Medicinal cannabis in Autism Spectrum Disorder: current evidence and challenges

Abstract

Objective: To critically review the most recent scientific evidence on the clinical efficacy, mechanisms of action, therapeutic safety, and ethical-regulatory challenges related to the use of medicinal cannabis, with an emphasis on cannabidiol (CBD), in the management of Autism Spectrum Disorder (ASD) in pediatric and neurodivergent populations. Methods: This is an integrative literature review developed using the PICO strategy. Studies published between 2019 and 2024 were included, sourced from PubMed, SciELO, and LILACS databases, in Portuguese, English, and Spanish. After screening 287 titles, 12 articles met the inclusion criteria and were analyzed across four thematic axes. Results: Evidence indicates that CBD shows promising effects in reducing psychomotor agitation, sleep disturbances, anxiety, and social difficulties in children with ASD. The mechanisms involve modulation of the endocannabinoid system and receptors such as CB1, CB2, TRPV1, and 5HT1A. Although adverse effects are generally mild, there are still gaps regarding formulation standardization, long-term follow-up, and regulation. Final considerations: CBD demonstrates safety and therapeutic potential in ASD; however, its clinical incorporation requires greater methodological robustness and specific regulatory frameworks therapeutic potential in ASD, but its clinical incorporation depends on greater methodological robustness and specific standardization.