Only 1.2% of autistic individuals in Israel's largest health system were prescribed medical cannabis

Only 1.2% of autistic individuals received medical cannabis prescriptions. The cannabis-prescribed group was diagnosed earlier (median 3 vs 5 years), had more complex clinical profiles, and higher socioeconomic status. 4.3% of prescriptions were for children under 5. Most prescriptions did not fully comply with Ministry of Health guidelines requiring prior trials of two FDA-approved antipsychotics.

Retrospective cohort study using electronic medical records from Clalit Health Services (Israel's largest HMO, serving ~4.7 million). All individuals with autism diagnoses from 1990-2025 were identified (N=36,610). Cannabis-prescribed (n=462) and not-prescribed (n=36,148) groups were compared on demographics and clinical characteristics.

Despite growing clinical interest and media attention around cannabis for autism, this large real-world dataset shows that actual prescribing remains rare and is concentrated among higher-SES families with more complex cases. The finding that most prescriptions bypassed required antipsychotic trials raises regulatory concerns.

The socioeconomic gradient in cannabis prescribing suggests that access may be influenced by health literacy, advocacy ability, or provider networks rather than clinical need alone. The non-compliance with prescribing guidelines highlights the tension between clinical demand and regulatory frameworks in emerging therapeutic areas.

Single HMO in Israel may not generalize to other healthcare systems. Cannabis prescription does not mean the patient actually used it or benefited. Clinical complexity was assessed from administrative data. The study could not evaluate treatment outcomes or side effects.