Tuesday, April 21, 2020

Autism, CBD-Low THC Presentation

Thank you to Compassionate Cultivation for coordinating the early AM Zoom meeting.  FYI ...Im tired. JR

Autism and CBD 
  • I am discussing a complementary treatment
  • The Low THC CBD program (TCUP) is NOT recreational cannabis.
  • I am treating a diverse population of neurologically complex individuals. 
  • People with autism have significant problems that impact their lives AND the lives of others
  • Cannabinoids have a biologic basis for efficacy
  • Clinical data for indication, risks is emerging but exists.
  • Link to a selection of PEER-REVIEWED articles (pro and con)

What is a Complementary Treatment?  Added therapy BEYOND Standard treatment.

AUTISM and the ENDO Cannabinoid System - see below
 Caveats -  Complementary therapies will:

(1)  provide a reasonable potential for therapeutic gain and (2) do not unreasonably place the patient's medical condition at risk. 

(2)  ... there is a professional obligation on physicians to:
 (a) investigate, understand and assess whether the underlying therapeutic basis is designed to improve a patient's overall quality of life (even anecdotally and for limited a duration) and to 
 (b) ensure that the therapy is not medically contraindicated


Incidence of Autism in Children  

In March 2014, the Center for Disease Control released a new estimate for children with an autism spectrum disorder. According to the CDC, one in 68 children have ASD, which is a 30 percent increase over the previous estimate of one in 88.  

Assuming there are approximately 7 million children in Texas (2016): 
  • 102,941 have autism 
  • 14,700 have mild cognitive impairment 
  • 9,100 have moderate and severe cognitive impairment 
  • In comparison, about 70,000 children have epilepsy in Texas and about 14,000 have refractory epilepsy. 
  • Theoretically, about 77,000 Texas children have autism and insomnia.  

Incidence of Insomnia in Children with autism, cognitive impairment 
  • Insomnia in children with ASD occurs across all cognitive levels, and the prevalence may be as high as 60–86%, which is two to three times greater than typically developing (TD) children [3, 7, 22–27]. 
  • 20% agitation. 

Outcomes for insomnia in Children  
  • Accidents 
  • Elopement 
  • Medicine side effects 
  • Poor daytime functioning / adverse developmental outcome 

What medicines are FDA-approved for insomnia in childrenNone. 
  • Medications such as benzodiazepines (e.g.valium) and diphenhydramine (e.g Benadryl) were shown to have paradoxical, excitatory or even SEIZURE-provoking response. 

What medicines are used? What are the side effects? 
  • Melatonin followed by α-agonists (e.g clonidine) 
  • Anti-Depressants (e.g.trazodone)
  • Anti-Psychotics
  • Anti-Convulsants
  • "In general pediatric insomnia, antihistamines are prescribed most commonly (n = 8367 [88.6%]), followed by antipsychotic agents (n = 465 [4.9%]), α-adrenergic receptor agonists (n = 399 [4.2%]), and selective serotonin reuptake inhibitors (n = 159 [0.1%]).” 
What about Commercial CBD Products?
  • Safety
  • Reliability
  • Watch for pesticides, lead – other health problems

Texas MCD – estimate of expenditures 
Costs:  ASD costs a family $60,000/year on average 
What number of physician visits for insomnia?  
  • The prevalence of sleep problems among typically developing children is as high as 25%. 
  • In one study of outpatient general pediatric visits “potentially sleep-related medications were prescribed for 6.1% of children (n = 9441)”.  

  • The Endocannabanoid System in Autism Click For the article

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