Is It Safe To Use Medical Cannabis To Treat Autism - Part 1

Episode Transcript

(00:01):
From the WA and M Studio onthe campus of Florida A and M University.
This is Mary Forum Radio, aweekly conversation on the education and research
of the medical marijuana being conducted atBAMUNI. Hi. I'm Heidi Otway,
your host for this Conversations on Cannabisvirtual form, brought to you by the
Medical Marijuana Education and Research Initiative atFlorida and M University. In this conversation,

(00:25):
we're talking about medical cannabis as atreatment for autism. So let's talk
and learn about this subject with ourguests. Doctor David Berger is a Board
certified pediatrician with more than two decadesof experience. He founded Holistic Pediatrics and
Family Care, one of the fewmedical practices in Florida that certifies children to

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use medical cannabis. Doctor David hasgained a national reputation for his expertise in
holistic pediatric primary care with specialties innutritional and lifestyle therapy for autism, ADHD
and related disorders. Doctor David isgood to have you back on the Forum.
It's so good to be back.It's good, good to see you.

(01:10):
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four to win a one hundred dollarsgift card provided by one of Mary's partners.
Now let's start this conversation on cannabis. So, doctor Burger, let's

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just educate our viewers and listeners,and can you explain to them what is
autism? Sure? And the termautism spectrum disorder is really the way I
like to think of it because itreally is a spectrum. So you know,
there are anybody who has a diagnosisof autism. There is some level
of difficulty when it comes to communication. Sometimes it may not be spoken word.

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It could be the ability to readbody language or to already understand things
with behavioral issues. Sometimes it canbe irritable behaviors, attention focusing, type
of issues, anxiety issues, etcetera, ocds, and then also some
level of social whether it's the youknow, some could be socially afraid to

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do things, or don't interact people, or may not share affection with others
the way they do so, butthere could be a very wide spectrum.
There are people who you probably knowwho would qualify for level of autism,
but you wouldn't know that. Obviously, a level three autism is somebody that
most people would recognize. So everybodyis different, everybody is unique. And
the term neurodiversity, which is aterm that we are now using a lot

(03:06):
more of. I really appreciate thatas well. You know, people were
using the word neurodivergent, but that'skind of a negative term. The diversity,
you know, the diversity is importantin all parts of life, all
parts of society, and that's truecertainly when it comes to people's development and
function as well. So what amI hearing you say that we're trying to
move away from the term autism toneurodiversity. No, No, just the

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it's kind of a word that peopleare using. But also neurodiversity could be
people with Tourett syndrome or people withADHD or other types of movement disorders in
the neurological behavioral realm, So autismspectrum disorder is kind of like the biggest
part of that, but it's stillkind of like you'd see if autism is
kind of like a subset of thegrander neurodiversity. Okay, very interesting,

(03:52):
Thank you for sharing that information.So can you tell us how is autism
commonly treated? The most common wayis through education and therapy, so most
people with autism have to be inspecial classrooms or if they're able to be
higher If they are higher function,they may work with an aid within the
classroom. Some will get pulled forcertain subjects, but people who have more

(04:16):
advanced autism may need to be ina special classroom all the time. The
most common type of treatment is calledapplied behavioral analysis or ABA. And then
from a medicinal perspective, there isonly one approved medication and that's for the
irritability of people with autism. There'stwo medications for spirital and abilify, which

(04:40):
are antipsychotic medications, but there reallyis no other pharmaceuticals that a lot are
used off label. If a personwith autism has anxiety, then of course
anxiety medicines are used if many ofthem do have ADHD, so the ADHD
medicines can be used, but there'sfor actual autism there that's the only that's
FDA approved would be those antipsychotics medications. Wow, that's interesting. So why

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should someone consider using cannabis as atreatment for autism? Yeah, so with
a basic understanding of first of allof our endocannabinoid systems. So people'll understand
that we all have cannabinoid receptors onalmost every cell of our body, and
we make cannabinoids. We don't makeTHC and CBD. There's one called two

(05:23):
AG and one called anantamine. Andthe role of the endocannabinoid system is to
main balance, maintain balance homeostasis.So if one cell is overstimulating another cell,
the second cell sends a message backto the first cell that basically says
chill. And so happens every momentof our lives. But people, the

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regulation could still be off, andso the plant based cannabinoids such SOCBD,
one of its main features is itkeeps our cannabinoids around longer. The ones
that we make, and in fact, people with autism, and back in
two thousand and nine, team we'refound to have lower levels of those naturally
produced endocannabinoids compared to people who didnot have autism. So in people with

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autism, there does seem to bea true deficiency of endocannabinoids. So if
CBD keeps that around longer, thenthat can be fixing that deficiency. THC,
on the other hand, it primarilyworks directly on that same receptor in
a stronger way than our endocannabinoids do, so again it's kind of like not

(06:29):
directly fixing the the human made cannabinoids, but it's stimulating the same receptors,
and that's how it does seem towork on the chemical level. Now,
in terms of like the things thatwe see a help though, you know,
it's you know, i'd probably sayanxiety and irritable behaviors and sleep are
probably the three most common improvements thatI see. You know, a lot

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of people with autism, especially oncepuberty hit, they're very commonly can develop
seizures, and we know cannabis canbe very hopeful for that. But I've
seen kids pay attention better. I'veseen kids you know, understand things better,
follow tasks better, and some kidsdo communicate better. Wow. Well,
recently I saw a news article inthe Tampa Bay area where you were

(07:12):
featured for having cared for a youngman with autism using medical cannabis. Can
you share a little bit more aboutthat experience and the outcomes of that.
Yeah. Yeah, And he hadbeen somebody who I had been seeing since
way, you know, for wayover a decade, probably closer to fifteen
years, I'm gonna guess. Andas time went on, really anxiety became

(07:35):
the most challenging thing from the thingthat was really holding him back. And
that and his ocds. Okay,and they got some running similar circles,
and he just had a remarkable responseto cannabis, both CBD and THC,
and his just ability to function inthe world, the ability to function at
home, ability to function with school, it just significantly improved. I mean

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so. And the beautiful thing aboutthat is how to improve the lives of
the parents, Because when you havea kid who's better functioning, better behaving,
then it takes a lot of theload off of the parents that they
don't have to be on guard allas much, or when's the next shore
gonna fall. And so you knowthat's another quote unquote side effective medical cannabis
and autism is it brings more peacein the household. So if parents are

(08:20):
listening or even adult who has beendiagnosed with autism, what are the steps
that they would need to take todetermine if cannabis could be a treatment for
them Medical cannabis here in Florida certainly. So it goes by what we call
the qualifying diagnosis. So autism itselfwas not one of the ten that we

(08:43):
had originally voted on, but therewas another section of the law that says
or other similarly debilitating conditions to theones that were actually listed. So,
for instance, a person with autismmay have irritability or OCD or an xiect
or insomnia, similar to a personwith PTSD, So we say that a

(09:05):
person with autism suffers in a similarway for those particular symptoms for a person
with PTSD. A person with Parkinsonsyndrome, for instance, may have an
inability to speak. Now it's avery different reason why they can't speak,
but still it's none not more orless debilitating to the individual. If you
can't speak, you can't speak.So for people who have a more speech

(09:28):
issue, we're more likely we'll say, well, this has a similar debilitating
condition to Parkinson's, et cetera.That's interesting. So they would go to
would they go to the office FloridaDepartment of Health Office of Medical Marijuana used
to go through a process to legallyget a card? Or should they go
to They have to be seen bya physician who's been certified by the state

(09:52):
to do it. So any physiciancan do it, a lot of haven't.
But so that's the first thing.So when they come my officers,
one of two things that happened.Now, most kids, well every kid
with autism has a diagnosis before theywalk in, right, you know,
because you know because now they're comingto me for treatment of a known condition.
So as long as I have documentation, whether it was from their pediatrician,

(10:15):
you know, obviously I see thesepatients myself, so I know that
they do. But whether it's froma developmental pediatrician, a psychiatry, psychiatrist,
psychologist, or neurologist, once Ihave the documentation, medical documentation that
they have the diagnosis, and thatobviously clarifies that. And so then there
are several different additional steps. Youknow, there's an informed consent form that

(10:37):
has to be signed every single time. You know, there's certain attestations that
they have to make, such asthey're not pregnant, which is great when
you're asking for a mother a FOIold boy, if they're foil boy is
pregnant, but we have to dothat too, you know, kind of
we kind of make a little chuckleout of that one. Yeah, And
so you know, there there's thesecertain amount of things that we just have

(10:58):
to document in the chart that we'vediscussed other options, et cetera. And
then in any child, anybody underthe age of eighteen, besides having the
physician, the certifying physician then goingahead and doing all that, every child
also has a has to have asecond physician who attests that the benefits out
weigh the risks for that particular patient. So I also serve for as that

(11:22):
second doctor for a lot of doctorsaround the state who want to have a
pediatrician kind of backup. You know, if they may not be a petition
themselves, but you know, evenif they are, they're actually that second
doctor on there. So you know, I have two other physicians that work
in my office here and so thethree of us cover for each other.
Yeah, you kind of touched on, you know, the risk. You
know, what are the risk ofhaving of someone with autism using medical canvas?

(11:46):
Okay, well they're very small percentageof kids. First of all,
don't do better. Okay, I'veseen kids get more irritable. Sometimes they
lack focus, you know, Andso that's obviously the first thing. So
you know, as a doctor whopractices functional medicine, to me that I
love that word because at the endof the day, how are you functioning?
You know, are you functioning better? Are you functioning worse? And

(12:07):
it's such a clarity of a termthat it makes parents be able to recognize
that. So you know, theremay be some times where I you know,
yes, cannabis can cause the munchies, and so you know, I've
had some parents be like, wow, I really have to keep a lock
on the refrigerator now or something likethat, you know, and some kids,
you know, And it's interesting whenit comes to attention and focus because

(12:28):
most people when they think of marijuana, they think of like a space cadet
or someone zoning out. And sofor me to have patients who tell me
that they're getting their kid off ofRiddlin or off of prozac or other things
that we have that all the time. In fact, in my experience,
the most common side effect for cannabisis reduction of other medications. So not
all stiff, but you know,so those things, but we check that.
But also a very big part ofwhat I do in my education is

(12:52):
we start super low and I alwaysrecommend starting with CBD first, which of
course doesn't have the intoxicating abilities ofTHAC, and we work that up and
then bring the THC in secondary whilethe CBDs there, because a lot of
people don't realize that CBD can bluntor can even stop the intoxicating effects of
THAC while the other benefits are there. One could even use CBD's an antidote

(13:13):
to THC if they took too muchTHAC. So that's in that step wise
fashion and taking very slow and slowjumping, we're not gonna we don't ever
see patients who just go off thewalls, because if you're taking the slow
approach up, you know, yeah, if you start somebody on a high
dose, god knows what's gonna happen. But if you start off this low
dose, and you've give them threeor four days to assess and then you

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know, I recommend all parents keepa spreadsheet or a log so that they
remember because maybe it turns out thatwhat they were taking a couple of weeks
before was actually the best combination forthem. But I also recommend making one
change at a time, so like, don't increase the CBD in the THAC
at the same time, choose one. So how are these young people children
consuming the cannabis? So, byfar the most common way is or you

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know, they do make capsules dropsat a like gummies. There are some
there are patches that are available thatcan be particularly effective during school or during
long therapy sessions. Because it's aslow it does what we call microdosing,
the release of a small amount onan ongoing basis, an amount that wouldn't
cause a person to be high anyway, but it's kind of they kind of

(14:20):
get the steady and it lasts allday long. Because one of the issues
is that most schools you're not allowedto You can't just leave it with the
school nurser for them to administer it. The parent has to come on property,
which many can't. So a lotof times we have issues where hey,
we have a great morning, butthe afternoon is not so much.
So a patch can be very helpfulthere. But I do have kids who
inhale. You know, flower itselfis not legal until eighteen, but you

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know, I do have people whodo use vape cartridges, and you know,
the beauty of that is the instantaneousness. So I have a lot of
Most of the families will use oralkind of as like a baseline kind of
start the day everything, but we'llalso use the inhaled versions in that hey,
emergency break class, I could seemy kids getting irritable, or hey
we have to make a stop ata store after school, or therapy we

(15:05):
weren't expecting. And my kid doesn'tdo well with change and likes the routine.
So they can give them, youknow, if you have to make
a change, we can give thema couple of puffs and you know,
change of plans, and they handleit better. So but by far the
most common way is oral. Andand just to clarify, children cannot smoke
cannabis, right, They're not thereuntil the day you turn eighteen. It's

(15:26):
grayed out in the in the registry. When we put the patients into the
registry through orders. There's no mechanismthat you can accomplish that. Yeah,
you touched on the part about theschools. I just find that so fascinating
that, you know, there's lawsthat say the schools have to allow it,
and they're you know, different restrictionsjust to ensure that the child is

(15:48):
getting the cannabis and no one else. Can you talk a little bit about
that, just to educate some ofour parents that may be listening on what
that process could potentially be. Yeah, And part of the issue is that
the only person who can administer cannabisto a child is a caregiver who has
a card. Okay, So thatmakes it you know, obviously a nurse
can't go out and get thirty sevencards, you know, for each patient,

(16:11):
and you know, and you're onlyallowed to have two caregivers, right,
So that's so part of the lawjust kind of prohibits that. Okay.
Now, prior to COVID, sothat would have been like that that
fall of ninety into the winter oftwenty nineteen, there was actually a mandate
for schools to all school systems tosubmit a plan that would allow for it

(16:37):
to be done. But then whenthe pandemic hit and obviously everything else shut
down, and I fully understand whydepartments of education and departments of health would
be like, hey, we kindof have some bigger, bigger things we
got to take care of right now, and so it kind of went by
the wayside and and unfortunately never resumed, so we never got the completion on
it. That's so interesting. Sowhat's the latest research on cannabis as a

(17:03):
treatment for autism? Yeah, soat the end of twenty twenty three,
this was at a study out ofBrazil in Frontiers in Psychiatry. It was
really fascinating. So no, itwasn't a double blinded, placebo controlled study,
which of course those are the best, and it had twenty subjects in
it, and of course you'd liketo see a larger study. But what
they did is and what I reallyappreciate is they did in this study and

(17:25):
it's the only time I've ever seenthis in a research study. What we
do here, they started the patientup on CBD, gradually worked up until
the caregiver felt that the maximum benefitwas there. The caregiver was then allowed
to then bring in THC individually andworking that up and then they would land
on a ratio. Some would belike a ratio of one thc to forty

(17:48):
nine CBDs. Others could be onethc to three and so. But whatever
it was that they determined was thebest. They then kept them there for
three months and then they did followup questionnaires. After the three months,
they found that ninety percent, soeighteen of the twenty individuals show actually ninety
five percent showed significant improvements in oneof the areas. Ninety percent said that

(18:11):
there was an overall benefit. Soa couple of one of them, even
though there was a great benefit,there was some side effects that they made
him say the overall it was anegative. But another thing is like around
eighty percent of the caregivers said theirlife, the caregiver's life was better because
kind of as we talked about before. So do you think that more studies

(18:32):
need to be done because you referencethat this wasn't it was done and where
not in Barzil in Brazil, Right, So what are your perspectives on,
you know, seeing more research donein the US as cannabis use says becoming
more legalized in states across the country, It's really gonna come down to if

(18:52):
slash when the FDA changes the schedulingof cannabis, because right now, because
it's considered the highest level of theschedule, they're they're equating it to LSD
and to cocaine, which you know, that's the category that's falling in.
And I mean, anybody who hasanything whatsoever can open up a textbook realize
and part of that being of thatlevel of scheduling says does not have any

(19:15):
medical benefit, which, of course, as we just presented, that's not
the case, and there's lots ofother studies about there. The issue that
we're having in America is that partof that being a controlled substance with no
benefit, people aren't allowed to justresearch it the way that they could riddle
in or the things like that.So we're not gonna probably see much budging

(19:37):
on that until you know, youknow, it is hopeful that President Biden
will will formally announce it, thenthe FDA will go ahead and change the
scheduling. And I think that there'sa relatively good chance that that'll happen before
the election. It's good politics,you know, but but you know,
so so I think once that happens, I think that that will be a
game changer mm HM. Earlier inthe when I was doing the introduction,

(20:02):
I referenced that you're one of thefew physicians in Florida that actually do what
you do, which is, youknow, treat young kids with cannabis when
they have autism. How many othersacross the state are in this level have
this level of expertiseing you in termsof people who are actual pediatricians that are
practicing pediatricians. I don't know thatthere's any There are filming medicine doctors and

(20:27):
other because you can be an internalmedicine doct you could be a radiologist and
get the certification and treat kids.So you know, as a pediatrician who's
actually doing this, and you knowas a person who as a holistic functional
medicine doctor. I've been using herbsin kids for twenty five years, not
this herb obviously you know what,Yes, But the thing is is,

(20:48):
so you know, all of thistime I had to figure out how to
come up with dosing regimens on anindividualized basis for them. So when cannabis
came around, when obviously most whetherthey weren't degreeing, freaking out, or
had no knowledge, I knew verywell how to do titration of natural supplements
in order to get to be ableto help a family figure out what the

(21:11):
right thing was. So I thinkI always had a really big headstart on
everybody. Yeah, what kind ofquestions do you get from parents who are
considering this kind of treatment for theirchildren? Yeah? Well most so there's
two parts. So in my mainpractice are just wanting to learn more to
see if they should in the firstplace, you know. So I actually
have two practices, Holistic Pediatrics andfamily care, which is my main clinic.

(21:32):
Holistic Relief is dedicated just to thecertifying of cannabis patients. So once
the patient has already made an appointment, they kind of already know they want
to start using knnabinoids, but oneof the things after because a lot of
people don't realize, and not justCBD, but I use a lot of
CBG George G in my practice,which is really good for anxiety, and

(21:53):
I use a lot of CBN inmy practice, which is wonderful for sleep,
and of course CBD as well.So I would say about ten to
fifteen percent of the patients who comein to get certified, once they learn
and I show them how to usethe dosings for the other they actually say,
hey, you know what, Iwant to use the HEMP rived cannabinoids
and let's hold off on actually puttingin for the card and doing that,

(22:15):
and I'll get back to you ifI need the cards. So I put
all the documentation down so if theywant to turn it on, we can
do that. But you know,really depends on the individual. But a
lot of parents were actually, hey, no, I'd be justifying not putting
my kid on THC if we canaccomplish other things. So as a rule
of thought for me, it's justlike I would never tell a parent to
start their kid on THC. I'dstart on the HEMP drive cannabinoids first,
right, right, Well, we'restarting to get some questions from our live

(22:37):
audience here, and we have aquestion from Elias wanting to know what are
the main effects of the drops?What is the main THC level of drops?
How long does the effect last?Okay, so let me ask the
third one part first. So theeffects typically last four ish hour, six
ish hours. It is variable.Different people have different metabolism, just like

(23:02):
with other medications. In terms ofthe drops, So when you swallow something,
so I would say that this istrue for edibles or capsules. Anything
that gets swallowed once it's going downinto the stomach then has to be absorbed
in the intestines. That's why ittypically takes longer to kick in, so

(23:22):
on average it also takes about anhour to kick it. Well, Doctor
David, thank you so much forbeing a guest on this Conversation on Cannabis
virtual form, brought to you bythe Medical Marijuana Education and Research Initiative at
Florida and M University. Thank youto everyone watching this program. Tell us
what you think about this forum bycompleting the survey post it in the comment

(23:45):
boxes on YouTube and Facebook after thislive program. If you complete the survey,
your name will be entered into adrawing on May seventh, twenty twenty
four to win a one hundred dollarsgift card provided by one of Mary's partners.
We also want to incurage you togo to the Florida Department of Health
Office of Medical Marijuana Use website tolearn how to obtain a legal medical marijuana

(24:07):
cart in the state of Florida.And we also encourage you to go to
Florida and M University's Merry website tolearn more about this initiative, it's educational
programs, and additional information about cannabisuse in Florida. Thanks everyone. The
views and opinions of our invited guestsare not necessarily the views and opinions of

(24:30):
Florida Agricultural and Mechanical University or theMedical Marijuana Education and Research Initiative