Dronabinol for Agitation in Autism Spectrum Disorder: Research From the National Update on Behavioral Emergencies Conference

Marinol (dronabinol) was found to be a potentially beneficial treatment for patients with autism spectrum disorder (ASD) who are experiencing acute agitation in emergency care, from a study presented at the National Update on Behavioral Emergencies Conference in New Orleans, LA, December 8-10.¹ While this may not be a first-line agent, Marinol may offer an adjunctive option for patients with ASD in emergency settings experiencing sensory overload, medication sensitivity, or are unresponsive to standard treatment.

In research presented at the recent conference, data were based on a review of real-world clinical practice. The review focused on 2 recent clinical cases in which Marinol was used to manage acute agitation in patients with ASD, with detailed chart reviews performed. Investigators noted presentation symptoms, prior treatment failures, dosing strategies, response to Marinol, adverse effects, and overall clinical course.¹

With the clinical complexity of agitation associated with ASD, new pharmacological interventions may be necessary, investigators outlined. Based on this case review, Marinol has potential to offer a calming effect, particularly for patients whose agitation is driven by sensory overload or who have not been responsive to standard treatments. Marinol may not be a first line treatment, but it can serve as a pragmatic option in emergency settings where first line treatments have not been successful, investigators highlighted. Cannabinoid-based treatments have potential as a meaningful addition to agitation treatment in ASD.

Marinol is an oral, synthetic form of delta-9-tetrahydrocannabinol (commonly known as THC), and is an agonist at cannabinoid receptors.² The drug is currently approved by the US Food and Drug Administration (FDA) for anorexia associated with weight loss in patients with AIDS and chemotherapy induced nausea and vomiting, and noted for off-label use for obstructive sleep apnea and chronic pain. Its mechanism of action is as a partial agonist at cannabinoid receptors CB1 and CB2, which have been shown to modulate D2, gamma aminobutyric acid, and glutamate. Cannabinoid signaling also impacts pathways including pain modulation, appetite stimulation, cognition, and antiemitic. Common adverse effects of Marinol include tachycardia, syncope, euphoria, paranoia, dizziness, somnolence, and gastrointestinal symptoms. This drug also has potential for abuse in patients with a history of substance use disorder.

Previous case reports and small studies have shown benefits of Marinol in patients with dementia and Alzheimer disease for agitation.³ Studies have also suggested that cannabis products containing THC may assist patients with ASD in managing behavioral symptoms, including agitation.⁴ Study authors noted that with current FDA approvals for risperidone and aripiprazole, these drugs do carry metabolic and extrapyramidal risks, with up to 39% of patients not responding adequately.

Investigators concluded that “over one third of patients with ASD taking these medications do not respond and end up requiring polypharmacy and possibly restraints. This highlights the urgent need for alternative agents in severe agitation which is where Marinol can be considered. Current literature highlights that Marinol has shown efficacy in managing significant agitation in a patient with ASD, with a more favorable side effect profile that should allow for less obstacles to care moving into the future.”¹

References

1. Jun J, Datla S, Bansal M, et al. Managing agitation in ASD patients using dronabinol: guidance for emergency psychiatry settings. Poster presented at:National Update on Behavioral Emergencies; December 8-10, 2025; New Orleans, Louisiana. Accessed December 22, 2025.

2. Marinol (dronabinol) capsules prescribing information. US Food and Drug Administration. 2017. Accessed December 22, 2025. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018651s029lbl.pdf

3. Outen JD, Burhanullah MH, Vandrey R, et al. Cannabinoids for Agitation in Alzheimer's Disease. Am J Geriatr Psychiatry. 2021;29(12):1253-1263.

4. Silva EAD Junior, Medeiros WMB, Torro N, et al. Cannabis and cannabinoid use in autism spectrum disorder: a systematic review. Trends Psychiatry Psychother. 2022;44:e20200149.