The use of medical cannabis in pediatric patients for a variety of health conditions and symptoms has been rising in popularity over the last two decades. According to pediatric cannabis expert, Dr. Bonni Goldstein, there is a growing body of evidence related to children with epilepsy, autism, and psychiatric disease having a dysfunction within their endocannabinoid system (ECS)(1). While the demand for and use of medical cannabis in pediatric populations is growing, more clinical evidence of its impact on a variety of pediatric conditions is still warranted. Top pediatric conditions commonly finding relief with medical cannabis include:

  • Autism

  • Epilepsy 

  • Pediatric Cancer 

  • Other psychiatric disorders including ADHD


Where is the evidence?

As the public’s interest grows in cannabis-based treatments in pediatric populations including those with Autism Spectrum Disorder (ASD) and epilepsy, there is a need to understand the research and clinical implications of treatments. According to a recent review, primarily pure CBD has been tested in controlled human trials with significant improvement in seizures and tolerability. Adverse events reported by patients included somnolence and reduced appetite. Interactions with antiepileptic drugs include an increased risk of hepatotoxicity with benzodiazepines, contributing to somnolence and potentially to efficacy.(2)

Another recent systematic literature review identified 21 published research studies related to medical cannabis in pediatric populations and found the evidence was strongest for chemotherapy-induced nausea and vomiting, with increasing evidence of benefit for epilepsy. More research is needed to support use for spasticity, neuropathic pain, posttraumatic stress disorder, and Tourette syndrome.(3)


 

Pediatric Autism

In terms of autism, a recent scientific literature review concluded that although medical cannabis appears to show promise in addressing core ASD symptoms, evidence-based recommendations are still needed to be developed to ensure safety and effectiveness.(4)

pediatric autism


 

Pediatric Epilepsy

In terms of pediatric epilepsy, in 2018, a systematic literature review was published in the journal Epilepsia, with authors reporting the latest findings related to the use of medical cannabis in pediatric patients with Epilepsy. The review noted that only a few randomized controlled trials (RCTs) have assessed medical cannabis use in pediatric patients. However, the evidence for short-duration, yet high-quality RCTs suggests cannabidiol can be effective in reducing seizures among children who are resistant to other drug regimens. Additionally, the only RCT evidence is related to cannabidiol, and not other cannabis based product formulations.(6) The authors published an updated review in 2020, noting that new evidence also supports cannabidiols role in reducing the frequency of seizures among children with drug-resistant epilepsy.(7)

pediatric epilepsy


 

Pediatric Cancer and Medical Cannabis

Increasingly Pediatricians are willing to consider medical cannabis as an option with children with cancer and the absence of dosing standards is a barrier to recommending medical cannabis.(8)


cannabis solutions

Medical Cannabis for Children and Adolescents with Intellectual Disabilities

The pilot study, led by the Murdoch Children’s Research Institute (MCRI) and published in the British Journal of Clinical Pharmacology, examined the use of cannabidiol (CBD) in pediatric patients with intellectual disabilities recorded a clinically significant change in participants’ irritability, aggression, self-injury, and yelling. The intervention was also found to be safe and well-tolerated by most study participants.(9)

 


References:
  1.  Source: http://www.bonnigoldsteinmd.com/cannabis-treatment-for-the-pediatric-patient/
  2. Aran A, Cayam-Rand D. Medical Cannabis in Children. Rambam Maimonides Med J 2020;11 (1):e0003. Review. doi:10.5041/RMMJ.10386
  3. Aran A, Cayam-Rand D. Medical Cannabis in Children. Rambam Maimonides Med J 2020;11 (1):e0003. Review. doi:10.5041/RMMJ.10386
  4. Shane Shucheng Wong, Timothy E. Wilens. 2017. Medical Cannabinoids in Children and Adolescents: A Systematic Review. Pediatrics Nov 2017, 140 (5) e20171818; DOI: 10.1542/peds.2017-1818
  5. Source: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2259-4#citeas
  6. Source: Elliott, J, DeJean, D, Clifford, T, et al. Cannabis‐based products for pediatric epilepsy: A systematic review. Epilepsia. 2019; 60: 6– 19. https://doi.org/10.1111/epi.14608
  7. Source: Jesse Elliott, Deirdre DeJean, Tammy Clifford, Doug Coyle, Beth K Potter, Becky Skidmore, Christine Alexander, Alexander E. Repetski, Vijay Shukla, Bláthnaid McCoy, George A. Wells, Cannabis-based products for pediatric epilepsy: An updated systematic review, Seizure,Volume 75,2020, Pages 18-22, ISSN 1059-1311,https://doi.org/10.1016/j.seizure.2019.12.006.
  8. Provider Perspectives on Use of Medical Marijuana in Children With Cancer. Prasanna Ananth, Clement Ma, Hasan Al-Sayegh, Leah Kroon, Victoria Klein, Claire Wharton, Elise Hallez, Ilana Braun, Kelly Michelson, Abby R. Rosenberg, Wendy London, Joanne Wolfe. Pediatrics Jan 2018, 141 (1) e20170559; DOI: 10.1542/peds.2017-0559
  9. https://www.sciencedaily.com/releases/2020/06/200624100039.htm
  10.  Simonian, et al. 2020. A critical narrative review of medical cannabis in pediatrics beyond epilepsy, part I: background. Pediatric Medicine, 3,0,8. 2020.
  11. Jane Alcorn, Stephanie Vuong, Fang Wu, Blair Seifert and Andrew Lyon (March 25th 2019). Pediatric Dosing Considerations for Medical Cannabis, Recent Advances in Cannabinoid Research, Willard J Costain and Robert B Laprairie, IntechOpen, DOI: 10.5772/intechopen.85399. Available from: https://www.intechopen.com/books/recent-advances-in-cannabinoid-research/pediatric-dosing-considerations-for-medical-cannabis
  12. Source: https://dph.georgia.gov/low-thc-oil-faq-doctors-0

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