Cannabis and its Possible Benefits with Autism   
Niall DiFazio
What is cannabis? Cannabis comes from Cannabis sativa which is one of the worlds oldest propagated plants. It all arises from the nineteenth century, where medical doctors started to experiment with cannabis to try and treat some mental diseases and even a disease that we know today, tetanus (Bridgeman, 2020).  Not so later on in the nineteenth century you were actually able to purchase cannabis extracts at local physicians and pharmacies all across Europe and America to treat small illnesses like migraines and even small stomach aches. If were to talk about today, cannabis is seen a lot differently. Today the term cannabis is most commonly called marijuana and is illegal under federal law in the United States. Marijuana is categorized as a schedule 1 drug under the CSA, Controlled Substance Act. But, at the state level cannabis, for medical and some recreational, has been decriminalized in over 30 states (Good, 2019). Even with cannabis being medically legal in some states some physicians still hold back a great amount when it comes to recommending it to its patients due to the lack of evidence regarding to how it is able to treat specific conditions. That kind of mind set creates a lot of difficulty for cannabis as a whole because without scientific evidence to show efficacy, cannabis, as a potential way of treatment, is most likely not recommended by doctors or practitioners. So, until cannabis is changed from a schedule 1 drug, research on the uses of the plant and its components are severely held back.To get more into with what actually makes up cannabis and how we are able to view it to potentially have medical benefits is that we look at its makeup. The cannabis plant is made up of a bunch of active chemical compounds which include terpenoids, flavonoids, and cannabinoids. Two cannabinoids include CBD and THC. THC stands for tetrahydrocannabinol and is the compound that has shown to have the intoxicating effects that and targets the endocannabinoid system in the central nervous system (Russo, 2011). One of the most common things that THC affects is your appetite, memory, cognitive function, etc. On the other side of cannabis, CBD is thought to be an anti-inflammatory, treat epilepsy, psych disorders, and does it without the whole intoxicating side effects (NIDA, 2019). Where nowadays research is mainly focusing on TCH and CBD there has been a slow upcoming of research that is being done with other parts of the cannabis plant and its compoundsTerpenoids, which come from the terpenes of plants. These terpenes are aromatic compounds found in many plants, though many commonly associate them with cannabis because cannabis plants contain high concentrations of them (Johnson, 2020). The aromatic compounds make the scent of many plants, such as cannabis, rose, pine, basil, and even mint. The smell of a lot of plants is due to a blend of terpenes. In nature, these terpenes defend the plants from animal grazing or infectious germs. Yet, terpenes may also offer some health benefits to the human body. As regulations surrounding cannabis become less strict, scientists are carrying out more research into these possible benefits (Johnson, 2020). These terpenoids are recognized as safe as food additives by regulatory bodies including US FDA (Food and Drug Administration) and the Food and Extract Manufacturers Association (Russo, 2011). Researchers have been able to study the affects on animals and humans. With their research they have been able to figure out that the medical effects of terpenes have the ability to be used as anti-inflammatory, antioxidant, neuroprotective, antidepressant, anxiolytic, anticancer, antitumor, anti-mutagenic, anti-allergic, antibiotic and anti-diabetic attributes (Nuutinen, 2018). For another use of terpenoids, scientists have figured out that not only do they have beneficial attributes to the human body alone but, when paired up with cannabinoids they create this effect by working together. This effect between the two compounds of the cannabis plant is called the “entourage effect”. This effect has forms that we can achieve based on the strains of the cannabis plant. We are able to breed the plants to best treat individual symptoms and diseases (Baron, 2018).When it comes to the FDA, the Cannabis plant has not been approved for any treatment of health conditions. Only some of its cannabinoids have been approved like THC and CBD but only for specific issues. There are currently only four drugs that contain cannabinoids that the FDA has approved. They are Dronabinol, Epidiolex, Nabilone, and Syndros. Dronabinol is a man made for of cannabis. It is used to treat loss of appetite that causes weight loss in people with aid and is also used to treat severe nausea and vomiting caused by cancer chemotherapy. Dronabinol is usually given after medicines to control nausea and vomiting (Multum, 2019). Epidiolex is an oral solution for the treatment of seizures related with two severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, in patients two years of age and older (Commissioners office, 2018). A fun fact about Epidiolex is that it was the first out of the four cannabinoids that the FDA approved. The next one is Nabilone. Nabilone is also a man-made drug that is very like the natural substances found in cannabis. It is used to treat severe nausea and vomiting caused by cancer drug treatments. It works by decreasing the signals in the brain that lead to nausea and vomiting (Nabilone, WebMD). Finally, Syndros is basically similar to Dronabinol but it is in liquid form. With these medications it offers patients alternative treatments and reliefs from pain instead of taking harder and addictive drugs like opioids.Now to that we have a better understanding on cannabis we can begin to indulge into how it finds its way to helping people with autism. Autism, or autism spectrum disorder (ASD), refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication. According to the Centers for Disease Control, autism affects an estimated 1 in 54 children in the United States today (Autism.org, 2015). 1 in 54 children in the united states is a high likelihood of getting autism. People with autism spectrum disorder have an extremely high chance of facing problems like, sleep disorders, epilepsy, behavioral deficits, and social and mental health. From what we have learned there are certain parts of the cannabis plant that could possibly help with those symptoms.In an uncontrolled case study of 300 combined patients from Washington state and California they wanted to test autistic patents with epilepsy to see if the use of cannabis in the form of an edible oil would create any results. They would use around 1.8ml to 80ml of CBD cannabinoid oil to be distributed orally every day. After the test, they found that 30 percent of the patients experienced a 75 percent to 99 percent reduction of seizures, 10 percent

experienced a full clinical response, while 14 percent of patients found none to very minimal effect in reducing seizures (Sulak, 2017). This was able to show us that there are indeed effects that surely do help with epilepsy. Not only did it help with epilepsy the people also reported in that it increased alertness as well. In this video it shows a one on one patient who uses cannabis oil to help them with their epilepsy.

The next way that cannabis benefits people with autism is how it helps with sleep disorder. More commonly 40 percent to 80 percent of kids with ASD have severe cases of sleep disorder preventing them from sleeping and consistently not getting enough sleep to the point where it can affect their health.  Sleep disorders have a huge impact on their life, it affects their daily life activities, the ability to interact socially, and have also been associated with increased parental stress (Devnani, 2015). For the research done to uncover if cannabis can help or not with sleeping disorders within a kid who has ASD there were over 75 trials with over 6,000 participants which concluded that there was in fact evidence that it could possibly help. Over those 75 plus trials they used The four treatments included: “placebo, 15 mg THC, 5 mg THC combined with 5 mg CBD, and 15 mg THC combined with 15 mg CBD, formulated in equivalent portions of ethanol to propylene glycol and administered using an oral spray during a 30 minute period“ at night. Outcomes from the study showed that 15 mg of THC looked to have calming and sedative effects while 15 mg of CBD amplified alertness but not majorly (Turner, 2003). This study was able to show us what exactly either CBD or THC could help. It helped focus in on the fact that THC was the actual benefiter to sleep disorder, creating a sedative type effect being able to help people fall asleep and continue to stay asleep thought the night. While on the other hand the CBD gave people a more alertness feeling, most likely not helping with the sleep.

Finally, cannabis testing with how it affects behavioral deficits and the mental health. Behavioral deficits and mental health are common reports within Autism. With behavioral deficits it creates sort of an aggression with oneself and could lead to hurting them selves or others. These factors really but a halt and a scare on a person with autism that is unable to control such outbursts. It can scare them because it will lower their chances of getting an education, getting a job, and even their own income. Sadly, when it comes to behavioral deficits cannabis is worth a try but has a lower likeliness than the others of succeeding. With only approximately 40% of chance of working it leaves the parents or the caregivers, taking care of the kids with autism and disruptive behavior, distressed and increasing social isolation which

is not an outcome no one wants to be put in (Aran, 2018). Now when we talk about mental health it has the same rate of 40 percent of kids with autism having some sort of mental health issue. One major mental health issue is anxiety. With anxiety being a part of a person with autisms life it could spark and aggravate other symptoms. Test have been done with all parts of the cannabis plant and for what has been testes they have come up with that CBD has the possibility to help. A test done to examine the safety and efficacy was conducted where they gave randomly selected patients either a placebo or 1000 mg of CBD a day. After that test they were able to conclude that “these findings suggest that CBD has beneficial effects in patients. As CBD effects do not seem to be contingent on dopamine receptor antagonism, this agent may show a new form of treatment for the disorder.” (Mcguire, 2017) Due to these findings and many other finding about the cannabis plant, the interest for legalizing it to allow better research has been gradually going up. Below is a graph showing the rate at which people are beginning to understand the capability that the cannabis plant has to offer.

Cannabis has been around all the way back to 500BC. The way people have grown to view the plant has really put a hold on what could have been researched and perfected. With the FDA classifying it as an “schedule one drug” since the start it has not allowed reasearchers to get their hands on it without the fear of doing something illegal. What people need to realise is that even though it has come up being used and saught out to be a drug for criminals and nothing else this plant actually benefits us humans especially the ones who have diseases like autism. Instead of looking towards harmful chemicals that is man made we are able to find new ways go at helping. Reasearch is still being done to figure out the will potential that the plants CBD, TCH, terpanoids, and whatever else that plant has to offer, is giving us a healthy and natural substitute to help with the affects that autism brings along. This substitue will not only help kids with autism reach a goal of living a heathy and longer self sustainable life.

References
Aran A, Brief report: Cannabidiol-rich cannabis in children with autism Spectrum disorder and severe behavioral problems—a retrospective feasibility study. J Autism Dev Disord. 2018. https://doi.org/10.1007/s10803-018-3808-2.Baron, E. P. (2018, August 27). Medicinal Properties of Cannabinoids, Terpenes, and Flavonoids in Cannabis, and Benefits in Migraine, Headache, and Pain: An Update on Current Evidence and Cannabis Science.Bridgeman, M. B., & Abazia, D. T. (2017). Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care Setting. P & T: a peer-reviewed journal for formulary management, 42(3), 180–188.Commissioner, O. of the. (). FDA Approves First Drug Comprised of an Active Ingredient Derived from Marijuana to Treat Rare, Severe Forms of Epilepsy. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms
Devnani PA, Hegde AU. Autism and sleep disorders. J Pediatric Neurosci [serial online] 2015 [cited 2020 Apr 15]; 10:304-7. Available from: http://www.pediatricneurosciences.com/text.asp?2015/10/4/304/174438Good CB, Parekh N, Fischer K, et al. Brief Commentary: Treating Pain—The Cannabis Conundrum. Ann Intern Med. 2019;170:123. [Epub ahead of print 8 January 2019]. doi: https://doi.org/10.7326/M18-3237Johnson, J. (2020, March 6). What are terpenes? Retrieved from https://www.medicalnewstoday.com/articles/what-are-terpenes

Russo, E. B. (2011, July 12). BPS Publications. Retrieved from https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/j.1476-5381.2011.01238.x

McGuire, P., Robson, P., Cubala, W. J., Vasile, D., Morrison, P. D., Barron, R., … Campos AC. (2017, December 15). Cannabidiol (CBD) as an Adjunctive Therapy in Schizophrenia: A Multicenter Randomized Controlled Trial. Retrieved from https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2017.17030325