Recently anecdotal evidence of possible therapeutic effects of cannabis products has emerged.
The aim of this study is to characterize the epidemiology of ASD patients receiving medical cannabis treatment and to describe its safety and efficacy.
Researchers analyse the data prospectively collected as part of the treatment program of 188 ASD patients treated with medical cannabis between 2015 and 2017. The treatment in majority of the patients was based on cannabis oil containing 30% CBD and 1.5% THC.
The Study...
During the study period, 188 ASD patients initiated the treatment. Diagnosis of ASD was established in accordance with the accepted practice in Israel. 6 board certified paediatric psychiatrists and neurologists were responsible for treatment of 125 patients (80.6%), the remaining 30 children were referred by 22 other physicians.
The mean age was 7-12.9 years,
-14 patients being younger than the age of 5 (7.4%),
-70 patients between 6 -10 years (37.2%)
-72 aged 11-18 (38.2%).
-27 patients suffered from epilepsy (14.4%)
-7 patients from Attention Deficit Hyperactivity Disorder (ADHD) (3.7%)
Cannabis products recommended to the patients were mainly oil applied under the tong (94.7%).
-7 patients received a license to purchase oil and inflorescence (3.7%)
-3 patients received a license to purchase only inflorescence (1.5%)
Most patients consumed oil with 30% CBD and 1.5% THC, on average dosage 79.5 ± 61.5 mg CBD and 4.0 ± 3.0 mg THC, three times a day.
Insomnia recorded in 46 patients (24.4%) was treated with an evening does of 3% THC oil with on average dosage 5.0 ± 4.5 mg THC daily.
Follow-up, one month...
After one month, out of 188 patients,
-8 stopped treatment (4.2%)
-1 switched to a different cannabis supplier (0.5%)
-179 patients continued active treatment (94.6%)
Of the latter group,119 responded to a questionnaire with 58 patients reporting significant improvement, 37 moderate improvement, 7 patients experienced side effects and 17 reported that the cannabis did not help them.
The reported side effects at one month were: sleepiness, bad taste and smell of the oil, restlessness, reflux and lack of appetite.
Follow-up, six months...
After six months, of the 179 patients assessed in the one-month follow-up,
-15 patients stopped treatment
-9 switched to a different cannabis supplier
-155 patients continued treatment.
Of the latter group, 93 responded to the questionnaire with 28 patients reporting a significant improvement, 50 patients moderate improvement, 6 patients slight improvement and 8 having no change in their condition.
Reported Side Effects...
The most common side effects, reported at six months by 23 patients (25.2%, with at least one side effect) were:
-6 patients, restlessness (6.6%)
-3 patients, sleepiness (3.2%)
-3 patients, psychoactive effect (3.2%)
-3 patients, increased appetite (3.2%)
-3 patients, digestion problems (3.2%)
-2 patients, dry mouth (2.2%)
-2 patients, lack of appetite (2, 2.2%).
Out of 23 patients who discontinued the treatment, 17 (73.9%) had responded to the follow-up questionnaire at six months.
The reasons for the treatment discontinuation were: no therapeutic effect (70.6%,12 patients) and side effects (29.4%,5 patients). However, 41.2% (7 patients) of the patients who discontinued the treatment had reported on intentions to return to the treatment.
Final thoughts...
-Cannabis as a treatment for autism spectrum disorders patients appears to be well-tolerated, safe and seemingly effective option to relieve symptoms, mainly: seizures, tics, depression, restlessness and rage attacks. The compliance with the treatment regimen appears to be high with less than 15% stopping the treatment at six months follow-up. Overall, more than 80% of the parents reported at significant or moderate improvement in the child global assessment.
-THC was previously shown to improve symptoms characteristic to ASD patients in other treated populations. For example, patients reported lower frequency of anxiety, distress and depression, following THC administration, as well as improved mood and better quality of life in general. In patients suffering from anxiety, THC led to improved anxiety levels compared to placebo and in dementia patients, it led to reduction in nocturnal motor activity,violence behavioural and severity of behavioural disorders. Moreover, cannabis was shown to enhances interpersonal communication and decrease hostile feelings within small social groups.
-CBD enriched treatment of ASD patients can potentially lead to an improvement of behavioural symptoms. These findings are consistent with the findings of two double-blind, placebo-controlled crossover studies demonstrating the anxiolytics properties of CBD in patients with anxiety disorder.
In one, CBD had a significant effect on increased brain activity in the right posterior cingulate cortex, which is thought to be involved in the processing of emotional information, and in the other, simulated public speaking test was evaluated in 24 patients with social anxiety disorder.
The CBD treated group had significantly lower anxiety scores than the placebo group during simulated speech, indicating reduction in anxiety, cognitive impairment, and discomfort factors.
-The cannabis treatment appears to be safe and side effects reported by the patients and parents were moderate and relatively easy to cope with. The most prevalent side effects reported at six months was restlessness, appearing in less than 6.6% of patients. Moreover, the compliance with the treatment was high and only less than 5% have stopped the treatment due to the side effects.
Researchers believe that the careful titration schedule especially in the ASD paediatric population is important for maintaining a low side effects rate and increase of the success rate.
While this study suggest that cannabis treatment is safe and can improve ASD symptoms and improve ASD patient’s quality of life, we believe that double blind placebo-controlled trials are crucial for a better understanding of the cannabis effect on ASD patients.
Source: https://www.nature.com
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