Sleep
The Use of Cannabinoids for Insomnia in Daily Life: Naturalistic Study.
Journal of medical Internet research · 2021
Abstract
BACKGROUND: Autism spectrum disorder (ASD) lacks effective options for core symptoms. Cannabinoids, especially cannabidiol (CBD) and combined CBD:Δ9-tetrahydrocannabinol (THC) formulations, are of interest, but clinical evidence is heterogeneous.
PURPOSE: To evaluate the effectiveness and safety of cannabinoid-based interventions for behavioral outcomes in children and adolescents with ASD.
METHODS: Six databases (Scopus, Web of Science, Embase, Cochrane Library, PubMed, PsycINFO) were searched from February 2024 to June 2025. Risk of bias was assessed using RoB 2 (randomized controlled trials [RCTs]) and the Newcastle-Ottawa Scale (non-RCTs); certainty was evaluated with GRADE.
RESULTS: Twelve studies (4 RCTs, 8 non-RCTs) were included; six ongoing trials were identified. Most interventions used full-spectrum extracts with high CBD:THC ratios (often 20:1), with titration up to ∼10 mg/kg/day; doses varied across studies. Responder rates for global improvement vs placebo (49% vs 21%) and greater improvement in social communication. No between-group differences were observed for sleep or overall symptom severity, and repetitive behaviors showed a non-significant trend toward improvement. Non-RCTs studies suggested benefits but had high risk of bias and very low certainty. Adverse events were mostly mild and non-serious (e.g., somnolence, appetite changes, sleep problems, irritability); no treatment-related serious adverse events were reported.
CONCLUSIONS: Evidence remains limited. A whole-plant 20:1 extract improved global clinical impression and social communication in one RCT, whereas other standardized outcomes were null. Current data support only cautious, adjunctive use under medical supervision. Larger, well-designed RCTs using validated outcomes are needed to clarify efficacy, optimal formulations, and long-term safety. PROSPERO registration: CRD42024508518.