is marijuana the world’s most effective treatment for autism?

I’m so happy to see this article vindicate me. OMG everyone who has ever given me shit for smoking weed can go fuck themselves!

The headline isn’t even timid about it: “Is marijuana the world’s most effective treatment for autism?” The answer is yes, although there’s something to be said for psychedelics.

It’s morning in Nahariya, a tiny Israeli town near the Lebanese border, and 4-year-old Benjamin is repeatedly smashing his head against the wall. He spins wildly in circles, screeching at full volume. As his mother tries frantically to calm him, he pulls down his pants and defecates on the floor.

When they leave their apartment, Benjamin wrestles free of her hand and nearly runs into oncoming traffic. Sharon attempts a trip to the supermarket but leaves before she finishes shopping because her son is screaming while he picks up items and throws them to the floor.

I guess the public image of autism can take one for the team as long as it makes the case that giving us weed is important to Prevent This Tragedy.

That was in October 2016, and typical of most days at the time. Sharon, a single mother who moved to Israel from the United States one year earlier, was alone and losing control. Benjamin was taking Ritalin, a drug usually associated with attention deficit hyperactivity disorder (ADHD), which he did not have. He’d also tried the antipsychotic ziprasidone and a mix of antidepressants and anti-anxiety drugs. None of them helped, and he often became more hyperactive as they wore off.

I’ve never had the misfortune of taking antipsychotics, so I can’t comment on that besides the obvious that it probably sucks.

Stimulants can definitely intensify your sensory environment and make you more active and stuck-in-a-loop. I avoid stimulants on days I know there will be leafblowers outside my apartment. Otherwise it’s just asking to end up in an agitated, irritable state. I notice some photosensitivity with CBD, but on balance I’d rather be using cannabis in all situations. Stimulants are sensory overload with an edge that’s hard to soften.

I think a lot of psychiatrists suck at prescribing drugs because they haven’t tried all the drugs themselves. What I said in the last paragraph is the kind of thing psychiatrists should know, but really they’re things that I know from taking drugs. Early in grad school I had a roommate who thought I was stupid for thinking Alexander Shulgin was cool for eating all the drugs himself. Unscientific blah blah blah. The horror of introspection and the subjective.

All that changed a year ago, when Benjamin started taking marijuana. In the little apartment he shares with his mother, mornings are now relaxed and orderly. His transformation may signal the arrival of a long-awaited and desperately needed healing for the many others just like him: children living with severe autism.

Autism spectrum disorder affects about 1 percent of children around the world, with disproportionately high rates in developed countries. In the United States, the Centers for Disease Control and Prevention estimates that one in 68 children has been identified as having ASD, a wide-cast net of a diagnosis that encompasses several complex brain disorders that make communication and other interactions difficult. Children with milder “high-functioning” autism are often uninterested in making friends, feel uncomfortable when touched and have a hard time making eye contact or reading social cues. These individuals face challenges but can usually navigate building a life within their society.

But in cases of severe “low-functioning” autism like Benjamin’s, the symptoms are more pronounced and often violent. Children engage in repetitive and sometimes harmful behaviors, like rocking and head-banging, and are hypersensitive to sound and light, with exposure often triggering tantrum-like meltdowns. They can’t sleep. They have rages. Some of these children never learn to speak, or they reach their teen years uttering only a few words.

ASD has no cure, and most children’s symptoms are treated with medications approved for depression, anxiety or ADHD. As was the case with Benjamin, these drugs often cause their own set of obsessive behaviors and insomnia, along with weight gain. For many children with severe autism, the drugs help for just a few hours; once they wear off, symptoms like hyperactivity become even more extreme.

I don’t know who originally said it, but I like the point that “there is no such thing as mild autism.”

True story: I was talking with a friend about how the government should subsidize hugboxes. “If we’re going to be untouchable, we demand it!” The next morning at work, someone had sent me some IMs thanking me for chewing people out in case comments. She said she’d never met me before but wanted to give me a hug, but my supervisor told her that I don’t like hugs. I’ve also had someone on OkCupid ask to confirm that I’m okay with people touching me before deciding she wasn’t feelin’ it. The stereotype is causing me at least as much awkwardness as the autism, and I can’t work on the stereotype. I’m subjected to it.

I rock and I have (relatively mild) “sensory processing issues.” I’ve spent a good portion of the day fiddling with a Rubik’s cube-like fidget toy. I become obsessed with particular songs and play them on a loop for hours. I used to have a problem with skin-picking, and I’ve injured myself in a meltdown badly enough to need medical attention. I have issues with early waking and spending a few hours up in the middle of the night before going back to bed. Having to take daytime naps depends on how much I’m overloaded, but it can mess with my sleep schedule as well.

I’m “high-functioning,” but I have some version of all the problems that are supposedly “low functioning,” except for being nonverbal. Even then, I do tend to communicate by quoting things, which is echolalia. The fact that I obsess over special interests especially “severely” has practical benefits, but it’s intense enough to be off-putting to other people.

I have pretty good coping skills, but am I “less autistic” than someone else?

But Aran was starting to see evidence in his favor. His first inkling that cannabis could work for autistic kids came from anecdotal reports of parents who had used the drug to treat children with epilepsy. The rationale behind the treatment, and the reason it worked, came down to the marijuana plant’s two primary chemicals: the psychoactive agent tetrahydrocannabinol (THC) and the antipsychotic cannabidiol (CBD).

The brain is filled with cannabinoid receptors, which are named after the plant and function like special locks to which THC is the key. When THC binds to cannabinoid receptors in the brain, several sensations flood the body, what marijuana users call “the high.”

It’s more like this:

CBD works differently, and often with opposite effects. It doesn’t bind directly to cannabinoid receptors, it’s not psychoactive, and it doesn’t alter how the brain functions. Instead, CBD interacts with the brain indirectly. That process, called modulation, combats psychosis, depression, inflammation, anxiety and depression. While it’s THC that gets people stoned—and poses a potential danger to immature brains—it’s the plant’s CBD that relaxes them and counters anxiety, making it relevant to epilepsy and autism.

CBD helps with stress and anxiety. That seems pretty psychoactive to me, and the whole point is that it alters how the brain functions.

It’s true that CBD is a “positive allosteric modulator” of GABA-A receptors, among other things, which means that it makes more chloride flow through the channel, but does so by binding somewhere other than the spot where GABA binds.

People with epilepsy suffer from reduced inhibition, which causes seizures. Over the past five years, a handful of successful studies on the use of cannabis, all employing specialized strains with little to no THC, have shown CBD is a legitimate treatment for certain forms of severe pediatric epilepsy. Doctors believe the drug works because CBD increases inhibition, thus helping to prevent the firing of seizure-triggering neurotransmitters, the brain’s chemical messengers. And because CBD does not cause a high, it’s believed that it presents little risk to the developing brain of a child when administered on its own.

There’s not a special class of “seizure-triggering neurotransmitters,” and neurotransmitters don’t “fire.” Neurons fire, which causes them to release neurotransmitters (through a calcium-dependent process that’s regulated by cannabinoids).

It’s interesting that the author believes the subjective effect of feeling high is the same thing as danger to a child’s brain.

When Charlotte’s case came to light in 2013, Aran was one of a handful of neurologists prescribing cannabis to young people with epilepsy. But nearly one-third of children with autism also suffer from epilepsy. As Aran watched his epileptic patients suffer fewer seizures, he noticed that for those who were also autistic, repetitive behaviors, communication difficulties and frustrations with social interactions also improved. Case studies in medical journals across the world noted the same overlap.

“We [in the medical community] saw children with epilepsy and autism really improve, not just in their epilepsy but also in their behavior,” says Aran. “Sometimes, it was only the autism symptoms that improved.”

There’s not a rule that a drug only has one mechanism of action. Drugs usually can affect multiple targets, and it’s a matter of dose when effects at a given target become non-negligible. CBD probably helps with epilepsy through its effect on GABA-A receptors (for example), but it probably helps with social anxiety through its effect on 5-HT1A receptors, a type of serotonin receptor. CBD also inhibits FAAH, an enzyme responsible for breaking down endocannabinoids.

The cannabis Aran prescribes for autism and epilepsy is a special strain originally produced for epilepsy patients, with the 20-to-1 ratio of CBD to THC that worked so powerfully for Charlotte Figi. So far, he has prescribed it only for his most severe patients: children who had never responded to traditional autism medications, were mostly nonverbal and quite violent, and whose parents were desperate. He has no interest, he says, in prescribing cannabis to children who suffer from other subtypes of autism, like Asperger’s syndrome, that potentially respond to therapy or traditional drugs. Cannabis, he says, is a last resort.

It’s not true that THC is bad and higher CBD-to-THC ratios are always better. Think about whether it’s better to take vitamins or eat fruits and vegetables. The fruits and vegetables are better because the overall effect of that combination of chemicals is better than a subset of the chemicals in isolation. A similar “entourage effect” exists with weed. Whole plant is probably medically better than a CBD pill.

The most pure, isolated chemical isn’t always the best, just like a drug that only targets one protein isn’t always the best.

I like to feel high. It feels better. The idea is to go through life high, and the CBD and some of the terpenes offset the “cognitive impairments.” So does tolerance, so it’s important to smoke every day if you want to smoke and do things like work.

Personally, I eat and vape oils with 1:1 THC:CBD ratios. I use “normal”, negligible-CBD weed, and I stretch out the CBD oil by mixing it with crumble of some “daytime” strain. Overall I’m consuming more THC than CBD. When the ratio gets too high, I’ll hit the pen with CBD oil to mellow things back out. The idea is more “maximal THC while functioning” than “maximal CBD-to-THC ratio.”

I also take Wellbutrin, so that probably counteracts some of the drowsiness or memory issues, too.

All this work goes into maintaining a state of being able to deal with life. I use cannabis, an antidepressant/ADHD drug hybrid, THERAPY, and tai chi, and all of them provide a benefit not quite offered by the others. For example, the cannabis might make me more social, and the tai chi more flexible, but the Wellbutrin adds motivation to actually socialize, and therapy concerns the details of the socializing. I’d survive if I had to lose a given coping mechanism, but it’s a bit one-dimensional to think they substitute for each other and people should have to choose. I can talk, so this guy doesn’t think cannabis would help me.

A paper that will be published later this year in the journal Pediatrics summarizes the results. Most parents said their children improved from the treatment. Nearly half saw a marked reduction in the core symptoms of autism, and nearly a third said their children either started speaking for the first time or were communicating nonverbally. One child said, “I love you, Mom”—for the first time in his life.

As for Benjamin, within two weeks of filling the prescription from Aran, Sharon says, he was calmer. He responded when she spoke to him. He could sit still and make eye contact. If she took him with her to visit friends, she could sit with the adults drinking tea while he played quietly in the other room. Within months, he was doing so well that his teachers recommended he leave his special-needs school for a standard classroom. “It’s like a miracle. I can leave the house and go out with him and not worry,” says Sharon. “I can breathe.”

…David, a burly, 6-foot-1-inch 20-year-old who spent most of his appointments with Aran wearing physical restraints, became gentle enough to hug his sister. He smiled and said her name out loud for the first time in his life. Eitan, a nonverbal 11-year-old who was obese, after years of medications for his tantrums caused compulsive eating, has lost the weight. Aran can’t be sure yet that these changes are related to CBD, and any data will require an extensive peer review before publication. Still, he says, “something is working.”


But seriously. The point of drugs has a lot to do with love.

The article actually does go on to describe a study of whether the entourage effect applies to autism.

I also give them a lot of credit for talking about THCV:

Dr. Eric Hollander, director of the Autism and Obsessive Compulsive Spectrum Program at New York’s Montefiore Medical Center, announced last year that he is running his own study on medical cannabis in pediatric autism—the first in the U.S. to explore cannabis for pediatric autism. “There’s a big unmet need,” he says.

But unlike in Aran’s study, Hollander’s patients are receiving a treatment that contains neither THC nor CBD. They will receive pure cannabidivarin, or CBDV, a cannabinoid derived from the cannabis plant that is very similar in chemical makeup to CBD. It also has a similar track record to CBD in terms of medical application. In studies among patients with epilepsy, CBDV has also been effective in reducing seizures.

The U.S. Department of Defense is funding Hollander’s study. After realizing that military families with autistic children struggle with relocation and placement in remote locations, the department began an active program on autism research. A cannabis grower based in London is providing the drug, administered in capsule form. The goal of his study is to see if CBDV alone can combat the core symptoms of autism.

Try smoking Durban Poison. It’s nice. THCV is a CB1 antagonist and an agonist at CB2 and 5-HT1A receptors.