Autism

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Decriminalize marijuana

<span class="postbigbold">The war on drugs has caused too much collateral damage: Even the ill face stigmatization by using an alternative to harsh pharmaceuticals.</span>

By Marie Myung-Ok Lee
The Los Angeles Times | June 07, 2009


I'm on the phone getting a recipe for hashish butter. Not from my dealer but from Lester Grinspoon, a physician and emeritus professor of psychiatry at Harvard Medical School. And not for a party but for my 9-year-old son, who has autism, anxiety and digestive problems, all of which are helped by the analgesic and psychoactive properties of marijuana. I wouldn't be giving it to my child if I didn't think it was safe.
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I came to marijuana while searching for a safer alternative to the powerful antipsychotic drugs, such as Risperdal, that are typically prescribed for children with autism and other behavioral disorders. There have been few studies on the long-term effects of these drugs on a growing child's brain, and in particular autism, a disorder whose biochemical mechanisms are poorly understood. But there is much documentation of the risks, which has caused the Food and Drug Administration to require the highest-level "black box" warnings of possible side effects that include permanent Parkinson's disease-like tremors, metabolic disorders and death. A panel of federal drug experts in 2008 urged physicians to use caution when prescribing these medicines to children, as they are the most susceptible to side effects.

We live in Rhode Island, one of more than a dozen states -- including California -- with medical marijuana laws. That makes giving our son cannabis for a medical condition legal. But we are limited in its use. We cannot take it on a plane on a visit to his grandmother in Minnesota.

Even though we are not breaking the law, I still wonder what my neighbors would think if they knew we were giving our son what most people only think of as an illegal "recreational" drug. Marijuana has always carried that illicit tang of danger -- "reefer madness" and foreign drug cartels. But in 1988, Drug Enforcement Administration Judge Francis L. Young, after two years of hearings, deemed marijuana "one of the safest therapeutically active substances known to man. ... In strict medical terms, marijuana is far safer than many foods we commonly consume."

Beyond helping people like my son, the reasons to legalize cannabis on a federal level are manifold. Anecdotal evidence from patients already attests to its pain-relieving properties, and the benefits in quelling chemotherapy-induced nausea and wasting syndrome are well documented. Future studies may find even more important medical uses.

Including marijuana in the war on drugs has only proved foolhardy -- and costly. By keeping marijuana illegal and prices high, illicit drug money from the U.S. sustains the murderous narco-traffickers in Mexico and elsewhere. In fact, after seeing how proximity to marijuana growers affected the small Mexican village of Alamos, where my husband spent much of his childhood, I was adamant about never entering into that economy of violence.

Because Rhode Island has no California-like medical marijuana dispensaries, the patient must apply for a medical marijuana license and then find a way to procure the cannabis. We floundered on our own until we finally connected with a local horticultural school graduate who agreed to provide our son's organic marijuana. But given the seedy underbelly of the illegal drug trade, combined with the current economic collapse, even our grower has to be mindful of not exposing himself to robbery.

Legalizing marijuana not only removes the incentives for this underground economy, it would allow for regulation and taxation of the product, just like cigarettes and alcohol. The potential for abuse is there, as it is with any substance, but toxicology studies have not even been able to establish a lethal dose at typical-use levels. In fact, in 1988, Young of the DEA further stated that "it is estimated that ... a smoker would theoretically have to consume ... nearly 1,500 pounds of marijuana within about 15 minutes to induce a lethal response." Nor is it physically addicting, unlike your daily Starbucks, as anyone who has suffered from a caffeine withdrawal headache can attest.

Although it has been demonized for years, marijuana hasn't been illegal in the U.S. for that long. The cannabis plant became criminalized on a federal level in 1937, largely because of the efforts of one man, Harry Anslinger, commissioner of the then newly formed Bureau of Narcotics, largely through sensationalistic stories of murder and mayhem conducted supposedly under the influence of cannabis. Cannabis was still listed in the U.S. Pharmacopeia, or USP, until 1941 as a household drug useful for treating headaches, depression, menstrual cramps and toothaches, and drug companies worked to develop a stronger strain.

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Study: Autism antidepressant works like placebo

Karen Kaplan, Los Angeles Times

Tuesday, June 2, 2009

An antidepressant commonly prescribed to help autistic children control their repetitive behaviors is no better than a placebo, according to a report published Monday.

Roughly one-third of all children with autism take citalopram, the antidepressant examined in the study, or others that are closely related. Citalopram is sold in the United States under the brand name Celexa.

The results of the nationwide trial, published in the medical journal Archives of General Psychiatry, have some experts reconsidering the appropriateness of not just antidepressants but many of the mind-altering drugs used to treat children with autism spectrum disorders.

"There are tons of things being advocated as treatments for autism, some with appropriate caveats and careful explanations, others without any of that," said David Mandell, associate director of the Center for Autism Research at Children's Hospital of Philadelphia, who wasn't involved in the study.

About 1.5 million Americans are estimated to have autism, a group of poorly understood developmental disorders characterized by problems with communication and social interactions. One of the hallmarks is obsessive, repetitive behavior, such as flapping one's arms or hands or memorizing car makes and models. When those routines are interrupted, severe tantrums can result.

Only one medication - the antipsychotic drug risperidone - has been approved by the U.S. Food and Drug Administration for the treatment of irritability and aggression in children with autism. But doctors, frustrated by their limited options, haven't shied away from giving other pharmaceuticals a chance. Worldwide spending on drugs to treat autism is estimated to be between $2.2 billion and $3.5 billion annually.

Because very few medications have been tested on autistic children in large, rigorous studies, doctors have looked to drugs that treat similar symptoms in other conditions, such as obsessive-compulsive disorder or attention deficit/ hyperactivity disorder.

That's what led physicians to a class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs, that help adults with obsessive-compulsive disorder. Their repetitive rituals, such as counting, cleaning or hand washing, are reminiscent of the behaviors seen in autistic patients.

But the medications will work only if the root causes of obsessive-compulsive disorder and autistic repetitive behavior involve the same biological pathways in the brain. The new study strongly suggests they do not.

Dr. Bryan King, director of psychiatry and behavioral medicine at Seattle Children's Hospital and leader of the study, said he was shocked that citalopram didn't help patients. Not only was the placebo slightly more effective, but the drug's side effects - such as impulsivity and insomnia - were at least twice as bad.

http://sfgate.com/cgi-bin/article.cgi?f ... 17V0DS.DTL

This article appeared on page A - 5 of the San Francisco Chronicle

Lack of Efficacy of Citalopram in Children With Autism Spectrum Disorders and High Levels of Repetitive Behavior - General Psychiatry, Vol. 66 No. 6 | Jun 2009

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Forest Laboratories’ Celexa Doesn’t Help Children With Autism

By Rob Waters

June 1 (Bloomberg) -- Forest Laboratories’ Celexa, part of a class of antidepressants widely prescribed for autistic children, didn’t help reduce their repetitive behaviors and caused some of them to have nightmares, a government study found.

About one-third of the 149 children taking the drug showed an improvement in behavior, the research showed. An equal percentage showed improvement from a placebo.

Celexa, available as the generic medicine citalopram, belongs to the class of selective serotonin reuptake inhibitors, or SSRIs. Doctors prescribe $2.2 to $3.5 billion worth of these drugs to treat autism, though they aren’t approved for this use and there’s little evidence that they work, according to findings reported today in the Archives of General Psychiatry.

Celexa “exhibited significant adverse effects without any evident therapeutic effects in children,” said Fred Volkmar, director of the Yale Child Study Center at Yale University School of Medicine in New Haven, Connecticut, in a commentary accompanying the study. “The medication does not appear to be useful for repetitive behaviors in children with autism and related conditions.”

Frank Murdolo, a spokesman for Forest Laboratories, said the company wasn’t involved in the study and had no comment.

<span class=postbold>‘Spectrum Disorder’</span>

One in 150 children in the U.S. has autism or related disorders, which interfere with their ability to communicate and engage socially, according to the U.S. Centers for Disease Control and Prevention,. Autism is known as a “spectrum disorder” because the symptoms can vary, causing some people to avoid eye contact or have impaired speech, while others engage in repetitive, obsessive thoughts and behavior.

While antidepressants are prescribed “off label,” none are approved to treat the core symptoms of autism, the study said. Johnson & Johnson’s Risperdal, an antipsychotic, is approved to treat irritability in autistic patients.

The study was sponsored by the U.S. National Institutes of Health and conducted at six universities across the country.

<span class=postbold>149 Children</span>

For the study, 149 children with autism, mostly boys age 5 to 17, were given either Celexa or a placebo. Their behavior was monitored and evaluated by doctors and parents.

Ninety-seven percent of the patients who took Celexa and 87 percent of those who took a placebo had at least one adverse effect emerge during the study. These included impulsiveness, hyperactivity, decreased concentration and insomnia. Among the children who took Celexa, 7 percent experienced nightmares.

The results of the study and others “provide insufficient research evidence” that antidepressants should be prescribed for children with autism, wrote the authors of the study, led by Bryan King, a professor of psychiatry at the University of Washington in Seattle.

“Perhaps these data will change this practice” of prescribing antidepressants for autism, Volkmar said in his editorial.

<small>To contact the reporter on this story: Rob Waters in San Francisco at rwaters5@bloomberg.net.</small>

Last Updated: June 1, 2009 16:00 EDT

Lack of Efficacy of Citalopram in Children With Autism Spectrum Disorders and High Levels of Repetitive Behavior - General Psychiatry, Vol. 66 No. 6 | Jun 2009

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Can Marijuana Help Kids with Autism?

momlogic.com | Tuesday, November 3, 2009

<span class="postbigbold">This mom says giving her kid pot has made all the difference.</span>

Gina Kaysen Fernandes


As the mother of an autistic child, Marie Myung-Ok Lee is navigating uncharted territory as she struggles to manage her son's condition. She has bravely come forward to share her son's battle with this mysterious disorder, and to discuss how medical marijuana has brought them both back from the brink of despair.

During what Marie calls the "dark phase," her son J had unpredictable mood swings that could erupt into fitful rages. Her 9-year-old would scream during lengthy tantrums, he refused to eat and threw his food on the floor. J broke plates, windows, and other household items as a way of expressing his pain and frustration. The family would hide out within the confines of their home until the darkness passed.

J's behavior disrupted his school performance and terrified the staff. "The teachers were wearing tae kwon do arm pads to protect themselves against his biting," Marie said. The school monitored J's daily outbursts on an "aggression chart" that documented as many as 300 episodes in one day that involved hitting, kicking, biting, or pinching another person.

With her son in crisis, Marie had no choice but to perform an intervention. But the only solution offered by child psychiatrists came in a pill bottle. "His school tried to force us to medicate him," says Marie, who feared the risk of dangerous side effects associated with commonly prescribed antipsychotic drugs like Risperdal. Many of the FDA-approved drugs on the market used to treat symptoms of autism have no proven safety track record for use in children.

Despite the unknown risks, more kids are using prescription drugs than ever before. The number of children on psychiatric meds has skyrocketed in recent years, according to reports in medical journals such as Archives of Pediatrics and Adolescent Medicine. Prescription drug use is growing faster among children than the elderly and baby boomers. But when it comes to medicating kids with marijuana, the issue becomes taboo.

"There's no such thing as a harmless drug, but marijuana is much less harmful than other drugs," said Lester Grinspoon, M.D., a professor emeritus of psychiatry at Harvard Medical School. Dr. Grinspoon is a leading expert in the field of medical marijuana, who has authored several books on the subject. "No one in the world has died from marijuana," insists Grinspoon, who has spent four decades researching the illicit drug.

Undeterred by the social stigma, Marie pursued this more natural approach to calm J's demons. After discussing her wishes with J's pediatrician, Marie decided to check out Marinol, a synthetic form of THC, which is the primary cannabinoid in marijuana. After fine-tuning J's dosage, she began hearing praises like, "J was a pleasure to have in speech class," instead of complaints about his violent episodes.

After a few months, J built up a tolerance to the drug and his unruly behavior returned. "The drawback of taking Marinol is that it's only THC. That's the most powerful cannabinoid, but it may not be the most relevant," said Mitch Earleywine, Ph.D., an associate professor of psychology at the State University of New York at Albany. Earleywine says there are about 70 different cannabinoids in the marijuana plant, many of which have medicinal value. Marie decided to take a chance on the real deal.

All it took was a signed prescription and a background check for J to become the youngest person in Rhode Island to obtain a license for pot. After buying some marijuana-infused olive oil, Marie made a batch of pot cookies. That night, J ate half of one cookie and "he was tired and conked out," said Marie, who checked hourly on his sleep, "half-expecting some red-eyed ogre from Reefer Madness to come leaping out at us." To her relief, J slept soundly and appeared happy and mellow the next day.

Over the past four months, Marie has documented her son's progress in an online blog entitled, Why I Give My 9-Year-Old Pot, Part II. While she doesn't believe marijuana is a cure for autism, it "allows J to participate more fully in life without the dangers and sometimes permanent side effects of pharmaceutical drugs."

Dr. Grinspoon has seen positive results with a number of his autistic patients who are undergoing pot therapy. "I can confidently say to a parent that marijuana relieves some types of pain. It's not going to hurt them if you use it responsibly," Grinspoon says. Ingesting the drug works better because the effects can last up to eight hours. "A little goes a long way," says Earleywine, who reminds parents that the drug can take up to an hour and a half to kick in, "so wait a little while before administering any more."

While a growing number of distressed parents are turning to the herbal remedy, many moms with autistic kids are skeptical. "I feel it does more harm than good," says Trish, the mother of a 7-year-old boy with autism. "You are sedating the child, not treating the cause of the rage." Trish believes that medicating kids with pot is a cop-out. "Nobody said parenting was going to be easy, or that the solution to every problem is to get our children stoned."

The mainstream medical community shuns the subject, and the government refuses to fund any research that would legitimize marijuana use in treating autism or aggression disorders. "Marijuana is a very loaded subject," says Cara Natterson, M.D., a pediatrician and mother of two. "As a parent and as a pediatrician, I feel a responsibility to know that what I am putting into a child -- mine or someone else's -- is safe and tested."

The American Academy of Pediatrics opposes the legalization of marijuana, but does support further research into the potential medical benefits of cannabis. "We need to make sure the treatment is safe -- we haven't done that," Natterson adds. The doctor can sympathize with parents who desperately want to help their child. "But wanting to advocate for your child and making sure your child is safe are two different things," Natterson said.

Marie is confident that she has made the right choice when she sees J's transformation. "He doesn't look stoned. He just looks like a happy little boy."

Read more: http://www.momlogic.com/2009/11/can_mar ... z0VrWm0hBg

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The ultimate herbal remedy: Can cannabis improve autism?

<span class="postbold">The debate over its risks has split political and scientific opinion in Britain. But American mother Marie Myung-Ok Lee says cannabis isn't only safe enough for her autistic son – it's dramatically improved his condition</span>

The Independent | Thursday, 5 November 2009



My son, J, has autism. He's also had two serious operations for a spinal cord tumour and has an inflammatory bowel condition, all of which may be causing him pain, if he could tell us. He can say words, but many of them – "duck in the water, duck in the water", for instance – don't convey what he means. For a time, anti-inflammatory medication seemed to control his pain. But in the last year, it stopped working. He began to bite and to smack the glasses off my face. If you were in that much pain, you'd probably want to hit someone, too.

J's school called my husband and me in for a meeting about J's tantrums, which were affecting his ability to learn. The teachers were wearing Tae Kwon Do arm pads to protect themselves against his biting. Their solution was to hand us a list of child psychiatrists. As autistic children can't exactly do talk therapy, this meant using sedating, antipsychotic drugs like Risperdal.

Last year, Risperdal was prescribed for more than 389,000 children in the US – 240,000 of them under the age of 12 – for bipolar disorder, ADHD, autism and other disorders. Yet the drug has never been tested for long-term safety in children and carries a severe warning of side-effects. From 2000 to 2004, Risperdal, or one of five other popular drugs also classified as "atypical antipsychotics", was the "primary suspect" in 45 paediatric deaths, according to a review of US Food and Drug Administration (FDA) data by USA Today. When I canvassed parents of autistic children who take Risperdal, I didn't hear a single story of an improvement that seemed worth the risks. A 2002 study on the use of Risperdal for autism, in The New England Journal of Medicine, showed moderate improvements in "autistic irritation" – but the study followed only 49 children over eight weeks, which limits the inferences that can be drawn from it.

We met with J's doctor, who'd read the studies and agreed: No Risperdal or its kin. The school called us in again. What were we going to do, they asked. As an occasional health writer and blogger, I was intrigued when a homeopath suggested medical marijuana. Cannabis has long-documented effects as an analgesic and an anxiety modulator. Best of all, it is safe.

The homeopath referred me to a publication by the Autism Research Institute describing cases of reduced aggression, with no permanent side- effects. Rats given 40 times the psychoactive level merely fall sleep. Dr Lester Grinspoon, an emeritus professor of psychiatry at Harvard Medical School who has been researching cannabis for 40 years, says he has yet to encounter a case of marijuana causing a death, even from lung cancer.

A prescription drug called Marinol, which contains a synthetic cannabinoid, seemed mainstream enough to bring up with J's doctor. I cannot say that with a few little pills everything turned around. But after about a week of fiddling with the dosage, J began garnering a few glowing school reports: "J was a pleasure have in speech class," instead of "J had 300 aggressions today."

But J tends to build tolerance to synthetics, and in a few months we could see the aggressive behaviour coming back. One night, I went to the meeting of a medical marijuana patient advocacy group on the campus of the college where I teach. The patients told me that Marinol couldn't compare to marijuana, the plant, which has at least 60 cannabinoids to Marinol's one.

***

Rhode Island, where we live, is one of 13 states where the use of medical marijuana is legal. But I was resistant. My late father was an anaesthesiologist, and compared with the precise drugs he worked with, I know he would think marijuana to be ridiculously imprecise and unscientific. I looked at my son's tie-dye socks (his avowed favourite). At his school, I was already the weirdo mom who packed lunches with organic kale and kimchi and wouldn't let him eat any "fun" foods with artificial dyes. Now, I'd be the mom who shunned the standard operating procedure and gave her kid pot instead.

I thought back to when J was 18 months old. We were vacationing on the Cape, and, although he just had the slightest hitch in his gait, I was sure there was something wrong. His paediatrician laughed. I called back repeatedly until a different doctor agreed to see us. J was taken in for emergency surgery, to remove a tumour that was on the verge of inflicting irreparable damage. Sometimes, you just have to go with your gut.

And yet, I still hesitated. The Marinol had been disorienting enough – no protocol to follow, just trying varying numbers of pills and hoping for the best. Now we were dealing with an illegal drug, one for which few evidence-based scientific studies existed, precisely because it is an illegal drug. But when I sent J's doctor the physician's form that is mandatory for medical marijuana licensing, it came back signed. We underwent a background check with the Rhode Island Bureau of Criminal Identification, and J became the state's youngest licensee.

Having a licence, however, is different from having access to marijuana. While California has a network of "compassion centres," basically pharmacy-like storefronts that provide quality product from registered growers, Rhode Island's Republican governor has consistently vetoed that idea, despite the local stories of frail patients being mugged in downtown Providence as they go in search of pot. We weren't about to purchase street marijuana, which could be contaminated with other drugs, so we looked into growing the pot ourselves. But by law, medical marijuana must be grown indoors, and it requires a separate room with a complex system of hydroponics, fans and precise lighting schedules. (This made me wonder how much THC, the main psychoactive substance found in cannabis, was actually in the spindly plants the high school goofballs I knew grew in their closets).

The coordinator of our patient group introduced us to a licensed grower. A recent horticulture school graduate, he'd figured out how to cultivate marijuana using a custom organic soil mix. His e-mail signature even quoted Rudolf Steiner. The grower arrived at our house with a knapsack containing jars of herbs. We opened the jars to sniff the different strains of "bud" – Blueberry, which did smell fleetingly of wild blueberries, and Sour Diesel, which had a rich, winey scent. The grower had also cured some leaves for tea, and he brought a glycerine tincture, a marijuana distillate in olive oil (yes, organic), cookies (ditto), and a strange machine that looked, fittingly, like a lava lamp. Basically an almost-bong, this vaporiser heated the cannabis without producing carcinogenic smoke.

For most adults, the vaporiser is the delivery method of choice, as it allows the patient to feel the effects immediately and adjust the dose precisely. J gamely put his mouth on the valve and let us squeeze a little smoke into him. It shot right back out of his nose. He looked like Puff the Magic Dragon. The grower left us with a month's worth of marijuana tea, glycerine, and olive oil – and a cookie recipe. No buds. We paid $80 (£50).

We made the cookies with the marijuana olive oil, starting J off with half a small cookie, eaten after dinner. J normally goes to bed around 7.30pm; by 6.30 he declared he was tired and conked out. We checked on him hourly. As we anxiously peeked in, half-expecting some red-eyed ogre from Reefer Madness to come leaping out at us, we saw instead that he was sleeping peacefully. Usually, his sleep is shallow and restless. J also woke up happy.

But in a few days, J decided he didn't like the cookie anymore and smashed it with his fist. We brewed him the tea, which smelled funky and grassy. He slurped it down, but it didn't seem to do much. Many of the psychoactive compounds in marijuana are fat soluble, so I added a dropperful of the oil that we used in the cookies. That made him sleepy-looking but still aggressive. It became clear that when J ingested pot orally, it took two hours to see the results, and by then there wasn't much we could do to dial the dose up or down. The grower visited us again to give J another try at the bong, but with little success.

Perhaps J needed a little time to get off the Marinol. After two weeks, we noticed a slight but consistent lessening of aggression. And he wasn't nervously chewing holes in his shirts.

***

A month or so into the treatment, it was still too early to know if we could find a dose and mode of delivery that would give us consistent results. Even if J could learn to use the vaporiser, it costs $600 and would leave the house reeking of pot. And we didn't want to get too dependent, because of the inherent limitations. Though we'd love to calm J with pot so that he can visit his grandmother in Minnesota, bringing a controlled substance on the plane isn't the best idea.

But since we started him on his "special tea," J's little face, which is sometimes a mask of pain, has softened. He's smiled more. For most of the last year, his individual education plan at his special-needs school was full of blanks, recording "no progress" because he spent his whole day an irritated, frustrated mess. But soon after starting on the tea, his reports began to show real progress, including "two community outings with the absence of aggressions".

My husband and I are both academics and writers (me, novelist and essayist; he, historian), given to close observation and note taking. It was these habits that finally helped us see our son's allergic sensitivity to certain foods and seek advice from a gastroenterologist for his behaviours – aggression and chronic diarrhoea – instead of the recommended psychiatrist. (Gut pain and digestive problems, coined as "autistic entercolitis", are now considered a common biological affliction of many autistic children).

At first we weren't sure if we were seeing results from the cannabis, but after about three months, which included weekly consultations with our grower as we experimented with different strains, we observed a much happier and outgoing child – who did not act or appear "stoned" in any way. Four months in, J came home from school and I noticed something different. Pre-pot, J ate the collars of his shirts, teasing his clothes apart and swallowing the threads. There's a name for this disorder – pica (pregnant women sometimes chew on chalk). It got so bad he ate his pyjamas and we had to start dressing him in organic cotton shirts. Then one day he came home from school wearing a whole shirt.

J's school reports improved too. At one parent meeting, his teacher produced the latest "aggression" chart, showing attempts or instances of hitting, kicking biting or pinching other people. For a year he had scored an average of 30 to 50 aggressions a day, with a high of 300. The latest data showed days, sometimes consecutive, with zero aggressions. And on the school bus, J has transformed from a child who has hit the driver in the face and bitten people into a sparkly eyed boy who says hi and quietly takes his seat.

***

There's a twist to this happy story, though. The aggression has eased but J's autism has become more distinct. His vocal outbursts – screams, barks, yips of happiness – still happen and while our home is no longer full of thrown food, broken dishes and scratched faces, we still see people in the local area react to a family that remains different – and not always to their liking. There's a father on the next street who stops playing ball with his son when we approach. A mother won't make eye contact and ignored a party invitation. Most people responded well to J but sometimes we feel we're being shunned.

Marijuana isn't a miracle cure for autism. But in our son's case it eases his pain and inflammation so dramatically that he can participate in life and learning again. It also protects him from the sometimes dangerous side-effects of pharmaceutical drugs. We have settled on a good strain (White Russian, a favourite pain-reliever for end-stage cancer patients) and a good dose. And now he's not in pain, J can go to school instead of a children's psychiatric hospital, where all too many of his peers end up as a result of violent behaviour.

When I think of the embarrassment I may feel if my colleagues see this article, or teachers or parents at J's school, or his less open-minded doctors, I pause. Although I occasionally smoked pot as a teenager (believe me, in northern Minnesota, there was not much else to do), now that I'm a law-abiding adult, all the scary anti-drug messages are flashing in my brain. But when I researched cannabis the way I did conventional drugs, it seemed clear that marijuana wouldn't harm J, and might help. It's strange that the virtues of such a useful and harmless botanical have been so clouded by stigma. Even the limited studies that have been done suggest marijuana's potential as an adjunctive therapy for cancer. Marijuana, you need some re-branding. Maybe a cool new name.

One of the biggest tests for J through this journey was a visit from Grandma. The last time she came, over Christmas, J hit her during a tantrum. This time, we gave him his tea, mixing it with goji berries to mask any odour, although it occurs to me that my mother, a Korean immigrant, probably doesn't even know what pot smells like (it actually smells a lot like ssuk, a Korean medicinal herb). She remarked that J seemed calmer. As we were preparing for a trip to the park, J disappeared, and we wondered if he was going to throw one of his tantrums. Instead, he returned with Grandma's shoes, laying them in front of her, even carefully adjusting them so that they were parallel and easy to step into. He looked into her face, and smiled.

<span class="postbold">What are the downsides to this experiment?</span>

By Jeremy Laurance, Health Editor

The first reaction of most parents to Marie Myung-Ok Lee's story is likely to be one of surprise, shock, even horror. What is she doing turning her nine-year-old son into a pot-head? Has she not heard of the dangers of cannabis smoking to the mental health of adolescents, never mind the disorienting effects of an intoxicating substance on one so young?

Possibly this will be their second and third reactions, too. Ms Myung-Ok Lee was giving her son, J, cannabis to relieve pain (from his spinal tumour and inflamed gut), not just to treat his autism. Even so, the stigma that surrounds illegal drugs is so deeply entrenched, just because they are illegal, that many people are simply not prepared to weigh up their benefits and harms.

We have seen in the row this week over the sacking of the UK Government's chief drugs adviser, Professor David Nutt, how the debate over drugs is driven more by fear, emotion and political calculation than by scientific evidence. The Labour Government, facing possible annihilation at the next election, is anxious to be seen to be tough on drugs – so the outspoken Professor Nutt had to go.

As an academic, Ms Myung-Ok Lee is perhaps better placed than many to resist the voices of unreason and take a cool look at the evidence. Cannabis, as she points out, is already prescribed as a pain killer, as an anti-nausea agent for cancer sufferers and as a treatment for multiple sclerosis. In all these areas it has been shown to be effective, though there is debate about just how effective. In the UK, it is available as Sativex, a spray taken under the tongue, which contains a cannabis extract. More than 1,200 patients in the UK have received it for relief of symptoms associated with multiple sclerosis. It is not, however, prescribed to nine-year-olds (or anyone under 18).

Ms Myung-Ok Lee started her son on medicinal cannabis, and then went a step further by giving him the herbal kind, as a tincture or baked in a cookie. This, too, is not without precedent – among adults. There have been frequent reports of patients smoking cannabis and gaining relief from pain or the spasticity associated with multiple sclerosis, and in the UK when they have been prosecuted for possession of a controlled drug, the courts have shown leniency.

But in trying herbal cannabis on her son, Ms Myung-Ok Lee and her doctor have stepped beyond even the anecdotal evidence, into the unknown. J became Rhode Island's youngest ever patient licensed to use marijuana for medical reasons.

She acknowledges it is an experiment, but she reasons that as cannabis has low toxicity and is safer than most other drugs, the risks are low. Any parent, confronted with a screaming, suffering child who is so distressed that he smashes things, hits people and tears at his clothing with his teeth, must feel sympathy for her. In that situation, which of us would not try anything to ease our child's pain? Moreover, the experiment appears to have worked – at least for the first few months.

The difficult questions are: will the effect last? Will there be a downside to using the drug in one so young? Is the effect real? The last question is the trickiest. Children grow and change and those with autism are no different from the rest. The changes his parents have noticed in J might have happened anyway, as part of his natural development. The cannabis could turn out to be a coincidental factor, with zero impact on his condition. It was coincidence that led to the scare over MMR and autism – because the first symptoms of the condition typically occur around 14 months which is the age at which babies receive their first MMR jab.

It would be a disaster if cannabis came to be seen as a panacea for children in the same situation, on the basis of this anecdotal report. As always in science, we need more evidence.
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