Patient Case Study: Autism

by Dec 31, 2020Case Study, Education

Introduction

Patient demographic
Patient NI is a 14 year old male with autism who presented with his mother (JJ) as a caregiver. They had previously visited two other medical marijuana dispensaries, however his medical marijuana regimen was not successful in managing his symptoms of autism.

DOH certification
Autism

Case Presentation

Medical history and allergies

  • History of anxiety, speech delay and ADHD
  • Allergies: no known drug or food allergies

Medications
Broccoli extract, fish oil, coconut oil, vitamin D, vitamin K, super selenium, and a probiotic

Illicit substances or ETOH
No history of alcohol or illicit substance use

History of Cannabis use
Patient and caregiver (mother) had visited two dispensaries previously. At the time, the patient was taking DREAM tincture (8:1 THC:CBD) 1 mL sublingual, 1 hour before bedtime with improvement in sleep and HOPE 1 tincture (1:1 THC:CBD) at 1 mL sublingual several times/day, without much improvement in symptoms.

Chief complaint(s)
Anxiety, repetitive questions and inappropriate speech manifesting from autism disorder, and difficulty sleeping

Restrictions of use (personal and DOH)
Patient and mom have a personal preference to avoid vaping

Management

Formulation(s)

  1. Vireo Yellow 6:1 Solution (THC: 20.5 mg/ml, CBD 3.5 mg/ml)
  2. Ilera Hope 2 5:1 Tincture (THC: 8 mg/ml, CBD 1.6 mg/ml)

Dosage

  1. Vireo Yellow: start with 0.25 mL PO (~5 mg THC and 0.875 mg CBD). Titrate by adding 7 drops (~0.125 mL) if needed to produce desired effect and if not experiencing negative side effects.
  2. Hope 2: start with 1 mL SL or PO (8 mg THC and 1.6 mg CBD). Titrate by 0.25 mL if needed until desired effect is seen and if not experiencing any negative side effects.

Frequency

  1. Vireo Yellow: take 1 hour before bedtime
  2. Hope 2: take 2-3 times per day. Space doses by about 4 hours, ensure last dose is taken before 5pm.

Other comments
Vireo Yellow tincture recommended in place of Ilera Dream tincture given Dream was out of stock. JJ and her son left with detailed instructions on initial dosing, dose titration, and method of administration.  

Outcome

A positive change was noted by mom JJ after switching to the Hope 2 tincture from Hope 1. She reported that her son seems much calmer and she noticed a decrease in his self-talk. She titrated up to a dose of 1.5 mL of Hope 2, given twice a day. Vireo Yellow tincture was also helping with NI’s sleep as was the Dream tincture, however, the patient did not like the taste of Vireo Yellow. Therefore it was recommended to mix the dose in a drink and ingest the full drink to improve palatability. Side effects were not reported by the patient’s mother.

Discussion

Medical marijuana is one of several potential options to help manage symptoms of autism, as the endocannabinoid system is thought to be dis-regulated in people with the disorder. Switching to a more highly concentrated THC tincture with a higher THC:CBD ratio and titrating to an effective dose improved patient NI’s symptoms of autism, including a decrease in self-talk and inappropriate speech.

Switching from 1 mL of Hope 1 to 1.5 mL of Hope 2 increased NI’s THC dose from 5 mg to 12 mg while decreasing his CBD dose from 5.5 mg to 2.4 mg. Improvement in NI’s symptoms of autism were seen after this change was made. It’s plausible that the higher THC:CBD ratio provided by Hope 2 and higher daily dose of THC benefited patient NI as THC has been associated with decreased hyperactivity and irritability and improvements in speech in patients with autism.

It’s not uncommon to try several medical marijuana products before ultimately discovering the right ratio and dosage of THC and CBD, however consulting with a pharmacist can often speed up this process, help guide the patient in the right direction, and reduce the risk of adverse effects from occurring. In this case, consulting with a pharmacist allowed JJ to discover a new product that provided a higher THC:CBD ratio and ultimately improved NI’s symptoms.

Additionally, the pharmacist was also able to recommend an alternative administration method for the Vireo Yellow solution in order to improve tolerability and therefore patient compliance. It is not uncommon for product availability to vary at a medical marijuana dispensary, therefore the pharmacist can play an important role in making an alternative product recommendation that provides equivalent or similar THC and/or CBD doses.

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