USE OF COMPLEMENTARY AND ALTERNATIVE TREATMENTS (CBD, MELATONIN, AND HERBAL PRODUCTS) GENERAL INFORMATION • Always ask patients and caregivers about any non-prescription products a patient may be taking. Ask specifically about over-the-counter medications, herbal and dietary supplements, and nutraceuticals. • Evaluate medication list of prescription and non-prescription medications for drug-drug, drugdisease, and drug-food interactions that may impact care. • Dietary supplements and herbal products are not FDA-approved and therefore are not regulated by the same rules prescription medications are, increasing chances of product strength variation. SPECIFIC PRODUCTS, CATEGORIES, AND PEARLS • Cannabis and Derivatives: ￮ The cannabis plant contains many derivatives; the two most well-known are delta-9tetrahydrocannabidiol (Δ9-THC, or THC) and cannabidiol (CBD).5,11 ￮ CBD is most commonly formulated into oil. Ideally this oil would be purely CBD, but most report having some THC too. The maximum allowable amount of THC that can be present in CBD oil sold in the U.S. is 0.3%, or 3 mg/mL.8 ￮ THC has been linked to the development of schizophrenia and is a contributor to neurodevelopment deficits in adolescents.3,11 There are no indications for medical marijuana for pediatric patients with mental health disorders, sleep disorders, anxiety, pain or posttraumatic stress disorder.7 ￮ We do not recommend the use of medical marijuana in pediatric patients. Both the American Academy of Child and Adolescent Psychiatry and American Academy of Pediatrics opposed marijuana legalization for both medical and recreational use because of the danger to children and adolescents with increased access, decreased perception of harm and increased marijuana use among parents and caretakers.1,2 ￮ In a sample of 84 products purchased online, less than 50% of the products had accurate amounts of CBD concentration. Also, THC was detected in 21% of the samples with concentrations as high as 6.43 mg/mL.4 This raises concern about what concentration of CBD and THC a consumer is purchasing without oversight by the FDA. ￮ Pure CBD oil has been FDA-approved for Lennox-Gastaut and Dravet syndrome in pediatric patients.16 It is, however, not recommended to prescribe or recommend non-prescription, over-the-counter CBD oil, THC or any other cannabis-derived products for children.
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