—6— O’Shaughnessy’s • Summer 2009

Courtney update from previous page

change, thanks to the arrival of A Brief Report of Two Cases
an analytic test lab that will
enable growers to breed high
Cannabis Treatment in Childhood Autism
By Philip A. Denney, MD
CBD strains, but as of now the
ratio of THC to CBD in most Autism Spectrum Disorder is an in- fear being reported to the police or Child
strains available in Northern creasingly recognized behavioral illness Protective Services.
California is well above 20-to- of childhood characterized by develop- B.T.
1. The patient wishing to ingest mental delay, often profound. Many chil- B.T. is an 11-year-old male, product
a gram a day of CBD would re- dren diagnosed as autistic are severely of a normal term pregnancy and birth.
quire an enormous intake. disabled and present major challenges to Behavioral problems began at age 10
ONE GRAM OF CANNABIDIOL in crystal form
Recently, when called upon families, physicians, and educators. Vio- months characterized by progressive vio-
(left) and a comparable dose of Vitamin C (ascorbic
to testify on behalf of a grower acid). “There is 90 times more CBD in a pound of lent behavior directed at self and others lence and aggressiveness. At age 15
facing various charges, I was cannabis buds than there is Vitamin C in a pound of is a particularly difficult symptom. Cur- months, a diagnosis of Pervasive Devel-
able to tell the court in good oranges,” according to Dr. Courtney, “and CBD is rent treatment modalities include fam- opmental Delay was made. At age 17
conscience that his 30 pounds twice as potent an anti-oxidant.” Crystal CBD ily education, behavior modification, months a diagnosis of Autism Spectrum
of sinsemilla amounted to a courtesy of THC-Pharm, Frankfurt, Germany. special education services, a wide vari- Disorder was made. Despite aggressive
Vitamin C courtesy of Trader Joe’s, Santa Rosa CA. ety of psychotropic medications and in- intervention and multiple psychotropic
three-month supply of CBD for
. stitutionalization in some cases. medications, severe violent behavior
one patient. 4 379.91 Ocular pain I have recently evaluated two children persisted. The family described multiple
4 721.2 Thoracic DJD
Conditions treated with cannabis, continued whose families have decided to use can- injuries to B.T. and his caregivers and
4 720.0 Ankylosing Spondylitis
11 780.7 Chronic Fatigue 4 346.2 Cluster Headaches nabis in lieu of standard medications for the need for around-the- clock assis-
10 304.4 Amphetamine Dep. 3 353.0 Thoracic Outlet Syndrome treatment of autism. They report dra- tance. Violent behavior ultimately pre-
9 307.42 Persistent Insomnia 3 595.1 Interstitial Cystitis, chronic matic improvements. vented any school attendance at all.
9 719.49 Multiple joint pains 3 307.23 Tourette’s Syndrome E.S.
9 306.8 Bruxism 3 251 Hypoglycemia(s) E.S. is a nine-year-old adopted male.
2 717.7 Knee, patellar chondromal
Complete elimination of vio-
8 715.16 Lower Extremity DJD He is the product of an uncomplicated
8 715.16 Knee, DJD 2 717.7 Patellar chondromalacia full-term pregnancy delivered by C-sec- lent behavior and a marked in-
8 716.9 Arthropathy, Degenerative+ 2 787.01 Vomiting tion. The neonatal period was unremark- crease in affection and coop-
7 959.2 Shoulder Injury Unspec 2 782.0 Myofacial Pain Syndrome**
able. Severe behavioral problems were eration.
7 732.4 Osgood-Schlatter 2 344.00 Quadripiegia(s), unspec
7 345.1 Epilepsy, Grand Mal 2 337.2x Reflex Sympath Dystrophy noted beginning at 20 months, ultimately
7 715.91 Shoulder, DiD 2 310.9 Brain Trauma leading to a diagnosis of Autism. Noting internet reports of success
7 340.0 Multiple Sclerosis 2 250.2 Diabetes, Adult uncontrolled Despite aggressive treatment with be- with cannabis for Autism and concerned
6 138.0 Post Polio Syndrome 2 296.2 Menopausal depression havioral interventions and multiple about the use of psychotropic medica-
6 710.0 Lupus 2 296.2 Major Depression, Sgl Epis medications including the atypical tion for their son, the parents decided to
6 245.x Thyroiditis 2 305.2 Cannabis Abuse antipsychotics, severe behavior prob- try cannabis. The results were dramatic:
5 242.0 Graves Disease 2 042 AIDS Related Illness lems, especially violent behavior, per- with complete elimination of violent
5 250.6 Diabetic Neuropathy 2 733.0 Osteoporosis sisted.
5 250.6 Diabetic Gastroparesis 2 362.5 Macular Degeneration** behavior and a marked increase in af-
5 724.02 Spinal Stenosis 2 696.0 Psoriatic Arthritis fection and cooperation. B.T. has been
5 789.0 Pain, Abdominal 2 558.9 Colitis, unspecified + His teachers have noted ma- able to return to school and is described
5 304.0 Opiate Dependence+ 2 725 Polymyalgia rheumatica jor improvements in learning as a “different child.” He has been able
5 443.0 Raynaud’s Disease 2 300.22 Agoraphobia to eliminate his prescribed medications
5 053.9 Shingles (Herpes Zoster) 2 054.10 Genital Herpes and socialization. completely. Mom administers small
5 728.71 Plantar fasciitis 2 577.1 Pancreatitis
Encouraged by internet reports and servings of cornbread made with can-
5 959.3 Forearm/Wrist/Hand pain 2 218.9 Uterine Fibroids
desperate for an alternative, the parents nabis-infused oil and adamantly denies
5 562.1 Colon diverticulitis 2 359 Muscular Dystrophies
4 847.9 Back Sprain 1 070.52 Hepatitis, Viral B chronic began using small amounts of cannabis any adverse effects.
4 054.13 Herpetic infection of penis 1 722.83 Post Lamin. SyndLumbar concentrate administered in yogurt. The Conclusion
4 787.91 Diarrhea 1 733.00 Osteoporosis results were immediate and dramatic. In summary, these two cases suggest
4 556.9 Colitis, Ulcerative 1 737.41 Cervical kyphosis Violent outbursts became rare, self- a potentially significant therapeutic role
4 710.1 Scleroderma 1 296.5 Bipolar Disorder, depressed stimulation stopped completely. The for the cannabinoids in the treatment of
4 296.4 Bipolar Disorder, manic 1 732.1 Legg Calve Perthes Dis child became calmer and more focused. Autism Spectrum Disorder. Its safety and
His teachers have noted major improve- lack of toxicity may make cannabis an
PRACTICE UPDATE: WILLIAM TOY, MD ments in learning and socialization. these attractive alternative to psychotropic
Dr. Toy (Grass Valley), began conducting cannabis consultations part-time positive changes have persisted for more medications for many children. In addi-
in 2002 and full-time (40 weeks/year) since 2004. than a year, while the dose of cannabis tion, study of the endocannabinoid sys-
Approvals issued to date: approximately 2,000 has remained stable. The parents report tem as it relates to Autism may lead to a
Previously self-medicating >99%. no adverse effects of cannabis use, but better understanding of both.
They would not have come to my office and paid money to have the approval
if they had not had a good experience.
Most common conditions: PRACTICE UPDATE
Intractable pain > 50%. The most common causes are failed orthopedic sur- PHILIP A. DENNEY, MD
gery (involving the spine and peripheral joints) and orthopedic problems (se-
vere arthritis, degenerative spinal disease, spinal injury). AND ROBERT SULLIVAn, MD
Gastrointestinal problems 15-20% (including irritable bowel syndrome, Drs. Denney and Sullivan share a
Crohn’s, ulcerative colitis, failed GI surgery). practice in Carmichael. Denney spent
Neurological problems c. 10% (including spinal cord injury and neuropa- most of his career in Family Practice,
thies). Sullivan in Emergency Medicine. (He is
Dysmenorrhea and menopause-related problems c. 10% a Fellow of the American College of
Malignancies c. 10% (for nausea, pain and depression) Emergency Physicians.) By opening of-
HIV c. 10% fices in Lake Forest (Orange County) in
TMJ and other painful conditions about the mouth c. 5% 2004 and Redding (Butte County) in ROBERT SULLIVAN trying to convince
Inflamatory arthropathies and collagen disease, including HLA-positive 2005, they helped bring the medical the Sacrmento City Council that cannabis
spondylitis 5% marijuana movement to parts of the state has valid medical uses. He described pa-
Results reported: Approximately 80-90% of patients in the pain group report that had been underserved by pro-can- tients coping with migraines, chronic pain,
reduced opiate intake by at least 50%. Several patients completely removed nabis doctors. In 2008 they decided to and nausea. “These symptoms can erode
themselves from Oxycontin. Cannabis is very good for treating anxiety and consolidate closer to home. your life en toto. When you find something
that really works, is free of significant side
insomnia associated with various conditions.
Approved use of cannabis by how effects, and allows you to function, why
Observations re dosage:
many patients? would you not want to use it?
I am quite amazed that people do not escalate their dose. Most patients report “What my patients want is a normal life
44,300 (of which an estimated 17,000
that they actually can go without marijuana without undue side effects. Many of —not to get high. They are a cross section
are renewals)
the are using up to or around an ounce a week, which has been the average dose of the usual Americans, not a weirdo
Denney 2000-2008 27,400
for serious conditions. If they run out or want to go on a trip and cannot use subculture... Cannabis allows them to
Sullivan 2004-2008 16,900
cannabis, they report doing quite well with minimal withdrawal symptoms. function —that’s a central difference
Adverse effects? Conditions for which patients are us- between it and conventional medications.
The most important adverse effects are respiratory problems cause by smok- ing cannabis? “Returning patients tell me about
Chronic pain (all causes) 50% significant improvement in their home life,
ing. Most patients who have respiratory problems use vaporizers or edible forms
typically enjoying their marriage and kids
of cannabis. We go out of our way to get patients on vaporizers and we now Psychiatric conditions 20%
again because they’re able to participate...
have only a small percentage of smokers —mostly people who have been smok- GI 12% The headlight of their medical problem is
ing marijuana for 30-40 years. Most in this group use very little, maybe one or Harm reduction 4% no longer shining right into their eyes but
two doses a day. Neurologic 3% off to the side, allowing them to focus more
Other 11% on that ‘normal life.’”