The endocannabinoid system is the target of a whole new class of drugs to treat a wide range of diseases and illnesses. As we have covered in the past, the prospects of cannabis, or drugs which act on the same receptors in the body, are being developed for everything from cancers, to MS, to dementia, and a wide list of other applications. Cannabidiol, or CBD, was also approved by the United States FDA for the treatment of seizures in patients as young as 2 years old. However, new studies are pointing to CBD use in the treatment of autism spectrum disorder in both children and adults.
The use of CBD in the treatment of autism is complicated, and does not come without criticism. In today’s article, we will explore the science behind this new therapy, and the direction the industry is heading towards in the future. Like with many other new treatments we have seen, often the phytocannabinoids found in cannabis are a gateway to understanding the complex network of interactions between the various systems of the body, allowing for the discovery of entirely new lines of treatment which act to support or suppress the actions of the body’s endogenous cannabinoids.
What is Autism Spectrum Disorder?
Autism Spectrum Disorder, also known as just Autism or ASD, includes a range of complex developmental challenges including social interaction, speech and non-verbal communication, and restricted or repetitive behaviors. Because the symptoms vary greatly from one individual to another, it is referred to as a spectrum. The diagnoses criteria for ASD is set by the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5), published in 2013. According to a recent study using data from several US locations and the DSM-5 criteria, it is estimated that 1 in 59 eight-year old’s in the United States are on the autism spectrum, white 4 times more males than females, and the largest ethnic group being white/non-Hispanics. The findings of the CDC are similar, with a reported prevalence of 1 in 54 children. The CDC website also indicates that the prevalence of ASD has increased 3-fold between the year 2000-2016, from 1 in 150 individuals to 1 in 54, however it should be noted that the definitions used for diagnoses have also changed during that time, as has the number of sites reporting data.
Because autism disorder is a spectrum, it is hard to describe the exact symptoms and conditions it carries. Some diagnosed with autism may have high IQ’s and be able to function relatively normally in their homes, school, or work. Others may be more severely affected, lading to great difficulties int their own lives and those of their family members. Persistent and uncontrollable outbursts of anger, aggression, or so called ‘fits’ can be common. Over time, these can lead to families being broken apart, parents being unable to work, and, if proper support networks are not in place, a greatly diminished quality of life for the person and their family. Only two medications are currently available to treat ASD symptoms, aripiprazole and risperidone, both of which are not very effective and have many undesirable side effects including weight gain, type 2 diabetes, and breast tissue growth. So, it is no wonder that, just like with cancer, MS, or dementia; patients and their families are trying anything possible and are often self-medicating with cannabis. So, it is time for the medical industry to start taking cannabis use seriously in ASD patients, including children.
Are Autism patients finding relief with cannabis?
A quick google search for CBD and Autism comes up with more than 4 million pages. One quickly notices that many of these are actually magazine focused on parents with autistic children, with stories from other parents describing how they could not find relief anywhere else and then found it in CBD. If we then look at the scientific literature, we can find a wave a new studies being published in the last several years investigating this relationship, and making recommendations for future studies and uses.
One of the first real promising reports comes from 2018, which retroactively analyzed the data from a safety assessment involving 60 children with ASD. It found that after treatment with a high CBD cannabis extract (20:1, CBD:THC), most (61%) were ‘much improved,’ or ‘very much improved.’ Of the children, 86% saw improvement in anxiety and communicative problems, there was a 29% decrease in disruptive behaviors, and parents reported a 33% decrease in stress scores. The only side effects reported in more than 1-2 patients were sleep disturbances (14%), Irritability (9%), and a loss of appetite (9%).
One of the most remarkable studies is from 2019, which gave a CBD enriched cannabis extract (75:1, CBD:THC) to 18 autistic patients. Of the 15 who completed the trail, 10 were also epileptic, and 5 non-epileptics. Of the 15, only 1 patient showed no improvement in their symptoms in the first month. Three patients then dropped out due to the psychoactive effects of the cannabis, but after the 6-9 month follow up all of the remaining 12 patients showed marked improvement in there diagnosed symptoms. Furthermore, 5 patients needed no other medications, and 9 other patients were able to reduce or even withdrawal from some of their medications. This study was not a double-blind placebo-controlled trial, but helped show the promise of CBD as a therapeutic or treatment of ASD.
A more recent review, published in October 2020 took a critical approach to looking at the studies conducted over the last several years. And although this review questioned the techniques or findings of many of the previous studies (including those presented above), it concluded that “despite these potential sources of bias, this study showed a trend toward improvement in controlling hyperactivity, self-injurious behavior, anxiety, and sleep disturbances with CBD oil through observation and anecdotal evidence.”
What is next in the pursuit of using CBD to treat Autism?
The anecdotal or sparse clinical research done thus far on CBD in the treatment of ASD is not enough to convince physicians or the wider medical industry. However, it is enough to warrant further investigation, and as this article is being written there are several phase II and II trails, including one double-blind, placebo controlled trails going on. Such trails are the so called ‘gold-standard’ of medicine, and many are eagerly waiting their results.
One of the first trials is being conducted by the United States Department of Defense and GW Pharmaceuticals, the maker of FDA approved CBD drug Epidiolex®. This trial will use the cannabinoid Cannabidivarin, or CBDV, which is closely related to CBD, and also non-psychoactive. This study of 100 patients has already began, and should conclude around September of 2021.
The second study to watch is coming out of Israel, and is being led by Dr. Adi Aran. This study proposes to use a mix of cannabinoids (20:1, CBD:THC) extract as well as a placebo and a whole plant cannabis extract. Although the study started in January 2017 and has produced three short articles articles, it has not been completed yet.
The final registered clinical study is taking place at the University of New York, and is an open Phase II trial with 30 participants. The trial began in March of 2019, and is set to conclude in January of 2021. This trial will also use the drug Epidiolex®. This trial will administer 3 different dosage levels of pure CBD to participants to evaluate the variation in effects at varying levels of therapy.
The future of CBD in the treatment of Autism
After many years of anecdotal reports from parents who had nowhere else to turn, the medical industry is now looking at CBD and other cannabinoids found in cannabis to treat the symptoms of autism. After the lackluster results from the two currently available autism medications, aripiprazole and risperidone, this is a very welcomed development for patients, their parents, and their families. Already, so many have found relief from CBD and now the science is catching up to justify and refine these types of treatments. In the short-term, it appears that CBD is becoming more accepted as an additional treatment that will allow patients to reduce their dependency on other medications which have known long-term and chronic side effects. Over the next few years, we can also expect that CBD drugs such as Epidiolex will become more widely available to ASD patients, and may even receive FDA approval if the current clinical trials are a success.
For the long-term, we may be able to expect changes within the way we understand and treat ASD because of the finding s that arise from treatment with cannabis. Like so many other fields of medicine that we have seen over the last decade, the journey begins with cannabis showing marked improvements in symptoms, but also has issues that slow its acceptance in the medical community including variability, psychoactive effects (which can be viewed as detrimental, but also thwart placebo controlled studies), reproducibility, dosing, and routes of administration. But, once we understand the mechanisms of action, or the how and why, regarding cannabis’ therapeutic uses then new drugs can be created which target analogues in the body or affect the CB1/CB2 receptors in similar ways. This is only the beginning, but a new sense of hope is on the way for so many families struggling to deal with autism today.