would sup-
others, children or adults. They do not communicate “My son J, who is nine years old, has autism. He’s port without question — pose real risks to children.
experiences and there is little if any spontaneous or also had two serious surgeries for a spinal cord tumor For now, we’re sticking with the weed.
imaginative play; instead they prefer monotonous, soli- and has an inflammatory bowel condition, all of which “How is J doing now, four months into our can-
tary activities. They may spend hours performing ritu- may be causing him pain, if he could tell us. He can nabis experiment? Well, one day recently, he came
alistic repetitive motions. They can be fascinated by say words, but many of them don’t convey what he home from school, and I noticed something really dif-
one limited subject or activity to the exclusion of all means. ferent: He had a whole shirt on.
others and they are sometimes violent in their resis- “J’s school called my husband and me in for a meet- “Pre-pot, J ate things that weren’t food. He chewed
tance to efforts to change the focus of their attention. ing about J’s tantrums, which were affecting his abil- the collar of his T-shirts while stealthily deconstructing
They appear to fear novelty and may explode in rage ity to learn. Their solution was to hand us a list of child them from the bottom up, teasing apart and then swal-
when faced with change. psychiatrists. Since autistic children like J can’t ex- lowing the threads. His chewing become so uncon-
Many autistic children are hypersensitive to minor actly do talk therapy, this meant sedating, antipsychotic trollable we couldn’t let him sleep with a pajama top
noises, smells and physical sensations, and some are drugs like Risperdal (risperidone). (it would be gone by morning) or a pillow (ditto the
hyperactive, impulsive, aggressive and self-destructive. “As a health writer and blogger, I was intrigued case and the stuffing). The worst part was watching
They may throw tantrums in response to apparently when a homeopath suggested medical marijuana. Can- him scream in pain on the toilet, when what went in
trivial frustration, repeatedly bite themselves, hit them- nabis has long-documented effects as an analgesic and had to come out.
selves with their fists, or strike their heads against a an anxiety modulator. Best of all, it is safe. A publica- “Almost immediately after we started the cannabis,
wall. Their language develops slowly and in an odd tion by the Autism Research Institute described cases this stopped. Just stopped. J now sleeps with his or-
way, making them unintelligible; some do not speak at of reduced aggression, with no permanent side effects. ganic wool-and-cotton, temptingly chewable com-
all. The vast majority, but not all, are retarded. A few, “After a week on Marinol, which contains a syn- forter. He pulls it up to his chin at night and declares,
who may or may not be retarded, have unusual talents; thetic cannabinoid, J began garnering a few glowing ‘I’m cozy!’
they are known as savants. school reports. But J tends to build tolerance to syn- “Next, we started seeing changes in J’s school re-
There is no cure for autism, nor is there “one-size- thetics, and in a few months, we could see the aggres- ports. At one August parent meeting, his teacher ex-
fits-all” treatment. Treatment options include behav- sive behavior coming back. One night, at a medical- citedly presented his June-July ‘aggression’ chart. For
ior and communication therapies, educational thera- marijuana patient advocacy group, I learned that the the past year, he’d consistently had 30 to 50 aggres-
pies and drug therapies. Our interest here is in explor- one cannabinoid in Marinol cannot compare to the 60 sions in a school day, with a one-time high of 300. The
ing the possibility of a new drug therapy. in marijuana the plant. charts for June through July, by contrast, showed he
Drugs have a place in treating autistic symptoms, “Rhode Island, where we live, is one of 14 states was actually having days —sometimes one after an-
but their uses are limited. Antipsychotic drugs and where the use of medical marijuana is legal. And yet, I other—with zero aggressions.
mood stabilizers may help autistic patients who repeat- hesitated. Now we were dealing with an illegal drug, “I don’t consider marijuana a miracle cure for au-
edly injure themselves. The older conventional antip- one for which few evidence-based scientific studies tism. But I do consider it a wonderful, safe botanical
sychotic drugs have serious side effects on body move- existed precisely because it is an illegal drug. But when that allows J to participate more fully in life without
ments. The novel or atypical drug risperidone I sent J’s doctor the physician’s form that is mandatory the dangers and sometimes permanent side effects of
(Risperdal) has shown a glimmer of promise in recent for medical marijuana licensing, it came back signed. pharmaceutical drugs, now that we have a good dose
research. Anticonvulsants may be useful in suppress- We underwent a background check, and J became the and a good strain. Free from pain, J can go to school
ing explosive rage and calming severe anxiety. About state’s youngest licensee. and learn. And his violent behavior won’t put him in
20% of autistic people have epileptic seizures, and some “The coordinator of our medical marijuana patient the local children’s psychiatric hospital —a scenario
researchers have suggested that unrecognized partial advocacy group introduced us to a licensed grower, all too common among his peers.
complex seizures, which cause changes in conscious- who had figured out how to cultivate marijuana using “We have pictures of J from a year ago when he
ness but not muscular convulsions, are one source of a custom organic soil mix. The grower left us with a would actually claw at his own face. That little child
autistic behavior disturbances. month’s worth of marijuana tea, glycerine, and olive with the horrifically bleeding and scabbed face looks
In several studies, selective serotonin reuptake in- oil — and a cookie recipe. We paid $80. to us now like a visitor from another world. The J we
hibitors (SSRIs) have been found to relieve depres- “We made the cookies with the marijuana olive oil, know now just looks like a happy little boy.
sion and anxiety and reduce compulsive ordering, col- starting J off with half a small cookie. J normally goes “We worried that ‘the munchies’ would severely
to bed around 7:30 p.m.; by 6:30 he declared he was aggravate J’s problems with overeating in response to
Lester Grinspoon, MD, Associate Professor Emeritus
tired and conked out. As we anxiously peeked in on his stomach pangs. Instead, the marijuana seems to
of Psychiatry at Harvard Medical School, was the first U.S.
doctor to prescribe lithium carbonate for bipolar disorder. him, half-expecting some red-eyed ogre from Reefer continued on next page
While writing Marihuana Reconsidered (Harvard, 1971) Madness to come leaping out at us, we saw in-
he became convinced that the plant was beneficial. Mari- stead that he was sleeping peacefully. Usually,
huana: The Forbidden Medicine (with James Bakalar, Yale, his sleep is shallow and restless.
1997) lists its wide range of applications. “When J decided he didn’t like the cookie any-
more, we switched to the tea. After two weeks,
we noticed a slight but consistent lessening of
aggression. Since we started him on his ‘special
tea,’ J’s face, which is sometimes a mask of pain,
has softened. He smiles more. For the last year,
his individual education plan at his special-needs
school was full of blanks because he spent his
whole day in an irritated, frustrated mess. Now,
April’s report shows real progress, including “two
community outings with the absence of aggres-
“The big test has been a visit from Grandma.
photo by George Heyer
O’Shaughnessy’s • Summer 2010 —17—

Cannabis for Autism from page 3

have modulated these symptoms. J still

can get overexcited if he likes a food too The first obstacle in the path wetting) although
these drugs were
much, so the other day, we dared to ex- of anyone who wishes to ex-
originally approved
periment with doenjang, a tofu soup that plore cannabis as a medicine by the FDA for other
he used to love as a baby. The last time
we tried it, a year ago, he frisbeed the is to overcome the widely held purposes. Anecdotes
belief that it is a very danger- or case histories of
bowl against a tile wall.
the kind presented
“We left J in the kitchen with his ous substance. here by Marie
steamy bowl and went to the adjoining
Myung-Ok Lee are,
room. We heard the spoon ding. Satis- there pediatric studies of the toxicity of
in a sense, the small-
fied slurpy noises. Then a strange noise risperidone and other conventional drugs
est research studies
that we couldn’t identify. A chkkka used in the treatment of autism. How-
of all.
bsssshhht doinnng! We returned to the ever, to the extent that one can extrapo-
kitchen, half expecting to see the walls late the adult toxicity profiles of the an- present a problem that has always haunted ever, inhalation is not an option for
painted with doenjang. Everything was tipsychotic drug risperidone and can- medicine: the anecdotal fallacy or the fal- children who suffer from autism; for
clean. The bowl and spoon, however, nabis, the latter is the much safer drug. lacy of the enumeration of favorable cir- these patients, the best route for admin-
were gone. It is often objected, especially by fed- cumstances (counting the hits and ignor- istration is oral, in the form of cook-
“J had taken his dishes to the sink, eral authorities, that the medical useful- ing the misses). If many people suffering ies, brownies, tea, etc.
rinsed them, and put them in the dish- ness of marijuana has not been demon- from, say, muscle spasms caused by mul- There are now available marijuana
washer —something we’d never shown strated by controlled studies, the rigor- tiple sclerosis take cannabis and only a few cookbooks from which a variety of
him how to do. In four months, he’d gone ous, expensive, and time-consuming get much better relief than they could get edibles which appeal to children can
from a boy we couldn’t feed to a boy tests necessary to win approval by the from conventional drugs, these few pa- be found. (See article at right) With in-
who could feed himself and clean up af- Food and Drug Administration (FDA) tients would stand out and come to our gestion, the therapeutic effects will not
ter. The sight of the bowl, not quite for marketing as medicines. The pur- attention. They and their physicians appear before one and a half to two
rinsed, but almost, was one of the sweet- pose of the testing is to protect the con- would understandably be enthusiastic hours, but the advantage is that they
est sights of my parental life. I expect sumer by establishing both safety and about cannabis and might proselytize for last for many hours.
more to come.” efficacy. Because no drug is completely it. These people are not dishonest, but they Beyond preparing the edible are the
safe (nontoxic) or always efficacious, a are not dispassionate observers. There- challenges of determining the right
drug approved by the FDA has presum- fore, some may regard it as irresponsible dose (such as beginning with a frac-
ably satisfied a risk-benefit analysis. to suggest on the basis of anecdotes that tion of a cookie and increasing the dose
The cost of doing the controlled stud- cannabis may help some people with a va- as needed) and establishing a schedule
ies necessary for FDA approval may run riety of symptoms and disorders. That for taking the medication. These tasks
to about $800 million per drug, a cost might be a problem if marijuana were a will require some experimentation on
borne by the drug company seeking it dangerous drug, but it is becoming in- the part of the parents, but with expe-
as a necessary pre-requisite for the dis- creasingly clear that it is remarkably safe. rience they will soon find the best reci-
Because autism is such a devastating tribution of its patented product. Because Even in the unlikely event that only a few pes for their child, the ideal dose and a
and so far incurable disease, and the it is impossible to patent a plant, phar- autistic children get the kind of relief that workable schedule. Unfortunately, be-
available pharmaceutical products have maceutical companies are not interested “J” gets, it could be argued that cannabis cause there is presently no easy and
such limited usefulness and serious side- in developing this herbal medicine and should be available for them because it available way of knowing with any pre-
effects, anguished parents like Marie so far the cannabinoid products they costs so little to produce, the risks are so cision the potency of any particular
Myung-Ok Lee seek out alternative have developed are not nearly as useful small, and the results so impressive. batch of marijuana, each newly pre-
therapies. as whole herbal marijuana. While federal law is absolute in pro- pared edible will have to be re-titrated,
I have had the opportunity to consult Should FDA Rules Apply? hibiting the use of marijuana for any pur- but with experience caregivers will find
with and help a small number of these But it is doubtful whether FDA rules pose, beginning with California in 1996, this an increasingly less difficult task.
parents explore marijuana as a medicine should apply to marijuana. First, there there are now 14 states where it is pos- It is also important to remember that
which can help to control some of the is no question about its safety. It has been sible to use it as a medicine within speci- cannabis is a very forgiving medicine;
severe behavioral problems. (For the used for thousands of years by millions fied limits. California, in addition to be- one would have to be considerably over
approximately one in five children with of people with very little evidence of sig- ing the first state to make an accommoda- the “ideal” dosage mark to cause any
autism who suffer some sort of seizure nificant toxicity. Similarly, given the tion to patients in need of cannabis, is also difficulty.
disorder, it is important to note that mari- mountain of anecdotal evidence which one of the states in which the legal inter- One way of minimizing what are
juana is an excellent anticonvulsant and has accumulated over the years, no pretation of those needs and the means by usually minor therapeutic differences
was widely used as such in the last part double-blind studies are needed to prove which they can be filled is broad enough between one batch of cannabis and an-
of the 19th century and the early decades marijuana’s efficacy. Any astute clini- to satisfy the demands of patients with the other is to try to use the same strain of
of the 20th). Those who have persevered cian who has experience with patients wide variety of symptoms and syndromes marijuana every time an edible is pre-
in the arduous process of both finding who have used cannabis as a medicine for which this herb is useful. pared. At the same time, many patients
the correct oral vehicle and titrating the knows that it is efficacious for many New Jersey, the latest state to adopt who use marijuana as a medicine take
optimal dose have been rewarded in people with various symptoms and syn- medical marijuana legislation, is, unfor- advantage of the fact that there is a
more or less the same ways as J’s par- dromes. What we do not know is what tunately, among the most restrictive. It is growing variety of available strains,
ents. proportion of patients with a given symp- so restrictive both with respect to the each with slight differences in the per-
The first obstacle in the path of any- tom will get relief from cannabis and symptoms and syndromes for which a centages and ratios of the different
one who wishes to explore cannabis as a how many will be better off with can- patient is allowed to use the drug and the therapeutic cannabinoids. This allows
medicine is to overcome the widely held nabis than with the best presently avail- means by which patients are allowed ac- patients to empirically explore the dif-
belief that it is a very dangerous sub- able medicine. Here large, controlled cess to it, that only a relatively small per- ferent strains in an effort to identify the
stance. The misinformation campaigns studies will be helpful. centage of the patients who would find particular strain which appears to be
of the United States government and marijuana more useful, less toxic, and less the therapeutically most useful for their
such organizations as the Partnership for Controlled experiments were expensive than the conventional drugs symptomatology.
a Drug-Free America notwithstanding,
marijuana is an unusually safe drug. In
not needed to recognize the they presently use will have access to it. The parents of autistic children
Fortunately for her and her family, Marie carry a heavy burden. They are con-
fact, after federal-court-ordered lengthy therapeutic potential of chloral
Myung-Ok Lee lives in Rhode Island, stantly challenged and frustrated by the
hearings before a Drug Enforcement hydrate, barbiturates, aspirin, where after presenting the appropriate cre- child’s inability to communicate, his
Administration Law Judge involving curare, insulin, or penicillin. dentials from J’s physician, she was li- impulsiveness and his destructive and
many witnesses, including both patients censed to legally obtain marijuana. How- self-destructive behavior. They and
and doctors, and thousands of pages of Physicians also have available evi- ever, in most states patients or the people other caregivers become emotionally
documentation, Judge Francis L. Young dence of a different kind, whose value responsible for their care have to make, drained and physically exhausted from
in 1988 asserted that “marijuana, in its is often underestimated. Anecdotal evi- what for many of them, is a very difficult the constant need for supervision. It is
natural form, is one of the safest thera- dence commands much less attention decision —whether to buy or grow can- my hope that this paper will bring to
peutic active substances known to than it once did, yet it is the source of nabis outside of the law. the attention of many of these parents
man...” much of our knowledge of synthetic Beyond gaining access to marijuana, the possibility that there may be a new,
Cannabis was much used in Western medicines as well as plant derivatives. there are the problems involved in the if not officially or even medically ap-
medicine from the mid-19th century un- Controlled experiments were not needed preparation of this medicine in a form suit- proved, approach to their daunting
til shortly after the passage of the Mari- to recognize the therapeutic potential of able for children. The most common way challenge. While this approach may
juana Tax Act of 1937. There has never chloral hydrate, barbiturates, aspirin, in which marijuana is used as a medicine not work for all, it assuredly will do
been a recorded death attributable to curare, insulin, or penicillin. Further- is through inhalation of the smoke from a no harm.
marijuana. When it regains its rightful more, it was through anecdotal evidence pipe, a joint or a vaporizer. This is the
place in the US pharmacopeia, it will that we learned of the usefulness of pro- preferred method for adults, because it
soon be recognized as one of the least pranolol for angina and hypertension, of makes it possible for the patients to pre-
toxic medicines in that compendium. diazepam for status epilepticus (a state cisely titrate the dose because with this
While there are no studies of the toxic- of continuous seizure activity), and of method of delivery they will perceive the
ity of cannabis in children, neither are imipramine for childhood enuresis (bed- therapeutic effects within minutes. How-

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