CBD In Colorado - Seeking A Marijuana Miracle

Shandar

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Ana grabs his arm, but he pushes her back. She tackles him and squirts the oil into his mouth, but he coughs it back up. She reaches for her cellphone.

"Help," Ana writes in a Facebook message to the community of parents who have tried the same treatment. "He is spitting it out and gagging. Can I mix it with food, give rectal? Any suggestions?????"

Ana's mom, Milly, stirs more medicine into ice cream and brings it over. But Preston won't eat. Ana bribes him with his favorite YouTube videos – "I'll press play if you take a bite." He still refuses.

She promises him that his little sister, Sydney, will dance if he takes his medicine. "I'm not doing it," Sydney says.

Ana's shoulders slump, and Milly tells her to back off.

"You're overdoing it," Milly admonishes. "Skipping it is not going to hurt him."

But Ana's jaw clenches.

"Why did we even come down here if he's not going to take it!?" she snaps.

"We can't force him to take it!" Milly shouts.

"He needs to learn to take it!" Ana says.

Milly walks out of the room, saying they should try later.

"Stop arguing with me!" Ana finally says. "Damn."

She turns toward Preston, and, as if he senses the tension, the cringe on his face pivots into an awkward smile. He starts to laugh, and she does, too.

"Silly mommy," he says quietly.

Ana eventually calls a friend, who suggests giving the medicine in emptied pill capsules delivered as a suppository. She grimaces. But she has already been at it for an hour. The odds that seizures will kill Preston increase every year; the damage in his brain may soon be permanent. She is compelled to try.

"OK," Ana says as she fills the capsules. "It's not going to be pretty."

This time, she walks to him without a smile. She leads him into the bathroom and pulls down his diaper. She muscles him close.

Preston squeals. Once. Then again.

"I know!" Ana pleads. "I'm sorry!"

His cries fade to whimpers. His eyelids twitch with another seizure. Ana sits on the toilet, holding him on her lap as he quivers in her arms.

"It's OK," she whispers. "It's OK, Boo-Boo."

Seven months and 1,600 miles after their journey began, Ana has finally given Preston his first dose of marijuana.

Exodus

Medical marijuana has made Colorado a promised land for desperate parents trying to save their children.

Children have arrived here nearly lifeless. Families have lived out of motels when they couldn't find housing. Parents have shown up at a medical marijuana provider's house in the middle of the night.

At least two children and one woman across the country have died while their families prepared to move to Colorado for medical marijuana. One child who made it here died when the treatment didn't help her condition enough. Her mother moved back home alone.

But no one knows more than anecdotes because Colorado does not track how many families come to treat their children with medical marijuana – although it's in the low hundreds – or where they go.

No agency thoroughly regulates the treatment providers, beyond basic licensing. No rules govern the right formulation or dosage of the marijuana extract at the core of the treatment. No studies conclusively document the side effects.

Most important, no one knows how often it works.

A handful of organizations have sprouted in the past couple of years to offer support to parents moving to Colorado and those already here. Communities of families have grown up to provide advice and encouragement and a happy source of friendship.

But, when parents such as Ana Watson arrive with little more than a desperately sick child and a hope to make it better, they walk into uncharted territory. They become part of a medical experiment that plays out in living rooms, not doctors' offices.

"I can't be the parent who didn't try," said Janéa Cox, a mother from Georgia who brought her daughter to Colorado in March for treatment of seizures that left her unable to even breathe on her own. The move meant breaking up her family; her husband remained at home in Georgia.

"Colorado represents hope at this point," she said. "This is the state of hope."

A spectrum of illnesses afflict the children coming to Colorado for medical marijuana: cancer, autism, Crohn's disease. Most, though, are seeking help for incurable forms of childhood epilepsy – diseases with names taken from medical-journal bylines: Dravet syndrome, Lennox-Gastaut syndrome and Doose syndrome.

The migration began just over a year ago, when CNN aired a documentary featuring a Colorado girl named Charlotte Figi, whose constant seizures caused her to stop speaking for months. While taking a form of the marijuana treatment, the seizures subsided, and she bloomed anew into a happy child seen laughing and playing in video clips. News stories began reporting that other children were seeing similarly miraculous results. To parents of kids with severe disorders, the articles seemed almost out of a storybook. So it was fitting that the brothers who grew the marijuana for the kids named their product Charlotte's Web.

Smaller numbers of children in California and other states have also begun to use marijuana to treat seizures. But what makes Colorado the epicenter is the state's large medical marijuana system, which allows for kids to be registered patients; the growing community of families with sick children; and the feedback loop of publicity that surrounds the treatment. Every happy story about a family seeing success with cannabis in Colorado pushes another family to move here.

Today, there are 427 children under 18 on the state's medical marijuana registry, including 13 under 2 years old. That total number is up from just 60 in August 2013, when the documentary aired. More arrive every month.

This is marijuana that often comes in medicine bottles, an oil extract from cannabis plants that is frequently squirted under a patient's tongue. It's the opposite of most commercial cannabis. Rather than being high in THC – the plant's psychoactive chemical – the marijuana is low in THC and rich in CBD, a compound that does not get users stoned but has shown medicinal potential.

The few, small studies of its efficacy, though, are preliminary and even disputed. Federal laws against marijuana have hampered research on CBD for the past four decades. As a result, states have increasingly passed their own laws legalizing CBD, based on little more than stories such as Charlotte Figi's and the hopes of families following in her path.

An early and oft-reported survey of children on Charlotte's Web found that 80 percent who tried it eliminated at least three of every four of their seizures. Now, even one of the specialists involved in that study questions whether it was overly optimistic. Subsequent studies have suggested the response rate might be closer to 30 percent or, perhaps, even lower.

It's not just that parents are taking a gamble by moving to Colorado. It's that they don't even know the odds.

"When these kids come, we hear a lot about it," said Dr. Larry Wolk, head of the Colorado health department and a skeptic of the treatment's success. "They get their CBD oil or their Charlotte's Web. And if they respond, we continue to hear about it. If they don't, they quickly disappear."

Like all of the parents coming to Colorado in search of a cure, Ana Watson hopes hers will become a success story. Staying in North Carolina offered no hope for Preston. Still, she can't predict what lies ahead.

The journey would be harder and more complicated than she ever imagined.

Preston's journey

Preston's baby book begins with pictures from a sonogram.

"It's a boy!" the sticker on the page proclaims.

Turn the page, and there's a picture of Preston in a white onesie. Then a picture of Preston sitting in a kid-sized Jeep.

On the next page is a picture of Preston with his head swaddled in gauze, a thick bundle of electrical wires poking out of the top of the wrapping like a bizarre ponytail.

"The Journey" is the title of this new section in the book. It sounds so much better than calling it an ordeal.

Ana was only 19 when she learned she was pregnant with Preston. She was a college freshman who had to take a break from school and live with her parents for a few months in rural Whitsett, N.C., while she prepared for motherhood. Her pregnancy was normal, aside from the delicate tremors she sometimes thought she felt in her womb. Her high school sweetheart, Preston's father, drifted out of her life. He has never seen Preston in person.

After Preston's birth, the doctors told Ana that his strange leg twitches were common – the result of underdeveloped muscles. It was three months later that she learned the doctors were wrong.

She was giving Preston a bath – not his first, not unusual. But then his eyes rolled back in his head and his face went white and his little body began to shake and Ana was certain he was dying. At the hospital, doctors quickly sent her home. Lots of kids have random seizures that never recur, they said. But Preston's did.

Ana doesn't remember what Preston's first word was. What she does remember is that first word arrived right on time. As did his first crawls. And his first steps.

It wasn't until his second year of life that Ana began to notice the toll the seizures were taking. When other kids Preston's age were learning more words and stringing them into sentences, he didn't. When walking and grasping led to running and catching for other children, it didn't for Preston. It was as though his life ground to a stop, even as time ticked on.

The neurologists were baffled and kept hunting for new medicines.

They started with a drug called Depakote when Preston was 3 months old. But the seizures continued – as did the new treatments: Klonopin and Felbatol and Keppra. Zonegran and Topamax and Diamox and Banzel. Vitamin infusions. A special high-fat diet. An implanted electrical nerve stimulator. There were two other drugs not yet fully approved by the federal government that cost hundreds of dollars a month. There was another that has also been suggested for use in executions.

The government safety sheets for each drug listed dozens of side effects. Tremors. Problems with walking or coordination. A potentially fatal rash. Panic attacks. Thoughts of suicide. Aggression.

To Ana, it sometimes seemed as if what epilepsy didn't take from her son, the drugs would. But she also knew that just one year of uncontrolled seizures meant a 1 percent chance of dying. The longer Preston's seizures ran riot, the likelier epilepsy would kill him.

"You know you're fighting for your child," she said. "You just do whatever it takes to get what you need for your child. People slack off. You have to stay on top of them."

Being Preston's mother taught her not to cry because tears won't make her son better. For her, there is a process: Try one thing, then move on to the next. Lessons can be learned and applied.

So Ana kept searching for a cure.

Her bookshelf at home charted the journey and spoke to her struggle. First came "What to Expect in the First Year." Then "Keeping Faith." Then "Delmar's Drug Reference for Health Care Professionals." Then "Three Weeks to Say Goodbye."

Ana married, and Sydney was born. She and her husband fell into debt, in part because of medical bills before Preston qualified for Medicaid. Their marriage collapsed under the stress, and Ana moved back in with her parents. She tried working full time, then cut back to part time.

It wasn't until Preston was 6 years old that doctors finally put a name to his condition: Dravet syndrome. And in some ways, that was worse than not knowing at all because it meant there was no cure to find.

"Seizures all of the time"

At the North Carolina Children's Hospital in Chapel Hill in May, Dr. Robert Greenwood hustled into the meeting room wearing a tie covered with Dr. Seuss characters.

"It's been a constant struggle of trying to limit the number of seizures he has," Greenwood said of Preston, who at age 1 started as a patient of Greenwood's. "We have tried literally everything."

As a pediatric neurologist, Greenwood had treated hundreds of kids with epilepsy in his 37-year career. But Preston's case was a unique challenge.

"In his case, the biggest problem is he has seizures every day," Greenwood said. "Multiple seizures. At times, he could walk down the hall and you could see 10 to 20 seizures happening, little jerks. So he was literally having seizures all of the time."

Dravet isn't like other epilepsies.

While some can be treated by targeting the specific areas of the brain where the seizures' electrical overloads originate, Dravet's seizures come from everywhere, the result of a genetic mutation that occurs in every nerve cell in the brain.

Some epilepsies respond well to generalized anti-seizure drugs. But the specific genetic mutation of each Dravet patient is different, meaning what works for some won't work for others. Preston has at least four different kinds of seizure types, and they varied in severity and frequency as he grew older.

There are the grand mals, full of violent convulsing that can last minutes, which Preston falls into about once a week. But much more common are the little eye flutters. In medical terms, they are called myoclonic seizures. Ana calls them "blinkies." They look as though Preston is on the verge of sneezing.

He can have hundreds of blinkies a day. And, though they usually pass gently, each one is like an eraser across his brain's chalkboard. Over and over, new development is wiped clean by the seizures. So, over and over, he learns the same things.

At 12 years old, Preston cannot spell his name. He cannot reliably count to 10. He is still learning his colors. He doesn't know his mom's name or where he lives or how to call home if he gets lost. He wobbles when he walks and falls over easily.

Sometimes, Greenwood and Ana would find a medicine that worked for Preston. The seizures would lessen and Preston would start to walk more steadily. But, just as quickly, Preston's brain would rewire itself back to a broken state and the seizures would return.

Sitting in the hospital meeting room, Greenwood said there was little more he could do for Preston with the medicines available. Without something new, Preston's seizures would continue into adulthood – assuming he didn't die before then.

Asked whether Preston would ever be able to speak a complete sentence, Greenwood's eyes lit up with the idea, then quickly dimmed.

"That would be really nice if he got that far," he said, "but there's not much evidence right now he's moving toward that."

Daydreams in check

Preston's eyes slowly opened somewhere under the fluff of his mother's comforter.

"Time to get up, Boo-Boo," Ana said to him. "Come on."

A voice tiptoed back to her with the peanut-butter-mouth slur of a child's early words: "Wuh moh minuh."

"OK," Ana said, "One more minute."

It was about a month before the move away from their little brick house in Greensboro, N.C., and, sometime in the night before, Preston left his own bed and sleepwalked into Ana's. Sydney was already there. When Ana woke before dawn, she was nestled between children.

Once begun, the morning ticked along with practiced precision. Ana made the fried potatoes Preston only ever wants for breakfast. Eight-year-old Sydney quietly dressed and got ready on her own, until it was time to ask mom to fix her ponytail.

Finally dragging Preston from bed, Ana sat him in his skull-and-crossbones pajamas in front of the television and turned on a video of Barney the dinosaur. Sydney walked by and scrunched up her face. She had already outgrown Barney.

But Preston watched rapturously, planting his elbows onto his knees and his head into his hands. His eyes are a deep walnut color and are framed by long eyelashes. Brown hair swirls atop his head in casual rebellion. His smile is all in the top lip, pulling up past his gum line to reveal a row of glimmering teeth.

Slowly working his way through the potatoes, Preston's hands stopped and his eyelids flickered for a few seconds before popping back open. The first seizure of the day had come and gone.

Over the fireplace hung a photo of Preston in a straw cowboy hat. He's shirtless, leaning onto his left elbow. His mouth is closed and his eyes set in a stoic glare, and he appears startlingly mature – a boy trying to look like a man trying to look like a rock star.

There are times, Ana said, when she can almost see what Preston could become if the seizures would just let him.

Everyone in her family has their own vision of what Preston might be. Ana's mom sees Preston getting a job at a park running a lawn mower. Ana's dad – the man who taught Preston how to be a boy, to love mowers and tractors, and to shout, "Crank it!" – imagines playing catch with his grandson.

Ana tries to keep her daydreams in check. What good is it to view her child as something he's not? But there is one thing she hears the parents of Dravet children often say, and, yes, she hesitantly admitted, she would like it, too.

"The big thing that parents are always saying," Ana said, "is they want their child to say, 'I love you.' "

Leap into the unknown

Ana's decision to move had seemed like an easy one. In late 2012, she saw on Facebook a video of a California man using medical marijuana to treat his son's seizures. "This brought tears to my eyes!" she wrote then.

The documentary about Charlotte Figi aired the next summer, and by late 2013 – as Preston approached his 12th birthday stuck in the same developmental rut he had been in for his previous nine – the online whispers of a marijuana miracle in Colorado had turned into a roar. One by one, other Dravet children's parents – with whom Ana had become close friends online but never met in person – began arriving in Colorado, posting hopeful updates on their children's progress. The hope tugged at her.

"We've pretty much tried everything else we can," she reasoned.

And so this was the logical next step. A leap into the unknown.

The closer the move came, the worse Preston seemed to get. He suffered a grand mal seizure at the fundraiser Ana and her parents put together to raise the $15,000 needed for the move. He suffered another grand mal returning from a last-second beach getaway.

He grew reluctant to eat or drink, which left him not only weak but also not getting the right dose of medicine hidden in his food. The day the movers arrived, Preston sat on the grass holding his grandmother's hand while the blinkies attacked.

"Wha doin'?" he shouted between seizures, because he didn't know what it meant for the movers to be there.

In advance of the move, Ana reduced the dose of one of the three main seizure medicines he takes – a drug called Onfi – because she had heard from other parents that CBD amplifies it. He was now taking about a third less than what Greenwood had prescribed, although she didn't tell the doctor her plan.

Greenwood had been cautiously supportive of Ana's move, in part because it preserved some of his input into Preston's care. Tell a family no when they're on the trail of hope, and they'll leave you behind. For all of the parents asking him about moving to Colorado – Ana was not the first – Greenwood had told them the same thing: There's no hard evidence it works, but there's no hard evidence it's causing harm, either.

When he looked at the exodus of families heading to Colorado, Greenwood worried about the people who might prey on their desperation. But he also worried about the enthusiasm that might spring from their hope. He had warned Ana strongly against taking Preston off his other seizure drugs.

"He is quite capable of going into a seizure that is basically all the time – all day and all night," Greenwood said.

After the movers left, Preston's blinkies hit even worse. Drool dribbled off his chin and onto his T-shirt. Milly, who was watching him while Ana packed up the last things, sensed a bigger seizure building. She fanned Preston, hoping to calm the blinking.

"You think you'd get used to seeing him like this," she said. "But it scares me to death every time."

Hope for Preston

It took 12 days after arriving in Colorado for Ana to get the marijuana oil for Preston's first dose. Twelve days of waiting. Twelve days of seizing. Twelve days of wondering what would happen.

She had to wait another three days after picking up the oil for a lab report to come back to confirm its potency. When the day of the first dose finally arrived, in mid-July, Ana bounded into the kitchen of her new home to pull a bottle of the oil from the fridge.

She cracked it open and burst into giggles.

"It smells like marijuana," she laughed. "I didn't think it would."

Drawing the amber-colored oil into a dropper, she scanned the report to figure out how much she should give Preston. But the report was indecipherable. The oil contained 5.65 milligrams of CBD and 0.15 milligrams of THC. How could she convert all these different numbers into the recommended dose?

She checked her phone for online answers. Finally, eager to move on, she set the phone down.

"All right," she said, "We'll figure it out later."

She drew a small amount of oil into the dropper and looked over to Preston.

"We have a special squirt-squirt we need to do, OK? You need to be a big boy," she said.

Walking toward him, she had no idea of the frustration ahead, and no inkling of the discomfort she would inflict on them both in her effort to bring relief.

All she knew as she looked toward her seizing son was that she held in her hands the latest, best chance to move his life forward.

With the first dose given, she returned to the kitchen and shakily exhaled.

"That," she breathed back in, "was pain."

What is CBD? CBD or cannabidiol, as it's known scientifically, is one of dozens of compounds in marijuana called cannabinoids. The compounds work by plugging into receptors on nerve cells, although much of their activity is still unclear. Tetrahydrocannabinol, or THC, is the most famous cannabinoid found in marijuana. But, unlike THC, CBD does not get users stoned.

How is CBD taken? Kids using CBD don't smoke it. Instead, it comes infused into a cooking oil, like olive or safflower oil. Typically, parents are told to squirt the oil under their children's tongues. But some families mix it in food or give it through a feeding tube.

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