A 10-year-old autistic boy named Einav and his family were spiraling to a dangerous low point a year ago. The parents soldiered through their son’s rages and obsessive behaviors, not to mention bends that would last entire days into sleepless nights. He would hit them and even throw stones at them. He would also harm himself by cutting his skin and trying to swallow objects. Once he almost electrocuted himself.
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His spent parents, who live in southern Israel near the border with the Gaza Strip, traveled with him to Jerusalem to meet Dr. Adi Aran, who heads the neuropediatric unit at Shaare Zedek Medical Center.
In January, Einav became one of Aran’s patients and research subjects. Aran is working on a pair of clinical trials to test medical marijuana oil for children with autism – including children like Einav who experience severe autism.
Some of his patients are nonverbal and prone to extreme outbursts.
“The strain of marijuana Einav receives relaxes him. Here and there outbursts occur, but it’s nothing compared to what we experienced last year,” says his mother, Ronit.
“Autism is still there, it’s part of him. But there’s no doubt: the marijuana saved us.”
The attempt to find a way to help children and young people with autism is part of a larger story: the growing area of medical marijuana research in Israel. The country has been positioning itself as a leader in the field, bolstered by a Health Ministry that encourages research, and an increase in the number of growers, who also collect evidence on which strains and compounds seem to work best for patients with specific conditions.
Officials like to point out that Israeli researchers are not constrained by the limits in the United States, where the study of medical marijuana is limited because of its classification as a dangerous drug. Israel’s relatively liberal atmosphere for research has also been drawing attention as it attracts international investors looking for a way to get these potential treatments to market.
Researchers, growers and Israeli health officials prefer the term medical cannabis to medical marijuana; they say they’re trying to move away from the stigma associated with the word marijuana.
Researchers caution that marijuana is a complicated plant. It has tremendous potential for a range of health problems, but science is still in the early stages of understanding how cannabinoids work.
Aran is working on a double-blind, placebo-controlled study on 120 autistic children with the results expected next year, after a full year of research has been conducted.
There is also parallel research: an “open label” clinical study of 60 children and young adults where all the patients have been given the oil. This type of trial is considered less scientifically rigorous since both the researchers and patients know what they are receiving.
In the open research study, the patients are given a strain of medical marijuana developed by the Israeli companies Breath of Life Pharma, also known as Bol Pharma, Tikun Olam and Better. These strains are made up mostly of cannabidiol, known as CBD, and a small amount of THC (tetrahydrocannabinol, the main compound in cannabis). Unlike THC, CBD is not psychoactive.
In recreational use of cannabis, THC is usually at a high level. But the oil blend that the children and young people are receiving in this study is 20 parts CBD to one part THC; drops of the oil are usually placed under the tongue.
From the preliminary – still anecdotal – evidence, a majority of the patients in the open label study have reported less anxiety and fewer outbursts. And about one-third have reported that communication has improved.
Aran notes that patients who have both autism and another condition (or conditions) have so far responded less favorably than those who only have autism.
“This is the only research of its kind in the world, though lots of others are beginning to try,” Aran says. “We are lucky to have access to medical-grade marijuana and a regulatory system that enables and allows for its study.”
Because of the lack of federally funded research, U.S. physicians find themselves in a bind when it comes to advising patients. Although they can authorize a medical marijuana card for patients, they cannot give prescriptions for which varieties and strains might work best for specific conditions and diseases.
Those patients are dependent on the advice of staff at medical marijuana dispensaries, who are often well informed but not medical professionals.
That is beginning to change in Israel. The Health Ministry is leading training sessions in hospitals for physicians, giving them guidance on which specific strains and blends of medical marijuana might work best for a patient’s condition, according to Dr. Michael Dor, who heads the ministry’s medical marijuana research unit.
It was Dor who approved Aran’s study. It grew out of research that found that medical marijuana was helpful for treating children with epilepsy, some of whom also had autism and whose autism-related behavior also improved.
Start of a long road
“Lots of research still needs to be done,” says Bol Pharma CEO Tamir Gedo. “We need to see why it works on one person and not another. This is going to be the first of many trials,” he says, adding he has been encouraged by the results to date.
The Volcani Center, the home of Israel’s Agricultural Research Organization, is home to several studies on medical marijuana. One of its researchers, Dr. Hinanit Koltai, a plant molecular biologist, is examining the possible use of medical marijuana for breast cancer and digestive illnesses.
“When you go to get a medicine, even antibiotics, you know exactly what you are getting,” Koltai says. “We want medical marijuana to be the same.”
Abigail Dar, from the Tel Aviv suburb Ramat Hasharon, treats her nonverbal autistic son Yuval, 24, with medical marijuana and says she has seen markedly fewer aggressive outbursts. Yuval is not part of Dr. Aran's study.
She has become an outspoken advocate for the cause and something of a guru among the parents of autistic children in Israel looking for guidance. She hosts a Facebook page for parents, leads a WhatsApp group and gives lectures trying to educate people about medical marijuana as a possible treatment option.
“What interests me is what really works for the kids,” Dar says. “I’m gathering data and tracking who got what and how he responded to a given strain. For me, this is the way to really understand the cannabiniods and how to really work out what works for our kids.”
As for her own son, Yuval, she says she doesn’t “have to be afraid of him having outbursts anymore. I’m worried I sound terrible. I adore my son, but there were outbursts you could not live with.”
She fears the recent media attention will sell parents a dream that two drops of marijuana oil will cure their child of autism – and that's not what’s happening, she says. “But it does make everything more manageable. We are talking about our kids having less anxiety, restlessness and outbursts, a real game-changer for the quality of life of people with autism and their families and caregivers,” Dar adds.
For Tanya, the homeschooling mother of Leia, a nonverbal, low-functioning, autistic 10-year-old, medical marijuana offers some hope for relief in the form of medication that has already been tested and proved effective.
“We want to get the right treatment for her,” Tanya says. “I’m not expecting miracles. I want it to help Leia sleep, that’s what I want it for. I have no idea what to expect, so I want to give it a try in an organized way.”