Medical Minute | Cannabis + Kids

Let’s clarify; no one advocates for the recreational use of cannabis for children. I think everyone would agree that it is not a good idea to use any brain-altering substance in a growing and developing brain, including nicotine, alcohol, and high fat and sugar foods. However, if a child has a condition that needs medical intervention, then all the tools in the toolbox should be considered, and a parent/caregiver must assess each of the risks and the benefits before choosing any intervention. That includes every medication, not just cannabis medicine. We will also agree that there is no such thing as a panacea. We are all individuals, and everyone responds differently to the same treatments.

In order to make an informed decision, we need to understand what science and research provides. With the understanding that cannabis is medicine, the results of its use are quickly evolving.

WHAT DO WE KNOW?

Tetrahydocannabinol (THC) is the most well-known molecule of over 400 molecules in the cannabis plant. Its popularity is mostly based on its ability to be intoxicating or cause a “high.” That does not mean that THC is not an important medicine, nor does it mean that all amounts of THC cause that intoxicating feeling. Synthetic THC—called dronabinol—has been FDA approved and available in all 50 states since 1986. In 2003, the World Health Organization (WHO) recommended transferring THC from a schedule I or II drug to schedule IV, citing its beneficial medical uses and low abuse potential when used for medical conditions.

As the cannabis plant grows in nature, it actually makes THCA— the acid form of THC. Parents of children with epilepsy discovered that this non-intoxicating cannabinoid could help reduce their child’s seizures, along with traditional anti-seizure medications, when they found CBD to be ineffective.

THC and THCA have been found to reduce pain and inflammation and decrease chemotherapy-related nausea and vomiting. In 2017, the National Academy of Science, Engineering and Medicine found that cannabis is very effective for these indications.

The question is if a child is being treated with chemotherapy does it make sense to use cannabis to reduce nausea and vomiting and improve appetite? The National

Academy report found three studies involving children treated with chemotherapy. Comparing the response of cannabinoids against standard anti-nausea and vomiting treatment: two of the three studies showed cannabinoids were better than standard treatment, and the third showed no difference in benefit.

There are some physicians who have reported success with treating autism using an integrated approach including a diet change and small doses of THC. See Dr. Christian Bogner’s lecture on autism, the endocannabinoid system and THC: https://www.slideshare.net/ChristianBogner/endocannabinoid-signaling-in-autism

Cannabidiol (CBD) has become very popular since the Dr. Sanjay Gupta report highlighting this cannabinoid for its anti-seizure properties and that it doesn’t cause the intoxication or “high” like THC. GW Pharmaceuticals received FDA approval for the indication of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome. The WHO recently reported that CBD is safe and well-tolerated in humans (and animals) and is not associated with any negative public health effects or potential for abuse. Since that report, CBD is now readily found almost everywhere—from food and beverages to room air fresheners!

However, that doesn’t mean CBD should be used without discretion. Just like grapefruit, CBD does interfere with metabolic pathways and may interfere with the breakdown of other medications.

CBD is being investigated for treating children with autism. THC may

not work for everyone. Studies in animals and preliminary studies in Israel suggest that CBD may work for some autism patients and with less side effects than other treatments.

CBD is also being studied for treating children with ADHD or anxiety symptoms that often accompany ADHD. Patient reports suggest that CBD successfully reduces the anxiety related to ADHD.

CBD is being used for various painful conditions. There are patient reports that show CBD to be effective in children for the treatment of pain. The use of CBD could reduce or replace other pain medications that may have more serious side effects.

These are but a few exa-mples of how cannabis or cannabinoids may play an important therapeutic role in the treatment of children with certain medical conditions. Of course, more studies need to be conducted so we can understand more clearly how to use cannabis in children and for which conditions. Until then, my advice is to seek out a physician to partner with who will help create a therapeutic strategy for your child. Start low and go slow is the cannabis treatment mantra. It really does take patience and may take some examination to discover an effective medicine for your child.

Be well, Dr. Deb