11 April 2018

Call for cannabis trials for kids with autism

Clinical Drugs Paediatrics

Experts are on the hunt for better therapies for children with difficult behavioural problems, and are turning to cannabis as a potential solution.

A paper published in the Journal of Paediatrics and Child Health calls for trials of medical cannabis for children with autism spectrum disorder, attention-deficit hyperactivity disorder, anxiety and intellectual disability. 

“There is an urgent need to conduct well-designed trials of pharmaceutical-grade medical cannabis products in children with behavioural and psychiatric disorders,” the co-authors, paediatrician Dr Daryl Efron and neurologist Dr Jeremy Freeman, said.

Because psychological interventions are not really an option for children with symptoms of irritability or frustration, treating paediatricians often turn to stimulants, antidepressants and antipsychotics. 

“These medications carry a risk of serious adverse effects in children and adolescents in general, and patients with developmental disabilities may be at particularly high risk,” the authors said.

These drugs are coupled with medications such as metformin to manage the common side-effects, such as weight gain. 

Polypharmacy and “knee jerk psychiatry”, where frequent changes were made to medication regimes, were concerning practices in this vulnerable patient group, the authors said.

Medical cannabis, which is known to produce feelings of relaxation, euphoria, sociability, with limited adverse effects, may be a better treatment for children with these disorders – but the evidence is lacking.

In children, medical cannabis is mainly indicated for drug-resistant epilepsy, and there is some evidence to support its use as an additional treatment for specific seizure types and epileptic syndromes.

Only one trial on the use of medical cannabis use for behavioural problems in children has  been initiated. This trial is currently under way in Israel using cannabis oil with a 20:1 ratio of CBD to THC in patients with ASD.

Some anecdotal evidence also exists. A six-year old boy with autism saw improvements in hyperactivity, irritability and speech following treatment with dronabinol (THC), according to a 2010 report. 

And a small study of adolescents with intellectual disability found most were less likely to injure themselves after taking a similar medication. 

Dr John Lawson, a paediatric neurologist, said medical cannabis was worth exploring for children with behavioural and developmental problems because these conditions were very common, and there was still a big treatment need. 

But the evidence for medical cannabis was still “extremely thin”, he said and discussions about the potential benefits could generate a lot of false hope. 

“We’re a hell of a long way from showing that [medical cannabis] works,” said Dr Lawson, who is the lead investigator for the NSW medical cannabis trials for children with treatment-resistant epilepsy.

While it is now technically legal to prescribe medical cannabis in Australia, the tight regulation around prescribing puts a high burden on treating doctors. 

Sydney-based GP Dr Brad McKay has received many expressions of interest in medical cannabis from desperate parents.

 “Cannabis has been shrouded in mystery and stigma for the past hundred years, causing scientific research to be inappropriately stifled,” Dr McKay said. 

“Hopefully better solutions will be found for our children as we study medicinal cannabis, without the prejudice of the past century being imposed on researchers,” he said.

Journal of Paediatrics and Child Health 2017, 4 April