8/13/16

Christian Bogner, MD, FACOG

Phytoelements,LLC
email: drb@phytoelements.com
Re: Physician expertise letter of support for adding Autism to the qualifying conditions list for the New
Jersey Medical Marijuana program
Dear New Jersey Department of Health,
This is a letter in support of adding autism to the list of qualifying conditions in your Medical Marijuana
Program

Background
I have worked as physician in the State of Michigan. I am currently a Staff attending at several
institutions, including William Beaumont Hospital in Royal Oak and McLaren Oakland Hospital. I have
researched autism for the last 10 years and have been looking into the benefits of cannabis for the
autism spectrum.
We petitioned to add autism to the qualifying condition list in Michigan in 2015 and the panel which
consisted of physicians and other experts voted in favor 4:2. This was mainly due to the overwhelming
evidence we presented. Our case was not that it demonstrated to be bulletproof effective for autism
(there is no studies yet for obvious reasons), but because of what we know about its safety and adverse
profile. Only then we weighed those and see if it is heavy enough to allow it to be legal, so the doctor
and patient can work out the best way to do just that without fearing prosecution.
I have spoken at the annual AutismOne conference in Chicago this year about the current understanding
of the endocannabinoid system in relation to autism pathophysiology. I was also part of the Holistic
Cannabis summit in 2016. We see incredible results countless reports from parents all over the country
and in my opinion could actually heal a whole generation if we work together and make the choice for
them, our children to explore this treatment modality.

What research exists that shows Cannabis is safe for children affected with Autism?
The first answer would be: What research do you have to counter-demonstrate that it makes the
already severe autism condition worse? Especially, when you have such strong anecdotal success
stories, including my own personal very close family friends.
As you are well aware, conducting a federally approved study on children with autism seems a thousand
times more impossible than even getting an adult study with cannabis approved on a federal level. So
then the next question would be:

 What evidence exists that demonstrates that cannabis is safe?

And then most importantly, we need to ask ourselves, what is the best way to see if we will do harm
with it or not? Unless we let these parents try as their personal choice, alongside the guidance of a well
trained physician who could recommend medical cannabis, we will not. So hence, let me make a case for
it. And this case is based on scientific research conducted at reputable institutions all over the world,
including our own Ivy leagues.
Let us begin with the current considerations of medications for the treatment of autism and their side
effects. Please note that none of the following medications are FDA approved for the treatment of
autism and are used off-label. This treatment regimen is being used by the leading authority on
Autism in the State of Michigan, Dr. Harry Chugani at Childrens Hospital of Michigan and appears to be
the current gold standard along with ABA, speech and OT therapy.
Zyprexa (Olanzapine) neuroleptic malignant syndrome, severe extrapyramidal symptoms,tardive
dyskinesia, dystonia,severe hyperglycemia, diabetes mellitus, hyperlipidemia, stroke, hypotension,
syncope, dysphagia, aspiration, hyperthermia, anaphylaxis, angioedema, seizures, priapism,
hepatotoxicity, pancreatitis, rhabdomyolysis, anemia, thrombocytopenia,
neutropenia,leukopenia,agranulocytosis and more
Klonopin (Clonazepam)
Respiratory depression, dependency (abuse), seizures, suicidality, hypotension, tachycardia, syncope,
blood dyscrasias, hepatomegaly, withdrawl symptoms, impaired coordination, depression, dysarthria,
amnesia, confusion, disinhibition, irritability, dystonia, incontinence, LFTs elevated, rash and more
Risperdal (Risperidone)
Severe hypotension, syncope,severe extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant
syndrome, severe hyperglycemia, diabetes mellitus, seizures, stroke, TIA, QT prolongation,
hypersensitivity reactions, angioedema, neutropenia, suicidality, hypothermia, hyperthermia, insomnia,
dystonia, headache, akathisia, confusion, epistaxis, photosensitivity and more
Abilify (Aripirazole)
Neuroleptic malignant syndrome,extrapyramidal symptoms, tardive dyskinesia, dystonia, stroke, TIA,
syncope, hypotension, seizures, severe hyperglycemia, diabetes mellitus, severe dysphagia, aspiration,
hyperthermia, hypertension, tachycardia, hemorrhage, intestinal obstruction, cholecystitis, pancreatitis,
blood dyscrasias, leukopenia, neutropenia, hypokalemia, hyperkalemia, rhabdomyolysis, suicidality,
depression, anxiety, akathisia, incontinence, insomnia, fatigue, fever, dystonia, dyslipidemia, impaired
body temperature regulation, xerostomia and more
These adverse reactions happen. Otherwise they would not be on that list. Each one of those reported
side effects above could kill a person or leave them more debilitated than before. Do we have ANY long
term studies on brain development on those medications? Certainly not. Yet, most are ok with
prescribing them as a physician to your patients. In 2010, there were roughly 40,000 deaths attributable
to medication overdose alone in the United States. An overdose of Cannabis is never lethal. There are 0
reported deaths attributable to cannabis overdose reported in recorded time.

Review of the literature relevant to our topic

The Endocannabioid system and as it relates to Autism, Dr. Christian Bogner, Joe Stone 2014
In this 16 page summary we carefully reviewed 45 papers that add up to about 800 pages of solid
scientific data. It is attached to this letter and should be studied carefully in addition to my letter of
support. Some of the arguing scientific support for cannabinoids causing NO harm to neuronal
development we may highlight these conclusions based mainly on phytocannabinoids (e.g. the
cannabinoids from the cannabis plant):
These alterations in endocannabinoid signaling may contribute to autism pathophysiology (Fldy
2013, Krueger 2013, Onaivi 2011, Siniscalco 2013).
Endocannabinoids regulate stress responses, in part via the modulation of the 5-HT system (HajDahmane 2011).
Neurogenesis (Galve-Roperh 2007, Jiang 2005, Avraham 2014, Campos 2013)
Neuroprotection (Hampson 2003, Lara-Celador 2013, Sanchez 2012)
Antioxidants (Borges 2013, Pertwee 2010, Hampson 1998, Hampson 2003)
Neuromodulation (Davis 2007, Lara-Celador 2013, Pertwee 2010, Youssef 2012)
Anti-inflammatory (Pertwee 2010, Izzo 2009, Nagarkatti 2009, Klein 2005)

Official United States Government Evidence

The United States Government filed a patent on the beneficial effects of Cannabinoids in 1999:
Cannabinoids as antioxidants and neuroprotectants Patent US 6630507 B1 US department of

Health

It has surprisingly been found that cannabidiol and other cannabinoids can function as
neuroprotectants
No signs of toxicity or serious side effects have been observed following chronic administration of
cannabinoids to volunteers
It is an object of this invention to provide a new class of antioxidant drugs
-Source: http://www.google.com/patents/US6630507

The Shafer Commission Report Evidence

The Controlled Substances Act created the Presidential Commission on Marijuana and Drug abuse
specifically to advice on the proper scheduling on cannabis. Thus was born a council that would become
one of the most legendary fact-finding bodies ever conceived: the Shafer Commission.
In the early 1970s, President Nixon appointed Gov. Raymond P. Shafer of Pennsylvania, a former
prosecutor with a law-and-order reputation, to run a commission that would demonstrate enough
evidence to re-affirm Marijuana to the most dangerous list, Schedule I.
The Shafer Commission recorded thousands of pages of transcripts of formal and informal hearings,
solicited all points of view, including those of public officials, community leaders, professional experts
and students. They conducted separate surveys of opinion among district attorneys, judges, probation
officers, clinicians, university health officials and free clinic personnel. They commissioned more than
50 projects, ranging from a study of the effects of marijuana on man to a field survey of enforcement of
the marijuana laws in six metropolitan jurisdictions.
Shafer brought his report to the White House March 21, 1972. It was 1,184 pages long.
A short summary of the Shafer Commission for pertinent points relating to the Public hearing on Autism
as qualified diagnosis for the New Jersey Medical Marijuana Program in Trenton,NJ in 2016:

No significant physical, biochemical, or mental abnormalities could be attributed solely to their marihuana
smoking...
No valid stereotype of a marihuana user or non-user can be drawn...
Young people who choose to experiment with marihuana are fundamentally the same people, socially and
psychologically, as those who use alcohol and tobacco...
No verification is found of a causal relationship between marihuana use and subsequent heroin use....
Most users, young and old, demonstrate an average or above-average degree of social functioning,
academic achievement, and job performance...
The weight of the evidence is that marihuana does not cause violent or aggressive behavior; if anything
marihuana serves to inhibit the expression of such behavior... Marihuana is not generally viewed by
participants in the criminal justice community as a major contributing influence in the commission of
delinquent or criminal acts... Neither the marihuana user nor the drug itself can be said to constitute a
danger to public safety... Research has not yet proven that marihuana use significantly impairs driving ability
or performance...
-Shafer Commission report 3/21/1972
Source: http://www.iowamedicalmarijuana.org/documents/nc1ch2.aspx#2f
Nixon response to the media 2 days after its release: If we move the line to the other side and accept
the use of this drug, how can we draw the line against other illegal drugs? The Shafer Commission
report has never been disproven.

National Institute of Drug Abuse Evidence

The NIH subdivision NIDA (National Institute of Drug Abuse) defends Marijuanas current scheduling. In
regards to the long term effects on brain development, it concluded that a study showed that people
who started smoking marijuana heavily in their teens and had an ongoing cannabis use disorder lost
an average of eight IQ points between ages 13 and 38. This study was conducted by Meier in 2012. I
want to point out its fundamental key concerns:
1. Meier studied an individual between ages 7-13 and measured the IQ. Then he sent out a
questionnaire to "someone who knows the patient well" when the patient was aged 38 and had that
submitted back to Meier. This is a confounding error and not good science. Selection bias and survey
sampling bias to name just 2.
2. Only 41 patients of "heavy chronic use were examined, for which the conclusion was drawn that it
causes cognitive decline. 41 patients do not reflection the whole population. This study has no
correlation to clinical applicability. What makes a study good is power. More study subjects increases
your power. This study has absolutely no power.
3. Even if you dissect those 41 patients, the arbitrary SD deviation (0.8) that was set out to be SEVERE
cognitive decline was never achieved by any group tested. The heavy users were considered to have
only a SD deviation of 0.3, which according to the paper is "only" SMALL decline. But the word SMALL
was never mentioned in the ultimate conclusion. Neither was it addressed if an IQ drop of 8 over 30
years has any negative impact on social integration.
source : http://www.drugabuse.gov/publications/drugfacts/marijuana
Ironic that on one side there is a 26 page government patent praising its neuroprotective value in the
treatment of many neurocognitive degenerative diseases, on the other side the government claims the
best defense to keep it from everybody is an 8 page study is easily dismantled and labeled scientific
noise for someone able to talk about true evidence. Studies like this are not even debatable. Using this
as argument against usage of Cannabis for autism is not only non-sense, but in my opinion unethical.
Similar studies have appeared recently and I encourage everyone to examine the study design first
before listening to somebody elses conclusion. Please examine how many people were studied and
consider all other factors that we were taught as medical professionals to determine what makes a
study a good study.

Additional evidence
80% of autistic patients have gastrointestinal problems. There is mounting evidence in the scientific
literature about the benefits of even non-psychoactive THC-A (the actual plant does not have the
psychoactive delta-9 in it, that happens only with decarboxylation, which is done best with heat) and its
healing effects on the gastrointestinal tract.
Irritable bowel syndrome (IBS) might be counteracted by cannabinoids, at least the motility-related
symptoms, where cannabinoids could reduce muscle spasms underlying the symptom of abdominal
pain -The endocannabinoid system in the physiology and pathophysiology of the gastrointestinal tract,
Massa and Storr, 2015, J Mol Med (2005) 83: 944954

Conclusion and final thoughts

When conventional therapies have fallen short and the likely outcome of not intervening is worse than
the potential adverse effects of the use of cannabis (as a last-line defense), legal protection should be
granted in these extreme cases. Not because Cannabis may or may not be as suitable for a wide range of
autistic patients, but because it might prove therapeutic value.
As fellow colleague of each one of you panel members, I really encourage you to study this material and
look at the bigger picture. We have clearly been misled for many years in regards to Cannabis. The few
studies that demonstrate long term dangers (poorly powered, not clinically applicable) are a little grain
on a beach of overwhelming evidence that cannot be ignored anymore. Our own government knows
that this works and is trying to patent this plant. Since this can grow in everyones backyard, one can see
why this is hard to patent. Only prohibition has worked so far to keep it from the population. 80% of
Americans approve the use of medical marijuana. Almost half of the states of the US have adapted
medical marijuana programs for their citizens. It is a controversial situation we have created here for
you as panel member, but still, it might be just as controversial if this does not get approval. Because our
highest duty and promise to our patients should be only one and that is DO NO HARM. With the
powerful support of my States finest experts (Dr. Chugani) and National Experts from Ivy league
Universities (Dr. Grinspoon out of Harvard) we need to move forward and help these families. I can
assure you, there will be great harm reduction if you chose to vote Yes. Please provide protection for the
parents of the affected. We need your vote. We need to set an example to the rest of the world.
We have done our homework. I want you to be confident about voting yes and use any evidence that
we presented as your defense for any backlashes this might cause in your current professional career.
Feel free to contact me at any time at drb@phytoelements.com.
Respectfully,
Christian Bogner, MD, FACOG
Clinical Director
Phytoelements,LLC
Detroit, MI