When I first started writing about the claims made for medical marijuana and the cannabis oil derived from it, it didn't take long for me to characterize medical claims for cannabis as the "new herbalism," as opposed to pharmacognosy, the branch of pharmacology devoted to the study of natural products. The reason is simple. Although I support legalization of marijuana for recreational use, when I look at how medical marijuana has been promoted as a "foot-in-the-door" prelude to legalization, I see testimonials and flimsy evidence ruling over all. I see all the hallmarks of alternative medicine herbalism and none of the hallmarks of pharmacology. Here's what I mean. Pharmacognosy examines an herb, plant, or other natural product and seeks to identify the chemicals within it that have pharmacological activity against a condition or a disease, the better to purify and isolate those chemicals and turn them into drugs. Herbalism, on the other hand, emphasizes the use of whole plants or extracts from plants, rather than the isolation of the most active compounds. Thus, herbal remedies often contain hundreds, or even thousands, of different compounds, of which only one or a few are active. Even extracts, such as cannabis oil, contain many compounds.
In contrast to pharmacognosy, herbalists often make the claim that whole herbs and plant components possess a a sort of magical synergy that is missing from the purified active constituents and/or that the mixture is somehow magically safer than the pure components because one compound can reduce the side effects of another without reducing therapeutic efficacy. When looked at closely neither claim stands up to scrutiny. Synergism between plant constituents is rare and very difficult to demonstrate, for example. In essence, herbalism turns back the clock 200 years to a time before scientists had developed the techniques and abilities to isolate active ingredients with pharmaceutical activity. Moreover, herbalism, in contrast to pharmacognosy, emphasizes anecdotes over scientific evidence.
Indeed, in my previous posts in this series on medical marijuana, one theme has emerged, which is that cannabis—specifically, a class of active chemicals in marijuana known as cannabinoids—has potential for some diseases but is not the panacea claimed by its proponents. It does not cure cancer, for instance, contrary to glowing testimonials promoted by people like Rick Simpson. For other conditions, the evidence is either not particularly compelling or only mildly promising. The answer to the question of whether medical marijuana is good medicine is, as far as I'm concerned, mostly "no" and "we don't know."
So I reacted with considerable dismay last Friday night when I saw this news report on the 11 o'clock news, "Michigan panel recommends allowing marijuana for autism":
And, indeed, there have been stories all over the local news in Michigan like the one above and this one:
Note all the hearty cheering from the audience when the vote tally was read.
Here's what happened:
Michigan would become the first state to allow medical marijuana for children with severe autism if a senior official follows the recommendation made Friday by an advisory panel.
The state's Medical Marijuana Review Panel voted 4-2 to recommend autism as a condition that qualifies for the drug.
Supporters say oil extracted from marijuana has been effective in controlling extreme physical behavior by kids with severe autism. Pot wouldn't be smoked.
The panel was influenced by comments received earlier from some Detroit-area doctors, especially the head of pediatric neurology at Children's Hospital of Michigan, and parents desperate for relief. Many of the three dozen spectators cheered and applauded after the vote.
This is an utterly horrible idea, but it looks as though our state is nonetheless about to take the plunge into the Brave New World of treating autism with cannabis oil. Indeed, Michael Komorn, the President of the Michigan Medical Marijuana Association and the attorney who brought the petition before the board, basically admitted in the first news clip above that there was no science behind the board's recommendations when he said: "It's a no-brainer. And you heard the testimony of these people. They just want a little hope. That's all they're asking for." Notice the distinct lack of any mention of strong science as a rationale for adding autism to the list of qualifying conditions. Komorn even went so far as to tout how the parents "are responsible for growing the plants or acquiring the cannabis, and they are in charge of dosing, frequency of use, and method of ingestion."
Think about this for a moment. Is there another regulated drug for which this is the case? The board didn't even provide, along with its recommendation for approving autism as a qualifying condition for treatment with cannabis oil, anything resembling recommendations for dosing, method of ingestion, or frequency of use, very basic recommendations that, for example, the FDA includes in its approvals and even those evil drug companies provide for their poisons. (I do so love my sarcasm.) Yet, here, in the fantasy world of medical marijuana, apparently parents are as knowledgeable as physicians—more so, even, given that most physicians here have no idea how to prescribe medical marijuana—and no guidelines for use are needed. The lack of dosing recommendations is another powerful indication that there is no science behind this recommendation, because if there was science behind it we'd know the optimal dose and method of administration to use cannabis oil to treat autism. Clearly, emotion, not science, ruled the day on Friday. Indeed, how Dr. Harry T. Chugani, the head of pediatric neurology at an institution as respected as Children's Hospital could testify in favor of this nonsense is beyond me, but apparently he did:
"It seems to work. ... Wouldn't that be better than giving them all these psychiatric drugs?" Chugani said. "Not every autistic kid would take this, but if your behavior is wild and you have to be institutionalized, I as a physician would prefer to try medical marijuana. I have at least 50 patients on multiple drugs and still their behaviors are not controlled."
Notice that Dr. Chugani, too, didn't cite anything other than anecdotal evidence. How, for instance, did he know that the child isn't calmer because he's high on cannabis? And if we're going to drug autistic children to make them behave, why not use opioids or other sedatives as well?
In any event, if you want evidence that medical marijuana is far more akin to herbalism than pharmacology, we need look no further than my state's dubious position of becoming a "pioneer" in something that no state should be a pioneer in. That's why I'll first examine how the Medical Marijuana Review Panel got to where it is now, then the general claim that cannabis is a useful treatment for autism. Finally, I'll evaluate the existing scientific evidence, which is pretty thin.
Misguided activism advances cannabis herbalism
As has been the case with virtually all uses of medical marijuana sanctioned by states, the road to the Michigan Medical Marijuana Review Panel recommending approval of cannabis for autism began not with doctors and scientists clamoring for it based on evidence, but with parents becoming politically active to lobby for it based on emotional anecdotes. Such was the case in Michigan, and, if you've been paying attention to the "autism biomed" movement, this quote will sound very familiar:
The review panel voted 4-2 in favor of a petition submitted by Lisa Smith, a Michigan mother who has said cannabis oil has helped improve her severely autistic 6-year-old son's behavior, sleep patterns and eating schedule.
"The parents I've talked to are passionate and adamant that this represents a dramatic improvement in the quality of life for them and their affected children," said David Crocker, a medical marijuana doctor and member of the panel.
What other treatments for autism have we heard the same claims for? Let me think... Oh, yes. We've heard them for quite a few "autism biomed" treatments, with parents being just as passionate. Unfortunately, the vast majority of "autism biomed" is rank quackery. Examples include "Miracle Mineral Solution" (MMS, a.k.a a form of bleach fed to autistic children and administered as enemas for which miraculous results are claimed), chemical castration with Lupron, chelation therapy, GcMAF, and many, many other pseudoscientific "treatments" featured at quackfests like Autism One. I've even seen glowing testimonials touting homeopathy for autism and the IonCleanse® "foot detox" bath. As regular readers know, homeopathy is, as I like to say, The One Quackery To Rule Them All, and "foot detox" baths are a scam. Not surprisingly, segments of the autism biomed movement have embraced medical marijuana. For example, the "Thinking Moms' Revolution" (TMR) has numerous posts on its blog extolling the alleged virtues of medical marijuana for treating autism and advocating "freedom of choice." If you doubt the increasing embrace of medical marijuana by the autism biomed quackery movement, look no further than this ad for an Medical Marijuana for Children with Autism eConference, sponsored in part by TMR. Indeed, Jeff Bradstreet, the longtime antivaccine autism biomed quack who committed suicide a month and a half ago after the FDA raided his clinic was a speaker! So was a key supporter of medical marijuana for autism in Michigan, Lester Grinspoon.
Does this striking resemblance between autism biomed rhetoric and medical marijuana rhetoric mean that cannabis is useless for autism? Not necessarily, but it raises red flags. In any event, it would be more accurate to say that we don't really know whether cannabis oil is efficacious for treating autism. I mention this similarity between the autism biomed movement and medical marijuana movement to emphasize how anecdotal evidence is incredibly unreliable, particularly for a complex condition like autism spectrum disorder (ASD). If you don't believe me, consider this. Equally glowing testimonials for the rank quackery that is homeopathy to treat autism are not difficult to come by, which is one reason why testimonials are insufficient evidence upon which to base public policy; yet, that's just what is happening in Michigan—and has been since medical marijuana was first approved. Remember, autism is a condition of developmental delay, not stasis, and autistic children frequently improve as they get older. Some even improve sufficiently to lose the ASD diagnosis.
I understand (at least as much as someone who hasn't actually experienced having a child with special needs can) how parents would be desperate to do everything they can for their children, but personal experience and anecdotes, contrary to what is claimed, can be extremely misleading, as we've described here many times before. That's why anecdotes are not enough, and carefully controlled randomized clinical trials are needed, which, contrary to the claims of advocates, don't really exist. Indeed, the science cited in the petition, as we will see in the final section of this post, is inadequate to make such a major policy change, consisting as it does of mainly preclinical evidence and case reports.
How Michigan got to where it is today
With that in mind, it's useful to note that the road to this "victory" began years ago and actually represents a rebound from a defeat two years ago. In 2013, the Michigan Medical Marihuana Review Panel voted against adding autism to the list of indications for medical marijuana by a 7-2 vote:
Jenny Allen, whose 6-year-old son was diagnosed with autism several years ago, has tried giving him "mind-bending" medications, signed him up for behavior therapy and changed his diet. But his problems, including self-destructive behavior and biting, continue.
Now the 32-year-old Lansing mom wants to try giving him part of a brownie -- a pot brownie -- but was brought to tears Tuesday when the Michigan Medical Marihuana Review Panel rejected a petition that would have given her the legal means to do so.
The panel, in a 7-2 vote, gave a final recommendation against adding autism to a list of debilitating conditions suitable for treatment under Michigan's voter-approved medical marijuana law.
"I'm incredibly disappointed," Allen told MLive after the hearing, going on to question whether all panelists had thoroughly researched the topic. "I'm pretty shocked, actually, that nobody even brought up what the base condition is. It's rather appalling."
The panel made this decision in 2013 based on a correct assessment of the state of the evidence, which is that there is "not much quality, peer-reviewed research exploring marijuana as a treatment for autism," that the case for adding autism to the list of approved conditions for which medical marijuana can be prescribed consists almost entirely of anecdotes and testimonials, and that not enough is known about the effects of long term use of cannabis on the developing brain. This assessment was correct in 2013, and nothing has happened in terms of the existing science during the intervening two years to change that assessment. So what really happened to reopen the case?
Not surprisingly, it was litigation that forced the Department of Licensing and Regulatory Affairs to submit a new petition for autism to the Medical Marihuana Review Panel. It was submitted on behalf of a woman named Lisa Smith for her son Noah, who has severe autism:
Lisa Smith says her son's behavior was dangerous: hair pulling, kicks, punches, all related to a severe form of autism. But it began to change more than a year ago when he was given daily oral doses of oil extracted from marijuana.
"That's all stopped. He's more focused, he's calmer," Smith said of 6-year-old Noah. "He sleeps better through the night. He has a better appetite. You can tell he's growing, gaining weight."
Another parent who features in several of the news stories about this issue is Dwight Zahringer:
Dwight and Ixchel Zahringer's son Brunello is going on 4 but has yet to speak. Last fall, his parents heard the chilling diagnosis — autism.
"We've had a hard, fast education in this for the last nine months," Dwight Zahringer said. "Think of it like always being at a rock concert — everything really loud — and then you're trying to have conversations or focus on things but you can't because everything is overwhelming," he said.
The dealings with health professionals form a familiar tale — advice to use powerful prescription drugs that are costly and may have worrisome side effects, the failure to see that those drugs are helping and the decision to stop them.
The Zahringers have thus far been disappointed with the progress their son Brunello has made with conventional therapy, such as Applied Behavioral Analysis. Seeking faster progress, they found medical marijuana and latched on to it for hope:
"We've been watching a lot of videos, a lot of documentaries, and we've seen proof that it can help," said Ixchel Zahringer.
"One family had a kid who was very severe" with autism symptoms, "and they started giving him some of that (cannabis) oil, and they saw the child calming down."
Dwight Zahringer came to his belief that he needs medical marijuana for his Brunello the same way that many in the autism biomed movement come to the conclusion that their child needs, for example, MMS. He pored over Internet sites and marijuana-themed literature, which convinced him that he needed to try cannabis on his son ASAP. He started using hemp oil, which apparently gets around the state's current ban on treating autism with marijuana, but really wants the real thing. Parents like the Zahringers and Lisa Smith are clearly loving parents who want the best for their children, just as most parents who fall for "autism biomed" quackery love their children and want the best for them. Unfortunately, as we have seen and will see, the pro-cannabis literature and websites that tout cannabis as a treatment for autism provide a very biased and cherry-picked view of the medical literature.
Cannabis for autism: The evidence (or, more correctly, the lack thereof)
Perusing the news reports on the vote of the Michigan Medical Marijuana Review Panel, one point I've seen is that the reason why this vote came down in favor of adding severe autism to the list of qualifying conditions and the vote in 2013 did not is because the science was so much better described in the petition this time around. Indeed, advocates tout having bolstered the petition with "over 75 peer reviewed articles with over 800 pages of research on the issue of cannabis as a viable option for the treatment of autism" in addition to the "nineteen families, as well as physicians from MI and around the country." Apparently, two advocates had a major hand in picking these articles:
The individuals who navigated the deepest into the science behind Autism's riddling labyrinth of theories are without doubt Joe Stone and Dr. Christian Bogner. They were able to provide peer reviewed evidence that cannabis not only has the potential to provide palliative relief of symptoms related to autism, but may also have the potential to target the underlying causes of autism itself.
Note that nowhere in this report is mentioned evidence from well-designed clinical trials. In any event, I could not find the exact petition text, but there is a MoveOn.org petition to add autism to the list of qualifying conditions for medical marijuana in Michigan posted by Joe Stone and signed by Dr. Christian Bogner, Chad Carr, Dr. Harry Chugani, M.D., Dr. Lester Grinspoon, Michael A. Komorn, and Joe Stone. At the end, it lists links to research, specifically a paper written by Stone and Bogner that, one notes, was published online on the Cannabis for Autism blog rather than in a peer-reviewed medical journal, entitled "The Endocannabinoid System as it Relates to Autism". This paper is also available on Scribd, with a complete list of references. It is clear to me that this discussion, along with its references, was the basis of the science presented to the panel.
Before I address this paper, which appears to be the best evidence advocates can put forward, let me just refer you to a good solid analysis of the state of the evidence for cannabis for neurological disorders by Skeptical Raptor. You can read the whole thing if interested, but the point I want to emphasize is that there is weak evidence that cannabis could be useful for epilepsy, as I discussed in my first post on this topic, but that a Cochrane review concluded that high quality evidence was insufficient to recommend it. There is also some evidence for the use of medical marijuana for spasticity and pain. The reason that this is relevant is because advocates for using medical marijuana for autism frequently point to cases where cannabis is used to control seizures, which many autistic children suffer from. This is a separate issue than whether cannabis is specifically therapeutic in autism, but the two issues are often conflated.
Sadly, Stone and Bogner's "paper" is one of the most blatant examples of cherry-picked research I've seen in a long time, and that's saying something. Indeed, plowing through the list and looking up key papers was a tediously predictable endeavor. Basically, Stone and Bogner take papers that look at some aspect of cannabinoid function, whether it's about autism or not, and extrapolate to autism. Let's take a look at their most convincing piece of evidence first (to me, at least). In this case, by "most convincing," I mean least unconvincing:
"Rare mutations in neuroligins and nerexins predispose to autism" (Földy 2013). Neuroligin-3 is the only known protein required for tonic secretion of endocannabinoids that include AEA and 2-AG (Földy 2013). Neuroligin-3 mutations have been shown to inhibit tonic endocannabinoid secretion (Földy 2013). These alterations in endocannabinoid signaling may contribute to autism pathophysiology (Földy 2013, Krueger 2013, Onaivi 2011, Siniscalco 2013). These finding have in part prompted researchers to apply to conduct research with nonhuman primates in order to further elucidate this link (Malcher-Lopes 2013).
Endocannabinoid system deficiencies are suggested to be involved in the pathophysiology of a growing number of diseases (Marco 2012, Russo 2003). Pacher and Pertwee both cover the endocannabinoid system in detail (Pacher 2006, Pertwee 2010). The number of functions that endocannabinoid signaling regulate in the human body is extensive and beyond the scope of this paper (Pertwee 2010). For sake of brevity only a few potentially relevant aspects will be listed:
So what are these elements? Basically, Stone and Bogner cite a whole bunch of papers supporting the conclusions that endocannabinoids:
- Modulate synaptic function
- Regulate GI functions
- Suppress proliferation and cytokine release in the central nervous system (CNS)
- Regulate stress responses
- Increase cerebral blood flow
- Modulate neural and glial cell function
…you get the idea. So, yes, cannabinoids are important molecules in the CNS and elsewhere. No one argues against that. It's also true that it was recently shown that mutations in neuroligins and nerexins appear to predispose children to autism and that neuroligin-3 mutations inhibit endocannabinoid secretion, suggesting that bolstering endocannabinoid secretion might antagonize or reverse the abnormalities associated with such mutations. (A decent overview of this research suitable for a lay person can be found here, and the original paper is here.) Let's just put it this way. This is a rodent model, and right there it's a question of how relevant it is to real, human ASDs. This is very preclinical evidence, meaning that it might or might not turn out to be relevant to human ASDs. At best, it justifies further study. Moreover, the primate model referenced in Stone and Bogner's paper appears to be merely a proposal presented to a conference in Qatar. This is thin gruel indeed, as a recent review article on medical marijuana published in the Journal of Developmental & Behavioral Pediatrics by Hadland et al. points out:
Many advocates cite scientific literature regarding benefits of cannabis for the treatment of pediatric behavioral conditions, but often, data cited are from animal model-based research that does not yet have translation to human subjects. For example, a 2013 study 80 from Stanford University showed that mice with a specific and rare gene mutation linked to autism showed altered endocannabinoid signaling in the central nervous system. These data were then cited by online and print media supporters of medical marijuana (e.g., the High Times 81) as evidence that cannabis could be used as a treatment for autism. As another example, when another recent study 72 based on a mouse model of Fragile X syndrome (described earlier in this review) showed alterations in endocannabinoid signaling pathways, these data were referenced (in this case, by more mainstream media outlets, such as the Huffington Post 8 and Fox News 82) as evidence for a promising role for cannabis as treatment. Although these and other high-impact studies share important insights into the pathogenesis of autism spectrum disorders (ASD) and Fragile X syndrome, based on their results alone, it is erroneous and potentially harmful to conclude that cannabis should be used as treatment for either of these disorders at this time.
Indeed. Not surprisingly, Stone and Bogner's article references that very same study on Fragile X syndrome as well. Much of the rest of their article boils down to the list I enumerated above plus other correlations, their arguments reduced to, in essence, this:
- The endocannabinoid system is important in [insert important CNS function or signaling pathway here] in preclinical cell culture and animal models.
- Autism and ASDs involve abnormalities of this important CNS function or signaling pathway.
- Ergo, cannabinoids can be used to treat autism and ASDs.
In other words, there's a whole lot of confusing correlation with causation and assuming pathogenesis when what is being observed might just be an epiphenomenon. There might be a direct role for these correlations in causing autism, and some of the signaling pathways might even represent promising targets, including the endocannabinoid pathway or a subset of it. Stone and Bogner go wrong by assuming all of these studies indicate a critical role for endocannabinoids in autism, such as elevated cytokine levels. For instance, take a look at this list of effects of cannabidiol (CBD):
- CB1/CB2 agonist blocker (can inhibit overstimulation of CB1 by THC)
- FAAH inhibition increases endocannabinoid levels (including AEA, 2-AG)
- AEA reuptake inhibitor
- 5-HT1a agonist
- Suppressor of tryptophan degradation
- PPAR alpha and gamma agonist Positive allosteric modulator at glycine receptors
- TRPV1 and TRPV2 agonist
- Adenosine uptake competitive inhibitor
- Antagonist at abnormal-CBD receptor
- Regulator of intracellular Ca 2+ T-type Ca 2+ channel inhibitor (Izzo 2009)
This is a wide range of effects, some of which could be relevant to autism/ASD. The problem, of course, is that we don't know which ones are the most relevant and which ones actually involve promising therapeutic targets for intervention.
Extrapolate, extrapolate, extrapolate!
Whenever writing a research paper that is basic science that could potentially be translated into a treatment for a disease, it is generally considered mandatory to speculate at the end just how this could come about. For instance, when scientists write about cannabinoids in the context of models of neurodevelopmental disorders, after all the basic science, cell culture, and animal model work, naturally they try to describe how their results could be pursued so that they translate into a clinical treatment. It's known as showing clinical relevance to your findings, no matter how basic science they are. Stone and Bogner quote several of these sorts of speculative statements in the discussion or introduction of papers as though they were Gospel truth, then conclude:
Given the known role of the endocannabinoid system in ASD it seems entirely possible, if not likely, that cannabinoid rich botanical extracts from cannabis can be utilized as useful agents targeting the pathophysiology of ASD, as well as the many debilitating symptoms and conditions associated with it. The wealth of options that cannabis has to offer those that suffer from ASD in MI is not currently legally permitted. We believe that needs to change.
As I said before, Q.E.D. (Yes, that's sarcasm.)
Where's the beef (i.e., the clinical evidence)?
What all these 75 references really mean is that there is some correlative evidence that the endocannabinoid system is abnormal in autism. However, it's not at all clear whether these abnormalities are causative or downstream effects from the true cause or causes, whatever they might be. What this evidence means is that it's probably worthwhile to study the endocannibinoid system in autism and whether modulating its activity can have an effect on autistic symptoms. What it most definitely isn't is compelling evidence to authorize any doctor in the state who wants to do so to use cannabis oil to treat autism. Yes, because the law states two doctors have to sign off for use of medical marijuana in children, parents will have to find two doctors, but, really, does anyone think that will be very difficult?
To recommend a treatment for general use, we need high quality clinical evidence. Is there any such evidence for cannabis oil for autism? The answer is a resounding and unequivocal no. Indeed, an excellent indication of the paucity of evidence regarding cannabis oil and autism is the way Stone and Bogner dance around the issue by citing anecdotal reports about the use of cannabis oil and cannabinoids to treat epilepsy:
How can combinations of cannabinoids be put into practical use by individual families? For our purposes let's review the anecdotal reports of cannabinoid based treatments currently being utilized in MI (and around the world) for pediatric epilepsy. I think this is a good comparison due to the range and complexity of both conditions. CBD continues to prove its effectiveness in treating many types of epilepsy, but not all (Porter 2013). Anecdotal reports provided in online groups with families that share dosing and other related information to cannabinoid based pediatric epilepsy treatments reveal that in many cases parents (and physicians) find that an increased ratio of THC is required to increase the efficacy of treatment. The range seems to vary significantly from 24:1 to 1:1 (CBD:THC). Some partial explanations for this might include the ability of THC to increase GABAergic transmissions via CB1 activation, its modulation of ion channels, and that it's a PPAR gamma agonist which is neuroprotective in epilepsy (Stone 2014).
Due to the range of ASD it seems possible that, similar to cannabinoid based epilepsy treatments, varying ratios of cannabinoids (specifically CBD:THC) will prove to have a greater efficacy overall when compared to individual cannabinoid based treatments (like Dronobinal). This concept has been further supported by the research and clinical use of Sativex, a 1:1 (CBD:THC) botanical extract marketed for use in a range of treatments throughout the world (Hazekamp 2013, Russo 2006). The ability to specifically tailor cannabinoid ratios in botanical extracts from cannabis in a case specific manner may prove an even greater efficacy.
This is nothing more than handwaving, comparing two different conditions and assuming that what is observed in one condition will apply to another condition. Worse, as Skeptical Raptor reminds us, despite these anecdotal reports of benefit due to cannabinoids or cannabis oil in epilepsy, a recent Cochrane Review concludes that "no reliable conclusions can be drawn at present regarding the efficacy of cannabinoids as a treatment for epilepsy." In other words, there's no high quality evidence that cannabinoids are efficacious in treating epilepsy. There's even less evidence that cannabinoids can be used to treat autism. Indeed, as the aforementioned review by Hadland et al. notes:
Regarding human data on use of cannabis for developmental and behavioral conditions, to the best of our knowledge, the only available data are from small case series or single studies. For example, one 6-year-old boy with autism was treated with daily dronabinol for 6 months and was noted to have improvement in hyperactivity, irritability, lethargy, stereotyped behaviors, and speech, as measured by the Aberrant Behavior Checklist.83 This single case study was uncontrolled and unblinded. In another single case study 84 of a cannabis-using adult male with attention-deficit hyperactivity disorder (ADHD) off stimulants, the subject's driving skills in a simulated test during a time of abstinence improved after smoking marijuana (What is unclear is whether this subject may have actually been experiencing cannabis withdrawal from his abstinence, with alleviation of his symptoms through subsequent use of marijuana.85). Another small case series 86 showed an improvement in self-injurious behaviors among adolescents after dronabinol therapy, but to date, the study has not been published, leaving protocol details scarce. In sum, none of these studies provides sufficient, high-quality data to suggest that cannabis should be recommended for treatment of ASD or ADHD at this time.
And neither does Stone and Bogner's analysis, which was the basis of the evidence submitted with the petition to the Michigan Medical Marijuana Review Board to add autism as a qualifying condition for medical marijuana treatment. Their analysis is the very definition of cherry picking studies and extrapolating wildly from preclinical cell culture and animal studies and studies that address other conditions to conclude that cannabinoids are efficacious treating autism, while ignoring the dearth of evidence that counts: Actual clinical trial evidence. As the Cochrane review I cited pointed out, there were four randomized trials including a total of 48 patients using cannabinoids to treat autism. One report was just an abstract; another a letter to the editor. None of the trials provided randomization details, and there was no description of whether the control and treatment groups were equivalent. The studies were thus of incredibly low quality. All there are, are a handful of uninformative single patient case reports like this one.
Yet, when this this incredibly thin gruel was combined with emotional testimonials of distraught parents of severely autistic children, it was the emotional testimonials of distraught parents that won out. There isn't another drug for which the FDA or a state would give doctors the go-ahead to use to treat humans for conditions like autism or cancer based on such slim to nonexistent evidence.
Approving the use of cannabis oil for autism: "Premature" doesn't even begin to describe it
There is no doubt that the approval of medical marijuana for various medical conditions is driven far more by politics than science or clinical observations. For no condition is that more true than autism, for which even the anecdotal evidence is weaker than it is for other qualifying conditions such as chemotherapy-induced nausea, chronic pain, and epilepsy. Moreover, in this case, the Michigan Medical Marijuana Review Panel abdicated its responsibility to interpret existing science with respect to medical marijuana and autism. It is a travesty that the panel could take the cherry picked list of studies annotated with unjustified extrapolation of preclinical studies and conclude that there was a compelling case for adding autism to the list of qualifying conditions. The panel failed even to require that only relevant specialists, such as pediatric neurologists, be allowed to prescribe cannabis oil for autism and instead let any licensed physician (OK, two licensed physicians) do it. Worse, these physicians don't even have to monitor how often or how much is given to an autistic child for whom they prescribe medical marijuana. They can leave it all up to the parents, the vast majority of whom have no medical training.
This lack of oversight is a big deal because, contrary to what medical marijuana advocates claim, science still doesn't have a good understanding of what the long term effects of chronic daily cannabis use are on the developing brain. We do know that teenagers who were found to be dependent on marijuana before age 18 and continued using it into adulthood lose IQ points. One can argue that IQ is a poor surrogate for intelligence, but nonetheless such findings are worrisome. We do know that marijuana use is associated with abnormalities in the brain in young users in an exposure-dependent manner. There are other potential adverse health effects as well. In any decision to use a drug, there is a risk-benefit analysis, and thus far in autism there's almost no evidence for benefit and troubling evidence of risk when cannabis is used long term in children.
Fortunately, the recommendation of the Michigan Medical Marijuana Review Board is not binding. That recommendation will now go to Mike Zimmer, director of the Michigan Department of Licensing and Regulatory Affairs. He will have the final say over whether autism is added to the list of qualifying conditions. We in Michigan can only hope he realizes what a massive mistake the review board made and overrules their recommendation. Although new evidence might change this in the future, at present, medical marijuana for autism is unscientific herbalism, not pharmacognosy, and has no place in science-based medicine or state policy.
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So here's the question yet unanswered despite the length of this post:
If you favor legalization "for recreational purposes", what prevents someone from blowing (legal) pot smoke into their autistic child's face, or some other variation on the theme with extracted oils?
You have this very parochial way of framing these issues which doesn't help your argument. Much like the vaccine business, where you have expressed amazement that the mandate passed in California, you don't appear to have a very good understanding of human nature.
The American Academy of Pediatrics (AAP) has a clear, recent policy statement against the medical use of marijuana for pediatric patients (https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/American-A…), which is better than the policy statement they don't have regarding "alternate" vaccine schedules. But since the AAP has no spine when it comes to speaking out on anything that might give them backlash, I wouldn't hold breath waiting for them to speak out against this ridiculous recommendation that defies logic, common sense and science.
My closest friend uses cannabis for the relief of very severe chronic pain.
#1: It seems to come down to claims vs results. Does recreational use of marijuana produce a high - usually, thus the claimed "benefit" is achieved. Does medical use of marijuana achieve a medical benefit in any situation - maybe, but that requires evidence.
The reason false (or at best unproven) claims are harmful is they might: a) preclude other therapies that might be more effective, or, b) produce side-effects that could be harmful. Both these issues are tested in trials but not with just anecdotal evidence.
I think, zebra, that without legalization of this for children (which I oppose same as Orac), most parents pondering "blowing smoke" would correctly fear intervention by their state's child protective services agency and being charged with child abuse/neglect.
#4 douq millar
No, it comes down to making a fuss over the issue because pot is a "regulated drug"
...while at the same time advocating that it be de-regulated.
Makes little sense to me.
#5 Chris Hickie,
So how about people who smoke tobacco in the house or give their teenager a beer? Or don't have their kids vaccinated?
Not sure where this is going #7. It is illegal in all 50 states in the US for teenagers to consume alcohol and some states have additional laws for prosecuting adults who knowingly give alcohol to minors. I don't know if there are any laws about tobacco smoke exposure to children in their homes but I have seen CPS called for children with severe asthma if home tobacco exposure is felt to be causative. Vaccination laws? Unless you've been in a vacuum, you know three states in the US allow only medical exemptions for attending school without being vaccinated whereas the other 47 states allow some sort of either personal or religious belief exemption.
Again, you give your kid a pot brownie or blow marijuana smoke in their face--that is child abuse/neglect. Period.
I wasn't aware of laws prohibiting smoking in a private home with or without presence of children? I know there are few states that prohibit smoking in a car with minor, though.
Nor is not vaccinating your children a crime.
Giving alcohol to minors in a crime, albeit one not rigorously enforced.
Currently, blowing cannabis smoke into the face of a minor is a crime.
The fact that a minor crime isn't enforced doesn't make it legal, even if the chances of getting caught doing it were minimal, and even if you try to compare legal and illegal acts, it doesn't make one the other.
Was there a point you were trying to make?
Orac's second link for TMR is written by Poppy whose 'nym derives from her interesting theory about opiates; IIRC she's the one who wrote about her son's 'parasites' going mad around the time of the full moon causing him to behave badly.
Another TM, Thalia Michelle Seggelink ("Tex') has recently helped create a group advocating MJ for autism in Austin, Texas ( see texasmamma.org).. They're "conservative Christian activists" and include a quote: Genesis 1 " Then G-d said, ' Behold, I have given you every plant yielding seed that is on the surface of the earth...'." I'm sure.
I don't use cannabis and haven't really since university days- rarely then but I'm never one to stop a party.
I have no problem with it being legal. I personally know people who have used it recreationally since the mid- 1970s who have families and careers with no apparent damage to their psyches. And sure, I've met those who used it for physical illness. I don't think that it should be regarded as panacea for every problem though as a way to make it more 'respectable' and acceptable to the general public.
As a side note, I have traipsed around Mendocino County where its semi-legal. Supporters say that laws have led to an economic boom in depressed areas which have lost farming, fishing and forestry income in the past several decades.
I have no idea if this were true but they seemed rather happy to me. There are no angry drivers there either.
-btw- I didn't get any MJ but I did gather oakmoss which is an important ingredient in perfumery.
Forgot the quote from my last post.
"Even where the drug is legal, parental pot-smoking can be considered as a factor in child-neglect cases, just like alcohol. As a result, some parents have been accused of endangering their children and had them taken away by child protective service agencies."
(Source Washington Post)
Zebra @ 7
In at least 18 states, courts have ruled that subjecting a child to tobacco smoke is a factor which should be considered in deciding custody.
Vaccines and custody
As for alcohol
#8 chris hickie,
Not sure where you are going either.
See my #6.
If pot is legalized, then the situation will be similar to alcohol, tobacco, and no vaccination-- it will be a high bar to intervene.
For the morbidly curious:
to read Poppy's articles- see TMR/ blogs by author/ Poppy
you may especially enjoy:
" Voodoo Magic Sugar Pills" and
" Bugs, Moon Cycles and Lunacy"
You know, if it's possible the high in marijuana means that kids might feel calmer and have more appetite...
... giving it to children, especially ones who are still developing communication skills, especially with a complete lack of dosage guidelines, strikes me as unwise. At least with other drugs, there's at least the pretense that folks care about the difference between 'totally stoned' and 'dialing down the symptoms with minimal side effects'*.
(Also, once again, I reflect on the fact autism is presented as a condition of un- or barely communicative children, rather people of all ages, may of which have developed communication skills as they grow up**. If cannabis for autism is so good, why are we getting the parents of autistic children and not the autistic adults? I assure you, we can write things on the Internet. )
* Whether or not this translates in practice is a different matter.
** As all humans do.
You blather on, at length, questioning synergy,( proposed by Sanjay Gupta, among many other researchers) "valid" pharmacognosy,which isn't even allowed per your friendly federal gvt., and yet you never ask the question that is so simple: Does it work ?
Honestly we have no idea "how" Cannabis is so effective on Dravet's syndrome. We do know it works, and has incredibly little in side effect.
Before we knew "how" alcohol sterilizes, by cell dehydration, membrane disruption, and protein coagulation, we knew alcohol was "good for wounds"
So while you want to be all upstairs in the ivory tower with your lab coat,and know why,or how, which undoubtedly has a grand place in medicine, lets not forget efficacy, and harm caused, or the lack thereof are top priority.
@CH #8 I believe it is legal to consume alcohol WITH your teen (16+) in Wisconsin. Certainly not endorsing the idea.
Although I'm on my way out of the door:
Becca, I seem to recall reading somewhere that use of MJ by children/ adolescents has deleterious effects on the development of skills like those called executive functioning and something else about applying themselves academically.
So you're an autistic adult: according to Ann Dachel, you aren't really here.
Zoiks, Grinspoon's still around? It was the annotated bibliography to Psychedelic Drugs Revisited (the only really valuable part of the book, as I recall) that set me on a quest to find a copy of Millbrook.
I seem to also recall there being an increased risk of schizophrenia among young regular users of marijuana. But hey, at least they won't be a hand full for their parents.
And Becca, thank you for commenting. While I'm sure that a lot of parents do want to do what's best for their kids, I would guess that there is also a not insubstantial personal motive among parents/caregivers to relieve their own stress. Calmer, less violent children improve the parents' quality of life, but I'm wondering how the children's quality of life is measured, particularly among nonverbal kids?
Let’s take a look at their most convincing piece of evidence first (to me, at least). In this case, by “most convincing,” I mean least unconvincing
They manage to cite one paper (Földy 2013) four times in the space of four sentences. TBF, there are other references in the quoted passage, but that strikes me as being a bit heavily reliant on a single reference. I'm not familiar with citation standards in medical journals, but the review paper by Hadland et al. is closer to what I am accustomed to than the Stone and Bogner paper. The latter authors' style of providing citations for every. single. sentence. comes off as being paranoid about plagiarism charges.
Which, I hear, is a side effect of marijuana use (not that I know this firsthand).
Another thought that crossed my mind as I read this: what effects would cannabis (whether in oil, brownie, or smoke form) have on an individual with pica, a disorder can be comorbid with autism? Would it increase their ingestion of non-food items? I did a quick search on PubMed and was unable to find any studies using the search terms "marijuana pica" or "cannabis pica".
As for the differing treatment of marijuana, tobacco, and alcohol, there are historical reasons. Several former English colonies in the Americas were founded for the purpose of growing tobacco and other crops (such as sugar cane) which are not suitable for the climate of England. Marijuana was not specifically grown for its intoxicating properties; rather, the purpose was to be a source of hemp fiber (i.e., rope), although some growers (including, allegedly, George Washington) did partake of the leaf. Alcohol of course has the history that beverages containing ethanol could be safely consumed, unlike water in most parts of the world--the other option was to boil the water to make tea or coffee. And in the US there was a concerted propaganda effort over several decades (most notoriously the mid-1930s film Reefer Madness) to demonize marijuana use--that's how it ended up on Schedule I when the Controlled Substances Act was passed ca. 1970. Other countries followed the US lead on marijuana; IIRC it was Paul McCartney's marijuana arrest in Japan that precipitated the breakup of Wings. Meanwhile, tobacco smoking was an unremarkable vice among my parents' generation; it has been mainly during my lifetime that it has fallen out of favor in the US, and it is still very much in favor in many other countries (most notoriously China and Japan).
A lot of it had to do with race panic, as I understand it.
Recently published study contradicts some prior marijuana research
zebra, we hardly agree but I like the way you think is intriguing.
I don't know why Orac mentioned his support of legalization of marijuana for recreational use because I don't think it is germane to his point, but I also don't see your issue with it.
He's being entirely consistent with his other views when he writes:
"...at present, medical marijuana for autism is unscientific herbalism, not pharmacognosy, and has no place in science-based medicine or state policy."
Sorry. Bad html cut off Orac's quote in my last comment.
#28 see #6
A somewhat OT note but a tiny bit of sanity albeit not exactly logical in the drug world. Why under 12 is a really interesting questions that Health Canada does not seem likely to answer.
@Not a Troll (#27)
Interesting. Though the studies I linked put the increased risk in the context of genetic predisposition to schizophrenia, rather than being a causative factor in its own right. Essentially, if one is already at increased risk of a psychotic disorder due to other factors, cannabis use can increase that risk a little bit more.
Were you linking to multiple studies or just one? There is only one link.
Thanks for pointing out the context of a genetic predisposition. I should have clarified.
The reason there is no data is because it has been illegal and the DEA has hammered very severely anyone trying to get data on it.
It doesn't fit the "Pharma business model", where things like Oxycodone do.
From my experience (as someone with Asperger's and an extremely constricted affect from PTSD due to childhood abuse), it helped me a lot. I haven't used any in 25 years. I appreciate that my experience is an anecdote, and when I was using it, I also had senior clinician psychotherapy.
It is very unlikely to be a one-size-and-dose-fits-all-miracle, but it doesn't have to be to be helpful.
@Not a Troll
Ah, the second link was broken. Here's the other paper.
Agreed that the classification of marijuana as a controlled substance has definitely hampered research into its pharmacological effects.
That said, it's premature to start recommending it as a treatment for anything in the absence of evidence that it is a) efficacious and b) safe. What is the safest and most effective route of administration? What is the best dose? What duration of use strikes the best balance between safety and efficacy?
It ought to have been studied long ago, but that isn't a reason to give it a pass now, as many advocates would argue.
It is interesting that a scientifically studied subject (vaccination) needs to become political but a political policy (on marijuana) apparently requires no scientific study
zebra, I think your point in #6 would carry more weight if it was within the debate of medical marijuana in general and not confined to its use in minors for autism.
You lost me on why people breaking the law to blow smoke into their autistic kids' faces has any bearing on Orac's stance. They are freely able to do this now although there are legal consequences for doing so.
I'm glad that Todd W. clarified the role of genetics.
ALSO I wonder how much parents of kids with ASDs believe that MJ serves as a calmative or induces sleep?
Why would my point carry more weight if it "was within the debate of medical marijuana in general and not confined to its use in minors for autism."?
He started using hemp oil, which apparently gets around the state’s current ban on treating autism with marijuana, but really wants the real thing.
Why would anyone use hemp oil when the concentration of either THC or cannabidiol (CBD) is minute? I suspect that what the individual is referring to is not pure hemp seed oil, but the oil adulterated with added cannabidiol (CBD) derived from the leaves and stalks of hemp, which is otherwise known in the online marketplace as "CBD oil". To my knowledge, these products are virtually devoid of THC. They are also extremely expensive and illegal for sale as foods or dietary supplements in the U.S. for the simple reason that such high levels of CBD have not previously been consumed in foods in the general marketplace and therefore require safety studies beforehand, along with submission of the data to the FDA for approval as a New Dietary Ingredient.
As indicated by Orac, to assume that either CBD or THC are safe for use in ASD is clearly premature and tantamount to experimenting on people without established safety or efficacy beforehand. For that matter no one has fully established that either cannabinoid is responsible for the anecdotal accounts of improvements in children with ADS administered cannabis – a plant also known to contain numerous terpenes with pharmacological activity. Still, it wouldn't be the first time that anecdotal accounts and case reports of a plant product for a given medical condition led to a well controlled clinical study.
Assuming that endocannabinoid receptors are viable targets in the treatment of ASD, other non-THC phytocannabinoids might also be considered, as they are in cancer research: http://www.ncbi.nlm.nih.gov/pubmed/26179998
To muddy the waters further, there may be other experimental treatment options, including legally available extracts of non-toxic plants. In any case, they would also need to be tested in well controlled clinical trials, rather than relying on testimonials and anecdotes from either genuine sources or those disguised by marketers and others with an agenda.
oil adulterated with added cannabidiol (CBD) derived from the leaves and stalks of hemp, which is otherwise known in the online marketplace as “CBD oil”. To my knowledge, these products are virtually devoid of THC. They are also extremely expensive
Is this the stuff you have in mind? Tried (unsuccessfully) in NZ on a one-off basis to treat status epilepticus.
There was also talk of a pure CBD extract approved for a clinical trial for seizure disorders.
Recently published study contradicts some prior marijuana research
I know that this is a press release and that the APA is going to puff its publication as much as possible, so they have an incentive to describe the results as "a little surprising", but aren't the researchers just replicating Shedler and Block's results from 25 years ago?
Is anyone else starting to miss the dental student?
"Parochial" in what fashion?
Yes, Z.'s petulant quest has devolved into fantasizing about being a 10th-grade English teacher.
Where's this, precisely? Do collate your sources so that you can properly contextualize them.
you don’t appear to have a very good understanding of human nature.
To the Moon, Alice Orac, to the Moon!!!
^ Eh, I wish I hadn't b0rk3d the last blockquote.
@ her doktor bimler #42:
Yes, that would appear to be it, although there are other similar products available. Basically, we're talking either a solvent or supercritical CO2 extract of hemp leaves and stems for a CBD-rich fraction mixed with hemp seed oil readily obtainable from China or Canada. The immediate market is parents of epileptic children residing in states where marijuana is not legal. Otherwise, they would be able to obtain CBD-rich marijuana products popularly touted as effective.
You may already have seen this:
The British League of Nerds podcast did an episode on Cannabis Quackery with respect to cancer, the comments from the guest (Cancer researcher Vicky Foster) are well worth hearing:
@herr doktor bimler #43
I am not qualified to answer that question so I asked someone. If they get back to me, I will let you know their answer.
Meanwhile, I found an outline of the debate of impacts of MJ use in the general population. It has been going on a long time and I don't expect it will resolve anytime soon.
To clarify, I find the discussion here to be concerning the regulation of medical marijuana. If Orac accepts both a social use and a medical use, then I don't see why he can't discuss the regulation of each independently.
For the interaction between the two, it isn't that you can't have an argument about allowing social or medical use or both or neither but that is a different discussion. And, that is where I think you're at.
Regarding the association between cannabis and psychosis: https://www.ncbi.nlm.nih.gov/pubmed/11185941
This is an old review, but I'm not sure current thinking is terribly far from their conclusions.
There is definitely a correlation between schizophrenia and marijuana use, but schizophrenia also correlates with use of most other drugs, and the causation is probably from schizophrenia to drug use, though how direct is uncertain.
As for marijuana causing schizophrenia, the evidence is unclear, and interpretations less so. In a person with no history and low risk factors for psychotic episodes, the increased chance of developing schizophrenia from marijuana is as close to zero as anyone can detect.
If you specifically look at individuals with genetic predisposition for schizophrenia, a risk seems to appear, though it's unclear how to interpret this. It may be the case that marijuana is a risk factor for schizophrenia only given certain genetics, or it may be that marijuana can trigger psychotic episodes in undiagnosed schizophrenics.
To put that latter hypothesis into context, imagine someone takes marijuana and has a psychotic episode. After he comes off his high, he suffers further drug-free psychotic episodes in the future and is eventually diagnosed with a mental illness. Now of course the psychotic episodes could be totally unrelated to the drug except by coincidental timing, but there is another possibility: This user would have developed his illness anyway, but five years later. We would never know, and a study would have to be carefully designed to even look for this at the population level.
These more recent reviews may prove useful:
Psychosis and cannabis:
Schizophrenia and cannabis:
Adverse effects of cannabis:
OT: On epilepsy and cannabis (Epidolex; GW Pharmaceuticals):
The link I posted above ("You may already have seen this") is to a press release you can find online under: Three Studies Shed New Light on the Effectiveness of Cannabis in Epilepsy. American Epilepsy Society, October 14, 2014.
I can't be the only one who kept reading their names as "Stoned and Bonger"
As an attendee at a large cannabis club with many hundreds of members from the ADHD and high functioning autistic categories, myself dyslexic and ADHD, I can categorically state that reducing stress via cannabis, has been a lifesaver to many who are sufferers of these neurological complaints.
Other peoples ignorance of these disorders, especially including med-staff, are a major cause of stress for sufferers.
Hell is of other people.
'Ganga' literally means in Sanskrit: stress leaving body.
re Bob a few comments up.
A study was released this week showing no correlation with cannabis and psychosis. The main risks are from first timers freaking out, respiratory health for long term heavy users, and cadmium build up from smoking carbon based material, any carbon based material....
Cannabis users become reflective, which can trigger questioning, guilt, shame or a spiritual and existential crisis.
No matter how much marijuana you did in your rebellious youth – or how little because you were a good lad – it will not come back to haunt you as an adult much at all.
That is the surprise finding of US researchers in one of the only studies to have tracked teen users of marijuana over two decades.
First surveyed at 14 years old, the 408 young men were followed until their 36th birthdays by the University of Pittsburgh Medical Center, a leading American healthcare provider, and Rutgers University in the US.
Even though 22% of the participants were chronic users of marijuana – smoking the drug regularly every week – they were no more likely than their old schoolmates to experience depression, anxiety, psychosis or asthma by their mid-30s, said the report...............cont in link
The link I posted above (“You may already have seen this”) is to a press release you can find online
#49 Not a troll,
"For the interaction between the two, it isn’t that you can’t have an argument about allowing social or medical use or both or neither but that is a different discussion."
If pot is made legal, how would you distinguish between "social use" and "medical use"? How would you "allow" or not "allow" "medical use"?
re Bob a few comments up.
A study was released this week showing no correlation with cannabis and psychosis.
The Independent journalist there is churnalising the press release from the APA linked by Not a Troll in comment 27.
The distinction would be on how it could be marketed, sold, and paid for. If it were legalized, but not for medical use, then it could not be sold with specific health claims, would not be available by prescription, and it would be unlikely to be covered by medical insurance plans. It could also be possible to legally restrict its purchase and use to an arbitrary subset of the population (example: cannot be purchased or consumed by anyone under 21) without an exception to treat a medical condition. It would not, of course, be possible to prevent people with using it with the goal of treating a disease, real or imagined, based on rumor or science.
...prevent people from using it ...
I think I'd rather take Sanjay Gupta's word over this author. I mean he works for CNN and turned down the position of Surgeon General of the United States.
Just because this author is a surgeon doesn't impress me. Being a surgeon is not that uncommon, being writing speeches for Hillary Clinton. And having your own show on CNN while you still perform neurosurgeries is. Tell me this author, do you think you're smarter than Sanjay Gupta?
This is such a pointless debate. It is so hard to study cannabis in this country, this would be like debating genetics the a few months after sanger sequencing was invented.
There are little to no facts, and trust me if you know medical marijuana patients there are 2 types. Some just enjoy the drug to relax after work (nothing wrong with that.). But some people are actually getting relief. You tell me, Author, if it's quackery how come I've seen the same woman with MS painfully make her way back to the dispensary each week?
Do some real research, don't just sit behind you're computer and write biased articles.
#59 M O'Brien,
Hence my comment #1.
@Joseph - based on his reading of marijuana research, Orac has concluded that there is very little good evidence that it provides a significant medical benefit. It is irresponsible to prescribe an unproven drug to treat a condition, whether it's marijuana or the latest offerings from GlaxoSmithKline.
If you have evidence to the contrary, please share.
If some day a good study is conducted, possibly in a country that has legal marijuana, that shows a significant clinical benefit, I'm sure everyone would be interested.
So Orac is a lesser doctor than Sanjay Gupta. Got that.
Joseph: if you'd actually bothered to read this post, and many of Orac's other posts about marijuana - he's not opposed to recreational use and has said so many times. What he IS opposed to is all the groups that have jumped on cannabis in various incantations and claim it's a "cure". It may help in some medical cases, but the research is too inconclusive or not there.
Hypothetical situation, Joseph: I created this GREAT medication, my friends and family have all tried it and are getting results. We're losing weight, looking younger, never get sick. My autistic cousin is calmer and even speaking words now. My aunt with cancer's mass went away! I can even point to some very basic studies that show it isn't toxic at the recommended doses. No, I have no studies that show it really works...but everyone who's tried it says so, so it must work!
I'll sell it to you cheap, to give to your child. Would you buy it?
#65 MI Dawn,
I have no dog in the fight WRT joseph, but the answer is of course I would give a non-toxic substance to someone, if it made them feel better or gave them otherwise unavailable hope.
That's probably why those French GP don't get all wound up about providing homeopathic stuff on occasion:
"If pot is made legal, how would you distinguish between “social use” and “medical use”? How would you “allow” or not “allow” “medical use”?"
zebra, you're in luck. Four states have worked/are working on that very thing. We'll see how it goes.
For your observation that Orac doesn't appear to have a very good understanding of human nature, I am inclined to think that you do not.
It's not earth-shattering news that people break the law or that MJ is not already widely available. However, not all who avoid risky behaviors do so because there is a law and not all who obey a law do so out of fear of being caught. Some obey it out of common sense and principle and there is principal here. It is that if a substance is claimed as a medicine it needs to abide by similar regulations as other medicines regardless of its availability legally or illegally. While you're pondering that, also consider how I can defend Orac's POV while not supporting legalization of marijuana.
zebra, well if you're giving it away and not selling it, that's a plus. But why not offer them love and compassion instead of lying to them? A ride to the doctor's office, clean their house or cook them a meal?
#67 Not a troll,
"...not all who obey a law do so out of fear of being caught. Some obey it out of common sense..."
Then they are not "obeying the law", they are just acting out of common sense-- the same as if there were no such law on the books. There's no law against touching a hot stove...
Some people "obey the law" not out of fear of the actual punishment dictated by the law, but because they have an Authoritarian psychology-- that is, they experience negative feelings if they "break the rules". That's how "morality" often works.
Not sure which category you are talking about; maybe the latter is what you mean by "principle/principal"?
Agghh.. Epic spell check fail. Should have been "principle" always.
Common sense follows a law just one that the precedent may or may not be on books. I obey the law in the eyes of the law and society whether out of fear or common sense so the pragmatist in me doesn't care.
Thanks! Your summary was very helpful for me in understanding where we are currently at in this debate.
I'm tired of how people don't understand that autistic people have reasons for a lot of their behaviours. It would help if they actually ASKED autistic people about these things. There are many autistic adults, even non-speaking ones, who can give a lot of insight into autistic behaviours but no, we can't have autistic people having a say about autism, can we? No, it's all about forcing things like ABA that a lot of autistic people consider abusive and unhelpful or forcing all kinds of nonsense on them. I hate that.]
Though, i do wonder if reefer would cause me to calm my tits and not get so constantly obsessed with things that frustrate me like this concept of tormenting autistic people for their own good.
Well, I think you should read #59, which is a very clear statement of the situation. This stuff you are saying about
"It is that if a substance is claimed as a medicine it needs to abide by similar regulations as other medicines regardless of its availability legally or illegally."
doesn't really mean anything to the individual, who may or may not want to use pot whether from "common sense" or "principle".
doesn’t really mean anything to the individual, who may or may not want to use pot whether from “common sense” or “principle”.True enough. As a doctor or a pharmacist, though, there is an ethical dilemma when recommending something that may not hurt but is not shown to help. A legislator should (but probably won't, as she/he is a legislator after all) also have issues in backing legislation justified by flimsy evidence, or which is clearly intended to be pure subterfuge.
^ Just because it is not a necessity doesn't signify that it has no meaning. It means a great deal to me and I wish it mattered to more.
Which is why I hold Orac in high regard. I'm sure we disagree on many things but he is attempting to hold the line in defense of his profession and I find that very admirable.
Yup, definitely works at calming tits, with few to no side effects to boot! Give it a try if you can.
Plus stoners are more accepting of autistic people, so the companionship within a club environment is fantastic.
Compared to the disappointment and frustration of mainstream medical services for autistics the difference was like night and day.
It was the supportive family I never had, and I miss it greatly.
Becca @ #16
Adults with autism who use cannabis: There are xillions* of us but we don't have autism (because of the cannabis) and it's completely obvious why you don't get to hear about it.
You wont find us on your autism forums and in your autism groups because we are just getting on with life amongst the human race instead of hanging out in rainbow jigsaw land.
You wont find out about us because cannabis is illegal, duh, and we don't have autism so we are not going to loudmouth it everywhere.
You wont find out about us because moderators love to censor autistic adults. Ditto talk of cannabis.
You wont find out about us because if we were to boast that cannabis was fixing our autism, we would be admitting to having autism, and that defeats the object, which is not to have autism, which is why we use cannabis.
I share some of the same concerns as other readers here. In an ideal world we would absolutely have multiple independent clinical trials. Unfortunately, we don’t live in an ideal world, and evidence based medicine doesn’t dictate that doctors wait in extreme situations. It’s also not as if Marinol isn’t being prescribed commonly off label in these situations anyway. THC is obviously the concern being cited in terms of brain development. Unless there is a claim that these oils (often with greater amounts of CBD than THC) are potentially more harmful than pure THC itself, then these arguments in regards to brain development are somewhat moot. Additionally, there may be evidence that isn’t being considered within this discussion. This seems likely to be the reason that pediatric neurologists working with many of these parents including Dr. Harry Chugani, and Dr. Jules Constantinou, both support this policy. It’s possible that they support this policy because they’ve witnessed successful turnarounds and they seek legal protection for a greater level of involvement on their behalf. These aren’t “friendly pot docs”, these are respected experts. The denial of this policy only serves to ensure that their involvement remain limited, which stifles the possibility for sound research to be conducted, and guarantees that families are truly on their own.
This policy is currently being framed within this discussion as a giant leap into the “brave new world”. Flimsy preclinical evidence leading to mass experimentation. From an outside perspective I can appreciate how this policy might be interpreted this way. However, the fact is that the supporters of this policy aren’t suggesting that everyone on the spectrum explore these therapies. Rather, legal protections for families choosing to explore these options as a last-line therapy when two certified physician with bonafide relationships with the patients have agreed that it may provide palliative relief is being
Entirely overlooked, albeit with some sound reasoning that’s been provided, are the families that are currently utilizing these therapies with success. Chugani and Constantinou have provided care to some of these patients, and their support for this policy is based off of their clinical expertise combined with the next best external source of evidence. In this case that happens to be preclinical research by in large. A large number of families currently utilizing these therapies have been willing to come forward. They’re already procuring oils that have been analyzed to ensure a known level of
active constituents are present, and self-titrating with success. Due to a lack of legal protections it’s often parents helping parents at this point with these aspects. Undoubtedly, a greater level of involvement from experts would be preferred. That’s what this policy would permit.
Denying this policy won’t stop the therapies that are currently claimed to be fostering improvements. It only prevents the experts from playing a larger role in these therapies. Many parents aren’t willing to wait decades for multiple clinical trials of specifically tailored cannabinoid ratios to become available when they already have access and success utilizing them now. Should they be arrested for that?
Once again, anecdotes don't show that something works. I can provide anecdotes about homeopathy providing near=miraculous results for autism, and homeopathy is nothing but water. This is not limited to parents, but to physicians who have been fooled as well. Clinical expertise without clinical trial evidence often misleads, and clearly Dr. Chugani doesn't realize that. A lot of doctors don't, unfortunately. What Michigan is on the verge of approving is, in essence, legalizing what is currently a form of autism biomed quackery. Bogler and Stone's recounting of the "evidence" for medical marijuana for autism is risible in the extreme, purely cherry picked. At best, it's evidence for further preclinical study. At worst, it's a justification for quackery, prematurely extrapolating from preclinical evidence that might or might not be relevant to autism.
Nobody is denying that clinical trials are the gold standard, but to suggest that off-label meds aren't commonly in use that haven't been studied with autism the way you're describing would be inaccurate, or disingenuous. Also, we’re not just talking about just Dr. Chugani, Dr. Constantinou is also an avid supporter. Not giving any weight to the parents on their own is one thing, but when the specialists involved with providing care agree that the cannabis therapies delivered undoubtable value, you at the very least expect them to be able to exclude any other interventions being utilized. You’re right in that this still isn’t sufficient evidence to recommend everyone on the spectrum to try cannabis therapies, but none of the supporters are suggesting that. However, in similar situations that these experts have witness these therapies work in the past, very severe cases, as a last-line therapy they should be granted access to the same pharmacopeia that’s being safely utilized by other segments of the population, including minors. This is being framed as mass experimentation when in all reality that’s simply not the case. This policy ensures the role of two qualified physicians in these therapies, rather than the families doing this on their own as they have been up to this point.
Are your homeopathic examples accompanied with preclinical evidence suggesting a role for them in targeting the system involved in the pathophysiology of the condition? Has the water been documented preclinically to reduce cognitive deficits associated genetic variances commonly associated with the condition it miraculously treated? Is there clinical and preclinical evidence describing the physiological mechanisms involved with this underlying system, and the pharmacological usefulness of your water in targeting the system in order to provide palliative relief for the most common ailments associated with the condition? Are there multiple experts that specialize in their field that have concluded that the water is of therapeutic value through the act of providing care for individuals that have utilized water therapies? Are people being arrested for using that water? If so, I’d take another look at the policies on that water.
Apples and oranges. Off-label use is defined as using a drug that is already FDA-approved for an indication other than the one that the FDA approved it for, usually based on clinical trial evidence suggesting its efficacy and safety for the off-label indication. Since cannabis oil is not FDA-approved for anything resembling autism and, even if it was, there is no good clinical evidence that cannabis oil is efficacious in autism, your use of an analogy to off-label prescribing is what's disingenuous, not my post.
They're suggesting that parent who can get two doctors to sign off on it should be allowed to use medical marijuana on their autistic child without anything resembling what I would consider proper medical oversight. As for doctors other than Chugani, the same thing applies as what I said above. In a condition like autism, personal clinical experience can be very misleading, thanks to confirmation bias (remembering what supports your belief and forgetting what does not, or remembering the "hits" and forgetting the "misses"), placebo effects, observation bias, etc. It is because, especially for conditions like autism, even experts can be fooled, that randomized clinical trials, preferably double-blinded, with outcome measures as objective as possible are needed.
As for your bit about homeopathy, you're misunderstanding Bayes' theorem and exaggerating the quality of the preclinical evidence for medical marijuana in autism, which is thin gruel indeed. But if you want another example, I can find glowing testimonials in autism for secretin, chemical castration by lupron, bleach enemas, and a wide variety of supplements.
Based the fact that one of those off-label drugs is pure THC, I think my analogy is perfectly acceptable. Unless the claim is that botanical extracts with greater CBD:THC ratios is of more concern than THC itself. Even NIDA publicly cites the safety and efficacy of CBD. In large part, CBD is the additional cannabinoid being added in comparison to current Marinol treatments.
Yes, two physicians are required for approval. If physicians aren't qualified to diagnose, and/or don't have a bonafide relationship with the patient then that seems like an issue with those physicians and not this policy. We seem to agree that more research should be conducted. This policy provides the legal framework for more robust research.
While the paper being cited doesn't fully delve into the specific mechanisms involved with each individual type of palliative relief that the cannabinoids present in botanical extracts from cannabis can provide in symptoms associated with autsim, that doesn't mean that more evidence isn't available. The preclinical evidence in regards to the genetic variances has been provided, and preclinical in vivo experiments have documented CBD as reducing the cognitive deficits associated with FXS in mice.
It seems to me that you likely take issue with the MMMA itself. Medical cannabis laws allow for the use of non FDA approved cannabinoids for the purpose of providing palliative relief in a number of medical conditions. It seems that possibly by your standards that none of the currently accepted conditions that qualify for medical cannabis should be allowed. This too seems to be a separate issue from this policy specifically.
MMMA is a compassionate law enacted to protect patients, families, and physicians that participate in cannabis based therapies for the purpose of palliative relief.If you don't approve that's an issue to take up with the voters. The fact still remains that there is ample evidence in regards to cannabinoids therapeutic value in terms of palliative relief in symptoms associated with severe cases of autism. As the director of the Autism Alliance of Michigan, Stephen D'Arcy, stated in written testimony provided to the panel: "It is unreasonable to deny them the same access to pharmacological treatments presently afforded to many others in the community. This is in fact a form of discrimination against our citizens with autism. As with other pharmacological products we expect that physicians authorized to prescribe medical marijuana will pursue appropriate medical pathways in exploring the possible use of this drug in the autism community."
You can find glowing testimonials for 'secretin, chemical castration by lupron, bleach enemas,' coming from autistic adults, not just your darling parents?
Sceptical now, impressed later maybe?
13 years ago: http://www.letfreedomgrow.com/articles/poll021120.htm
'It begins 'While conceding that Internet website polls are hardly scientific.." and ends "Finally, we note an astonishing ten patients (2%) using cannabis for the treatment of autism."
It seems that pot will treat everything from diabetes to hypoglycemia, anorexia to obesity, and constipation to diarrhea. Truly a wonder drug.
I'd say the bigger story is the fundamental role that the endocannabinoid system plays in human health and disease. It's an absolute fact that its discovery is leading to a greater understanding of the pathophysiology of a number of conditions, and appears to be a potential therapeutic target in the treatment of many of them. Additionally, natural compounds that target the endocannabinoid system are vastly prevalent throughout nature, not just cannabis. Though this paper is now outdated (2006), it's provides a decent overview: http://pharmrev.aspetjournals.org/content/58/3/389.short
Neurotherapeutics. 2015 Jul 28.
Endocannabinoid Signaling in Autism.
Chakrabarti B, Persico A, Battista N, Maccarrone M.
Can anyone access the full paper and tell us what it means please?
So, a very interesting discussion all around, and we still don't have an answer to the underlying logical flaw in Orac's position:
If, as Orac would like, pot is legalized, then the major impediment to his parade of horribles, with parents experimenting and so on, is removed.
Now, I doubt pot is a "universal wonder drug", but that's irrelevant. What's relevant is that Orac is not arguing for the benefit of the children involved, but for some (poorly conceived and/or articulated) principle or concept to which he is obsessively attached.
Oh boy, look who showed up!
Except it wouldn't. In fact, there would likely be additional legal impediments. If marijuana was legalized, any responsible law doing so would restrict children from using it (much like is currently the case with alcohol). A parent giving their child marijuana would likely face similar consequences to a parent supplying minors with alcohol.
We do not have a great understanding of the effect of cannabis on the development of children. It's entirely possible that this treatment could have negative effects and there is no good evidence that there is benefits. Experimenting with such a treatment, especially in a particularly vulnerable population is highly unethical. It seems to me that Orac is the only one who has the childrens' welfare in mind.
My understanding of Orac's underlying principle or concept is that of science based medicine. Medical treatment should be that most likely to produce a positive outcome; the way we know what treatments provide the most positive outcome is through science.
A second principle is one of professionalism. Part of professionalism, as I read it, is not lying. Telling people that, say, marijuana has proven medical uses - based on his reading of the research - untrue.
That is my understanding as a layperson.
"additional legal impediments"
"any responsible law doing so would restrict children from using it"
Got it. It's legal now to give your children pot, right?
I don't see a principle there. You need to articulate it in a way that we can test its application-- compassionateobserver [in the future to be referred to as CO] makes good points about off-label drugs and the fact that there are qualified MD participating as much as possible given legal constraints.
What's the principle? "No doctor should be able to act without Orac's approval"?
Well, no. But that seems to be what these quacks are advocating with using marijuana to treat autism and what Orac is against. You seemed to suggest that Orac's position on legalizing marijuana is at odds with his position that using it to treat autism is a bad idea. There would be additional legal impediments relative to a world where it is legal to give children marijuana in the name of treating autism. Apologies for not being more clear that that is what I meant.
You, really are disappointing in the way you portrayed me and my family. More from the aspect of trying to place words in my mouth and the simple conclusion of any research I've done, or steps I've taken to vet the possibility of treating my son with sever autism. You left out that I also stated it may not be a silver bullet, it may not help him and I'll continue to seek other alternative treatments as well. It took my family a lot to just come out and speak and advocate for the option - that we currently don't have legally. My wife was very brave in doing so and yes, it made us vulnerable to selfish, outspoken egotistic people like you.
It's easy to armchair an opinion on what I think or should be doing or where I get my information from behind a computer and I can see you have some real passion for the topic. Maybe try to put it to good use? Maybe you should have come to the meetings and expressed your concerns and support publicly and have it on record. But that would involve more effort on your part that would also open you up and make you vulnerable to other trolls of the opposing sides.
YOU don't have a child with autism, so YOU CANNOT walk in my shoes. You CAN'T FEEL what I feel. But I'd love to invite you over to do so, let me know. Then you can come away with some real experience as a part-time parent and voice judgement on those who only wish to help their child's development, communication and pain.
Be very careful which cage you poke a stick in, you don't know me apart from what journalists crafted for they're audience.
Mr. Zahringer: Although I haven't encountered you personally before, I have encountered many parents like you with autistic children who are desperate to do anything they can to help their children. Unfortunately, many of them fall under the spell of what is commonly known as "autism biomed," which consists of alternative treatments with little or no evidence behind them that range from supplements, to hyperbaric oxygen chambers, to chelation therapy, to secretin, to bogus stem cell therapies, to homeopathy, to, yes, what are in essence bleach enemas. I linked to some of my posts about such quackery before in my post above, but here are a handful of examples. Note that, if you read only one other posts, please read the one at the very end of this comment, because it is the most relevant to what I'm trying to communicate. If you are willing to read more, I offer these three in addition to the one at the end:
As I discussed in depth above, medical marijuana for autism has been embraced by the autism biomed movement. It is not surprising, given that there is no convincing evidence that it works, and it is basically another herb or supplement that parents in this movement have pinned some of their hopes on. In your story, as portrayed in the news and as you relate it now, I see you in these parents. You describe yourself as investigating medical marijuana and other alternative treatments, just like these parents investigate a variety of treatments. Indeed, medical marijuana has become quite firmly part of the autism biomed movement.
Now, please don't take this the wrong way. You might be insulted by what I'm about to say next, but that's not my intent. What I am about to say applies to every single person alive on this planet today, including myself. We all make these mistakes because that's how our brains are wired. The main difference between a skeptic and the rest of humanity is that a skeptic knows he has these cognitive shortcomings that lead to error and can thus try to avoid them. Unfortunately, for most people it is very hard to hear this. Most people take this information as insults or personal attacks. The reason is simple. When people invest so much into something (as parents doing autism biomed do for the sake of that which they love the most, their children), it's very hard for them to separate their identity from the decisions they've made. I've made the same mistake myself on occasion, lashing out at people who, I later realized, had brought up legitimate criticisms of my words or actions.
That being said, every parent using the treatments I mention above believes that he or she has thoroughly researched it and come to a rational conclusion to try it. Every single one of them thinks he or she has become knowledgeable enough about the science to render a valid judgment, regardless of whether he or she has the background necessary to understand the science. Every single one of them. Many of them come to believe that these treatments work, even though many demonstrably do not. That's because people confuse correlation with causation, tend to remember the times when something appears to have worked and forget the times it has not. There are placebo effects. There are so many confounding effects that lead parents to believe that something has worked when it has not.
Even physicians are not immune to this, which is why a depressing number of physicians come to believe that autism biomed works and offer it. Indeed, physicians can be among the worst, because they sometimes fall under the illusion that their training inoculates them from these cognitive shortcomings and their clinical observations are not affected by the same problems that we all are. I should know. I'm a doctor, and I constantly struggle with this issue. I also struggle to get other physicians to understand and admit that they can fall prey to this too.
The bottom line is that nowhere near enough evidence, preclinical or clinical, exists to support the use cannabis oil or medical marijuana in children with autism. I don't think you're a bad guy. I know you love your children, just as much as the many parents doing autism biomed love their children. But this is the wrong way, in my opinion, and I won't stop voicing this opinion. There's a reason why the autism biomed movement so easily embraced medical marijuana; the two are basically the same.
I'll conclude with this. If you won't believe me, listen to one of my inspirations years ago, a man named Jim Laidler. He is a physician with two autistic children. Read his story. See what finally brought him out of the autism biomed movement. See if you don't recognize yourself in him:
You're not alone, nor are you unique in your love for your child. I have seen you before in many other parents.
You still aren't making sense.
Go back and read #59. I know you don't want to agree with me about anything but that is M O'Brian giving a good analysis.
The question is, is it more likely in a world where pot is legal that someone will experiment with treating their severely autistic child somehow, with oils or whatever. The answer is obviously yes.
And I wonder, how exactly would "the law" find out? Randomly test all autistic kids for pot?
In traditional chinese herbal medicine there are many contraindications for paediatric herb use. Ditto ayurveda.
Both trades used cannabis with people of all ages.
One wonders why there ware no paediatric contraindications for cannabis in the fossil record?
Could it be that xillions of children treated with cannabis over thousands of years did ok?
Disclaimer: I have autism so you can ignore me, thanks.
Mr. Zahringer: "YOU don’t have a child with autism, so YOU CANNOT walk in my shoes"
Is it okay for me to say that giving children with autism untested drugs, especially the types that affect the brain? My son has autism, and there are many more who post here that either are autistic or have family members who are autistic.
I was going to mention that in my reply to Mr. Zahringer. Indeed, I implore Mr. Zahringer to listen to my readers who do have autistic children. There are quite a few of them who read and comment here. Ask them about my history. Just because I criticized medical marijuana for autism and the Michigan Medical Marijuana Review Panel's decision harshly does not in any way mean I was attacking parents.
Ms. Knight: "Could it be that xillions of children treated with cannabis over thousands of years did ok?"
Please provide the PubMed indexed verifiable statistics of these case studies. The plural of anecdote is not data.
I confess to not having the data to hand and don't feel inclined to go looking for the references for you. Let's talk about something else?
Why don't you reply to one of my other comments instead?
From the article: "The Zahringers have thus far been disappointed with the progress their son Brunello has made with conventional therapy, such as Applied Behavioral Analysis. Seeking faster progress, they found medical marijuana and latched on to it for hope:"
Newsflash, Mr. Zahringer: it takes time. We are not talking weeks or even months, but years!
My son could not speak as a three year old, and it wasn't until he was five when he could utter a short sentence. He started speech therapy when he was two and a half, special ed. preschool when he was three, and started intensive twice a week speech therapy when he was four years old that went until he was eight, and once a week until he was twelve. So at least ten years of speech, plus the special ed. services.
He does speak, but it is not quite normal. When he was twenty three years old he ended up in the hospital with what we thought was a stroke (he also has a genetic heart disorder), but fortunately turned out to be a complex migraine. After he recovered the hospital staff flagged his speech, and he was referred for six weeks more speech therapy.
It will take lots of work, and there are no shortcuts. Giving your child drugs needs to be done with the utmost caution. Though I speak as someone whose child has a history of seizures (and migraines). One of the seizures was while he was sick and very dehydrated, which really screwed up his electrolytes. Trust me you do not want to muck with your kid's brain chemistry.
So are you going to ignore me because, choose one:
1. I speak as a parent of an adult with autism, one who has had several EEGs, a couple of head CatScans, and a brain MRI (plus several EKSs, echocardiograms and one cardiac MRI).
2. You don't like what I said.
Where can I find the list of FDA approved medications that are OK for adults but cannot be given to children because of the deleterious effects those drugs have been proven to have on developing minds?
Ms. Knight: "Why don’t you reply to one of my other comments instead?"
Because that was the only one I understood. You made a claim, therefore you need to provide verifiable evidence for those claims. As the article said, you don't just give kids some random chemical without any clinical trials.
So you made this speculative claim: “Could it be that xillions of children treated with cannabis over thousands of years did ok?”
There is no reason to discuss it or believe it has ever happened until you cough up the evidence. You just can't make stuff up and try to make us believe it is true.
Ms. Knight: "Where can I find the list of FDA approved medications ..."
Have you tried searching www.fda.gov ?
It's so sad that we have teenage girls with autism drinking 10 or more cans of Monster energy drink every day. Is it more dangerous than cannabis?
Is it less dangerous than xanax?
Is that less dangerous than alcohol?
"So are you going to ignore me because, choose one:
1. I speak as a parent of an adult with autism, one who has had several EEGs, a couple of head CatScans, and a brain MRI (plus several EKSs, echocardiograms and one cardiac MRI).
2. You don’t like what I said."
The reason to ignore you is, according to Orac:
Now, Orac, as he says, does not intend to insult or disparage parents with that observation. But it does indicate how much he values your opinion, right?
Nice try. I value Chris' opinion because Chris can always back that opinion up with facts and science.
Esther Knight: Personally, I would make many of those energy drinks illegal for children. They don't need the caffeine.
And I would agree. Too much caffeine.
Chris provided personal anecdote. I see zero difference from what people "on the other side" have provided.
More than a "nice try", I think. Your lack of scientific objectivity is showing.
MI Dawn there is so much that doesn't make sense. We positively encourage children with autism to do horse riding which has no evidence to back it up and is far more dangerous than cannabis, not to mention elitist and inaccessible.
Same example again but instead of Monster energy drinks, the teenage girl has a different choice: Cutting or Cannabis?
Which is safer? Cutting is legal. Long term harms of cutting are unremarkable. Is cutting effective?
We don't see this but it is there Master Chris.
@zebra: Seriously? Chris has been a commenter here since almost the beginning, over ten years ago and has taught me things. I've observed Chris's contributions and ability to back up assertions with evidence many years before you ever darkened this blog's comment section.
Sadmar, I have reading Orac's writings for well over ten years, starting at misc.health.alternative. I have learned not only to use facts and science, but also how to separate the good from the bad.
Ten years ago I took what I learned from reading Orac (plus the JREF forums and the Heathfraud listserv) to write a "Chelation is Bad" email to the disability listserv where that was being heavily promoted for our kids. I received lots of nasty grams, and no support from the moderators. So I unsubscribed from that list.
Then one week later this happened:
My question on why Mr. Zahringer was because it seemed he presumed all parents with disabled children know what is best for their children. Actually many of us do not have a clue. I am willing to admit that. Which is why I value learning how to evaluate claims from Orac, Dr. Novella, Dr. Hall, etc.
Thank you, Orca.
Ms. Knight, please try a bit more coherence. You have now made another testable claim: "We positively encourage children with autism to do horse riding which has no evidence to back it up and is far more dangerous than cannabis."
Please provide the PubMed .... you know the drill.
Oy, looking at that link, I wonder if I should get rid of that horrible old template on the original home of Respectful Insolence. A generic Blogger template would be better than that. :-)
Stupid tablet autocorrect: Thank you, Orac.
Now I need to be one with a serger. (ah, autocorrect struck again, should I have typed overlocker? Nope, autocorrect struck yet again, obviously the spellcheck folks aren't big on sewing vocabulary)
I confess to not having the paper to hand and don’t feel inclined to go fetch it for you.
I'm not going to ignore you and I'm not looking to take a shortcut.
Yes it's perfectly safe for you to say what you want. Yes, you have a right to your opinion on treatments, your journey and what has brought you success and why. You clearly have me beat on mileage in terms of dealing with autism as a parent. We've been doing 36+ hours of ABA a week for the past 10 months, special ed through public school 5x/week, occupational therapy 4 hours a week for over a year and same with speech. We've altered the diet and removed refined sugars and gluten. I've had the EEGs, the brain MRI and head CatScan and full expanded genetics too.
I also believe that everything takes time. Should it take years as a baseline? I'm hoping not, at a minimum I'm hoping to see some progress from efforts. Since it is a spectrum of disorders your assessment is not fair, in my opinion to say it will take a dozen years. I hope you are not right in my case however, I'll roll with whatever comes my way.
"Giving your child drugs needs to be done with the utmost caution."
I agree 100% and also believe that if there are new options then I need to be open to considering them. As not being a user of any illicit drugs I'm highly concerned. I've invested a lot of time and money to vet this and am not 100% sure it is a viable option however, I deserve the option with oversight by people like Orac, my son's neurologist, his pediatrician and other doctors and therapists, much like his IEP. This way there is a group of professionals with a wide variety of education and background to help guide me. This may not be a viable option for you for whatever personal reasons you have.
As I see it now there is a substantial lack of FDA-related studies on the use of cannabis on young children. This cannot happen until $$ is placed on the research and testing; short and long term. I'm sure the schedule 1 legality of it has some reasons more research $$ is not spent here (let's not turn that stone here). Unfortunately until that is viable I'll have to research more, speak to more patients who use, parents who treat and see where I can see and draw a conclusion. That and the research of those like Jim Stone and Dr. Bogner, Dr. Chugani and Dr. Constantinou - three who are all very reputable physicians. I want to also mention that three physicians, many accredited like Orac who voted to pass this as a treatment here in Michigan. Some work at hospitals a stone's throw away from his medical center. Confusing signals right? All of them made their determination from years of schooling, experience with patients and countless 100's of hours of ongoing training? I mean, where else would they draw their conclusions from- not just the 800+ pages of petition evidence. It's an illegal drug so they would not have any other interests to benefit from. Was it just compassion? How would they put their name allowing a schedule 1 narcotic to treat a young child with autism out of just compassion alone?
I'm no scholar but I'd venture to say that all of this has some weight, even if it's just to be looked at further. Bring it out of the back rooms and closed parent groups fearing CPS and search and seizure. There are an unbelievable amount of parents with adult children on the spectrum that also advocate and want to try too.
Lastly I haven't "found medical marijuana" as the articles claimed. I've yet to try on my son but I'm interested enough to advocate for a better, safer opportunity within the confines of the law. Maybe if it's signed in to law you'll give it more consideration too.
"My question on why Mr. Zahringer was because it seemed he presumed all parents with disabled children know what is best for their children. Actually many of us do not have a clue."
I don't assume anything of others and never said I knew what was best. I'm learning just like you are.
Thank you for giving your perspective on this matter. Clearly you are fighting hard for what you feel is best for your child.
Ms. Knight, you make some excellent points. While we don't know the long-term negative effects on a child's brain, we can reasonably conclude that they are less harmful than many treatments we routinely dispense to children these days. Less than alcohol almost certainly.
It does seem as if those who seek legal permission to try untested remedies are harangued by medical authorities who object to their making such attempts. It seems quite inappropriate to the potential for harm involved. Cannabis oil seems about as likely to be harmful to children as Lorenzo's oil.
Could you tell me what research Dr. Chugani has done regarding cannabis and autism? I just searched PubMed and haven't been able to find a single scientific paper by him addressing the question. Indeed, a search for his name and "cannabinoid" also revealed zero citations. I'm not playing "gotcha." I really want to know. By PubMed criteria, Dr. Chugani is not an expert in cannabis and autism. I also searched ClinicalTrials.gov for clinical trials by Dr. Chugani. None of the clinical trials he's done involves cannabis. So I really want to know what research he's done in this area.
As for Joe Stone and Dr. Bogner, I described in great detail above why their "research" is an utterly unconvincing bunch of cherry picked studies not to be taken seriously. I mean, really. I haven't seen such a clearly biased, cherrypicked "review" in a very long time, and they extrapolate far beyond what the preclinical data support.
"...Orac is not arguing for the benefit of the children involved,"
Orac, please correct me if I am wrong:
He is arguing for the benefit of the children at the hands of his profession and out of the responsibility he has taken on in accordance with his knowledge of science.
He is not omniscient to know at any given point who is going to break the law. None of us are for any law. If he wants to factor in the increase (which I am not convinced of) in availability of marijuana to children (for any reason) if it becomes legal for adults for recreational use then that is a separate issue.
For the real world/human nature thing, if an adult who thinks that his child needs marijuana to function better but doesn't give it to them because it is illegal now then why would they give it to their child when it becomes legal only for adults - and it is still illegal for children? It may or may not make it easier for them to break the law (see my next paragraph) but I don't know this translates into that they WILL break the law..
You claim availability but, real world again, I call BS on that. Give me some money and one night and I could deliver more MJ than you could smoke in a month (I'll concede a week if you're already a massive pothead). It is that ubiquitous and if you haven't figured that out perhaps you need to get out more.
1. If we don't know the negative long term effects, how can it be reasonable to conclude anything about the relative harm?
2. Does your comment about alcohol mean that you believe that children routinely drink alcohol? Is alcohol routinely prescribed to treat any medical condition, particularly to children? Thanks.
Thanks for the reply and clarifications. I am a skeptic like you however, there are too many of your colleagues that say maybe it can be tried. 3 on the board gave it the pass, that has to speak to some credibility, much like those that gave comment on the petition
I was raised in a society like many that you are just supposed to believe the white coats and their recommendations for treatments. If I was to follow my upbringing I'd say there were three there that day that said, with caution too, that it should be considered. Two said NO citing many of the same things you did in regards to research and long-term studies.
Society has changed dramatically over the years. Today you have to wrestle with what the truth really is, or who you should get that from. As a parent in this instance, I have to be extra cautious and make sure that I have the trusting team in my corner and in the confines of the law. I'm sure my education will be lifelong in regards to my son. I can confidentially tell you that I won't be quick to jump in any direction.
"Even physicians are not immune to this, which is why a depressing number of physicians come to believe that autism biomed works and offer it. Indeed, physicians can be among the worst, because they sometimes fall under the illusion that their training inoculates them from these cognitive shortcomings and their clinical observations are not affected by the same problems that we all are. I should know. I’m a doctor, and I constantly struggle with this issue. I also struggle to get other physicians to understand and admit that they can fall prey to this too."
Scary statement there, and not reassuring to the public with private healthcare. Wish there was more being done to get this centrally aligned and uniform. If it's all science then that should be followed.
I live in Washington, which means among other things that I am aware of our marijuana regulations. It's illegal to give or sell marijuana to anyone under 21; if I go to the friendly neighborhood cannabis shop, they check my ID before letting me in.
I have one of the conditions that is explicitly listed in the state's (older) medical marijuana law: multiple sclerosis. I tried asking my neurologist for advice on using small amounts of THC for treating anxiety, and the best she could tell me was that nobody really knows, but she was willing to write me an authorization letter.
When I went back at a later visit and said I was getting good results using it for spasticity, we agreed that I could just stick to that for the time being. I'm getting a THC-containing liquid on the recreational market, and using significantly less than it would take to get me high. (So, closer to pharmacognosy than herbalism, with the advantage of known dosages.)
Right now, I'm on vacation out of state, and just hoping I don't have that symptom while I'm traveling. None of the prescription options strike me as preferable, except that I could bring them with me to Canada, or New York, or any number of other places. .
(Orac, I hope the anon is okay; I'd rather not have a web search connect my real identity with my medical issues.)
WTF? Cutting has never been put forward as a treatment for autism or anything else. It's a behavior that's indicative of pretty severe emotional disturbance. Actually, I'd be willing to bet that teenagers who cut are more likely to use drugs or alcohol or both, since both behaviors are often a sign of underlying issues. Possibly in a minute I'll go find any relevant studies on the matter.
In any case, if autistic adults find that marijuana helps them cope with things, I'm fine with that. I think it should be legal for adult use in general, and I know several people who smoke pot to deal with social anxiety, as a way to relax, etc., the same way many people use alcohol. And yes, it is considerably less dangerous, as a drug, than alcohol is.
But when parents are giving it to kids, especially when they're more or less just coming up with the dosage on their own, it smacks more of chemical restraint to me than anything else. Sure, it might make the kid seem calmer and more relaxed, but especially if he or she is non-verbal, how is one to know whether the experience is even subjectively pleasant, let alone beneficial? Anybody who's ever been way too stoned knows that it can curb behavior of many sorts, like anything beyond breathing and staring fixedly ahead, but it's not a fun thing to experience, even if one probably seems pretty chill from an outsider's perspective.
Traditional Chinese herbalists never noticed that they were killing their patients with aristolochia. Ayurvedic practitioners seem to think that arsenic, like bacon, makes everything better. Do we really want to go down the road of going through the entire self-contradictory corpus of gibberish from both 'tradiitons' looking for confirmatory evidence of anything?
Why yes, self injury and substance abuse are associated. "Cannabis or cutting" isn't even coherent as an attempted analogy.
No, I love it!
JP no, your experience of cutting isn't relevant to this debate.
Pretend you are a teenage girl with autism and a job in an office. Only three things make you feel level-headed enough to perform:
1) Stimming. 30 mins of stimming. Not possible at work.
2) Cannabis. 1 joint. Not possible at work.
3) Cutting. 2 cuts. Possible at work in bathroom in less than 3 minutes.
Really? You must have a greater facility for decoding seemingly aimless, disjointed remarks than I do.
How does that work? Perhaps some specificity about the "many treatments" routinely dispensed to children "these days" that you're "comparing" with would help.
What does EtOH have to do with the price of tea in China?
Oh, and it turns out that I do have easy access to Chakrabarti et al. As for "what it means," the answer is "not much" from the perspective of cannabis fetishism – it's just a short review paper. In fact, I have no idea why they omitted the meat of it from the abstract:
"Accumulated evidence suggests that the eCB system constitutes a relatively less investigated piece of a puzzle that brings together 4 phenotypic features known to be atypical in autism: 1) social reward responsivity; 2) neural development; 3) circadian rhythm; and 4) anxiety-related symptoms."
I might be persuaded to make it available after I've had some coffee.
What experience with cutting? I don't have any. I'm talking about data.
False trichotomy; there are other ways to cope with stress. Cutting is maladaptive and leaves scars, poses the risk of infection, etc., etc. Getting stoned to get make it through the work day isn't functionally any different from drinking to make it through the work day, and I don't think either one is a very good idea, regardless of legality. They're both indicative of a substance abuse problem, really.
Given that a teenager doesn't need to work to put a roof over her head, a better idea might be to quit the job and find one that's less stressful, or maybe do some CBT to learn ways of coping with stress during the day, or one of many other options out there.
^ Given that a teenager probably doesn't need to work to put a roof over her head, that is. My experience was slightly different from the norm.
I like it too. Perhaps for a different reason. To me it has a nice retro look that makes me somewhat nostalgic.
I think you should have gotten involved with the public hearing or shown up on July 20th or the 31st. As for the clinical trials with Dr. Chugani and others, as a local physician who is obviously passionate about cannabis and autism I can't understand why you have not reached out to him yet and questioned his testimony? He's right around the corner from you in town and you are both respectable Dr's in this field. I think that would give you an opportunity to collaborate as two physicians who come together to form stronger, evidence based conclusions.
Regarding PubMed and other traditional science resources I already addressed this. You'd know better but there does not seem to be a ton of funded research on cannabis as it is a schedule 1 narcotic. But maybe this is where you come in to advocate for more testing and get the funds to do so. You'd have the opportunity to lead the way. Then your opinion turns in to research for all to benefit from.
Point one: I am not "passionate" about cannabis and autism in particular. What I am passionate about is science-based medicine, and this new Michigan policy with respect to medical marijuana for autism is anything but science-based, hence my post here and at my other blog. I see autistic children in my state potentially being subjected to a non-science-based application of cannabis oil to autistic children. That is why I have written about a variety of topics of this type. As for why I didn't speak out about this sooner, well, to be honest I didn't know about it until the news reports of the July 31 meeting. Mea culpa. Somehow I missed news reports of the meetings a few months ago (which should show you that I don't routinely follow medical marijuana news, although I do pay attention to the science).
Point two: Just because there is not a lot of funded research on cannabis and autism (an understatement, if ever there was one!) is not an excuse to skip the requirement for well-designed clinical trials and go straight to treating children with autism. I'm sorry, it doesn't (and shouldn't) work that way. There is a real potential for harm here with chronic use of substances that modulate the activity of a very important set of signaling pathways (cannabinoids) that, no one disagrees, are important in neurologic function. This is a horrible idea.
^ As far as general eCB reviews go, this looks much more promising, but I've only skimmed it.
^^ Also, who smokes an entire joint at once, let alone at work? It's puff, puff, pass, man.
^ "Don't bogart that joint, my friend"
Provides nothing to the conversation; I just couldn't resist.
I have read a lot of your posts,and I see a lot of similarities to my own condition in your son.The moderate to severe autism,the developmental delays,the cardiomyopathy and cardiac conduction disorder that started in the teenage years.I would love to be able to compare histories,if you had a Facebook page or blog.I don't know if your son has had all the medical tests I have had.The stroke like episodes can either be due to mitochondrial disease,or abnormalities in folate metabolism.I have both.I have been involved in a couple of clinical trials not generally available to autistic adults in these areas.Same tests and treatment,same doctors,but because of my age,they chose not to include me in the published studies.
Chromesthesia @ 73
Do you head bang? Do you cut yourself?Tell us why you do these things.
I can tell you my head banging was related to undiagnosed seizures.As this web page* describes.It also addresses a number of reasons autistics might cut themself.
Esther Knight @ 77
This gets to my point up here ^ There are different types of autism,and they can be treated in different ways.I am not judgmental,if cannabis works or you,and allows you to function normally,that's great.Especially if you are an adult.It sounds like you are pretty high functioning,with no other medical issues.I am not so lucky.I was low functioning,with many regressions and medical issues.I had to suffer until I was in my late 40s,before science found the genetic and metabolic causes for my autism and medical issues.It takes a very complex cocktail of supplements and prescription drugs to keep my autism and other brain issues under control so I am able to function normally.But I am still too sick to hold a job.
Esther,if you are using cutting to control behavior and to function normally for few minutes,that is not normal,and it is not "autistic" either.It is a now recognized condition called Non Suicidal Self Injury,often associated with Borderline Personality Disorder.BPD may or may not be a comorbidity of Asperger's,or it could be something misdiagnosed as Asperger's/HFA.There is quite a bit of debate about this.I could post more links,but I would rather not go into moderation.
*I know this is from the ARI,but it is still the best explanation for self-injury on the web.JP@ 127,129 you might want to read this too.As well as the article about NSSI
I had a next-door neighbor one summer, a very pleasant undergrad from Bahrain by way of London, who would routinely go through entire spliffs of high-test reefer on the back porch. Indeed, sometimes she'd wander off to class and leave them burning in the ashtray. I'm surprised she could remember her name and address.
She left some stuff with me in storage, but when I periodically checked in, it appeared that she wasn't going to be returning to finish the degree.
My own system seems to be wired such that one or two puffs are more than adequate to remind it of how this works.
But as for availability, I could probably get you a QP on 24 hours' notice.
It's amazing that many of the parents who are willing to experiment on their kids with mind-altering substances based on a handful of in vitro and animal studies are the very same ones who accuse the National Vaccine Program of using children as guinea pigs, in spite of the fact that vaccines have to go through 10 - 15 years of preclinical and clinical trials before they're approved.
Mr. Zahringer, I do feel for you. One of my children is neuro-atypical and it isn't easy.
Here's a question for you - if there was a scientific trial on cannabis and autism would you enroll your son?
Here's a question for the scientists - is there enough plausibility to make such a study worthwhile? (I recognize that designing, funding, getting review board approval, none of those things are trivial matters.)
Tool of the state
Whores of Babylon
Try in on
Pass the bong
A teenager can be age 13 or 19 or any age in between.
Teenagers can have jobs. Teenagers can have no parents that they can live with.
Here in the UK, a teenager (18 or 19) can legally buy alcohol at lunchtime at her office job. A sixteen year old girl can legally have the same job.
Does anyone here have first hand experience and data on:
JP do you have a daughter? Do you use pubmed as a parenting manual?
This is what I get for not keeping up. Halfway through the comments.
I know people with my illness that have tried and encourage everyone to try CBD oil, insisting that since it is from hemp it isn't pot, is legal everywhere, etc. Have also come across a lot of articles about "CBD oil" which had nothing resembling cannabidiol or even hemp extracts in it. One acquaintance, desperate to manage the pain of her illness and either unwilling or unable to deal with her pain management doctor about it, is now smoking kratom since medical marijuana is not available in her state. Many patients I know keep telling me I need to try marijuana. Unfortunately, it isn't legal in any way in this state, so I can only wonder if I would try it if it became legal.
This, of course, makes me wonder about some of these parents - are they sure they are getting real product? Are they sure it is consistently the same batch to batch?
It absolutely aggravates me that in some cases there are parents out there that "don't want to poison their child with psych meds" that are completely willing to sedate them naturally when investigation is beginning to show possible brain development issues when a young person uses cannabis consistently. The level of inconsistency in some of these people is baffling.
I know what I see with other people with my disease, though. They don't want to be "better" (reduced symptoms, improved quality of life), they want to be well, and living every day in less will make them desperate enough to do anything.
I don't know if I am too practical, too skeptical or if I have given up, but I wouldn't try marijuana without a lot more knowledge of how it might work and what long-term effects there might be vs what I do now. I suspect that if this was about my child I would be even more cautious.
Oh Narad, please?
It's an interesting quandary from where I sit. I first tried cannabis toward the end of my freshman year in college (about three weeks after my first beer, a Foster's oil can, for heaven's sake). My reaction after about two hours was something along the lines of "this is the most interesting thing ever, what time tomorrow?"
Whereupon everyone stared at me and probably remembered as a single man that I was also a fan of the eponymous debut LP of Huey Lewis and the News.
Set aside the physiological issues: Has anyone looked at whether effectiveness – with some sort of objective measure – decays with chronic use?
Yah, this is at the level of trying to get your cat stoned. But, perhaps unsurprisingly, there are two different things being confused: The new magic power of cannabis lies in CBD, which has... "unexpectedly high potency as an antagonist of CB1/CB2 receptor agonists in CB1- and CB2-expressing cells or tissues," (emphasis added), or something.
That's a pretty lazy, dated reference, but the new selling point is that CBD "doesn't get you high." (If I recall correctly, the pathway is CBD → THC → CBN, the latter of which seems to get awfully short shrift.)
The problem here is that this is a rather sloppy paraphrase of "is not centrally active," which means that one needs (1) a peripheral hypothesis of action* or (2) a need to get the story straight on that whole sativa/indica routine.**
Oh, and the Zorse predictably loses again.
* Immune system, digestive, that sort of thing.
It's one inadvertently giant link to Leon Gussow's blog, and then another around "or something" at the end.
Effectiveness of all herbs and medications drops away in time. Nothing lasts forever, even love is generally short lived except in propitious circumcixions.
Once the stress of having to deal with moronic health systems has been sublimated, the need to use cannabis is unnecessary. Unless money grubbing morons still surround you, and continue to harm you, due to your being reliant on them because of your damaged genes, probably caused by industrialisation or poor maternal incubation, toxins, parenting, society etc.
Weak offspring probably have it better in some ways compared to the past when infanticide was more common, but society may be making more of them, due to polluted bodies from modern living.
Sadhus in India sit around and smoke ganga everyday. They are old men who have disorders or are now less able members of society.
Let them eat cake I say.
Meds make them worse, as does grog and junk food.
Cannabis is a lesser evil, in the overall scheme of things.
Sure its not ideal.... but neither is being a stressed out reject.
Shakespeare was possibly a stoner, but didnt like cocaine!
Frank, 'Ganja' is from Gan (thought) as in jnana and Ja (born) as in jiva. Literally 'fertile thought'.
Ganga is the name of a river. Ganja is the Sanskrit word for cannabis flower heads.
I'm calling Poe.
155 Thanks Esther.
Thats my dyslexia for you.... and cannabis actually makes it worse!
But I can't use that excuse as I haven't had any for months, as its still illegal in NZ!
Cannabis for Autism is on Facebook
Ganja, GaNjA, गञ्जा - The Sanskrit word for cannabis flower heads.
Formed from the Sanskrit root gaN, meaning to imagine, evaluate or compute, and the word jaa meaning born, produce, or offspring.
Literally, 'fertile thought'.
Cannabis for Autism People with autism may struggle with social imagination and social play.
Cannabis has been known for thousands of years to increase imagination and creativity.
Autistic people in Vedic times would have been given cannabis to ameliorate their symptoms....
@Esther Knight #128
In traditional chinese herbal medicine there are many contraindications for paediatric herb use. Ditto ayurveda.
Both trades used cannabis with people of all ages.
One wonders why there ware no paediatric contraindications for cannabis in the fossil record?
Could it be that xillions of children treated with cannabis over thousands of years did ok?
In the older records on Chinese traditional medicine, cannabis was classified as a toxic plant. Apart from hemp fiber from the stalks and hemp seeds for oil, constipation, and sundry other problems, what possible uses are you referring to?
@Frank Collete #154
Maybe it was mummy dust.
So Orac, you go on and on about clinical trials. Let's get away from the personal anecdotes of your loyal followers and do some first-approximation science:
What would an acceptable clinical trial of cannabis as a treatment for autism be like? How would you determine that there was no long-term cognitive impairment, and how would you ethically justify the experiment?
And remember, this is for children with serious cases.
@Zebra the FDA managed to find a way to approve Aripiprazole for irritability in children with autism.
It's a fact that the long term effects of Aripiprazole on the developing brain are unknown.
I guess it's a case of showing them the money maybe? Certainly there is no logic to it.
I fully appreciate why there is concern in regards to a perceived lack of standardization, guidance in regards to dosages, and the overall fact that cannabinoids derived from cannabis have not been FDA approved which makes their use an exception to a certain set of standards within the medical field. This isn’t an issue regarding this policy as much as it is a failure on the part of the federal government to change its current policy of prohibition and schedule 1 status of cannabinoids derived from cannabis. The assumption that if this policy is approved there won’t be standardization practices in place, guidance in regards to dosages, and expert oversight seems erred, especially considering the support of Chugani and Constantinou, each the respective heads of their pediatric neurology departments specializing in treating epilepsy and autism at Children’s Hospital and Henry Ford. I’m not certain which field of medicine you practice, but I’d venture to guess that you’re not a leading authority on this subject much the way that both of these individuals are.
I notice you reference the Cochrane study as an indicator of the efficacy of cannabinoids in treating epilepsy. It’s noteworthy in my mind that that was isolated CBD, without any varying ratios of CBD:THC used in the trial. This indicates to me that you may not be familiar with the current practices amongst families utilizing cannabinoid based therapies. You may not give this statement any merit, but the majority of families that utilize these therapies are using varying ratios of cannabinoids. Neither THC nor CBD on its own show as much promise as the two of them combined.
Generally families follow particular protocols, but these protocols would be undoubtedly strengthened by the involvement of a professional. Cannabis chemotypes with known CBD:THC ratios are commonly used in autism and epilepsy therapies, are widely available, and the genetics often traded freely. The most commonly used are near 10:1, 5:1, 1:1 ratios. Analytical labs are used to ensure a verifiable amount of cannabinoids are present in a botanical extract used in these therapies.
This notion that we have so much of a greater understanding of the long term effects of Risperdal and/or Klonopin, or that they’re safer than these botanical extracts seem unfounded. The fact that THC is cited here as the compound of most concern, while it’s often used in many of these therapies in the form of Marinol suggests that the real issue is in regards to the perceived lack of regulation of botanical extracts, and not the active compounds present within them. Unless the claim is that higher CBD ratios present a greater level of concern.
Cannabinoids from cannabis can provide palliative relief in symptoms associated with severe cases of autism. This notion doesn’t seem to be contested here, or anywhere else. This is why the panel approved this recommendation. According to the pediatric neurologists that have been a part of these types of therapies over the past seven years their impression is “very favorable”. These men have specialized in treating autism for decades utilizing an array of off-label drugs. According to their expertise, without exception to the concerns cited here, they feel that these botanical extracts of cannabinoids offer a relatively safe set of options compared to conventional drugs which often do not provide therapeutic value in the types of scenarios being referred to. My guess is if they had a variety of clinically available ratios of CBD:THC they might prefer that, but we’re easily decades away from that, and they see the value these botanical extracts are bringing to therapies today. Parents say they can’t and won’t wait decades for something that they already have access to and success using now. Should they be arrested for that? If people are going to utilize these therapies regardless, would we rather more or less expert involvement? Should the decision to initiating a therapy of this nature be solely that of a parent, or would we rather two separate physicians weigh in?
I have an autistic friend who has written some about stimming. One thing I remember is that they can use music (headphones when out in public) and perfume and other scents to help them cope. They also sometimes fiddle with jewelry: people may wonder a little why someone keeps playing with a pendant, bracelet, or watch, but it's within the range of behavior that's accepted in a lot of circumstances.
zebra, I would suggest that you pose that question to people who are actually advocating medical marijuana: they have a better idea of what they want to test/discover. However, you are (like so many people) forgetting that not all autistic people are children. If there's reason to think that THC, CBD, or any other extract or form of Cannabis sativa is useful for handling autism, the ethical way to study that would be to recruit autistic adults. If you try to limit it to "children with severe cases" you're stacking the deck in ways that make me think that you don't expect or want an answer, but are looking for an excuse to justify drugging children who can't explain that they don't like being high.
Yes, Julian Pursell has earned himself quite a reputation here in the past.
1 in 3 children with autism also have some form of epilepsy or seizure disorder.
Cannabinoids for these disorders will end up in the hands of auttistic epileptic children!
Of course, no apparent reduction in their autism symptoms as a consequence will ever happen again. Sorry that it happened so many times already.
No, but I was a teenage girl less than a decade ago. Do you have a point?
You know my good Dr Orac I agree with what you say. However when I see these claims I am forced to take a bit of the attitude of the "shruggies" you talk about in other posts. Why?
Because, bottom line? Prohibition has failed, it has failed so hard that it didn't even roll a 1 in D&D it rolled a -10 on its chance to hit.
We have been subject to so many years of so much propaganda that has just so steadfastly cemented the social image that one person, smoking one puff, of one joint, once, will immediately go from Leave it to Beaver to Charles Manson or Ted Bundy forever.
I am of the believe we should legalize cannabis recreationally and decriminalize the harder drugs (with emphasis put on public health treatment and rehabilitation as opposed to punitive approaches.)
It's just that, when I argue with these anti-drug advocates, they are unflinching. No argument about the constitutional use of police to "protect us from ourselves" works, no argument about the failure of alcohol prohibition works, no argument regarding the success of portugal or other countries work.
Flat out, the only, and only thing I have seen sway these people's opinions are the ideas it might have legitimate medicinal purposes.
So with that I have to ask you, as a doctor who has an awful lot more knowledge then me, what would you recommend I use in my future strategies? Because I need a way to convince these utterly brainwashed Zombies that no, prohibition is what truly kills, not just the addicts but the society, through organized crime and the rise of the police and military's power to usurp our civil rights and civil liberties all in the name of The War on Drugs.
I know you're a very busy physician, so I won't blame you if you don't respond. But seriously, I plea for your help. I don't want to make medically dubious arguments, but they're all that seem to work. Thank you in advance. :)
If we're swapping anecdotes, I tried it for the first time when I was 18, back home visiting a friend, after an afternoon of spelunking, with no effect as far as I could tell. Ditto the second time, which was at a party in my second year of college. Third time was a charm, but I got waaaay to stoned and didn't enjoy it, although the next day I felt pretty good. I think I didn't really touch it again until I'd moved to Portland after college and was hanging out with some hometown friends on the regular - that stuff was homegrown, though. I've been known to indulge on occasion socially since then.
I've always preferred alcohol, though, TBH, which is sort of unfortunate, really. Now, psychedelics I can get behind, although I understand the effects are blunted when one is on an SSRI.
I actually am uncomfortable dosing developing bodies/brains with any medication. My parents were told to medicate me when I was eleven and adamantly refused. I don't know, of course, if medication might have made things easier, but an educational psychologist I was referred to in my early twenties said that I learned coping mechanisms to deal with a brain that didn't work like everyone else's. Since my son shows some of my characteristics, it was recommended a few times when he was younger that I get a psych consult for meds. I knew I learned self-control and coping, and decided to watch and wait instead. His grades aren't what mine were, but he is much better with people than I ever was.
Narad, my doctor and I have discussed medical marijuana. He says one issue with it is that with multiple active substances and even possible synergy between some of them, they can't be sure when isolating compounds if it is one active compound, another or a few that might be addresses a particular problem (pain vs seizure vs hypersensitivity to stimuli, etc.). The difficulty getting marijuana to research also reduces the opportunities to study.
I tried pot for an entire week. I found it affected my job performance at the time (still wet behind the ears and selling electronics), so I lost interest in it pretty quickly.
I'm trying to stick to the topic and also honor the idea of "science" as supposedly promoted by Orac. But apparently Orac doesn't want to discuss how to do the science to deal with his concerns, rather he wants to repetitively write some version of "but woo" or "but bleach" and so on.
Kind of like that stimming people talk about....
If you don't think it is ethical to do drug studies on autistic children, you should be very upset with conventional medicine. As Esther Knight points out, anti-psychotics have been tested.
I assume those children, as you say, were unable to communicate their displeasure.
But I think the inability of anyone to propose an alternative to what CO is talking about demonstrates the silliness of this particular post.
Orac favors legalization, which will inevitably lead to (more) unsupervised experimentation as purity and consistency improves, but complains about doing it now with the input of MDs. Again, it makes no sense to me.
Sorry, we are not going to compare histories. His sociability is not quite at that level, especially since he has been bullied online. So now he just avoids it.
As noted above, he was given a genetic screen specifically for his specific type (link to company the performed the scan).
The university's genetics doctor specializes in autism, and also thinks there may be a connection. But I doubt the health insurance company would pick up the tab for a full screen, and we are not going to pay the five figure price tag (yes, the price has gone down, but not the type used in medical research). She is welcome to son's DNA when she gets a grant.
As you must know from personal experience there are no short cuts to figuring everything out, including how to cope in this world. Good luck to you, and to your health.
Why should developmentally damaged peeps with compromised detoxification pathways be further poisoned with more toxic substances as well as common environmental pollutants, that put extra strain on said damaged detoxification abilities??
Revolving door medicine and chasing the almighty dollar?
A curse upon your houses!
I don't know about anyone else, but I can't make heads or tails out of what you're against or why you don't like my house.
Yes, LET'S talk about ABA.
We want to work together. ABA works better with cannabis.
ABA providers are not convinced (by the reports of autistic kids having cannabis and mainstreaming it all the way without the help of the accursed houses of ABA) perhaps?
Let's talk about the risks of ABA too.
How do you know?
Whoa Frank, whatever you're into is NOT mellowing you out. :(
@176 Meph O'B
Because being an autistic person around regular humans always goes better with cannabis.
Unless we can get ABA off of a robot, then we don't need the cannabis.
@Esther Knight - ah, so it's the obvious reason. The same reason I play pool better after a beer. Thanks.
178 danger bacon
I'm detoxing and doing a full rebuild, and clean as a whistle.
Its the mercury in my system from amalgam removal, making me cranky.
Even so, it needs to be said.
Profit focused housing, medical and education can never do a good job for recipients of these services.
Look at private prisons, they just want them to keep coming back!
Big Pharma dont want to lose $$$ by promoting effective and safe remedies....
Even Sativex has propylene glycol in it. Why? Tinctures are fine without it.
Eat the battery chicken, become the battery chicken.
I am hurt.
A plague a' both your houses! I am sped.
Is he gone and hath nothing?
Romeo And Juliet Act 3, scene 1, 90–92
I'm on your side on at least some of this--the prison-industrial complex is a scandal and a massive human rights violation, though unfortunately not forbidden by the 13th Amendment. But listing several things you object to doesn't create a connection between them. Vegetarianism won't open the prison doors, and socialized medicine doesn't prevent global warming.
Are you really quoting that bullshit study with a ridiculous sample size and methodology as reliable evidence that "marijuana use is associated with abnormalities in the brain"?
There was only one subject who showed a volume difference and that person alone skewed all the data. The study was heavily criticized by scholars who have never been involved with marijuana advocacy.
Please be more rigorous and less biased when selecting your sources. We do not "know" any of those things you claimed we do, at least until cannabis remains as a schedule 1 drug
Complementing what I posted earlier with sources:
"We do know that teenagers who were found to be dependent on marijuana before age 18 and continued using it into adulthood lose IQ points. "
Do we really? Turns out the study you linked is flawed, which was proven by a follow up study from the same university and another one from Univ College of London:
"We do know that marijuana use is associated with abnormalities in the brain in young users in an exposure-dependent manner. "
Do we really? If you take a moment to read what is possibly the most detailed analysis of the study you linked, by Berkeley professor Lior Pachter, you'll see how embarrassed you should be for referencing it.
"There are other potential adverse health effects as well. "
The study you linked to back that claim is extremely vague - its only conclusions are the most obvious issues such as "marijuana impairs driving", and basically just complains about the lack of research.
I'm with you when you say we need solid evidence before prescribing any medicine, but when you go on bashing cannabis, you just sound as the most 'anti-science' science blogger out there. You didn't even need to write that to support your main claims.
One notes that, for all your complaints, you haven't provided (1) one sliver of evidence that cannabis helps autistic symptoms or (2) that it is safe for long term use in children. Note that the children here are not young adults, as were the subjects of the study referenced. They are children as young as three or four years old. Can you honestly say that long term cannabis use is harmless from that age range on?
In the meantime, here's another summary:
In the arena of dueling research papers, here's a new one.
It is in young adults and with an even smaller sample size but I am curious to know if the research is solid. I am unable to reach the full text and even if I could, I would not be able to vet it. That's why I ask.
I'm too beat at the moment to go fetch the full text and read it, but I do find it curious that they used such a small sample size. One imagines it should be pretty easy to procure plenty of cannabis-using and non-cannabis-using undergraduates or grad students, especially if lured with a little money.
Yah. I would echo Chris in the suggestion to "try a bit more coherence."
I've already blown a couple of hours trying to wrestle the Chakrabarti et al. PDF, and I'm disinclined to pursue the task if this and this are the reckoning points, if you get my drift.
Yes, strange that. My only guess re: the tiny sample size is that it may be what is now considered adequate when using fMRI.
Thanks just the same for the offer to fetch it. It's funny that I even asked here. One of the physicians I connected with over the internet is a psychiatrist who works for the Hazelden Betty Ford Foundation. If he wasn't on vacation this week, I'm sure he would have provided me with a perspective and couple of good, solid references on this topic within a few days.
Esther Knight, August 9, 2015, #179:
The autistic person writing this reply did not find that to be true: your 'always', at least, is false. Lacking any evidence, I can't speak to the possibility that the rest of your statement is consistent with reality.
I would be surprised if there are ANY long-term studies of cannabis in children. If there are, I don't recall them from a search I conducted a year or so ago on – among other aspects – the safety of cannabis. Granted, there are some short-term studies in children with epilepsy, but they can hardly be applied to autism in any age group.
Although not the first to show error processing dysfunction from cannabis, the recent study cited above (#186) in 30 young adults in their late teens and early 20s was poorly balanced for gender, being largely composed of male subjects (n=24). The results suggested that chronic users of cannabis fail "to learn from negative feedback" and "have poorer learning from errors".
Yah, there's a campus lab that churns this stuff out. (Irritatingly, they make it trivially easy to find them at clinicaltrials-dot-gov to see the exclusion criteria but have to have the flyers they plaster the neighborhood with [when they're hard-up] preapproved by the IRB, which is an invitation to wasting people's time if one doesn't bother thinking through the designs in advance.)
Anyway, I suspect the limiting factor here is cost of the fMRI. I think I've already recounted winning a gold star for the most voluminous post-scan urine sample ever in the PET lab as part of a fenfluramine study. That was a production number.
August 9, 2015
Why should developmentally damaged peeps with compromised detoxification pathways be further poisoned with more toxic substances as well as common environmental pollutants, that put extra strain on said damaged detoxification abilities??
Revolving door medicine and chasing the almighty dollar?
A curse upon your houses!
Sir, a society is measured by how they treat and care for their lowest favoured member so how about I sue you for libel given your statement?
You see, your opinion is that we are toxic.
My science based opinion is that our brain is different.
According to current snake oil peddler who have medical training is that we're toxic.
According to science based medical doctors, we features 23% more neurons and a specific brain architecture which enable us to have better perceptual abilities and yet, disabilities in social situations.
You sustain that we are toxic. Can you reasonably that this toxic situation should account for 23% more neurons and increased perceptual skills while handicapping social awareness? If so, tell me because otherwise, I could sue you :)
@176 Meph O’B
Because being an autistic person around regular humans always goes better with cannabis.
Unless we can get ABA off of a robot, then we don’t need the cannabis.
Oh great. Now how about the regular humans take cannabis so they better understand the autistic person? How would that fly?
Ps.s as I've said, the measure of society so how they treat the lowest member of said society.
My immediate reaction is that this could run a strong risk of the adverse event "Irritating the Hell Out of the Autistic Person," but maybe that's a neighborhood thing.
the tiny sample size [...] may be what is now considered adequate when using fMRI.
Never mind the tiny unrepresentative sample, look at the pictures!!
Regular human being irritate the autistic member of society commenting here. I'll have to check with other member with the same diagnose or any others diagnose on the same spectrum but I guess I have 95% of obtaining the same opinion. And that is, without any of the post's substance being ingested by the bothersome peoples here.
Side thing, autistic members can bug the hell of other autistic members but that's just because no member look the same or had the same upbringing as other member of the guild.
^ And yes, I saw that blockquote fail unfold in slow motion.
Typo about personality:
Regular human being harbouring fixing the autistic without considering the ethic of cannabis on autistic without considering cardiac or any harmful condition triggered by cannabis on autistic human being.
Its the mercury in my system from amalgam removal, making me cranky.
If removing amalgam gives you mercury poisoning then you are doing it wrong.
Never mind the tiny unrepresentative sample, look at the pictures!!
A picture is worth a thousand test subjects?
Anyway, I suspect the limiting factor here is cost of the fMRI.
I thought about cost but isn't the equipment the bulk of the cost and not the running of it? And, in my tiny unscientific mind, if the sample size is too small to return anything of value, then didn't a whole lot of money just get flushed down the drain?
This is science people. I don't expect it to act like business!
Walter James Palmer, DDS, who attracted the indirect ire of AoA about petitions and a lion or something, specialized in cosmetic and mercury-free dentistry and amalgam removal.
Connect the freaking dots already.
'we features 23% more neurons'
All of we? I thought everyone had 21% more.
Many more studies show autistics to have heavy metal toxicity too, just google!
'If removing amalgam gives you mercury poisoning then you are doing it wrong.'
Completely wrong Doc. Ask any biological dentist before you comment.
If one doesnt want an elephant in ones kitchen, dont make friends with an elephant trainer.
Hey I'm off, too much unscientific and money grubbing bollocks here for me.
Peace and happiness to you all.
PS Please dont sue me Alain, I was not cursing, really I wasn't. Just cussing..... it was my dyslexia.
"...winning a gold star for the most voluminous post-scan urine sample ever in the PET lab.."
That sounds painful (and gives me visions of Austin Powers).
I hope they reimbursed you well.
And what would convince you "that it is safe for long term use in children"?
This has nothing to do with whether any evidence exists for benefit-- it's about your claim of being scientific.
Tell us what would constitute an ethical, valid, clinical trial, that would establish "safe for long term use in children".
You claim expertise in this area; it should be an easy exercise.
You want an ethical study on children for a substance without prior evidence of efficacy?
It's glad to know some things in life remain the same, even if it zebra's lack of understanding.
Keith Bell was the most recent exemplar, right?
Ok, you all win. Running fMRIs are hella expensive, and those researchers with small sample sizes are acting like business people.
Completely wrong Doc. Ask any biological dentist before you comment.
I deal only with robot dentists, which can be programmed not to talk.
Reading the strange emissions from "biological dentists" puts me in mind of the mystical doctrines of the philosopher-dentist R. King Dri in Mathew's novel "Tlooth".
Walter James Palmer, DDS [...] specialized in cosmetic and mercury-free dentistry and amalgam removal.
Ah, no wonder he has acquired so much money to travel around the world slaughtering megafauna. I did not realise that he he was aboard the mercury scamwagon.
Running fMRIs are hella expensive, and those researchers with small sample sizes are acting like business people.
I get the impression that the pressure to publish is even greater in neuroimaging than in other fields of research. Once the university have coughed up the money for a new 8-T scanner they want to see results right now.
Does anyone compile comparative rankings of research fields, to see which ones produce the greatest proportion of publications that are never replicated and never formally retracted and just fade quietly into oblivion?
Two other fMRI studies suggesting "diminished capacity for detecting errors" in cannabis users:
Face it, your fearless leader is not such an expert as he claims. Good at repeating "but bleach" and "but woo", though.
@zebra 214: and this shows safety how? Given the adverse effects, I'm not convinced.
Where did I say this shows safety?
I think you are not following the comments I was just making.
Surely no one is seriously suggesting that aripiprozole is less harmful than Bedrocan? Or Bediol?
Does Europe Exist?
@ Lighthorse #191, #213.
It sounds like Zebra is asking for a study design which would determine whether a drug is safe for use in children, assuming efficacy is already established. Said design would need to be ethically acceptable, provide conclusive safety evidence, and deal with long term effects.
As someone who has no experience with developing medical study designs, I'm going to leave it there.
Last time I looked it did. I don't have direct evidence for the last several months, though.
I'm guessing that #216 is meant to say "hey, look, evidence that cannabis helps autistic symptoms. Where are your mad pubmed and research skills now, monkey boy?"
'Mr Gover said the company would start research programmes into further targets in the course of the year. He told the Telegraph last month that GW would investigate whether a cannabis-based medicine could be used to treat severe autism.'
Part of it is visible as I type this which may or may not be helpful depending on your philosophical bent.
Your guess is as good as any. I have given up on trying to decipher zebra and his superior communication skills. He seems to think a succession of people failing to understand his blather while he accuses them of stupidity constitutes "a very interesting discussion all around". I don't.
@Esther Knight - I look forward to the results of their trials.
@Mephistopheles O'Brien - Yes, and while we wait can someone please explain what drove such a serious pharmaceutical company to make such an announcement?
Was it the pseudo-science or was it the anecdotes that persuaded GW pharma to back cannabinoids for autism in the Telegraph?
The failure of their cannabis-based product for cancer pain in a Phase 3 trial?
Presumably they think they have something. On the other hand, they thought they had something with their cancer pain drug as well, and this was not proved in their trial (though they remain hopeful and believe in their product). The company, GW Pharmaceuticals, seems dedicated to creating and selling drugs derived from cannabis. They currently have one product approved for use in 27 countries. I'm sure they want more, since one product is hardly enough for a company to be profitable with.
Lots of companies start testing drugs they believe in strongly due to preliminary research (or folklore). Not all prove useful, at least not at first. See Resveratrol for an example.
Was it the pseudo-science or was it the anecdotes that persuaded GW pharma to back cannabinoids for autism in the Telegraph?
They have invested a lot of money in that solution so now they will work their way through the list of potential problems..
I don't think GW would risk huge amounts of shareholder's money if the 'pseudoscience and anecdotes' route get laughed at on an important forum like this.
They must know more, or have done more?
Could they have given some cannabis to some autistic people already?
How does it work in the UK? Does anyone know?
@Esther Knight #225
I would hardly say that GW is "backing" cannabis for severe autism; only that they plan to examine the potential for any possibility of its treatment with one or another of their products.
I don’t think GW would risk huge amounts of shareholder’s money if the ‘pseudoscience and anecdotes’ route get laughed at on an important forum like this.
They must know more, or have done more?
Call me a hater, but I do not share this blithe faith in the altruistic motivations of the pharmaceutical industry.
If there is one thing this thread has done, it has revealed how cannabis affects thought processes.
Chris that is a very unscientific thing to say (#232)
There is no evidence that anyone here has been using cannabis.
Stick to your own rules or don't complain when others break them.
@Esther Knight - you said above "Adults with autism who use cannabis: There are xillions* of us". Common usage would mean that you include yourself in the group of adults with autism who use cannabis. That's not science, but it is at odds with your statement that "There is no evidence that anyone here has been using cannabis."
Poor Ms. Knight, she now knows how seriously I take her incoherent statements. Also my observation was about more than one person.
OK so my self-reported anecdote is a start.
How about those thought processes? How are they affected?
Am I autistic? What if I was misdiagnosed? What if I have an undiagnosed thought disorder?
Basically, let's stick to one set of standards and point out the hypocrisy along the way?
Sorry Chris but as far as I can tell, Zebra has been taking something I've never heard of and Frank is on something a bit stronger than weed.
That only leaves me. I don't know what those others are doing here, I really don't.
Frank is on something a bit stronger than weed.
Crank magnetism is one helluva drug.
I had a stoner roommate in college for a month. He got pretty incomprehensible at times, though so far as I know he was doing OK in his classes (but then, the first two semesters were all pass/no credit).
I have a friend who grew up in the sixties/seventies. Her parents were "cool" and had parties where they smoked pot. They would talk and talk, and they would think themselves quite brilliant, especially how they would make the world better.
Even when she was very young she thought they were talking nonsense. So she decided to stay away from marijuana.
Ok but the friends we have growing up or in college are not completely selected at random. Birds of a feather...
Even when she was very young she thought they were talking nonsense. So she decided to stay away from marijuana.
A similar reason lies behind the Doktorling Sonja's decision to abstain from beer.
hdb: "A similar reason lies behind the Doktorling Sonja’s decision to abstain from beer."
Were you providing the example? Youngest child has also made the decision to abstain from alcohol, similar reasons. She has also decided to never have children, as she sees what happens to people when they become parents.
Well, to share in the manner of the crazy/drug (ab)use boards, SWIM takes modafinil and 5-htp as needed.
Modafinil, yes, the "smart" drug. Except (n=1) if you really need it, it doesn't make you smart; it barely gets you passing as a functioning human being while also keeping you from falling asleep at the wheel.
But SWIM tells me that taking it as needed is always a gamble since you need to take it in the morning before you know how bad your day is going to be. In addition, it has an inexplicable half life that allows sleep 4 hours after taking it on some days and other days it is more like 17 hours. One never knows how long one will be awake after taking. Also, it causes bruxism on some days but not on others. [And, it costs around $400/month, probably because the military is competing with you for the same drug, but who knows.]
The 5-htp is for deep sleep and provides vivid (but luckily, most often comical dreams). How? I have no idea. SWIM generally keeps that on the low-down because it sounds crazy.
Note: Both are legal for SWIM to use. Do not try this at home without a Rx and/or consult with your doctor.
Were you providing the example?
"If you can't be a good role model, aim to be a bad example."
Would you care to elaborate what you believe the risks of ABA are?I know there are a lot of parents who swear by it,and say it helped their child greatly,but I have seen just as many stories of parents who say ABA did nothing for their child one way or another.So what are the risks you see?But please,spare me the usual neurodiverse BS about how treating the autism would take away your individuality,and erase who you are as a person.
It's a serotonin thing. I'm on 150 mg of Zoloft right now, up from 100 mg a week ago and on the way to 200 in a week. I've started having the long, involved, vivid and memorable dreams again that I remember from the last time I was on an SSRI. Last night I had a dream about diving for treasure, except when I got to where the treasure was, it was a purple dragon plushie with comically small wings. The great thing is that I was not disappointed, as this dragon was very important and meaningful for reasons I cannot explain in a waking state.
I know about the 5-htp because I once bought some as a sleep aid, and found out serendipitously just before taking it that it shouldn't be taken if you are taking an SSRI, as it can cause serotonin syndrome.
The Zoloft actually is causing some bruxism as well, but them's the shakes, I guess. With any luck it'll pass.
I haven't had a drink in days, so now I am having two, because I've decided that's how it works.
I had rater disappointing results with 5-htp and melatonin
( separately) for sleep.
Treasure and a plushie purple dragon? Did he sound like Mr Cumberbatch?
Nope, it was mute; literally a toy stuffed animal. Search me.
I'm happy to hear that you're having enjoyable dreams, and good advice on the 5-htp interaction with SSRIs.
Btw, you made my night. You're the first person to ever know what I'm talking about with the dreams. All I have ever read about (or heard about from my friends) have been the nightmares.
On that note, it's past time for bed on this coast. Perhaps I will run across your purple dragon plushie tonight.
(Note: Earlier I meant to write '"on the down-low" not "on the low-down". I do know the difference. Grrr.)
Oh, I've had some of the nightmares too, and they were truly awful. I only had them was when I was on Lexapro, if memory serves. Just really, really f*cked up dreams. There's one in particular that's seared into my consciousness forever, but I am not going to relate what happened here.
So far so good with the sertraline, though.
Roger I would love to oblige but why reinvent the wheel? TGPA on facebook seem to have it covered already - https://www.facebook.com/thinkingpersonsguidetoautism/posts/36747052662…
Let's talk about the risks of the neurodiversity movement!
I often wonder about the rights of all children. Whether it is bleach enemas or the effects of marijuana on young brains, the rights of these children are being abused. Using untried woo does not help children who have autism. It is a bit like saying that "my child is not learning quick enough at school, maybe I should try marijuana so he can know everything at six years of age". Use of standard applied behavioural analysis may not work instantly, but it can have long lasting good effects. Marijauna can have terrible effects on the adult brain, never mind on the brains of children aged three or four.
at 6 years of age"
Here in the UK we have somehow managed to approve riperidone for autistic children, despite the risks.
Is anyone here seriously suggesting that it's safer to give a child risperidone over cannabinoids?
From your article: ''More worrisome, however, are the side effects, the most significant of which is weight gain from an increased appetite.''
Because that doesn't happen with marijuana, right?
@Garou you'd think so but paradoxically no.
Long term cannabis users are less likely to be obese.
These are, however, self-selecting recreational users.
We might see a different effect in a clinical population?
We won't know until we allow it as long term medicine for a large enough population to study.
Seems like you could really use some real science. The link above will help you see that your points on MJ impairing IQ or damaging the brain in general are based on very bad science.
What the writer of this article fails to understand is that the marijuana will not be used to treat the core symptoms of autism, but to help alleviate some of the severe co-occurring challenging behaviours that cause pain and great suffering to both the child who is seriously impaired by autism and his or her family or care givers.
Oh, I understand that quite well. I argue that there's no good evidence that cannabis can do that either, because there isn't.
@Oughtism you fail to understand that some of us have autism with no co-morbidities and we are using cannabis to reduce symptoms of autism.
Orac if you were to design a trial of cannabinoid treatment for autism, which co-morbidities (if any) would you exclude?
'some of us have autism with no co-morbidities'
Access to drug comes at high price
Jade Guest's life has changed since she has been able to access medical marijuana in Colorado to treat her severe epilepsy, but it meant her family just spent their first Christmas separated.
Marijuana Stops Child's Severe Seizures
New York Nine Year Old Girl With Dravet Syndrome
Dies Without Medical Marijuana
Some things you should know about seizures
Cannabis For Autism & Seizures.
zebra, this one's for you.
^ Follow-up to my link above.
It looks like the Medical Innovations Bill (Saatchi Bill) has been revised to be the Access to Medical Treatments (Innovation) Bill. that is claimed to disallow the use of ‘quackology’.
There appears to be a war, on Facebook.
The cannabis for autism page and some anti-vaxxers appear to be at war.
@ Esther Knight
you fail to understand that some of us have autism with no co-morbidities
Seriously I do not believe you.
Meanwhile measles is merrily spreading its way across Queensland.
Orac, a glaring inaccuracy!
That Stone & Bognor essay was self-published on Scribe first then, tellingly without comment, simply reproduced on the 'cannabis for autism' blog.
One gets the distinct impression that the blog owner isn't particularly keen on pseudoscience, albeit possibly vulnerable to it?
Julian Pursell is somewhere around the level of Philip Hills.
Has Philip Hills not worked for the last five years either?
Struggling to see any similarity. Help.
Julian is a patient who uses exercise as therapy.
Philiip is a 'therapist' who sells woo.
Level-wise, which is lower?
to Cruz #260
From your study "state of evidence cannabis use and regulation"
"There are concerns that cannabis use, especially when initiated in adolescence, may lead to various forms of cognitive impairment. For example, a recent Health Canada advertisement flashed “loss of memory” and “learning problems” on the screen (Health Canada, 2014). The U.S. National Institute on Drug Abuse has warned parents that cannabis use “has negative effects on attention, motivation,
memory, and learning that can persist after the drug’s immediate effects wear off – especially in regular users” (NIDA, 2014). While there is moderate evidence to support a general claim that early-onset and sustained cannabis use is associated with certain cognitive deficits,
there remain important gaps in our knowledge regarding the full range of effects and their reversibility."
So they basically admit that marijuana consumption impairs cognitive function (which is kind of obvious), but hey, it might be reversible! We don't know exactly to which extent you're impaired!
I'd tend to agree that the effects are reversible, having seen people fully recover myself, but we're talking about children of school age that would be "treated" with marijuana on a regular basis here. Pretty safe bet that it's not ideal for their success. Not to mention the whole "giving a psychoactive drug to non verbal children that can induce badtrips and other unpleasant experiences.
If aspects of autism can be described in terms of 'over-memorising' and 'over learning' then perhaps cannabis is reducing these?
Having a child with autism is truly nothing you can understand unless your child has autism. The whole point of medical marijuana for autistic children is not just calm them down so that they are easier to manage, but to calm them down and center them so that they have the ability to focus and learn that they wouldn't have otherwise. There are very few "regulated medicines" offered to children with autism and even less that have been proven to work or have any long term benefit. It is absolutely heartbreaking to see your child change from one thing to another almost over night. You do feel alone and hopeless and don't have any answer to your a million burning questions. While I do think that there should be regulation in doses and frequency, you have to remember that not one autism is the same as any other. A standard dosage and frequency level would not work for every kid, defeating the purpose of legalization. As long as parents are safe, responsible and doing something legal it should not matter to anyone else, especially not someone who has no personal experience and probably watches youtube as a reference.
Does it work for that? What's the evidence for that? Thanks.
So, are you implying that Orac is watching youtube videos for reference? Maybe you should look up who he is before making these kinds of claims.
Although nobody doubts that your situation is not an esay one to be in and that you really love your child / children, that doesn't give you any kind of credentials when it comes to treating them for their autism.
Having been an extensive user of marijuana a couple years ago, I can tell you it doesn't rhyme with "focus and learn" as you say. In fact, quite the opposite. The claims on marijuana "curing" or helping with autism are not just unsupported by any kind of evidence or study, they don't even make sense in the perspective of what the drug does to the user.
@Esther knight #277
Is there such a thing as "over learning"?
Yes, the 'restricted interests' leads to learning a lot.
The 'inappropriate speech' is when that info gets dumped.
Whether we fail to learn a lot or avoid infodumping, the goal is not to infodump. What's the point of learning a lot if you have autism? It's not like anyone will listen?
P.S Orac may not be using youtube for evidence but he is using facebook in a cherry-picked way,.
By infodump, do you mean speaking with great detail to someone about something you are very knowledgeable about, but the person is not interested in hearing it?
Even if your "restricted interests" lead you to a lot of knowledge about something that you might not be able to share with many people, that doesn't mean that knowledge has no value. You can always find people with whom you share interests, especially with internet today.
@Garou you're very kind and I'm sure that happens to some of us but we can't rely on that for all of us.
Even now that the beauty of my youth gives way to the wisdom of my old age, not even the guys listen to my dumps.
If aspects of autism can be described in terms of ‘over-memorising’ and ‘over learning’ then perhaps cannabis is reducing these?
The only situation where there's no need for overlearning is in case of PTSD. Now would you please support overlearning for everything else?
The use-case is when I used to read a book three time in the same amount of days would I remember the text of the entire book _and_ the picture of ALL the pages in said book (and in my case, I used to remember over 1000 books in THAT details before 2004).
Only reason I no longer remember these books is because I met a few psychopath and ended up with a complex PTSD.
That kind of memory is incredibly useful in creating a good life for all the number of autistics in the world and I just absolutely can't figure out why you'd want to deprive them of this ability. And yes, I'm dead serious.
Alain you are right.
Being unable to learn the hard stuff I concentrated on the soft stuff instead. So when I met a few psychopaths I didn't end up with a complex PTSD.
Please accept my excuses regarding your motives. I failed to consider that your comment did not suggest using cannabis to treat overlearning in all cases.
That was a reading comprehension failure which is unusual for me because, I usually assume that I'm not understanding what is written unless I worked out all the possibilities of the meaning of your (or anyone else's written or verbal) statement.
You can see why I ended up with the complex PTSD; I work out all the implications of what's being said to me or at me.
Today, what's different is that I know what I'm worth and thus, keep the same method of deducting whatever is said to me or about me without it affecting me in any emotional manner.
Thanks you very much and please have my best regards,
Science, "the systematic knowledge of the physical or material world gained through observation and experimentation."
Thousands of people have observed the effects of medical cannabis on medical problems specific to them or their loved ones. Thousands of experimented. Let the voices be heard. Science is not exclusive to scientists who have to wait for funding, grants, approval and pretentious pious politicians and their self-serving agendas.
Nicoli, science is a bit more than random observations and random "experimentation". It requires care in determining just what you are observing. "[M]edical problems specific to them or their loved ones" shows a total absence of care in determining just what is being observed.
"Thousands [have] experimented" with exactly what, under what conditions: what have they actually observed? GFunding and approval embodies the criteria that allows the answers to be medically useful, rather than just random grabs at a sandpile.
"Science is not exclusive to scientists"
Surgery is not exclusive to surgeons.
Designing buildings and bridges is not exclusive to architects and engineers.
Police work is not exclusive to police.
Fighting wars is not exclusive to the military.
Things tend to turn out better when amateurs recognize their limitations and professionals are allowed to do their jobs
As a person who has seen DIRECT and IMMEDIATE improvement of severe autistic symptoms, with medical cannabis compounds. I have to say, you're absolutely wrong. Your arguments do not add up. You cite, "cherry-picked arguments." All the while, you constantly employ that tactic yourself. Do you care for any autistic children or interact with them daily? Would you care to explain to them, that trying a plant, (not big pharma, which reportedly has you in their pocket,) to treat their soul crushing symptoms, is "premature?" The first search hit for your name describes you as, "The ultimate quack of all time, ORAC from National Geographic funded "ScienceBlogs.com"
I am very glad that even the weak minded will have a hard time buying into your nonsense.
Justin: "As a person who has seen DIRECT and IMMEDIATE improvement of severe autistic symptoms, with medical cannabis compounds."
Please get your robust study of the "DIRECT and IMMEDIATE improvement of severe autistic symptoms" with the astounding study size of N=1 published in a PubMed indexed journal, and then come back to astound us with your brilliance.
I don't know what Justin used for search terms, but *I* certainly didn't come across The first search hit for your name describes you as, “The ultimate quack of all time, ORAC from National Geographic funded “ScienceBlogs.com” as MY first Google hit. Under Orac, there are several references to the Original, a Wikipedia entry about the Hadron Collider, and some references to posts on RI. Nothing on the first page had what Justin found (unless he used quack as one of the search items).
Under the NSSON, an AOA post does come up on the first page. Even there, however, I am not finding Justin's search results.
Oh, found it. It's the extremely important Farce*book* page "exposing" Orac with a few words dropped. Justin, didn't anyone ever tell you that when you quote something, if you drop words you are supposed to use an ellipsis (aka ...) to indicate missing words? You fail grammar today.
Just what the f*ck are you smoking??
Which symptoms, care to name any?
Did you f*ck!ng know that some autistics used cannab!s a few decades ago and left them seriously numb; which trigger a lot of anxiety??
Yeah, they feel numb and that cause anxiety. Is that what you want?? But hey, they're numb so you don't have to take care of the _ONE_ which you just submitted to the treatment...
Now, do tell me a$$hole, do you care enough about their anxiety to conclude that cannabis is not the answer you're looking for? If not, shame on you. You should never care for autistics.