The Michigan Medical Marijuana Review Panel voted 4-2 in favor of a petition calling for the addition of autism to the list of qualifying conditions allowing for a medical marijuana license under the MMMA. This was a tremendous victory for the families and experts that have supported this effort for the past two years. However, the final decision whether to approve or deny the petition is left to the director of LARA, the agency tasked with administrating the MMMA.
There appears to be some confusion about what this petition is suggesting, and what it isn’t. There’s also been some reservations cited by the dissenting votes on the panel. Here, as an advocate for this petition, I’d like to attempt to clear the air and address these issues from a personal perspective.
The MMMA is a compassionate program designed to protect patients, families, and physicians whom participate within its guidelines. It was established to help patients with debilitating conditions for which cannabis may provide palliative relief. Palliative relief means it may relieve pain or alleviate a problem without dealing with the underlying cause. Under the guidelines of MMMA, citizens from Michigan are granted the ability to submit petitions to add new conditions for consideration by the review panel. If there is sufficient evidence that cannabis may provide palliative relief for the condition, the panel is to recommend the addition of it to the list that qualify for a medical marijuana license, and the full legal protections under the guidelines of the MMMA. In a nutshell, this is what has happened up to this point.
This petition to add autism to the qualifying list was submitted by the mother of a once nonverbal autistic boy, whom subsequent to cannabis based therapies has improved dramatically to the point of attending school and living a more normal life. This petition was supported by multiple families from Michigan with similar dramatic improvements, as well as a number of other families that described a range of benefits. Equally important is the fact that this petition is supported by some of the leading pediatric neurologists that specialize in autism from Michigan including Dr. Harry Chugani, Chief of Pediatric Neurology at Children’s General Hospital, as well as Dr. Jules Constantinou, Pediatric Neurology Specialist at Henry Ford. This is likely attributed to the fact that through their clinical expertise providing care for some of the families that support this petition, they have witnessed improvements subsequent to cannabis based therapies first hand and they’d like legal protection for a greater level of involvement on their behalf.
“There is no doubt amongst families and experts that cannabis can provide palliative relief in autism therapies.”
All that being said, even though preclinical research clearly demonstrates the role of the endocannabinoid system in genetic variants (FXS, NL3) associated with autism, as well as autism itself (CB2 up-regulated), and the therapeutic value of cannabinoids when targeting the endocannabinoid system continues to be elucidated (which may provide scientific explanation for some of the anecdotal accounts supported by families and experts in Michigan) it’s still way too early to claim that cannabinoids can unequivocally treat autism. Nobody is claiming to have a miracle cure for autism.
However, palliative relief is another story. There is ample preclinical evidence as well as clinical evidence documenting the value of cannabinoids in terms of providing palliative relief for autism, as well as a variety of symptoms often associated with autism including repetitive and aggressive behaviors, seizures, G.I. disorders, anxiety, sleep disorders, and others. There is no doubt amongst families and experts that cannabis can provide palliative relief in autism therapies. This is what this petition is about. Providing families and experts dealing with autism with the same pharmacopeia that’s already legally available to other segments of the population, including minors, and is safely being used.
The opposition to the petition cites a need for long term clinical testing prior to allowing for the approval of autism as a qualifying condition. The MMMA has never required that for any of the conditions currently approved, and parents say they can’t and won’t wait decades for such research to make available what they already have access to and success using today, many experts agree. More importantly, the type of research they’re asking for would be enabled from having the legal framework in place like this petition’s approval would provide.
A major aspect of the opposition’s argument is fundamentally flawed, but when taken at face value appears to resonate with outside objectors. The opposition cites a lack of understanding in regards to the effects of THC on the developing brain. Though that’s arguably a reasonable statement on its own, it holds less merit when we consider the fact that Marinol, a pure and synthetic form of THC, is already often prescribed off-label in the types of severe cases being referred to for these cannabis therapies. In fact, there’s clinical research documenting its therapeutic value in autism delivering palliative relief. So if pure THC is being prescribed in some of these situations anyway, why would there be such opposition to cannabis based therapies?
Those unfamiliar with cannabis based therapies may ask themselves why cannabis is needed to be approved at all if pure THC is already available and in use. There’s at least two significant reasons. The biggest reason is that botanical extracts from cannabis contain more than just THC in terms of therapeutic value, which we’ll briefly address momentarily. Also of significant relevance to these families is that due to the high costs associated with Marinol it’s often unaffordable, while cannabis therapies on the other hand can cost a tenth as much.
Certainly the greatest relevance is the fact that cannabis contains more than just THC, and cannabinoids in general are often found to be less effective when isolated in comparison to their effects when administered in varying ratios simultaneously. Much of the palliative relief for autism is associated with a cannabinoid altogether different from THC, which is cannabidiol (CBD). Many of the cannabis based therapies currently successfully in use by families in Michigan utilize more CBD than THC. Each case is different, and there’s currently many available ratios of cannabinoids to choose from. This is something that Marinol will simply never be able to provide. The clinical safety and therapeutic value of CBD is well documented. Not even the NIDA would dispute this fact, and they’ve likely spent more money than any other agency in the US attempting to find adverse effects from cannabis.
Clinical and preclinical research indicates improved therapeutic value of THC and CBD when used in combination as compared to either on its own in some situations. CBD has also been demonstrated to limit the psychoactive effects of THC, which is cited as a concern amongst the opposition. One could reasonably argue that these botanical extracts with greater levels of CBD offer safer alternatives to Marinol in pediatric use. While there are other constituents, CBD is in large part what advocates are proposing the addition of when we’re comparing cannabis therapies to what’s already legally in use. Varying ratios of CBD and THC, rather than just THC, or even just CBD itself. Again, these are already widely available and in use in Michigan.
Those that support and oppose this petition likely agree on a few basic concepts, both want to help provide relief to these families, we just disagree how best to do it. One side would like to bureaucratically overrule the leading experts in the Michigan, as well as their appointed medical review panel, the other side wants to provide families and experts with the same pharmacopeia that’s currently available to other segments of the population as a last-line therapy in severe cases. Does an unelected bureaucrat have the right to get in between a doctor and their patient, particularly when those doctors are leading pediatric neurologists that specialize in the topic at hand? Let’s hope the director of LARA, Mike Zimmer, doesn’t think so.
While the opposition is willing to allow Marinol, their denial of this petition would force parents to cease cannabis based therapies or continue to face prosecution and child custody battles. This is regardless of the fact that many of these therapies simply won’t work without the added value of other constituents currently available in cannabis therapies. CBD along with THC provides significant therapeutic value to these therapies and has been proven as being exceptionally safe in comparison to many of the off-label medications currently in use. They ask that families wait until there are multiple independent clinical trials and FDA approval prior to allowing legal protections for experts and the families for these therapies. They claim to want the very type of clinical research that would be made possible by approving this petition. We should all agree that there should be more expert involvement and research, the experts want more involvement as well. Make no mistake that this is precisely what this petition allows for. In fact, two physicians with a bonafied relationship with the patient are required to oversee all underage cannabis therapies as required by the MMMA. Currently the doctors have no legal protection for their participation in these therapies, this limits their involvement.
“At this point, it [the decision] is entirely up to Mr. Zimmer.”
Families say they can’t and won’t wait decades for clinical research to make available what they already have access to, and success utilizing today. Pediatric neurologists in Michigan with decades of clinical expertise in treating autism agree that they shouldn’t have to. A number of autism advocacy groups, citizens, and physicians in Michigan and around the country also support this petition. This is precisely why the MMMA was enacted by the voters in Michigan; to provide legal protections to patients, families, and physicians that participate in cannabis based therapies for palliative relief.
Families and experts dealing with autism just want access to the same pharmacopeia that’s currently legally available and being safely used by other segments of the population, including minors. Nobody I’m aware of is claiming to want all children on the autism spectrum to begin cannabis therapies, however in severe cases when other therapies aren’t working, it offers another set of options for the experts and families involved.
“Families say they can’t and won’t wait decades for clinical research to make available what they already have access to, and success utilizing today.”
Based on the clinical expertise of the leading pediatric neurologists that specialize in autism, the moving personal accounts provided by families, over 800 pages of peer reviewed research, and the support of a number of autism advocacy groups, the medical review panel appointed by LARA approved this petition in a 4-2 vote. Let’s hope that Mike Zimmer, the director of LARA, who ultimately makes the final decision on this petition, follows the lead of experts and his appointed medical review panel, rather than stifling the possibility for research and expert involvement. Either way, families say current treatments aren’t going to stop.
Hopefully we’re near the end of the days that these families have to live in fear prosecution and custody battles with the children that they love so dearly, on top of all the other hardships they face on a daily basis. At this point, it is entirely up to Mr. Zimmer.