Sam is an eight-year-old male. He was diagnosed with Pervasive Developmental Delay- Not Otherwise Specified (PDD-NOS) when he was two and one-half years old by a pediatric psychiatrist at the M.I.N.D. Institute, UC Davis Medical Center. He was re-diagnosed at the M.I.N.D. Institute in October of 2007 with Autism Spectrum Disorder (ASD). As the psychiatrist told Sam’s mom and I, “Sam is a poster child for ASD”. Sam has lowered cognitive abilities and lowered verbal skills. Sam lives with his mom, dad and his younger sister who is six years of age. She is a typical child with no physical or mental health issues.

Sam was adopted at birth. He had no prenatal issues and was a healthy infant. At around 18 months of age he began exhibiting ASD like behaviors and after six months of reassurances by his primary doctors that he was fine Sam was diagnosed with ASD. Since his diagnoses he has received special education services, speech therapy, occupational therapy, and behavioral therapy. He had been on the Gluten-Casein Free Diet (GCFD). He has been treated by a doctor (supposedly one of the best in the country) who treats ASD patients following the Defeat Autism Now (DAN) protocol which emphasizes a “BioMedical” approach established by Dr. Rimland the founder of Autism Society of America and the Autism Research Institute in San Diego, CA.

As a family we have spent tens of thousands of dollars trying to help Sam. Even though as a teacher I have full coverage insurance, many of the services and doctors Sam has seen are not covered under my plan. Blue Cross of California still categorizes ASD as a “mental illness” instead of an “organic disorder” which precludes it from receiving the coverage a typical physical illness would be granted. I only mention this because since Sam was diagnosed with ASD we have devoted ourselves to helping him. This devotion has been in the forms of time, effort, education, therapy cost, medical costs, conferences, parent support groups, and most importantly love.

Sam’s Strengths

Sam loves people and he loves to “be on the go”. He has been to Disneyland four times, been camping many times, and has been to San Diego to visit the zoo, Wild Animal Park and Sea World. Sam loves to go to San Francisco Giant and Sacramento Kings games and loves to travel to San Francisco. Sam is our gift from God and we love him just as he is. Many tears have been shed from worry and from the joy of watching Sam achieve things parents of typical children take for granted. There have many moments of laughter and warmth given to us by our quirky, sweet, lovable, little boy.

Purpose of this Journal

I write this journal for Sam and other children like him. We almost lost our little boy to ASD and pharmaceuticals. By the grace of God and the help of a little Medical Cannabis (MC) we have him back. Maybe this journal can give other parents hope when all else seems dark and hopeless. Maybe this journal can prompt others to tell their stories if they have treated their ASD child with Medical Cannabis (MC). Even more important would be some legitimate scientific studies conducted to determine the effectiveness of MC to treat symptoms of Autism.

I never wanted to be an advocate for Medical Cannabis (MC). I do not drink alcohol, take marijuana, or any other psychoactive drug. However, this experience has been so profound and dramatic that I feel no choice but to speak out on the issue. I understand the political and legal sensitivity of giving an eight-year-old child medical cannabis but if one child and family can be helped from my disclosure any risk to myself is acceptable. As a parent, I only want to help my son. No one ever questioned our decision to give our son the potpourri of pharmaceuticals prescribed by his doctors that, in my opinion, almost destroyed him.

My wife and I both have very conservative parents and families who are very much opposed to any type of “illegal” drug use. We have their complete support. They witnessed Sam’s deterioration over the last year and they saw his almost miraculous turn around once we started using the MC. We have only disclosed treating Sam with MC to our closest family. We have shared the information with Sam’s primary pediatrician on the recommendation of Sam’s MC Doctor. The pediatrician has been supportive in an “off the record” manner. He has been Sam’s pediatrician since birth and he knows that we are responsible parents.

Sam’s Educational Background

Sam has had significant difficulty in school. He did well in preschool but began having constant problems once he entered Kindergarten. After a few months in a Kindergarten Special Day Class (SDC) Sam was removed from his neighborhood school and placed in a more specialized program for children with ASD. In 1^st grade he was removed from that program and placed in a very restrictive setting that deals only with ASD kids (also public school). The population of that program was much lower than Sam, i.e., he was the only verbal child out of 12. Throughout this time Sam continued to have severe behavioral problems. To begin the 2007-08 school year he was placed back at his home school. His negative acting out became so intense and frequent that he was only able to attend school for 3 hours each day and was getting sent home at least 2 days each week. He was extremely unhappy at school and this unhappiness seemed to compound the increasing difficulty he was having at home.

In December of 2007 Sam was placed in a Non Public School setting due to his aggressive, destructive, unsafe and antisocial behaviors. Data from a Functional Analysis Assessment done over a month period of time by a Behavioral Intervention Specialists (BIP) showed that Sam was having anywhere from 10-20 hitting, pushing, knocking things over, running off incidents per each 3 hour day. In summary, school was a disaster. Sam wasn’t learning anything and the teacher and his one-on-one aide were just trying to prevent him from hurting himself, them, or other children.

Medical Intervention with Pharmaceuticals

Throughout this time we were encouraged by school personnel and his doctors to keep trying different medications until we found one that would help him. We were told that this could be a long process because kids with ASD were extremely sensitive to medications in general and that there was no one drug that worked for every kid. We were constantly reminded of the success stories of other children. Unfortunately, taking any of the medications prescribed by his doctors never helped Sam.

On the contrary, Sam’s mom and I were seeing a dramatic escalation of his anti social behaviors at school and at home. We had never had such intense problems at home. Sam’s condition imminently threatened the safety of our six-year-old daughter whom he began hitting on a regular basis. There were times when I would have to physically restrain Sam because he was in such a rage. He would go around the house yelling and knocking things over as if he were going crazy. He would try to run out of the house at 10 PM in the rain with no shoes on. Our home became a lock down facility. We were all miserable and Sam just kept getting worse. The future looked bleak.

All this time we were going through a litany of medications to "help" him. Over a two-year period we did trials with Respirdol and Abilify (atypical antipsychotics), Ritalin and Adderall (amphetamines), Prosac, Paxil and Celexa (serotonin reuptake meds), and Tenex (Guanfacine), which is a blood pressure medication. We have a cupboard full of prescriptions for Sam. We tried different versions of the same type medications. We were encouraged to keep trying a medication until we knew for sure it worked or didn't work. The problem was he was having significant negative reactions to each medication he would try. He gained 10 pounds in 6 weeks on the Respirdol. Some of the meds, like the amphetamines, were obviously ineffective but others like the Abilify, Resperdal, and Paxil took time to develop negative side effects. The last medicine we tried was the Celexa. He was on it for 2 days in December and had a severe negative reaction. To put it bluntly, he "flipped out" on the medication. We stopped giving it to him immediately but the negative effects lingered with Sam for weeks. At that point we took Sam off all medication. His doctors recommended we try Depakote next. At this point, we were fearful that we would be able to manage him at home either with or without medication.

Decision to Use Medical Cannabis

At this point it was clear that the medications being prescribed by his doctors were not only failing to help Sam but they were harming him. He had gained significant weight, had an increase of aggressive and unpredictable behaviors and, most alarmingly to us, became very distant to those he had always loved so much. He began hitting his grandmothers and sister, and did not engage with his parents as he once did. He even became distant to me, his dad, the one person whom he had always had the most attachment. It was heartbreaking to watch him slip away. It was like the Sammy we had known was disappearing and we feared that he would steadily slip into greater isolation. There were several episodes that were so bad that we considered taking him to the hospital.

My wife came to me with the suggestion that we consider treating Sam with Medical Cannabis. She had found information on the Internet that documented another parent’s success in treating her son who had similar characteristics to Sam with Medical Cannabis. I researched the subject myself and found an article written by Dr. Bernard Rimland from the Autism Research Institute that authenticated the parent’s story and stated the he would be more in favor of trying MC before he would more “toxic” pharmaceuticals. The article can be found at the following address (http://www.autism.org/marijuana.html).

After discussing it with my wife and Sam’s grandparents, we decided to pursue it further. I knew very little about getting a recommendation from a doctor but was able to contact a doctor in my local area who recommends MC to patients. We had no idea how to obtain marijuana and we didn’t want to do anything illegal. We made an appointment with the MC doctor and gathered up all Sam’s medical and school records The doctor reviewed the case, examined Sam, and educated us on Medical Cannabis. He also made it clear that we would need to share information with Sam’s primary pediatrician. Additionally, we discussed the sensitivity of the issue and the risk that we were taking. As a team, we decided to maintain a “need to know policy” regarding Sam’s new medication. It was decided that school personnel did not need to know. Sam’s mom and I learned that in California a physician can “recommend” MC. It is not called a prescription but a recommendation. We also discovered that we would be able to obtain the MC locally through a Cooperative.

Alabama: Considering a medical marijuana law.
   HB642 - The Michael Phillips Compassionate Care Act of Alabama

Arkansas: Considering a medical marijuana law.

Florida: Medical marijuana petition drive underway.

Idaho: Considering a medical marijuana law.

Illinois: Considering a medical marijuana law.
   Bill Status of SB1381

Indiana: Considering a medical marijuana law.

Iowa: Considering a medical marijuana law.

Kansas: Medical marijuana petition drive underway.
   Marijuana Bill Reaches House
   Cannabis Compassion and Care Act

Maryland: Considering a medical marijuana law.
   Bill Status of SB 627

Massachusetts: Considering a medical marijuana law.

Minnesota: Considering a medical marijuana law.

Missouri: Considering a medical marijuana law.
   HOUSE BILL NO. 1670 - An Act relating to the use of marijuana for medicinal purposes
   Cottleville Mayor Don Yarber hopes Missouri legislature passes medical marijuana law

New Hampshire: Considering a medical marijuana law.

New York: Considering a medical marijuana law.

North Carolina: Considering a medical marijuana law.
   North Carolina Medical Cannabis Act

Ohio: Considering a medical marijuana law.
   HB 214

Pennsylvania: Considering a medical marijuana law.
   HB 1393

South Carolina: Considering a medical marijuana law.

South Dakota: Medical marijuana petition drive underway.

Tennessee: Considering a medical marijuana law.

Texas: Considering a medical marijuana law.

Many patients who utilize and benefit from medical cannabis do not wish to smoke due to the perceived health hazards of smoking or for other personal reasons. These patients are in something of a bind. Smoking cannabis delivers the active cannabinoids within seconds. Medicine is absorbed in the lungs and goes directly to the brain and general circulation. The same effect can be achieved with a vaporizer, which is safer than smoking burning vegetable matter. Since the effects of inhaled cannabis are so quick, it is easy for patients to titrate their dose by simply waiting a minute or two in between puffs.

Oral cannabis, such as our Better Bud Butter, is absorbed in a very different fashion from smoking or inhalation. The GI tract gradually absorbs Cannabinoids over the course of one to two hours. Medicine is processed first by the liver, which converts some cannabinoids such as delta nine to delta 11 version of THC. Orally delivered cannabis requires four to ten times the amount of the smoked version in order to achieve the same effect. Orally delivered cannabis can present a problem in achieving the required or desired dose level in any consistent fashion.

Tincture is designed to address the problems of rapid medicine delivery and consistent dosing. Most tinctures are made to be used under the tongue or sublingually. English pharmaceutical companies are presently working on a cannabis extract "spray" that can be used under the tongue in a similar fashion. These sprays are not expected to be approved for use in the United States for years and will be very expensive. Absorption by the arterial blood supply under the tongue is completed in seconds. One trick is to not swallow the dose as, if swallowed, absorption will be in the GI tract. Many patients, though, add their tincture to a cup of tea or cranberry juice for easy delivery. When tincture is used in a beverage, absorption will be slower than if absorbed under the tongue. While tincture absorbed in an empty stomach is accomplished in minutes, conversion in the liver remains, as does the difficulty in titrating dose. Usually, a tincture dose is delivered by means of a medicine dropper or a teaspoon. A rule of thumb on dose is that patients receive benefit from 3-4 drops to a couple of full droppers depending upon the potency of the tincture and the patient’s own unique requirements among other factors.

The methods listed below will detail two major methods of preparing tincture. While the methods are optimized for purity and potency, ultimately these will largely be determined by the purity and potency of the cannabis from which the tincture is made. Another item of note in regard to starting material for tincture is the patient or caregiver selection of strain. A rough rule of thumb is to select Indica dominant strains for cramping and muscle spasticity and Sativa dominant strains for pain relief. The reality, though, is often that the strain is unknown or not well characterized. Trial and error is usually required to acquire the appropriate strain and the proper dose level.

General Rules:

Tincture is an extraction of active cannabinoids from plant material. Cannabis contains many chemicals that can either upset the stomach or taste nasty. One of the goals of extraction is to secure the cannabinoids while leaving out as many of the terpenes and chlorophylls as possible. Both heat and light adversely effect cannabinoids and should be avoided or minimized. Tincture should be stored in airtight dark glass containers kept at room temperature or below. Avoid plastic containers. The ethanol in the tincture may solubilize some of the free vinyls in the plastic.

Making tincture cold preserves the integrity of cannabinoids. To be potent, this method requires starting material high in cannabinoid content such as flowers or kief made from trim and leaf. The material must be mold free and dry. Drying can be accomplished in the freezer (-4-10 degrees Celsius) or better yet by placing in a liquid proof bag into a dry ice/ethanol ice bath (-70 degrees Celsius). Once water has been removed then the surface area of the starting material requires expansion. This can be accomplished a number of ways but two ways stand out:

Using flowers (bud)- Place dried buds in a coffee grinder and pulse until thoroughly ground but not powdered.

Making kief- Rub dry trim and leaves over a silk screen. Collect the powder the comes through the screen. It should be a very pale green. "Kiefing" is an age old way of extracting trichomes from plant material.

Whether kief or ground bud is used both should kept ice cold for this preparation. Similarly, the ethanol to be used should also be ice cold throughout the process.

Selection of alcohol- ethanol or ethyl alcohol is the form of alcohol that can be used by humans. The proof listed on commercial alcohol refers to the percentage of ethanol that the beverage contains. The proof is twice the percentage, so 80 "proof" means that the mixture contains 40% ethanol. The higher the alcohol content used, the better the extraction will work. Ideally, 200 proof ethanol would be best except that ethanol cannot be distilled to this proof so benzene is used to remove the last vestiges of water. This makes "pure" ethanol poisonous.

Many folks use "Everclear" which stands at 190 proof or 95% ethanol. Everclear has no taste. Apparently, Everclear is not available in all States. A close second choice is 151 proof rum. This is a light amber liquid that is 75% ethanol that has a sweet taste. One of our caregiver writers will use nothing but Korbel brandy because she likes the taste. Others use iced Russian vodka. These "normal" distilled spirits are 40% to 50% ethanol. Some patients find that the higher proofs ethanols like Everclear and 151 rum burn too much under the tongue. If burning is a concern consider a high quality 90-100 proof Vodka.

Cold Extraction and purification- Use at least one ounce of starting material to each pint of ethanol. Place cold powdered kief or ground cannabis flowers together with ethanol in a glass quart-mixing jar. Close the jar tightly and vigorously shake for five minutes then return to the freezer. Continue to agitate the mixture every few hours with refreezing. Continue for a period of two to three days.

Pour the cold mixture through a double thickness of sterile cheesecloth. Save the cheesecloth "ball" for topical uses or use the material to make bud butter once dried. The liquid collected through the cheesecloth should then be filtered twice through a paper coffee filter. Use gloves throughout the process, as it is necessary to squeeze the cheesecloth and coffee filters to facilitate the extraction. Without gloves some of the material will be absorbed on the skin.

If Everclear is used the tincture will be pale green to golden. If 151 rum is used an amber tincture results. Dark green tinctures mean that excess plant material is present. This does not mean that the tincture will not be potent, just taste nasty. When Everclear is used, various flavor extracts may be added (vanilla, raspberry, etc.). Be careful to use only a few drop of flavor extract.

Place the ethanol and chopped cannabis in a large glass Mason jar. Shake at least once a day. Place the jar in a brown paper bag or otherwise shield the jar from light. Leave in a warm spot (near a window) for 30-60 days. The mixture will turn a very dark green. Strain as previously described through cheesecloth. Save the "shake ball" for topical applications.

While this method produces a nasty tasting tincture, it is powerful. It may upset some fragile stomachs. It is recommended that Warm Tincture be used orally in cranberry juice or coffee with sugar. Keep the filtered tincture in light blocking glass jars or bottles in a cool dry place (refrigerator or freezer is fine). The shake ball should also be kept in the freezer. For topical applications, just take out the cold shake ball and apply a few drops of fresh tincture to the cloth then hold it on the affected area for a few minutes with gentle rubbing.