White Coat Underground

Today over at Science-Based Medicine, Dr. Novella has a review of the so-called “biomed” movement in autism treatment. Anyone should be able to understand the desperation of parents with sick kids, but grief can lead to very bad decisions. As physicians, one of our jobs is to guide people away from these decisions and not to give false hope. Telling people what they want to hear might make you as a caregiver feel good, but as physicians, our goal is not to make ourselves feel good but to help others.

It pained me to read this story about a mom who gets her autistic son stoned. As a father I can only imagine the devastation of not being able to communicate with my child, but I hope that my better judgment would keep me from feeding her pot.

But it’s not the mom’s poor judgment that upsets me the most—it’s her report that she found a doctor willing to help her. There are no studies to support the use of cannabis to treat the symptoms of autism, and given the potential harm of exposing an already neurologically-impaired child unknown doses of a powerfully psychoactive substance, this could be easily construed as child abuse. Additionally, any doctor who would recommend the use of cannabis on an autistic child would find little sympathy from me if he were hauled up in front of a medical board or better yet, a judge. The only reason this is any better than the case of the religious wackos who prayed while they watched their daughter die of diabetes is that its unlikely that pot will kill the child. But imagine being autistic, being unable to separate out various stimuli and communicate effectively, and then suddenly finding yourself feeling strange, not knowing why, perhaps even suffering from a severe anxiety reaction, not uncommon with acute cannabis intoxication. That’s not death, but it is torture.

Comments

#1 Vince Whirlwind
November 23, 2009

I read the article and I don’t see what you’re worried about.
I recall reading that in the UK, around 50% of GP advice is non-evidence-based (which compared very well with the universally crappy advice provided by so-called “complementary medicine” practitioners).
In this case, it appears an evidence base for the medical use of Cannabis is appearing, despite the irrational campaign against it.

Cannabis also has a long history of being used as an appetite-stimulant and it seems to have worked in this particular case.

Controlled doses provided in food reduces the relevance of your alarmist
“…powerfully psychoactive substance…”
and
“…suffering from a severe anxiety reaction, not uncommon with acute cannabis intoxication…”.
Pffft! Ridiculous. She’s not giving her son a binge of bucket bongs, FFS.

From my reading of the literature in the UK, you would have to deny Cannabis to over 2000 users in order to prevent a single case of cannabis-induced psychosis – hardly grounds for denying a useful medicine to a child that desperately needs it, especially when you consider that anti-Cannabis campaigners deliberately confuse drug use with drug abuse in order to further their misinformation campaign.

I have a friend who has an autistic son who is 9 years old. He is very hard to manage, and he has been prescribed some sort of pill he takes every morning to help the situation – no doubt this also is some kind of “powerfully psychoactive substance”, presumably with some nasty side-effects, like most pharmaceuticals.
#2 D. C. Sessions
November 23, 2009

That’s not death, but it is torture.

Catch-22, Doc. If the kid complains, he’s cured! If not, no harm no foul.
#3 Dr. Smart
November 23, 2009

Alternative treatment to autism:

* By avoiding unnecessary vaxcinnes like the H1N1(manmade bioweapon) shot, autism can be avoided in most cases.

Supplements that help:

http://www.detoxamin.com

Choline: Improves brain function and nervous system function.

CoQ10 improves brain (and heart) function

SAMe is a natural antidepressant and is critical in the manufacture of brain chemicals.

MSM increases alertness, mental calmness, the ability to concentrate, and energy.

Ginko improves circulation in the brain.

Calcium with magnesium is essential for normal brain and nervous system functions.

————————–

I recommend chelation therapy to rid the body of toxins from vaccines. Also note that if some government dictator forces you to take the vaccine (which is illegal and treasonous) take a Tylenol as soon as possible every four hours for the whole day. Acetaminophen has properties that kill how the vaccine works.

The key is to avoiding unnecessary vaccines – especially when the vaccine is not tested and is used to treat a man made bioweapon like H1N1. Avoiding these dangerous vaccines can assure your survival and wellfair.

You may thank me now, or later!
#4 PalMD
November 23, 2009

oy.
#5 Chris
November 23, 2009

Why do I suspect “Dr. Smart” is an ND, otherwise known as “Not a Doctor, but plays one on the interwebs.”
#6 becca
November 23, 2009

Uhm, Pal, I kinda feel like your presentation on this one is a little misleading. It would be more reasonable to say “mother with a ten year old who refuses to eat, is medically extraordinarily difficult to communicate with, and who weighs 54lbs, marijuana brownies and sees him show an increased interest in food”.
I’ll fully grant there’s no good reason to expect THC to help autism. But there’s no good reason to DENY the evidence that marijuana stimulates appetite. I’m not saying it was wise- I’d love to see a comparative study with *whatever appetite stimulant you would prescribe* with marijuana, and I’d be happy to see that modern medicine has beat the stoners, but I don’t think this one is *quite* as whacky as I first thought from your post.
#7 becca
November 23, 2009

wait, make that 46lbs- below the 5% percentile for a 10 year old
#8 PalMD
November 23, 2009

Becca, i heart you, but the kid’s suffering + the plausibility of the intervention does not make it ethical or even a little bit wise. It is just a reasonable to assume that the kid is having horrible panic attacks but the autism prevents him from registering it in a way the mom understands. Perhaps the increased intake is due to the anxiety from the pot use.
#9 DLC
November 23, 2009

I’m surprised the kid’s mom isn’t in jail.
#10 Danimal
November 23, 2009

Doc Pal,

I love you, man, but why are you so hard against cannabis? You’re close to knee-jerk against it, which seems rather unlike you.
#11 Kim
November 23, 2009

Danimal, Pal’s position on cannabis is very consistent with his position on other inadequately studied interventions. Cf. his characterization of paleo diets as “hooey”.
#12 History Punk
November 23, 2009

Looks medicinal marijuana has side effects.

Also, more seriously, what evidence is there that H1N1 is a “manmade bioweapon”? Dare I ask for relevant citation of a declassified CIA or DIA memo on the matter?
#13 Chris
November 23, 2009

Seriously, History Punk, you expect a cogent answer out of “Dr. Smart”? We are still waiting for him to answer questions here!
#14 PalMD
November 23, 2009

I have nothing against cannabis except when used as a medical intervention without adequate evidence. If folks wanna do it because they think it helps them, that’s their choice. If they feed it to people who have no choice in the matter, not so much. If a doctor offers it up with promises that don’t match the evidence, also not so much.

If a doctor were to say, “some people say that [pot] [whiskey] [meditation][ecstasy] made them feel better” I have a little less problem with that, but if a doctor implies that the evidence goes well beyond that, there’s an ethical problem.

If a patient comes to me asking me if pot is good for, say, muscle spasms, i have to honestly say that the evidence is poor and I wouldn’t recommend it.

If they have a terminal malignancy and it makes them feel good, who could object? But not objecting is different than lying.
#15 becca
November 23, 2009

Pal- I admit, my perception is strongly colored by my discovery of a special gleeful gratification at plumping up my baby (I blame the brainwashing lactivists and the oxytocin).
And truthfully, I really think there *is* adequate evidence that cannabis increases appetite (thus the “benefit” side of the equation seems ok to me).
That said, I don’t really have any empirical sense of what marijuana would be like for an autistic child. If I could see how it’s harmful, I could understand your position much better (if I saw the “cost” side of the equation more clearly). Is it possible to have panic attacks without things like heightened blood pressure? Is it even possible to rule that out as a possibility?
#16 T. Bruce McNeely
November 23, 2009

Giving an autistic child “medical” marijuana makes about as much sense as giving a shy kid a shot of whisky before he has to make a presentation before his class. It just doesn’t seem like a good idea.

I recall reading that in the UK, around 50% of GP advice is non-evidence-based

I’d be interested in your source. I have a notion that it’s derived from The Crap Survey That Will Not Die – a poll done about thirty years ago on a ridiculously small number of GP’s that asked how much of what they did was “scientifically based”. Unfortunately I don’t have the reference at hand. Of course, this completely unscientific data is used over and over again to flog modern medicine as being unscientific.
#17 ZenMonkey
November 23, 2009

I’m a legal medical marijuana patient in my state, and I think this post is a bit needlessly sensationalistic.

However, this from Pal in the comments is exactly my concern here:

If folks wanna do it because they think it helps them, that’s their choice. If they feed it to people who have no choice in the matter, not so much.

Real MMJ patients, and by “real” I mean those of us who use it to relieve symptoms related to an injury or disease and aren’t just gaming the system to get high, are amateur pharmacologists. On any given day, I have to figure out how much cannabis, and which kind, to use depending on how I am.

First of all, how do the parents know where the child’s baseline is? And then, As I understand it, autism is an unpredictable syndrome where a child may have “good days” and “bad days,” much like my disability. So there is another need for the parents to have a good understanding of how much to dose the child from day to day.

And sometimes I get it wrong, when a strain turns out to be stronger or weaker than expected, or for whatever reason — maybe because I didn’t eat much that day — it just hits me harder than expected. As Pal suggests, how would you know if the kid were suffering as a result of this? Overmedication is a temporary annoyance at best for me, because I am fully aware of what’s going on.

I’ve learned much from people in the MMJ community who study the health effects of cannabis. People you would expect to be “rah-rah” about the uses of it for anything, but when it comes to disorders like depression and anxiety, a lot of caution is issued for people using cannabis. It’s not that unsafe for me, an adult woman, to use cannabis as a palliative for my chronic physical symptoms, since it’s akin to taking a Vicodin (on which I’d have to rely without the pot). But for people with mental illnesses, it’s more akin to taking a psych med, and all the scary stories I’ve heard from patients — or former patients — have been in those situations.

So between the lack of dose control due to impaired feedback, the lack of understanding on the kid’s part, and the questionable use of cannabis with mental and emotional disorders, this makes me very wary. The purported results sound like further controlled (and ethical) study could be very interesting. But even as a proponent of medical marijuana, I would not currently consider using it on an autistic child.
#18 Tom Cruise
November 24, 2009

This thread is trippin’ me out.

Just curious…. any of the pro-pot camp ALSO supportive of the “Psychiatry: An Industry of Death” (anti-Ritalin, anti-Prozac) viewpoint?
#19 ZenMonkey
November 24, 2009

Yes, Señor Cruise, some of them are. In my experience, for the most part they are psych patients who had a really bad time with pharmaceuticals but have found relief with cannabis, and then make the Jenny McCarthy leap of logic to the position you describe.

That, of course, doesn’t invalidate medical marijuana any more than the Jenny McCarthy Body Count invalidates science-based autism research. Unfortunately, activists who would really like to get more studies on marijuana out there (by rescheduling the drug, for one thing) are often foiled by these stereotypical crazies and the image they give to the movement.
#20 Dianne
November 24, 2009

There is a certain amount of evidence that marinol (THC) is effective as an appetite stimulant and anti-emetic in the setting of cancer related anorexia and nausea. I can’t imagine using it in autism outside the setting of a clinical trial, though. And I’d want the IRB to look at the clinical trial VERY carefully before approving it.
#21 #1 Dinosaur
November 24, 2009

I call Poe on Dr. Smart.
#22 Sam C
November 24, 2009

It pained me to read this story about a mom who gets her autistic son stoned. As a father I can only imagine the devastation of not being able to communicate with my child, but I hope that my better judgment would keep me from feeding her pot.

I’m with Vince Whirlwind #1 on this.

Real medicine hasn’t worked. Mother is desperate. Kid is sliding into really bad health. Mother gets some info about a treatment that might help, which is relatively low risk. Upside: it might work, absolutely brilliant if it works well, downside: it doesn’t work, kid’s slide into malnutrition continues, extreme (unlikely) downside: unexpected complications.

If one accepts that parents make judgements on behalf of their kids, then this experimentation seems entirely sane, ethical, and scientific. No evidence? As far as the mother is concerned, there is now. (Anecdotes might not be hard scientific evidence, but they can be the spur to effective scientific research.)

And I suspect that in the same situation you might try something similar, albeit with more enquiry and research, using your professional knowledge, justifying your decision on the basis of having evaluated the risks, benefits and so on. Just a difference of degree (or degrees, if you’re very well qualified!).

It is absurd for doctors to try to deny people the right to look for their own non-woo treatments when medical science is washing its hands of their problems.

There’s a BBC television series called Medical Mavericks which lauds doctors who self-experimented to progress anaesthesia, infectious disease research, stomach ulcer pathology, etc. I can’t see the difference, or are us non-gods not allowed to tread on your ground?
#23 DPSisler
November 24, 2009

@22, because this is not “self-experiment” but using her kid as a guinea pig! Get off your tin-foil horse.
#24 rob
November 24, 2009

lol.

so now potheads experimenting with uncontrolled drugs on their children are “medical mavericks.” you forgot to compare the mother to Einstein and Gallileo and rant about how she is being repressed by Western Medicine Big Pharma Shills.
#25 Calli Arcale
November 24, 2009

Vince Whirlwind:

From my reading of the literature in the UK, you would have to deny Cannabis to over 2000 users in order to prevent a single case of cannabis-induced psychosis – hardly grounds for denying a useful medicine to a child that desperately needs it, especially when you consider that anti-Cannabis campaigners deliberately confuse drug use with drug abuse in order to further their misinformation campaign.

If you’re saying that cannabis has a 1 in 2,000 chance of producing psychosis, then I submit that it is unacceptable to use it to treat a child’s lack of appetite without good data on efficacy and dose. (There is data on the former, but data on the latter tends to be lacking even for adults.) I can understand the mother’s desperation, and this doesn’t seem anywhere near as wacky as, say, Lupron. Besides, she’s not trying to treat the kid’s autism; she’s trying to treat his lack of appetite, and that has a higher degree of plausibility. Still, I’d want more than plausibility, and by using an illegal substance, she has taken a much bigger risk than the risk of psychosis. She’s taken the risk of being thrown in jail for drug possession and for furnishing the drug to a minor, which could also lead to losing parental rights. Personally, I don’t agree with the high penalties our countries apply to drug possession, especially in the case of marijuana. But the penalties do exist, and she had to have known. Maybe she thought she could persuade the courts to be lenient if she were caught; I don’t know.
#26 Calli Arcale
November 24, 2009

I take some of that back; I’ve looked at the article now. It *is* talking about not just appetite but about autism symptoms. I can see where it would settle the kid down if the kid was hyper, but so would alcohol, and I don’t see anyone advocating for that. Most of the quotes in favor of it are pretty woo-woo, advocating things without evidence and implying they feel that’s okay. That the evidence isn’t necessary. That it’s too bad the government won’t fund studies, so we should just go get stoned anyway in the absence of studies.

It also alleges that the government will only fund studies into the adverse effects of cannabis. This is not true. I have read of a few studies of THC conducted in the United States with the hopes of using it to improve appetite in cancer patients. They were small studies, and had disappointing results. (Which means they don’t really back up this kid’s story.)

I’d also like to point out that we don’t have evidence the pot actually helped the kid. We have an anecdote that his appetite improved after taking it. Given that picky eaters tend to shift dietary habits abruptly, we can’t rule out coincidence. If it is helping him, that’s good, but I wouldn’t make any decisions about other kids based just on this one kid’s case.
#27 Bridget
November 24, 2009

This begs the question: why do people try alternative medicine? Because “real” medicine isn’t working!! Even a harmless placebo effect is better than nothing.

Dr. Pal, I think that if you were in that woman’s shoes, you might see things differently. It’s my impression that a lot of drugs, especially psychiatric drugs, put people at risk and that these kinds of drugs are given on a trial and error basis. How is that more scientific than marijuana?

I know I’m going to be blasted on this because of the “scientific data” but really, I don’t see the difference. If marijuana hasn’t been studied, someone ought to get off their duff and study it so it can be added to the list of drugs that only work for some people some of the time.

May I remind you that ritalin is also considered a street drug. Why should it be treated any different than marijuana?
#28 PalMD
November 24, 2009

@B
that’s a whole lot of different questions wrapped into one. MJ is “treated differently” by the law than ritalin, but not much differently, and that’s a political decision. Ritalin, though, has significant amounts of data to help understand its use while MJ does not (also due partly to political reasons).
#29 DrugMonkey
November 24, 2009

Bridget, PalMD: In some sense MJ is treated exactly the same as Ritalin. In the sense that in order for a drug to be approved it has to go through an expensive process of regulatory approval. A process that has to be paid for by someone. No major source of $$ has tried this for MJ as far as I know. the MAPS folks are trying but they hardly have the same $$$ behind them as a drug company would for a promising therapeutic that had *some* abuse liability. like, you know, Ritalin.

The fact that no corporate interest has seen fit to try to get MJ through FDA approval is not evidence of some conspiratorial differential treatment.
#30 catgirl
November 24, 2009

if marijuana hasn’t been studied, someone ought to get off their duff and study it

Of course someone should study it. Nobody is saying we shouldn’t study it. Until then, we should stick to treatments that have already been studied and are backed up by evidence. My hypothesis is that studies of marijuana will show it to be useful in treating several things. However, my hypothesis is not a substitute for a data. I will fully support the use of medical marijuana as soon as I see the evidence for effectiveness, risk, and dosing, just like I would do for any other treatment.
#31 PalMD
November 24, 2009

I gotta say though that as interesting as MJ is, there are a lot of avenues of research that are a lot more interesting and important.

/ducks
#32 DuWayne
November 24, 2009

From my reading of the literature in the UK, you would have to deny Cannabis to over 2000 users in order to prevent a single case of cannabis-induced psychosis…

The problem with that logic, is that we are talking about a child who has a neurological issue that can produce a psychotic event simply because of a particular sound, or because they are touched in a particular place. Autism is partially defined by the way it complicates sensory input. Signals get screwed up in the mix as it is, throwing pot into the mix could very likely make things a lot worse – though the flip side of that is that it could make them better.

I am with Pal on letting people make decisions for themselves in regards to cannabis, medical or otherwise. I am not so inclined to support people making such decisions for others, especially children. I am not averse to seeing cannabis studied for pharmaceutical use, indeed I would love to see a few other plant preparations studied for pharmaceutical use.
#33 titmouse
November 24, 2009

In the sense that in order for a drug to be approved it has to go through an expensive process of regulatory approval. A process that has to be paid for by someone.

Off label use of Marinol for certain symptoms associated with autism might be justified for patients who have failed other interventions, BUT ONLY if sufficient published, peer-reviewed evidence exists.

A minimum standard might be an uncontrolled case series. Such a study doesn’t have to cost crazy amounts of money. But it would require the oversight of a human rights committee and registration of the study before it begins, to guard against the file drawer effect.

Experimental, long-shot trials are not out of the question. But they must be done in a manner that leaves a record useful for others.

If uncontrolled trials produced promising results, one of the pharmaceutical companies would likely agree to fund a controlled study that might eventually lead to an FDA indication. There are ways to create a patent for a drug already off patent (e.g., Adderall),

Sadly, the DAN! crowd produce “studies” that look more like marketing campaigns. They’re forever selling themselves to the public when they should be trying to convince their peers using genuine evidence. Thus I’m afraid I wouldn’t accept a Marinol case series from a DAN! doctor without someone more trustworthy being involved somehow.

I seriously doubt any child psychiatrist in the US will volunteer to be the first to use Marinol for autism. That’s like asking for an ass kicking from the CCHR and other similar anti-psychiatry front groups.
#34 titmouse
November 24, 2009

This begs the question: why do people try alternative medicine? Because “real” medicine isn’t working!!

I sympathize. But please recognize that “alternative” is not a scientific term. It’s a marketing term. It’s designed to stimulate desire.

In reality there are no “alternative” therapies. What we have is simply a set of therapies that have varying degrees of evidence concerning risks and benefits.
#35 daedalus2u
November 24, 2009

I am somewhat sympathetic to MJ use in the context of autism. My sympathy for it is in not a small way produced from my own anecdotal experiences.

I have Asperger’s and also PTSD from abuse during childhood. During my teens and early adult life I had an extremely constricted affect. During my 5 years at MIT I never once went to a professor or TA for help on anything because I was too anxious. I couldn’t ask questions in class and had essentially no social life. After I graduated, I lived with some MIT grad students, and first smoked MJ with them. When I was high, I became more social, and people did remark that I became “more normal”. What was happening was that my affect was becoming less constricted, that I was becoming more in touch with my feelings. I don’t attribute it solely to the use of MJ, the social context that I was using it in had a large effect too.

It was only after my affect had improved that I was emotionally able to have a girlfriend and I think using MJ in the social context that I did played an important role, as did psychotherapy. I think it helped me to learn how to be more of a social person. I think being a social person while high, facilitated neuronal remodeling that allowed a social state to persist when I was not high. I have not smoked in over 20 years, but I think it was useful to me in that developmental state. I appreciate this is a retrospective anecdote, and other people’s experiences will be different. Every drug effect is to some extent idiosyncratic, especially when dealing with very complex physiology, such as in the brain and even more in the more complex neurodevelopment and remodeling of that brain.

I think people who are not on the autism spectrum have a hard time imagining what it is like, including MDs who treat it. In the linked to article there are concerns expressed that MJ use is associated with schizophrenia and psychosis. Schizophrenia and psychosis are not associated with autism, and there is considerable thought that the opposite end of the autism spectrum isn’t neurologically typical, but rather schizophrenia, that NTs are in the middle between schizophrenics and autistics. If that is the case, then the data that some NTs (or perhaps marginally schizophrenic individuals) become psychotic with MJ use is not an adverse indication for autistics to use MJ, any more than the data that anticoagulants can cause bleeding is a contraindication for people in a hyper coagulable state to receive them.

Unfortunately there is such denial and stigma associated with mental disorders that they cannot be studied or treated rationally. The same is true with psychoactive drugs.

The drug abuse laws are in place to serve political and financial aims, not public health aims. The demonizing of MJ and its criminalization was in part due to lobbying by the alcohol industry to preserve alcohol profits and also alcohol taxes. The criminalizing of drug use is supported by the prison guard’s union lobby.

http://www.npr.org/templates/story/story.php?storyId=111843426

Why? Because keeping people in prison is big business. And getting bigger.
#36 ZenMonkey
November 24, 2009

I gotta say though that as interesting as MJ is, there are a lot of avenues of research that are a lot more interesting and important.

And there go any further attempts from me to bring some thoughtfulness to cannabis-related posts here. The bias is 100% clear so I think I’ll pick another battlefield where minds are still open.
#37 PalMD
November 24, 2009

Really?
#38 ZenMonkey
November 24, 2009

Pretty much. I don’t actually begrudge you your stance whatsoever, since I respect doctors who think about this stuff critically and don’t leap to conclusions. You’re more entitled to your opinion than many, due to your expertise in medical matters.

But since you have made up your mind about it, there doesn’t seem to be much of a point for me to continue pushing my agenda. I mean we could fence with opposing research all day but why? I respect your position as I said, so I’m staying out of it here for that reason, and also to conserve my energy for other stuff. (I don’t mean to be overdramatic with that statement; it’s just the nature of my illness.)
#39 Comrade PhysioProf
November 24, 2009

If smoking weed makes people feel good, I am morally opposed to forbidding them from doing so.
#40 DrugMonkey
November 24, 2009

And if feeling good too often makes you feel bad *unless* you smoke some more? And that only restores you to feeling kinda okay? What’s the moral position on that, CPP?
#41 Chris
November 24, 2009

I have no problem with people smoking pot, and agree it should be legalized. But also taxed and regulated.

I cannot stand the smell, so I would hope areas that do not allow cigarette smoke would also not allow pot smoke.

Also, I know it impairs judgment, so I assume that all laws that prohibit driving under the influence would apply to pot (and since my state structures its driving laws to include influence of things other than alcohol, like narcotics and even prescription medication — it would cover marijuana).

And just like tobacco, alcohol and many medications I would not give the stuff to a child.

Disclosure: Yes, I tried it when I was in college. I hated that while under the influence it made me stupid (now this presents an interesting factor in Daedalus2u’s story of becoming more social while under the influence while at MIT!). And it made me sick to my stomach (oh, and so does Percodan and Demerol, I am one of the 10% of the population who cannot tolerate many narcotics).
#42 Funky Fresh
November 24, 2009

And if feeling good too often makes you feel bad *unless* you smoke some more? And that only restores you to feeling kinda okay? What’s the moral position on that, CPP?

Oh, get off your high horse, DrugMonkey. We all know pot isn’t addictive.
#43 Chris
November 25, 2009

Funky Fresh:

We all know pot isn’t addictive.

Really? Note that I don’t care one way or the other, as long as I don’t have to sniff its smell. It would be nice if instead of an argument from popularity, that you would actually post some scientific evidence to that claim.

Also, since this is about giving it to children, perhaps you might tell us if it does or does not have a deleterious effect on children.
#44 becca
November 25, 2009

If cutting the heads off puppies makes people feel good, I am morally opposed to allowing them to do so. Down with things that Feel Good!

“I can see where it would settle the kid down if the kid was hyper, but so would alcohol, and I don’t see anyone advocating for that.”
Well, not much these days. I *was* told by a wonderfully sweet older woman that when babies are teething a couple of drops of whiskey can help. And if it doesn’t work, at least there’s whiskey for the parents!
I am actually thinking about this much more from the Mom’s perspective than I think I would have in the past. Given how difficult it must be raising a kid with severe enough autism that he won’t tell you why he’s not eating, something that “just” settles the kid might actually be really important. Which would *NOT* justify giving the kid something that actually made them suffer, but if there were a way to rule that out, I’m not sure it would be so bad. Reminds me of the ADHD medicine study that showed a placebo effect in the caretakers. If parents think they see an improvement, and that leads to a better relationship, it’s possible real positive neurological change can result from that better social context. I’m not sure it marijuana would provide this, but it might be worth looking into, if we can find a way that minimizes the risks (e.g. marinol).
#45 Calli Arcale
November 25, 2009

becca — yes, it was indeed common practice to settle a fussy baby with alcohol. I’ve heard from a number of elderly relatives that they’d calm the baby with a little bit of whiskey mixed into their formula. Drops of high-proof alcohol on the gums for teething is a little bit different; there it’s being used as a topical anesthetic, not as a tranquilizer. My point was mainly that it isn’t being generally suggested as a remedy now, and indeed, most people would be horrified by the suggestion of getting little kids drunk.

Of course, if we go back to the early 20th century, it gets worse. Not only were many infant medicines loaded with alcohol to quiet the fussy baby, but many of them contained opioids as well, usually morphine (which was believed to lack the addictive properties of opium, a fact which we know now to be totally wrong). Mrs Winslow’s Soothing Syrup was one of the more popular examples, containing lots of alcohol and morphine. It definitely settled fussy babies. In some cases, it even killed them. Incidents like that were instrumental in the creation of the Food & Drug Administration. Prior to that, it was not required for patent remedies to actually tell what was in the bottle, and parents had no idea what they were doing to their children. Even remedies which said they contained no morphine frequently did, and remedies containing alcohol became even more popular during the years of Prohibition (since alcohol remained legal for medicinal purposes).

I am actually thinking about this much more from the Mom’s perspective than I think I would have in the past. Given how difficult it must be raising a kid with severe enough autism that he won’t tell you why he’s not eating, something that “just” settles the kid might actually be really important.

Oh, absolutely. Medications given for various learning disorders and other psychiatric conditions aren’t intended to actually cure the disorder. They’re for symptomatic relief. Autistic children may be prescribed ADD medications to help them focus, anti-anxiety medications to settle their nerves, anti-depressants for the blues, and even anti-psychotics. Unfortunately, there is an understandable hesitation to perform clinical trials on children, so for many of these drugs, psychiatrists have to extrapolate from clinical trials on adults and limited research on children, and then prescribe them to their child patients off-label. It’s an awkward position for the psychiatrists.
#46 daedalus2u
November 25, 2009

In response to Chris, I wouldn’t exactly say that it “made me stupid”, it did make it a harder to think with rigor and precision (essentially impossible while high, but alcohol does that too) and the effect persisted for a few days. I wasn’t working on large complex projects that required continuity of rigorous, precise and creative thought over many months at the time. Those would be difficult (or impossible) if interspersed with getting high. However many activities would interfere with those activities too, watching TV every day, binge drinking, being in a war zone, eating a crappy diet, being starved, getting mugged, being audited by the IRS. Essentially any high stress event has similar effects and society makes no effort to prevent them comparable to the criminal sanctions on MJ use.

Alcohol use by children is extremely problematic. Alcohol does trigger neuronal apoptosis via signaling mechanisms, not only through acute damage. Childhood is a time of tremendous neuronal remodeling which includes a lot of neuronal apoptosis. Messing with the regulation of apoptosis during that time will likely have life-long consequences. I would never allow alcohol to be used on my child as a teething agent.
#47 Bill
November 26, 2009

Sounds like instead of paying for something like Megace the kid’s mom decided pot was cheaper.
#48 Vince Whirlwind
November 26, 2009

My point about GPs is that a good proportion of what GPs tell their patients is not entirely based on evidence, but rather based on the social interaction taking place at the time the advice is given: a GP isn’t just a doctor, s/he is also a counsellor whose job is to get a satisfied patient out the door of his/her surgery up to and including prescriptions of placebo.
In that context, there is no reason a GP should not support a patient’s use of an unproven remedy when that remedy is already in widespread use and is therefore known to have no serious side-effects.
The 2000:1 psychosis issue paints a worst-case scenario – people lump Cannabis users in with Cannabis *ab*users and the side-effects likely with a controlled low-level intake of Cannabis are going to be far less than that.
The constant “anxiety” refrain here is some sort of stereotyped reefer-madness reference – the slow onset with this method of delivering THC to the bloodstream means there won’t be any sudden changes to blood pressure, so I don’t see how anxiety could be a potential issue, quite apart from the mother’s observations which contradict that hype anyway.
And as for the child not making the “choice” – gee whiz, welcome to reality guys – until a child is 18, its legal guardian is responsible for “choices”, and in the case of a child requiring special care, the parents are likely to be making choices on that child’s behalf far into its adulthood as well.
In short, I personally think this treatment is perfectly plausible even if it only treats the appetite problem, and once again paints the absurdity of the legal status of cannabis.
#49 Ali
November 27, 2009

I’d like to offer a counter-anectdote to daedalus2u’s post. I’m also on the autism spectrum, and terrified of any substance that reduces my rationality or control. Being autistic (I specifically have Asperger’s, an outdated and outmoded diagnosis, but there it is) often means not understanding what is going on around you do to sensory processing difficulties–speech might seem garbled or colours too vivid to look at (or look away from) or everything too loud, too rough, too anything. While I appreciate daedalus2u’s story of use of pot as a social lubricant, I think it’s no less post-hoc to attribute his increased social awareness to pot (rather than therapy or maturation or finding a group of like-minded friends, which are also all factors) than it is for a parent who uses biomed, educational, and behavioural therapies to attribute his child’s decreased self injurious behaviours to whatever biomed treatment has been given.

I understand that pot can relax many people, and induce appetite, but it can also cause panic and a sense of unreality–and please do correct me if I’m mistaken about this. For a child on the spectrum who may not understand what is being done to him due to communication impediments and who cannot consent, it is unethical to give him a treatment with no proven efficacy which may cause adverse reactions. Many of us on the spectrum do not show the usual signs of panic or overstimulation, so we cannot trust purely behavioural results that he’s okay. I would say this about any unverified treatment, be it pot or lupron or chelation: there is no proof of benefits, therefore the risks automatically outweigh them. This is not to say I support any of the medical “treatments” currently available for autism, either (both risperdone and apiprazole are approved, and have a whole host of unsavoury side effects–I can’t imagine deciding to give them to my hypothetical child or take them myself). It’s basically all (unverified, probably) useless and (verified) bad-but-useful, a medical rock and hard place.

Finally, I’d love pot to be legalized. I really don’t see it as being different than tobacco or alcohol, and in the US we could certainly use the money we’d make on taxing it to help pay for better schools. It would also make research on efficacy much easier, I imagine. But none of that changes the fact that we don’t have any real proof of efficacy (except anectdotal evidence from the mom, and we have that to say chelation doesn’t suck, too) for pot in relation to autism/related refusal to eat YET and it may be causing this kid undue stress (even if it doesn’t appear to do so).
#50 DuWayne
November 27, 2009

What you are missing Vince, is that we are not talking about neurotypicals, we are talking about a child with autism. While daedalus may have had a reasonable experience with it, he is an adult and highly functional (at least he certainly seems to be). Ali seems rather high functioning as well and has a very different take. But when we are talking about people with autism, age is a very important consideration.

Children with autism, whether they are likely to grow into higher functionality or not, are generally not as cognizant of what is going on around them. Autism makes one very sensitive to sensory input. Even fairly high functioning adults with autism can be prone to extreme difficulties when exposed to certain sounds or textures. Cannabis just doesn’t make a lot of sense for a child who already has sensory issues. They are unlikely to understand what they are feeling and it is just a recipe for disaster in the context of sensory input.

Personally, I just have rather severe ADHD, which produces some symptoms that are similar to some of the symptoms of ASDs. As an adult, I have often experienced rather extreme anxiety in certain situations, after ingesting cannabis. And I used to be a rather heavy toker, as well as being cognizant of what was happening.

I am not saying that every time one might try giving a child with autism cannabis, it is going to cause a psychotic episode. I am saying that comparing what a person with an ASD might experience with what a neurotypical might experience is unreasonable.
#51 daedalus2u
November 27, 2009

I don’t at all disagree with what Ali and DuWayne have said. People are complex, and have complex reactions to complex drugs when taken in complex social situations.

First, not all MJ is “the same”. There are quite different subjective experiences using different strains, the “head high” vs the “body high” as well as different dose effects. There isn’t a good understanding of those differences, presumably they relate to different isomers of different psychoactive substances having different effects on different receptors.

Becoming paranoid is a common reaction to smoking MJ. That didn’t happen to me when I first started smoking it, and as I learned how to get high (it does take learning), I was able to learn how to control and avoid getting paranoid. A lot of that relates to the social circumstances I was in when I did smoke.

I don’t think I have ever lost the ability to think rationally, even when high. I don’t think I have ever hallucinated. How I understand what happened to me is analogous to “stochastic resonance”. Stochastic resonance is the phenomena where if you add noise to a signal, the sensitivity of your detector is increased. When you add noise, the detector is able to detect the sum of the signal plus the noise, and so is sensitive to smaller signals. The noise can then be removed via post-detection signal processing. Many normal physiological signaling pathways use this technique. Fluctuations are important and produce greater reliability and stability by increasing the size of the phase space that stable operation can occur in.

A temporary drug-induced fluctuation in affect allows the organism (me) to experience that fluctuation and learn to cope with it. Some of that learning remains after the drug-induced fluctuation passes, and some aspects of that drug-induced state are then available in the absence of the drug. In that context, even a bit of paranoia isn’t necessarily a “bad” thing, if you can learn to better cope with drug induced anxiety (which you know is temporary and drug-induced), then coping with anxiety from real life might be easier. It was for me, other people may have different experiences.

My problems were not just due to Asperger’s. I also had PTSD, and that was perhaps the more severe problem. I am able to substantially dissociate, so being able to dissociate from how I was feeling, when high, allowed me to experience the drug-induced affect while also analyzing my experience cognitively. I don’t think that there was anything “magic” or special about MJ that produced these effects that the effects could not have been produced with psychotherapy. I think psychotherapy in the absence of using MJ would have taken longer, perhaps much longer.

I have also experienced severe depression my whole life. A large part of my constricted affect was to isolate myself from my feelings of feeling depressed. It was only after I had somewhat recovered from that severely constricted affect that I was able to feel that I was depressed. It was then that I realized that feeling depressed is a lot better than not feeling.

I appreciate that my anecdote is completely idiosyncratic and no one else should expect to have a similar experience unless they have a similar life history, a similar physiology and experience these things in a similar way.

I think the most important aspects of my experience was having that experience in a way that I felt safe. Feeling safe is not something that can be imposed on someone from outside. A safe environment needs to be created and in that safe environment the individual can learn, dismantle protective mechanisms that are causing adverse effects and rebuild new mechanisms that are more functional. That is the essence of what happens in the psychotherapy relationship. Drugs are not a substitute for that, but drugs can greatly accelerate the process.

A problem with this in the context of autism is that many NTs don’t want to provide people with autism with a “safe” environment where the person with autism can figure out for themselves what kind of person they want to be. NTs want people with autism to conform to the “NT normative state”, and anyone who doesn’t is “the other” and triggers xenophobia in the NTs and they have a very hard time not showing it.

I think this is a large part of the reason that psychoactive drugs are so vilified by NTs and made illegal. NTs who have not experienced the effects of the drugs are unable to relate to people who are using them, and so the actions of the drug user trigger xenophobia and antipathy. When the drugs make people less susceptible to manipulation and control, that produces intolerance on the part of those trying to exert control. I think a lot of why the Scientologists are so against use of psychoactive drugs is because of this, the drugs interfere with the mind-control methods of the Scientologist leaders.
#52 KWombles
November 27, 2009

http://www.chicagotribune.com/topic/ktla-sweeps-sams-story,0,3243623.story

The GMA story isn’t the only autism/marijuana story out there. The overarching problem here isn’t related to marijuana in and of itself. It is the tendency of some parents with disabled children to experiment on their children with often unproven and untested therapies (that are often complete quackery).

There are parents putting nicotine patches on their children, feeding them pot-laced brownies, putting them in HBOT chambers, getting them IV chelation and IVIG, giving them lupron, and more, all in the misguided and inaccurate assumption that this will fix their children. Don’t even get me started on the Cutler protocol or Amy Yasko’s crap. Or the PK protocol.

I get desperation. I get that managing and helping autistic children can be tremendously difficult and draining, but our children are not guinea pigs. Should not be used as guinea pigs.

Legalize marijuana, tax the heck out of it, study it in an ethical and well-designed study, but mom and dad baking it up in brownies and feeding it to their autistic child to make their child more manageable is not okay, and it shouldn’t be regardless of whether a person personally finds pot to be awesome.
#53 Russ Belville, NORML Outreach Coordinator
February 22, 2010

I am the host of NORML’s talk radio program (NORML SHOW LIVE at http://live.norml.org) and I have interviewed Meiko Hester-Perez personally (hear for yourself at http://stash.norml.org/stash-for-wed-dec-16-2009) about her use of cannabis to treat her son’s autism.

I’m always stunned at the moralists who will demean the parents who use cannabis, a non-toxic and safe herb, to treat their children’s conditions and yet think nothing of the parents who pump their kids full of Ritalin at the slightest hint they may be a bit fidgety in class. Cannabis isn’t OK, but bring on the children’s Robitussin, children’s Tylenol, and any number of children’s over-the-counter formulations and nobody bats an eyelash, because they’re in pretty boxes with barcodes and the folks at the FDA (who approved Vioxx, thalidomide, and phen-fen) say they are safe.

And the notion that the autistic child is being “tortured” by cannabis is ludicrous, something that could only be written by someone who has not tried cannabis personally. Meiko told me of her son exhibiting over 300 “incidents” a day where he was violent to himself or others; following her use of cannabis brownies, she found him happy and smiling and calm, playing with his toys and exhibiting no “incidents”. Doesn’t sound like someone being “tortured”.

She told me of her son dropping to 46 lbs. before cannabis and putting healthy weight back on after cannabis. Doesn’t sound like someone being “tortured”, either.

For those who are nervous that cannabis hasn’t been scientifically and medically tested, you do have a point. However, 5,000 years of human use have shown cannabis to be extraordinarily safe. The testing you desire is something every medical marijuana advocate desires as well. Problem is that the National Institutes on Drug Abuse won’t allow scientists to do those studies. They tell us marijuana hasn’t been scientifically tested, but then they won’t let us do the studies.

In the meantime as we push for scientific studies in the short term and legalization for all in the long term, do we force Meiko to give up the therapy she’s found to be successful for her son? Is she to allow him to return to emaciation and self-injurious behavior until we can finally change enough politicians’ minds in five years, ten years, twenty years?

It’s also very disingenuous to compare the “faith healing” cases to Meiko’s case. The “faith healers”* are denying proven medical treatments to save their child. Meiko had tried all the proven medical treatments and they didn’t work. She is now trying an unproven medical treatment that does work; you cannot deny the improvement in her child’s autistic syndromes after using cannabis brownies.

Finally, supposing that the autistic child is going to experience the same anxiety or panic that affects a small minority of non-autistic adults who use cannabis is a huge leap. We know that certain mental illnesses respond to drugs in ways contrary to how the same drug affects a non-mentally ill person. The perfect example would be that Ritalin we feed the kids with ADHD – to non-ADHD kids, Ritalin is speed, but to the ADHD kids, the Ritalin slows them down. If cannabis was having an adverse effect on Meiko’s child, it’s hard to believe he’d be as calm and relaxed as Meiko tells me he’s become.

This post and many of the comments on it exhibit the worst qualities of Reefer Madness – an emotional reaction to cannabis use as a sinful, immoral, dirty habit, rather than a dispassionate look on a natural herb that appears to be a successful therapy for some children with autism.

Russ Belville
NORML Outreach Coordinator

*Full disclosure: My wife grew up in that “faith healing” religion and knows personally the families involved in the most recent “faith healing” headlines in the state of Oregon.
#54 Kyle
February 23, 2010

Did anyone read the actual article? Cannabis calmed his self-injurious and violent behaviors, stimulated his appetite…and his prescribed medications, with rigorous study, were not working. Enter a drug with NO toxicity whatsoever, very few side effects (a nice high, possible anxiety attacks if the user is inexperienced or had too much…however the mother in this story gave her child an impossibly small amount of cannabis), and historically proven to be much safer than what is prescribed to autistic children nowadays.

I’m a neuroscience student, I’m as hard science as it gets, and cannabis is consistently proven to be much safer than the cocktails regularly given to these (and other) children. I medicate with cannabis myself (chronic pain that I have a 10+ history with), and have found it useful for many other things (ironically, for me, focusing is one of them, but that’s not even as paradoxical as stimulant amphetamines such as ritalin increasing focus in ADHD sufferers).

The antivax people? Nutters, all of them.
#55 fausto
February 24, 2010

Sorry to break it to you, doc, but treating autism with mj is a growing trend in california, but its a growing trend because it works. Its apparent that you don’t know anything about mj, and your fear of it exists because of that. Please leave us cannabis users alone. We’ve found a drug that works for us and is impossible to overdose on and nearly impossible to become addicted (u must have a really weak mind to be incapable of stopping a mj habit) to. Frankly, being a college student afflicted with ADD, I benefit from it, and don’t want to substitute it w/ pharmaceuticals that are much easier to become addicted to, much easier to die from, and appetite suppressing. You have no idea how much it sucks to get pumped full of ritalin daily and constantly being weak because you can only eat in the mornings before the drug has taken effect. In the same manner, you have no idea how much it sucks to be a kid with autism that can’t eat because of his medication and constanly being in a crappy food because your weak and feelingsick. You disgust me, doc, if you really are a doctor…
#56 Vicki
February 25, 2010

Russ–

If all your historical information is as good as what you posted about the FDA, please do some more research before you go on the air again. The FDA did not approve thalidomide: when it was in the pipeline, a scientist there thought it looked fishy, and blocked it until it became clear that this was a dangerous drug. (Yes, they have since approved it in very limited circumstances, designed to make sure no woman who takes it is at any risk of pregnancy. But thalidomide is an example of the FDA doing it right. And, of course, everything has after-effects: part of what ACT-UP was against, decades later, was a “wait and see” culture on new meds, versus their realization that if they didn’t get medicine soon they would be dead.

Also, there is a major difference between acetominophen and either cannabis or ritalin: the latter are, by intent as well as effect, mind-altering substances. Children’s tylenol is not, except to the extent that reducing pain will make the mind clearer and the person happier.
#57 Dacks
February 25, 2010

Russ,
“Problem is that the National Institutes on Drug Abuse won’t allow scientists to do those studies. They tell us marijuana hasn’t been scientifically tested, but then they won’t let us do the studies.”

Can you elaborate on how you know this?
#58 Jeremy
April 9, 2010

Alexander used to beat himself black and blue. We had to give him valium, Haldol, Ativan, and a myriad of other “safe” drugs on a disturbingly regular basis.

We don’t know if MJ would have been a miracle drug. We only know this: he regularly was busting his lip, tearing out clumps of hair, and required hospitalization on more than one occasion due to intense self-injury. We had to keep his hands wrapped under a sheet to give him a CHANCE at not bruising or bloodying his face for a day. To keep him safe overnight required being wrapped in a sheet and strapped into a car seat. This was the only thing we found that calmed him down – knowing he was safe was the most calming thing we found, and the only thing that made him noticeably happy. No behaviorist managed to help him. No “good and safe” medications helped him.

You want to live my life and then spout this BS about the dangers of marijuana? Be my guest. You are ignorant and perpetuating a lie. Our son is now living hundreds of miles from home because we can’t care for him anymore. You try living that way before you get on your soap box.

The small amount of marijuana we were able to obtain changed him from a bloody, screaming mess to a calm and attentive child. He played with his hands out of his sheet. He got engaged with activities that encouraged fine motor skills. Your article (and many of the responses) are so full of fear and propaganda, it makes me feel sick.
#59 John
April 9, 2010

I have such trouble understanding why doctors are closed minded about new ideas. Frankly if you are not familiar with the current research, Dr PalMD sir, you should not be spouting ignorant and baseless opinions. You are in a position of influence and you are not taking that position seriously or with responsibility.
#60 MonkeyPox
April 9, 2010

Vituperation minus evidence = masturbation
#61 mia
May 10, 2010

I have aspergers and suffer from sensory input overload. I’ve found that a small amount of marijuana stops the physical symptoms (skin crawling, nausea, panic) and allows me to feel comfortable without numbing my brain…. so why do people think that if someone uses marijuana to control symptoms, they must be getting stoned?

I wish I could get it legally but I can’t. I’m a criminal because when every once in a while when I reach a point where my body breaks down, I use a medication that has been declared to be illegal.

my doctors put me on everything from prozac to risperidone and I lost years of my life to side effects that included night sweats, convulsions, acid reflux, hostility, anxiety, panic attacks, overeating, heightened sensory sensitivity… yet those are the “safe” drugs and marijuana is not? the side effects docs give you without a second thought can be worse than the disorder that made the docs want to put you on meds in the first place, so if marijuana mitigates the symptoms and makes the pharmaceutical experimentation an unnecessary exercise, I’m not going to condemn.

if it were my child who was unable to eat and suffering from sensory overload, I’d consider marijuana a viable alternative to the risky mainstream protocol of drugging the kid with unsafe and barely-tested antidepressants and antipsychotics.