What is CBD oil?
Cannabidiol (CBD) oil is an oil extracted from Cannabis sativa plants. C. sativia is more familiarly known as either hemp or marijuana; according to the director of the Steep Hill Arkansas testing facility, if the plant contains 0.3% THC or less, it is called hemp, and if it contains more THC than that it is called marijuana. Plant breeders have produced a very large number of different strains of C. sativia with varying levels of THC and other compounds for different recreational and medicinal uses; however, CBD oil is almost always only produced from hemp plants with low levels of THC. CBD oil with 0.3% THC or less is legal in all fifty states.
How is it made?
The plants are grown over the summer and then they are harvested and air-dried for several weeks. Then, the flowers are collected from the plants and ground up. There are several different processes used by different manufacturers to extract the oil; generally, they all involve some kind of alcohol extraction method and may involve other purification methods to produce the final CBD oil. This is referred to as a broad spectrum or whole plant CBD oil. Some manufacturers will use other purification methods to produce an oil with no THC or terpenes in it at all, called CBD oil isolate. Most manufacturers make the results of laboratory tests of their products available to prospective customers so you know exactly what you are getting.
Natasha Burton says it is important to carefully study a product you are considering purchasing because there are many different methods used to prepare CBD oil, which affects its contents and potency, and currently there are no regulations in place in regards to required labeling or mandatory quality control.
Another point to be careful of is to be sure you are getting CBD oil and NOT hemp seed oil. Some manufacturers produce an oil from the seeds, which although it can be used to make excellent salad dressing, does not contain any of the active cannabinoids found in CBD oil; some shady manufacturers do not make this clear on their websites or on the product's label, just vaguely calling it "hemp oil". Do not try to buy CBD oil off of Amazon, either, since they have a strict policy of not selling CBD oil and everything they do sell is misleadingly labeled hemp seed oil.
What is in CBD oil?
The active ingredients in CBD oil are chemicals called cannabinoids. These compounds DO NOT induce a high; the chemical in marijuana that induces a high is THC, which is present in CBD oil at 0.3% or less. The cannabinoids in CBD oil are also not addictive or habit-forming.
The human brain naturally forms cannabinoids, which it uses as unique neurotransmitters that work backward, says Scholastic. Normally, neurotransmitters are transmitted from a neuron to another neuron in order to activate it; cannabinoids are emitted from an activated neuron and bind to receptors on the neuron that activated it, where they act to inhibit that neuron from firing again, sort of acting like a dimmer switch. Thus, cannabinoids have powerful effects on the brain's function. Cannabinoid receptors have also been found on other kinds of cells throughout the body, such as in the immune system.
CBD oil first came to public attention some decades ago when people noticed it was an effective treatment for a rare form of childhood epilepsy called Dravet syndrome, and it was then found to be useful for another rare form of childhood epilepsy called Lennox-Gastaut syndrome, says WebMD. The FDA has approved a particular type of purified CBD oil marketed under the name Epidiolex to treat these two conditions. Many other people suffering from various forms of epilepsy have found CBD oil to be effective in controlling or preventing their seizures, and it is also commonly used to treat seizure disorders in dogs. One particular use in regards to seizures that may be life-saving is applying a large dose of it to the gums during a seizure; in most patients, the CBD oil rapidly stops the seizure.
CBD oil has also been used to treat a wide variety of other conditions such as chronic pain, anxiety, migraines, arthritis, sleep disorders, allergies, and many others. There is only limited evidence to prove its efficacy for treating these conditions. However, there are some published studies. For example, Healthline discusses a review article that evaluated all published articles on CBD oil used to treat chronic pain and concluded it seemed to be fairly effective with no side effects. In addition, fairly recently a well-designed randomized controlled trial showed CBD oil was quite effective in relieving arthritis pain in dogs. Pure Organics has a wide range of full-spectrum CBD products for these conditions.
It is important to note that although CBD oil with 0.3% THC will not cause a high, users may test positive for recreational marijuana use. Thus, persons considering using it who are routinely tested for drug use at their jobs should consider the risk and consequences of testing positive. In addition, drug-sniffing dogs may be able to detect bottles of some formulations of CBD oil, which could cause delays and possible arrests at airports and border crossings.
Autism is a developmental disorder with an onset during the first two years of life. According to the NIMH, symptoms of autism include:
Difficulty in interacting with people
Difficulty in functioning normally in all areas of life
Autism is generally referred to as a spectrum of disorders because there is a wide variation in both the range of symptoms and their severity. Most children with autism have normal intelligence levels but their difficulty in interacting with people and their narrow range of interests can impede their progress in school. In addition, many affected children become extremely upset in response to any changes in their routine and many engage in repetitive behaviors that can be disruptive in a classroom.
The cause of autism is unknown. The current theory is that there is a genetic predisposition to the condition that is inherited and then environmental factors during infancy trigger it to manifest. Autism tends to run in families. It is also more common in children born to older parents and in children born very prematurely.
There is currently no cure for autism. The best approach right now is to diagnose it as early as possible and get the child into a structured learning program intended to help autistic children learn social and communication skills, learn life management skills, and learn how to inhibit their repetitive and other disruptive behaviors. Sometimes various forms of medications are used to help control hyperactivity, anxiety, and aggression.
CBD for autism
Using CBD oil to help treat autism only began fairly recently, but its fame spread after a story about it was aired on the Today Show early in 2019. The idea to use it to treat autism was initiated when two boys with both autism and Lennox-Gastaut syndrome were given CBD oil to treat their seizure disorder, and the astounded parents saw that in addition to controlling their seizures, the oil had a strong beneficial effect on their autistic behaviors, particularly hyperactivity, anxiety, sleeping problems, aggression, and short attention spans.
A study conducted in Israel in 2018 treated 60 autistic children with CBD oil for seven months. The study was led by Dr. Adi Aran. At the end of the study, parents filled out a questionnaire about their children's behavior. The results showed that 80% of the children had improvements in their autistic symptoms, particularly in regard to decreases in problematic behavior, decreased anxiety, and improved communication.
It is important to note two features of this study: first, the CBD oil used in the study contained 1% THC. Oil containing that high of a concentration of THC is currently illegal in most states and parents may have difficulty obtaining it. However, it is currently unclear if 1% THC is necessary to treat autism or if 0.3% THC would work just as well; this topic will be discussed later in this article.
Second, the study was not controlled and the parents were aware of the treatment details and therefore there may be two biases affecting the results, one that the parents may have been engaged in "wishful thinking" combined with "poor recall of what the child's behavior was seven months prior" when they reported their children's behavior had improved, and the other being that the children were also being treated with a typical structured learning program and it may have contributed significantly to the behavioral improvements.
Autism Speaks hosted a conference on cannabis and autism in December 2018. The theme of the conference was to discuss problems that needed to be overcome in studying and using it to treat autism. Legal difficulties were discussed, as were the pitfalls of the observational/parent questionnaire design of scientific studies to evaluate its effectiveness, as briefly mentioned above.
Mechanism of action
It is currently unclear why CBD oil might improve autistic symptoms in general. One theory is that there is a disruption in the balance of excitation and inhibition in the brains of people with autism. As mentioned at the beginning of this article, cannabinoids act as "dimmer switches" to inhibit nerve transmission, and thus its use can be expected to change the balance of excitation and inhibition in the brain in favor of more inhibition. There is an ongoing randomized crossover study being conducted in the United Kingdom to explore this hypothesis using functional MRI to directly evaluate changes of brain function in autistic individuals in response to CBD.
For specific symptoms of autism, there is some evidence in non-autistic individuals that CBD oil can be helpful, such as for anxiety and hyperactivity.
Many people with autism suffer from anxiety, particularly in regard to interacting with other people and in regards to changes in their routine. Healthline states that two clinical studies reported that CBD oil is quite effective at controlling social anxiety. In addition to evaluating behavior, one of these studies used brain scans showing CBD oil-induced changes in blood flow in the parts of the brain involved in anxiety. In addition, a review of all published studies on CBD oil for anxiety found that it was effective in treating all forms of anxiety, including panic disorders and obsessive-compulsive behaviors.
These last two are particularly relevant to autism; many autistic children experience panic attacks when their routine is disrupted. And autistic children tend to engage in repetitive behaviors, very similar in nature to the repetitive behaviors that persons with obsessive-compulsive disorders tend to engage in.
Although the cause of repetitive behaviors in both obsessive-compulsive disorders and autism is not well understood, it is thought that they may in part be self-soothing behaviors used to try to control anxiety. The need to perform repetitive behaviors in autism may also be linked to these children's narrow range of interests and often obsessive interest in one particular topic. Thus, CBD oil may be able to control the underlying feelings that lead to the need to perform these behaviors.
Hyperactivity and its related short attention span and impulsivity are common symptoms of autistic children. In children treated for simple ADHD, stimulants like Ritalin are usually given and they have the paradoxical effect of stopping the ADHD. Very few studies have been conducted on the use of Ritalin in autistic children but one small study reported it was effective and well-tolerated. However, doctors have concerns about it worsening the repetitive behaviors seen in autism.
As mentioned above, CBD oil seems to act to switch the excitatory-inhibitory balance in the brain towards inhibition. Thus, it may very well be effective to control ADHD. Although CBD oil has not been specifically studied in regards to treating ADHD, some doctors prescribe it to their patients for this purpose and a randomized controlled trial reported that preparation of cannabinoids delivered as a nasal spray was effective in controlling ADHD.
Many children with autism suffer from poor sleep and abnormal sleep cycles. There is a lot of evidence linking the innate cannabinoid system in the brain to the circadian rhythm. Certain cannabinoids are generated at higher levels in the evening and seem to be involved in helping to induce sleep by dialing down brain activity.
One of the common side effects of taking CBD oil is feeling drowsy, suggesting it may be very effective in inducing sleep; in fact, many individuals use it for that very purpose. They take a dose of the oil at bedtime to assist them in falling asleep and staying asleep. Thus, it is very likely that CBD oil can be used to help autistic children with sleeping problems overcome this symptom.
Many people with autism suffer from disordered eating. This problem can be so severe that malnutrition or even starvation can develop. There seem to be several contributing causes to these problems. One is the behavioral rigidity of these individuals; they tend to want to eat the same thing every day and every meal, which of course does not allow for consumption of a nutritious, varied diet.
The other cause seems to be sensory disturbances that many autistic individuals experience. What is pleasant food for most people may be experienced by someone with autism as having an extremely repulsive texture or taste. And some individuals with autism suffer from pica: the consumption of random non-food items, which can be fatal depending on what is ingested.
In addition to the above, other strange eating behaviors like binge eating and rumination, where the person regurgitates and re-chews the food before swallowing it again, can also occur in some people with autism.
Although CBD oil has not been specifically studied for use in treating eating disorders in people with autism, CBD oil has been shown to be effective in treating binge eating disorders and may also be effective in helping individuals with anorexia. Thus, it is possible it may be helpful in treating disordered eating in autistic individuals.
Does it need THC?
As mentioned above, the landmark study that showed CBD oil was effective in improving the behavior of children with autism used a formulation that had 1% THC, which is much higher than the 0.3% or lower level found in most formulations of CBD oil. Another small study conducted in Chile on the use of cannabis for treating autism used a product that contained a fairly high level of THC. However, many parents who have used CBD oil with a low level of THC have reported good results.
Currently, there is no evidence one way or the other as to whether the presence of THC in the oil affects the results of treating autism. Some users claim it works far better if THC is present, but which level is believed to be optimal varies from user to user. Others claim it doesn't matter if THC is present or not. Some say the presence of THC reduces its efficacy and causes side effects like increased anxiety.
Bottom line, this is an area that urgently needs more research. Due to legal issues in most states, it is probably safest and easiest to just use CBD oil with 0.3% THC or less to see if it provides good results; if not, it may be worth it to try a formulation with 1% THC.
How do you take it and how much?
Due to the variations among CBD oils produced by different manufacturers, exact dosing guidelines are not available. The manufacturer may provide dosing guidelines for their product. The general guideline is to start with a low dose and gradually increase it until the desired effect is seen. The most often recommended dose is nine to fifteen milligrams for a child weighing 30 to 50 pounds.
Determining how many milligrams per drop of CBD oil are in your selected product may require doing some calculations. Some oil manufacturers will helpfully tell you how many milligrams of CBD per drop is in their product, but others only provide information about how many milligrams of CBD is present in a bottle, and the total volume found in the bottle.
In this case, you should take the standard assumption that there are twenty drops in a milliliter of oil and calculate how many drops are in the bottle. Thus, if the bottle contains ten milliliters, it has 200 drops in it. Then you divide the total milligrams of CBD in the bottle by the number of drops to determine how many milligrams per drop.
The vast majority of users and evidence suggests that CBD oil is most effective if taken sublingually, namely the oil is placed under the tongue and held there for a couple of minutes before swallowing. The active ingredients are thought to be rapidly absorbed through the mucous membranes and then enters the bloodstream.
However, this method of dosing has not been conclusively proven to be the best method of consuming CBD oil. There are many food-based products used to deliver CBD oil such as in "gummy" candy form, and these products seem to be fairly effective as reported by users. In addition, some companies make flavored products, such as chocolate-flavored oil. Bottom line, the most important factor is whether your autistic child will accept the product.
Most people suggest dosing two or three times a day, but this again is not firmly established and some trial and error may be necessary in order to determine the best dosing intervals for each individual and for each specific product.
Side effects and risks
There seem to be very few side effects of using CBD oil; most users report none at all, although some experience nausea and diarrhea or sleepiness. However, doctors admit they are not sure if using CBD oil during childhood and adolescence, while the brain is developing, is completely safe, says Dr. Zuckerman. It is theoretically possible that its use during this period may affect brain development. It is clear that the use of recreational marijuana during adolescence can adversely affect brain development, but that may be due to its high THC content.
In conclusion, although there is a serious need for additional research in many areas, there is evidence that CBD oil may be beneficial for children with autism and it seems to be safe and lacking in serious side effects.