The potential for medicinal cannabis to help manage challenging behaviour in people with intellectual disability: A perspective review
Laura Korb 1, Samuel Tromans 2 3, Bhathika Perera 4 5, Nagina Khan 6, Lisa Burrows 7, Richard Laugharne 8, Angela Hassiotis 5, Victoria Allgar 9, Daryl Efron 10 11 12, Ian Maidment 13, Rohit Shankar 8 9
- 1Haringey Learning Disability Partnership, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK.
- 2Department of Population Health Sciences, University of Leicester, Leicester, UK.
- 3Adult Learning Disability Service, Leicestershire Partnership NHS Trust, Leicester, UK.
- 4North East London NHS Foundation Trust, London, UK.
- 5Division of Psychiatry, University College London, London, UK.
- 6Centre for Addiction and Mental Health, Toronto, Canada.
- 7Royal Cornwall Hospitals NHS Trust, Truro, UK.
- 8Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK.
- 9Peninsula Clinical Trials Unit, Faculty of Health, University of Plymouth, Truro, UK.
- 10Royal Children’s Hospital, Melbourne, Australia.
- 11Murdoch Children’s Research Institute, Melbourne, Australia.
- 12Department of Paediatrics, University of Melbourne, Melbourne, Australia.
- 13College of Life and Health Sciences, Aston School of Pharmacy, Aston University, Birmingham, UK.
Affiliationer
Background: Around 2% of the population have intellectual disabilities. Over one-third people with intellectual disabilities (PwID) present with ‘challenging behaviour’, which nosologically and diagnostically is an abstract concept. Challenging behaviour is influenced by a range of bio-psycho-social factors in a population, which is unable to suitably comprehend and/or communicate concerns. This predisposes to poor health and social outcomes. There is no evidence-based treatments for managing challenging behaviour. Cannabidiol (CBD) and tetrahydrocannabinol (THC) are being trialled for a range of disorders, which are over-represented in PwID and provoke challenging behaviours, such as severe epilepsy, spasticity, post-traumatic stress disorder, social phobia, pain, etc.
Methods: This perspective review explores the different conditions, which benefit from medicinal CBD/THC preparations, by analysing recent literature from neurobiological, pre-clinical and clinical studies related to the topic. The evidence is synthesised to build an argument of the therapeutic benefits and challenges of medicinal cannabis to manage severe challenging behaviour in PwID.
Results: There is developing evidence of medicinal CBD/THC improving psychiatric and behavioural presentations in general. In particular, there is emergent proof in certain key areas of influence of medicinal CBD/THC positively supporting challenging behaviour, for example in children with neurodevelopmental disorders. However, there are significant challenges in employing such treatments in vulnerable populations such as PwID.
Conclusion: Further clinical research for the considered use of medicinal CBD/THC for challenging behaviour management in PwID is needed. Strong co-production with experts with lived experience is needed for further testing to be done in this exciting new area.
Keywords: Medicinal cannabis; challenging behaviour; developmental disorders; intellectual disability; polypharmacy.
