An Open Label Study of the Use of Dronabinol (Marinol) in the Management of Treatment-Resistant Self-Injurious Behavior in 10 Retarded Adolescent Patients

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Purpose/Background:In the treatment of severely disturbed children, the control of self-injurious behavior (SIB) which occurs in a small percentage of these children, must be given a high priority (Powers, 2001). Lorenz (2004) reported on the therapeutic use of cannabis (in a liquid preparation) in children with combinations of neurological disorders (6 of the 8 also had epilepsy), with improvements.Methods:Ten patients (ages 11 to 17) with SIB from a convenience sample, with varying degrees of retardation and autism, received Marinol 2.5 mg bid up to 5 mg qid. The patients had failed to respond to a number of medications, ranging from 4 previous medications to 17, including four who had tried naltrexone (two of whom were still on it and two who had discontinued it due to negative side effects).Results:Seven of the ten had a significant improvement in the SIB and their overall mood/well being as reported by caregivers. Two experienced agitation from the Marinol and it was discontinued. Five of the seven who responded had no change in their appetites, and the two that did, benefited from that effect. At follow up to 6 months out, patients continued to respond favorably to the Marinol.Conclusions:In a series of patients who presented with treatment-resistant self-injurious behavior, eight of the 10 showed an improvement in their behavior when treated with Marinol without serious enough side effects to merit discontinuing the medication. At 6 month follow-up, seven of the 10 continued to benefit from the Marinol, and the eighth patient had discontinued the medicine due to a change in her living situation. The tolerability of Marinol in this study is consistent with the experience of Lorenz (2004) whose patients presented with a variety of neurological disorders but not specifically SIB.

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