By Dr. Gary Deel, Ph.D., J.D.
Faculty Director, School of Business, American Public University
Note: This article is the first in a two-part series about using CBD as an autism treatment. The content of this article is intended for informational purposes, and it is not a substitute for professional medical advice. Always seek the advice of a qualified medical professional for the diagnosis and treatment of medical conditions.
In recent articles, I told the story of my autistic son Carl and how I came to be involved in autism research. Autism is a psychological and behavioral impairment that affects children — mostly boys — worldwide at an increasing rate, yet the causes and dynamics of this condition are still not well understood.
Autism Is a Costly Disease
Autism encompasses a range of mental conditions that primarily hinder one’s ability to communicate and navigate social interactions and relationships. The financial and emotional costs of autism on diagnosed individuals and their families can be crippling.
For instance, a study in the Journal of the American Medical Association (JAMA) Pediatrics found that the lifetime cost for an individual on the autism spectrum was $2.4 million on average when an intellectual disability is involved. Unfortunately, we still have not discovered a cure for this condition.
Cannabidol Could Offer a Potential Treatment for Autistic Patients
One potential autism treatment being explored is the use of cannabidiol (CBD). CBD is a derivative of the hemp and marijuana plants.
Unlike tetrahyrdocannabinol (THC), CBD does not appear to be psychoactive, which means that users don’t experience a “high” from CBD in the same way that they do from marijuana. Instead, CBD seems to have calming, regulatory effects on the brain and nervous system. People have used CBD products to treat multiple medical conditions, including depression, sleep disorders, anxiety, post-traumatic stress disorder (PTSD), pain management and seizures.
CBD used to be completely illegal pursuant to the federal government’s flat-out ban on marijuana, hemp and all of their byproducts. The only places where CBD was quasi-legally produced and sold were states where marijuana and hemp were legalized; the federal government had adopted a policy of non-enforcement of federal drug laws in such states. Consequently, marijuana and hemp products could be manufactured and traded, but they could not legally cross state lines into any other states that did not adopt the same legal position.
Changes to the Status of CBD and Hemp
However, in June 2018, the Food and Drug Administration (FDA) approved for market the drug Epidiolex. This drug is used to treat seizures and epilepsy, and its primary ingredient is CBD.
Later that same year, Congress passed the Agriculture Improvement Act of 2018 (a.k.a. the “Farm Bill”), which removed hemp — defined as cannabis varietals with a THC concentration of 0.3 percent or less — from the Controlled Substances Act (CSA). This meant that hemp is no longer classified as an illicit substance under federal law.
However, it is still subject to regulation by the Food and Drug Administration (FDA), and so far the FDA has been slow to recognize the legal sale of hemp-derived or hemp-related products. Additionally, states are still free to prohibit the sale or possession of CBD, and different states have adopted a wide variety of stances on this issue, so those interested in CBD should also consult their state’s laws.
It’s worth noting that marijuana, which includes cannabis varietals with THC levels much higher than those of hemp, is still very much illegal under the CSA at the federal level. The Farm Bill made no changes to the classification of marijuana.
Sales of Hemp-Derived CBD Have Risen
The FDA has issued warning letters to CBD vendors concerning the sale of products that have not been approved for market. However, hemp-derived CBD can be purchased today in retail stores and online businesses nonetheless; it is sold and shipped throughout the United States with no prescriptions required from a medical professional. CBD is packaged in a variety of forms, including oral liquid droppers, nasal sprays, topical creams, lollipops, lozenges and even suppositories.
Since the passage of the Farm Bill, the sale of CBD in the United States has exploded, and the market is expected to hit $16 billion by 2025. Most users of CBD purchase it for anxiety treatment; others use it to treat chronic pain, insomnia and depression.
CBD Yet to Be Fully Accepted by the Medical Community
The science behind CBD’s effects is still very much in its early stages. While one can find countless anecdotal accounts of positive results from CBD users on the internet, medical experts hold a wide variety of opinions about its actual efficacy, ranging from enthusiastic support to wary skepticism. Very few clinically controlled studies have been completed so far, and those studies have rendered mixed results.
Stacey Kram, Assistant Dean and Chief Nurse Administrator for APU’s Nursing Education Program, reports that “there are currently 215 clinical studies registered with the National Institutes of Health examining the use of CBD on various diseases and disorders. While this is exciting, it will still take some time to discover long term effects of CBD, if any.”
For autism, CBD is being closely looked at as a potential treatment because of the presence of common co-morbid symptoms in autistic individuals, which include aggression, hyperactivity, sleep problems, anxiety, and lack of focus. Because CBD has been reported, albeit inconsistently, to help with some of these conditions in non-autistic individuals, some experts believe that CBD might yield the same benefits for autistic patients.
The basis for this belief is that CBD is thought to act as a neuroprotectant — a factor that allows the brain to function better — and an anti-inflammatory agent that reduces irregularities in normal brain function and promotes REM sleep. Although research on CBD as a treatment for autism has been very limited, results so far give reason for hope. Some preliminary studies — such as this 2018 trial — have suggested positive benefits from CBD administration in terms of abating emotional and behavioral challenges with autism.
Use of CBD Appears Safe, but More Control and Studies Needed
Notwithstanding debate in the medical community on the efficacy of CBD, use of the product appears to be fairly safe. Dosing recommendations are hard to pin down with specificity because of how new the product is, but the World Health Organization (WHO) stated in 2018 that CBD “is generally well tolerated with a good safety profile.” They also opined that CBD “exhibits no effects indicative of any abuse or dependence potential.” As with any substance, unexpected reactions with other medications a user may be taking at the same time is always a concern, especially with some anticonvulsant medications.
Some of the biggest concerns over CBD today are quality control and dishonesty in marketing. Because CBD oil is marketed as a supplement and not as a medicine, sellers are held to less stringent legal standards regarding the purity of the product they offer and the claims they make about its benefits.
Studies have reported that some CBD supplements on the market do not contain the concentrations of CBD they claim to contain. More seriously, other studies report that some CBD supplements also contain substances that can be addictive or dangerous. Furthermore, the FDA has issued warning letters to some CBD vendors over unsubstantiated claims about CBD benefits.
I am not a medical doctor, so it is my strongest advice to anyone reading this article that you speak with your own doctor before considering any CBD supplement for yourself or a family member. But after extensive research and discussion, my wife and I ultimately decided to give CBD a try with my autistic son, Carl.
In the second part of this article, I’ll share our experience and what we’ve learned from the journey, including how we went about the supplementation and whether we think it was effective.
About the Author
Dr. Gary Deel is a Faculty Director with the School of Business at American Public University. He holds a J.D. in Law and a Ph.D. in Hospitality/Business Management. He teaches human resources and employment law classes for American Public University, the University of Central Florida, Colorado State University and others.