Autism

The Qualifying medical condition stated under the Utah Medical Cannabis Act in Utah Health Code 26-61-104 include: 

Autism 

Summary: There is insufficient evidence to support or refute the conclusion that medical cannabis or cannabinoids are an effective or ineffective treatment for symptoms of autism or autism spectrum disorder.

• Guidance on the Suggested Use of Medical Cannabis – Autism

The medical literature, as of 2019, is devoid of results from randomized, blinded, placebo-controlled clinical trials to guide the use of cannabis or cannabinoids in children or adults for the treatment of autism spectrum disorder (ASD). There are, however, three recently-published short-duration uncontrolled observational studies from Israel that show possible benefits from the use of a CBD-predominant (chemotype III) cannabis extract in the treatment of ASD (Aran et al., 2018; Schleider et al., 2019; Barchal et al., 2019). Patients treated in these three studies included children and young adults (age range 4-22 years) with behavioral problems that were refractory to standard treatments. Treatment consisted of concentrated cannabis extract with a CBD: THC ratio of 20:1 administered sublingually and titrated up based on effect. Measured outcomes were generally favorable and included reductions in anxiety, disruptive behaviors, hyperactivity, rage attacks, self-injury, and seizures. Improvements were noted in mood, quality of life, self-care, and sleep. Some patients did not experience clinical improvements. Reported adverse events were generally mild, involving somnolence and appetite, and were non-life threatening. 

These three studies suggest the possibility of favorable outcomes from the use of CBD-predominant cannabis extract (chemotype III) in the treatment of comorbid and behavioral challenges associated with ASD, but they are limited due to their observational nature as they do not include randomized untreated control groups, and hence, causation as to the benefits and risks of using CBD-predominant or CBD-enriched cannabis extract in the treatment of ASD cannot be established nor excluded based on these studies. Long-term safety and efficacy likewise cannot be determined based on the short duration of these three observational studies. 

Managing behavioral challenges associated with ASD can be very difficult. Currently, there is no randomized placebo-controlled trial to guide the use of cannabis or phytocannabinoids as in the treatment of ASD. However, there may be clinical situations where FDA-approved medications and interventions are causing substantial adverse reactions or are not adequately controlling behaviors of concern associated with ASD. In such situations and after careful consideration of all possible treatment alternatives, a clinician may decide that the potential benefits of using medicinal cannabis may outweigh the potential risks of medicinal cannabis and/or the potential risks of leaving the individual’s severe behaviors unmanaged. This would generally happen after failed attempts using interventions that have positive clinical trial data to support their use and have been approved by the FDA.

 If medicinal cannabis is recommended by a qualified medical provider, the following general dosing suggestions (based on observations made in the above three reports from Israel) may be a helpful starting point: 

• Suggested chemotype: Chemotype III, CBD predominant – 20:1 CBD: THC 

Dose form: Cannabis extract prepared for oral or sublingual use

Route: Sublingual drops 

Starting Dose: CBD 15mg/THC 0.75mg administered sublingually three times per day, followed by careful titration based on individual response to dosage increases. Lower starting doses should be considered in younger children.

Titration: The dose range for efficacy is likely quite variable depending on unknown or unpredictable individual patient factors and may be as high as 10mg CBD/kg/day.s